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Even pets need a paycheck

The benefits of rewarding during the veterinary exam

 A healthy pet wellness exam should not be upsetting, but how many of your patients are anxious, timid or downright aggressive when they are there?  There are some procedures such as vaccination or heartworm testing that may be slightly painful, yet for the majority of examinations there is not much pain involved.  Often veterinary staff will see animals react with fear at some point during the examination.  Some pets may just cower a little or shake while others may go into full blown aggression.   Some dogs come in happy go lucky ready to greet and accept a treat from everyone.  Although there is not much pain occurring during exams, there must be additional factors that are causing the anxiety in many pets coming to a veterinary clinic.

The majority of  traditional restraint methods , focus on  holding  the animal, keeping teeth, claws or hooves away from the veterinarian  while not increasing physical  pain. The trouble is that these methods often increase anxiety or stress on the animal.  Handlers may quickly position animals for treatments, startling the animal or forcing the body of the animal into position.   Has it ever happened to you that a cat exam went from one to 3 techs holding the cat down to receive vaccinations?   This cat is not schizophrenic.   The cat is clearly telling you it does not like to be held down by resisting.  Most staff would agree that the animal is telling us that it does not like the restraint, but many staff would argue that hard holding is the only way to get the job done.    It is possible to motivate, or get the animal to do what we need without so much force that then incites the anxiety and fear.  Rewards during the veterinary exam are one element to motivate these animals. It is possible to “teach” a dog to lie on its side voluntarily to have the abdomen examined or nails trimmed without struggle.

Animals tell what they are thinking primarily by their body language.   Veterinarians and techs have not been educated in normal, fearful and aggressive body language, especially how it presents in the veterinary clinic.  It can be difficult to judge why the animal is becoming fearful or aggressive.  So, we continue in our traditional methods of exam and restraint only to cause more fear and problems.  Animals are always telling us what they are thinking.  Every response has some preceding action that causes it.  Understanding what that pet needs to feel less upset is the first step to providing a better response.  In other words, give a pet a reward for the right behavior, and they will likely repeat it.

Rewards are a very powerful motivator for pets and people.   First of all, these animals are working to be good when they come to the clinic. Rewarding a pet for coming into a veterinary waiting room, standing for examination on a table or receiving a vaccination is not spoiling them.  They have to ignore smells, sounds, and the hands of humans they do not know well.  The dog or cat has learned that there is something painful or uncomfortable about getting on that exam table or when the person in a white coat enters the room.  Rewarding this animal for not struggling and for just being there is the paycheck they deserve.    So the reward helps to insure good behavior because it is paired with the behavior we want – no struggling or attempting to bite.  Another powerful benefit of rewards is how they help to change the attitude (mind if you will) of the pet in.  Because dogs like chewie treats, and they feel good when they get them, seeing the chewie treat helps them become “happier”.  Now when you pair that chewie treat with seeing the exam table the dog will associate the good feelings that the treat gives when seeing the exam table.   This is not spoiling – this is learning!   Think of it this way.  Imagine you are nervous about getting your mammogram.  Just seeing the mammography department makes you break out in a sweat.  You go from mildly sweating to heart pounding headache as you proceed through the exam.  Last year, it was uncomfortable and they had you wait an extra 30 minutes as they took additional more intense views.  Although everything was ok, you were sore, scared and emotional.  Now imagine a different scenario.  Imagine as you walk into that mammography department the receptionist gives you $10 for showing up.  When you come into the room in your little cape, the tech gives you $10 again and through the exam upping it to a $20 bill during the big squeeze.  As more views are taken you continue to get more money.  Now, would this experience make you feel any better about getting your mammogram?  Would you feel a little less tense each time they gave you money through the exam?  I imagine you would, since money makes many people feel good.  I would also argue that you worked for that money reward.  You were not being spoiled by getting money, it was a way to help you associate something good with the mammogram, and likely make the next year’s exam be less upsetting to you.

Timing the rewards is important so that we are reinforcing or rewarding the right behavior. Typically the reward needs to be given within a second of the right behavior. Cut the treats up, about the size of half of a cheerio.  One treat is cut up or broken into many small pieces so the amount of food eaten is not much.  When the animals reacts with growling or struggling, stop the rewards then resume as the animal relaxes or decreases struggling.  This way they are pairing the rewards with less struggling.

