Introduction

A visit to the veterinary hospital should not be a traumatic experience, for the pet, the owner or the veterinary hospital staff. If time is taken to observe the pet's initial reaction to entering the front door, many unpleasant situations may be avoided. By understanding that the pet's behaviour is influenced not only by its genetic makeup (temperament) but also its previous experiences (and what it has learnt from them), as well as the current environment in which it finds itself, it is easy to see that by adapting our approach to each individual pet and situation, it should be possible to decrease stress and anxiety for all.

The aim of all staff should be to make each visit, especially the first visit of the pet, regardless of whether it is a puppy or kitten or an adult, as pleasant and stress free as possible.

What is Stress?

The stress response is seen as a coordinated reaction to threatening stimuli. Stress responses are modulated through altered cholecystokinin, opioid and dopaminergic mechanisms.

The signs generally include:

 Avoidance behaviours

 Increased vigilance

 Increased arousal

 Cortisol release from the adrenals

 Activation of the ANS (sympathetic division)

Physiological measurements of stress include increased catecholamine levels and resultant brady- or tachycardias (parasympathetic and sympathetic autonomic nervous system); increased corticosteroid levels resulting from stimulation of pituitary-adrenal axis; decreased neutrophil/lymphocyte ratios; and altered response to adrenocorticotropic hormone (ACTH) stimulation test.

Production and release of substance P may also be responsible for some behavioural effects, such as salivation and GI distress.

Stress is also thought to play a key role in the development of anxiety related conditions.

Stress is quite a complex response, and it can be considered quite normal and even in some instances beneficial. However, long-term stress or even acute severe stress can be detrimental to the health and welfare of our patients.

What is Fear?

Fear is a physiologic, behavioural, and emotional reaction to stimuli that an animal encounters. The physiologic reaction results in an increase in heart rate, increased respiratory rate (panting), sweating, trembling, pacing and possibly urination and defaecation. Dogs and cats will exhibit changes in body posture and activity when afraid and may engage in an avoidance response, such as fleeing or hiding.

A fearful animal may assume body postures that are protective, such as lowering of the body and head, placing the ears closer to the head, widened eyes, and tail tucked under the body. If the animal perceives a threat, the response can also include elements of defensive aggression. Whether an animal fights or flees when fearful or defensive depends on its genetic predisposition and its previous experiences and the environment that it is in.

Fear is a normal behavioural response and can be beneficial to the survival of the animal. However, prolonged fear or a severe fearful response has detrimental consequences.

What is Anxiety?

Anxiety is defined as the anticipation of future danger or misfortune, and there does not always appear to be any obvious cause. The threat may be real or imagined, and may be normal or abnormal depending on the context. It is usually accompanied by signs of hypervigilance, such as scanning; autonomic hyperactivity such as gastrointestinal upsets; and increased motor activity, such as pacing.

Anxiety can occur after sensitization to a specific stimulus and then become generalized to other situations. It may also be nonspecific in origin.

The actual prevalence of anxiety-related conditions is unknown, but they are probably the most common class of disorders in pet animals. Anxiety disorders make up over 95% of veterinary patients presented to referral behaviour clinics.

Although the specific genes have not yet been identified, a genetic predisposition for many anxiety disorders has been established in people. The prefrontal cortex, amygdala and limbic system, and hypothalamus (hypothalamic-pituitary-adrenal axis) are thought to be involved in the regulation of fear. Serotonin, noradrenaline, dopamine and GABA are all involved in the development of fear and anxiety.

When anxiety is out of context and occurs at a constant and elevated level, then it is likely to become a problem.

What is a Phobia?

This is an intense response to a situation that the animal perceives as fear inducing. The response is out of proportion to the stimulus and is maladaptive.

Common phobias in animals involve noises and places. Phobic responses have physiologic, behavioural and emotional responses similar to fear, but they are extremely exaggerated. They are maladaptive.

Senses

Dogs and cats have superior hearing to that of people. A dog's hearing is about 4 times more acute, and they can hear ultrasound and infrasound. Thus dogs and cats can become stressed with some of the noises in a veterinary clinic, and this can make them fearful and apprehensive or reactive and more difficult to handle.

A dog's sense of smell is at least 1,000 times more acute than that of humans. Veterinary clinics have very distinct odours that can be disturbing to dogs and cats despite having easily cleaned surfaces that are not porous. Dogs and cats can also detect various pheromones that can communicate alarm or distress.

As predators, dogs and cats are very good at detecting very slight movement of objects and can be easily startled by them. Thus sudden movements can also increase their apprehension and so pets need to be approached slowly and calmly to help make them relax.

Consideration also needs to be given to the surfaces that they stand or lie on. Many dogs find it frightening to walk or stand on slippery surfaces. A dog that is already apprehensive may become even more reactive unless surfaces with secure footing can be provided to decrease anxiety and reactivity.

Additionally, some of the medications used in a veterinary clinic can increase reactivity. For example, acepromazine increases noise sensitivity and may lead to more unpredictable behaviour.

Prevention

Puppy Preschool® and Kitten Kindy® classes run at the veterinary hospital can provide a good introduction that allow the pet and the owner to become familiar with the veterinary hospital in a nonthreatening manner and associate it as a "friendly" place to visit.

Decreasing Stress and Anxiety

At each visit, the aim should be to make subsequent ones less stressful than the current visit. The attitude of the staff and the hospital environment can do much to help things run smoothly.

Tips for Handling Anxious Pets

 "See" the world from their perspective.

 Allow time - don't try to rush the animal.

 Recognize the four Fs - flight, fight, freeze and fiddle - and take steps early.

 Ignore the pet and talk to the owner.

 Never make direct eye contact with the pet.

 Watch your body language - approach the pet quietly, calmly and slowly.

 Speak softly, calmly.

 Offer treats.

 Use nonslip matting on examination tables to provide secure footing and decrease anxiety.

 Allow the cat to stay in its carrier and use towels to cover if needed.

 Use minimal restraint.

 Don't use physical force, punishment or aggression; it will make the pet and the situation worse.

 Use anxiolytics, Adaptil/Feliway.

 Use general anaesthesia if needed.

 Keep records on what works and what doesn't to make it easier for all concerned next time.

 Walk away for another day.

Conclusion

Stress and anxiety can have detrimental effects for pets as well as their owners. It can also make some pets more difficult to handle while in the veterinary clinic but also have prolonged effects on their physical and mental health.

References

1.  American Association of Feline Practitioners. Feline-friendly handling guidelines. AAFP; 2011

2.  Bradshaw JWS, Nott HMR. Social and communication behaviour of companion dogs. In: Serpell J, ed. The Domestic Dog. Cambridge, UK: Cambridge University Press; 1995.

3.  Landsberg G, Hunthausen W, Ackerman L. Handbook of Behaviour Problems of the Dog and Cat. Oxford, UK: Butterworth-Heinemann; 2013.

4.  Overall KL. Clinical Behavioural Medicine for Small Animals. St. Louis, MO: Mosby; 2013.

5.  Seksel K, Mazurski E, Taylor. Puppy socialisation programs: short and long term behavioural effects. Appl Anim Behav Sci. 1999;62:335–349.