Fear Free

Question 1

Emotional Medical Record

Answer 1

• document detailing a pet’s likes & dislikes
  
  • Favorite treats, people
  • prefered treatment area
  • stressful procedures

Question 2

Gentle Control

Answer 2

• How the pet is safely positioned with minimal restraint to provide needed care

Question 3

Touch Gradient

Answer 3

• Using a considerate approach & gentle control during examinations
• Moving from less to more sensitive areas

Question 4

Why FAS Matters

Answer 4

• FAS can mimic pain, nausea, & neurological disease callenging a diagnosis
• 78.5% of dogs demonstrated fear on the examination table
• less than 50% of dogs willingly entered the hospital
  
  • 13.3% dragged or carried
• Routine puppy and kitten visits can create lifelong FAS
• Cats are #1 most popular pet in USA but feline visits are limited
  
  • Lack of knowledge of needed care
  • Cost
  • Resistance to carriers and travel
  • Stress in the clinic

Question 5

Receptionist’s Role

Answer 5

• Scheduling
  
  • Reveiw emotional record
  • Travel
  • Being hundry
  • Carrier acclimation
  • Toys and Treats
• Arrival
  
  • Elevated surfaces for cats
  • Floor scale for dogs
  • Treats near reception and scale
  • Limit wait time, reduce chaos, and noise
  • Separated spaces as possible & visual barriers

Question 6

Exam room

Answer 6

• Elevated surfaces or perches
• Reduce background noise
• Non-slip, not cold, non-relective surfaces
• Thermostate control
• Examine where comfortable
• Use gentle congrol & touch gradients
• Owner present if its helpful
• Prepare supplies ahead of time
• Ventilation (1% bleach decreases olfction & increases anxiety)
• Toys, treats, or grooming tools
• Good dimmable lighting
• Soft colors
• Privacy, avoiding unfamiliar animals

Question 7

Sound Therapy for Dogs

Answer 7

• Classical music
  
  • more sleeping/resting
  • less vocalizing
  • lowered respirations & heart rates
  • Owner satisfaction increased
• Audio books
  
  • Calmer during kenneling vs. classical music

Question 8

Sound Therapy for Cats

Answer 8

• Species specific music before, during, & after exam
  
  • lowered stress
  • improved handling

Question 9

Fun Visits

Answer 9

• Informal (not scheduled) no cost visit
• Help prevent FAS in the hospital
• No procedures
  
  • treats and attention if positive!
• Completed by the client without the aid of the staff

Question 10

Victory Visits

Answer 10

• Formal (scheduled) with a fee
• Team member involved
  
  • desensitization
  • counterconditioning for a specific fear

Question 11

Feline Passive Restraint

Answer 11

• Upright position
• minimized restraint
• Stayed on the table 6.1x longer

Question 12

Feline Full Body Restraint

Answer 12

• On their side
• Immobilized head, body, and limbs
• 8.2x more attempts to flee
• 6 seconds longer to achieve positioning
• Increased respiration and lip licking
• Increased incidence of pupil dilation and holding ears back or to the side

Question 13

Optimal Anxiolytic

Answer 13

• Reliably effective (even with current FAS)
• Rapid onset
• Large safety margin
• No client abuse potential
• Easy to administer
• Reversible
• Inexpensive
• Readily available

Question 14

Gabapentin

Answer 14

• Less effective is already fearful
• Peak effect 1.5-2 hours after administration
• Anxiolytic properties not fully understood
• Potential benefit in pain management
• Pilled or mixed into treat/canned food
• Can use acutely or chronically
• Inexpensive
• Can combine with other drugs including trazodone, benzodiazepines & injectables

Question 15

Gabapentin in Cats

Answer 15

• Cats given gabapentin had significantly lowered stress during transport
• Decreased agression
• Increased examination compliance
• Side Effects:
  
  • Resolve within 8 hours
  • none (most cats)
  • sedation
  • ataxia
  • hyersalivation (rare)
  • Vomiting (rare)
• 50-100 mg/cat 2 hours before stress

Question 16

Gabapentin in Dogs

Answer 16

• 10-40mg/kg 1.5-3 hours before an examination
  
  • repeat every 8-12 hours as needed
• Avoid human liquid forms
  
  • xylitol in mix - hypoglycemia and acute liver necrosis
• Side effects:
  
  • none
  • mild sedation
  • ataxia
  • GI upset (rare)

Question 17

Trazodone

Answer 17

• Less effective if already fearful
• Serotonin antagonist and reuptake inhibitor
• Peak 1-3 hours (dogs)
• Widely used in Dogs: 4-12 mg/kg repeat every 8-12 hours MAX 600 mg/day
  
  • travel anxiety
  • separation and noise phobia
  • Veterinary visits
  • hospitalization
  • crate confinement
• Acute or chronic dosing is acceptable
• Inexpensive
• Can combine with other anxiolytics, sedatives or injectable drugs
• Side Effects:
  
  • none
  • sedation
  • GI
  • Aggression (rare)
• CAUTION with severe heart, liver, or kidney disease

Question 18

Trazodone in Cats

Answer 18

• Reduces anxiety for transport
• improved examination handling
• Side effects
  
  • None
  • Mild sedation
  • may lower blood pressure at doses above 50mg/kg

Question 19

Dexmedetomidine

Answer 19

• Anxiolytic, Sedative, and analgesic effecting the locus coeruleus
• Fast onset
• Can reverse with IM atipamezole (Antisedan)
  
  • Standing in 5-15 minutes
• Side Effects:
  
  • Stings IM
  • Vasoconstriction with reflex bradycardia
  • arrhythmias
  • hypothermia
  • Decreased respiration
  • Vomiting
• Avoid using withL
  
  • hear disease
  • Respiratory disorders
  • liver or kidney disease
  • shock
  • debilitated
  • caution with geriatic and young animals
• IV route:
  
  • Peak sedation 2-45minutes
• Oral transmucosal route to dogs
  
  • similar heart and respiration rates and sedation
  • OTM peak 30-60 minutes
  • effects last longer

Question 20

Cat Dexmedetomidine Sedation

Answer 20

• Combine IV/IM with
  
  • Ketamine
  • Opioid (buprenorphine may take longer)
• Onset sedation and lateral recumbancy about 1-5 minutes
• Reverse with Atipamezole IM
  
  • sternal to standing in 5-15 minutes
  • extralabel use
• No reversal recovery in 60-90 minutes

Question 21

Oral Transmucosal (OTM) Dexmedetomidine

Answer 21

• FDA approved for noise phobia
• Need gloves to administer
• 2 hours between doses
  
  • max of 5 doses
• Discard opn syringes after 48 hours
• Benefits:
• Anxiolytic
• non-sedating
• reduced vocalizatinos (whining, yelping, etc)
• reduced avoidance
• reduced trembling/ panting
• reduced urination / defecation
• effect in 30min- 1 hour
• Side Effects:
  
  • Pale at administration site
  • sedation
  • emesis
• Avoid use with cardiovascular, respiratory, liver, kidney, or dental disease

Question 22

Adjunct Therapies

Answer 22

• Drugs:
  
  • Opioids
  • Ketamine
  • Acepromazine (tranquilizer)
  • Benzodiaxepines- diazepam, alprazolam, lorazepam
• Clothing:
  
  • Basket muzzle
  • Thunder shirt
  • Thunder cap
• Pheromones:
  
  • Dog Appeasing Pheromone
  • Feliway
• Supplements

Question 23

Pateient and Client Centered Approach

Answer 23

• Acknowledge client’s expertise on their pet
• Explain FAS impact on pet
• Give options when possibe
  
  • reversible sedation
  • sending anti-anxiety meds and returning
• Check in
• Reflective listening
• Empathy
  
  • Verbal
  • Non-verbal: pausing for Qs, nodding, leaning in
• Practice and roleplay scenarios with colleagues