Rewards can be food, petting, verbal praise or even changing the place of exam.  Food motivates many pets, especially dogs.  It helps a lot of the animal is hungry when they come in for their exams.  Not all clients will comply with fasting their animal, but many will cut feeding in half before exam time which does help.  When you do use treats, have a choice and make the pieces about the size of a half a cheerio.  That way the reward can be consumed quickly, there will not be many additional calories, and the treats go a lot farther.

There are some dogs and cats that are just not interested in food rewards period.  For them, notice how they respond to “jolly talk” the animated high pitched happy talk that we all do to our pets but are too embarrassed to show anyone else.  Many dogs get happy when their hear this.  Use it to your advantage. 

Play can be a reward.  A Kong toy smeared with peanut butter can given on the floor or the exam table to reward and occupy a dog.  This is especially great for puppies that can be very active in the exam room.   A client can bring the pet’s favorite toy to have during the exam and visit. 

 Rewarding during veterinary exams should start at home.  Clients can reward their pets as they ride in the car, load up in the carriers and arrive at your door. If your clients forget to do this, the pet can still learn that there are wonderful things waiting for them inside the veterinary clinic improving travel to the clinic.  Your staff can remind clients to bring treats to use after arriving at the office, or to set the cat carrier out in the open a few days before the exam.
Upon arrival at the clinic, the receptionist will offer hypo allergenic treats from the desk area. One treat jar reduces clutter around the desk, and is universal for any pet that may come in. A highlighted note can be put on the record if this pet must be absolutely fasted.   As the client is greeted the staff will toss the treat or give it directly to the dog depending on how accepting the dog is.   For cats, the staff or owner can put the treat in the carrier.  Now when the pet sees the reception desk, waiting room, etc they will associate good things.   If a dog is reactive – barking or pulling at the leash wanting to sniff out every other animal or person there- have the owner take the dog to a corner or wait in another area to decrease this dog’s arousal.  It will also help the other waiting animals to be less anxious.  The waiting area is an important area to control and reward for good behavior.  If your staff can minimize the ramping up of agitation and anxiety it decrease how much more the pet will escalate in the exam or treatment area.

Walking to the exam area, verbal praise and a few small rewards are given by the staff. For dogs that balk at entering the exam room, have the staff toss a few treats in the room just past the entrance.  If the dog will not enter, have the owner go in praising as the animal follows.  Do not drag the animal in.  Some short tugs on the leash may get them to go, which is when you praise lavishly.  Using DAP pheromone spray by CEVA in the exam room can help reluctant dogs to calm down once you are in.  A shelf where various treats are kept should be handy for the staff to use.  Have the staff keep universal treats in their pockets for handy rewarding.

As the staff is taking history, have the staff toss treats to the dog.  As the dog takes the treats off the floor, drop them closer to the staff until the dog may accept them directly from the staff.    For cats, opening the door to the carrier to allow the cat to come out on its own helps the cat to relax.  If the cat is upset in the carrier, Feliway feline pheromone spray applied to a towel placed over the carrier can help the cat to relax.  A tasty cat treat can also be tossed near the front of the carrier.  Cats are not as motivated to take a treat, yet having the treat can still help associate good with the clinic.

When the veterinarian enters the room, the veterinarian must toss and offer rewards to the animal. A dog or cat needs to have a good association with the veterinarian.  Petting them is not enough – often our hands are the source of pain.  They are working to accept our touch even when it is not painful, so pay them!  Be aware if there is a difference in the pet’s reactivity to the type of lab coat or smock you wear. Take off the white coat or wear a smock over your scrubs if you see this. The veterinarian’s dress is a signal to the pet that the administrator of pain is here.  Rewards help the pet to know you deliver good things too.

As the exam progresses on the exam table, rewards are continuously offered to the pet. Coordinate the giving or rewards or distractions with starting procedures. The staff can start to give rewards before an injection is given to help distract the pet.  Rewards continue as the injection is given and after.  If the pet will not take the reward as the injection is given, use jolly talk or other means to decrease the arousal of the pet to the veterinarian.  It is also important for technicians and veterinarians to communicate with each other as they are handling animals to be able to time rewards and procedures well.

Cats do require a bit of a different approach for rewarding.  Many cats will take liver paste by Kong as a reward during examination and procedures.  Distraction such as tapping on the head, or hiding the head under a towel or blanket helps many cats to calm down.  Avoid scruffing the cat for restraint.  This is uncomfortable for the cat and now the cat is going to associate scruffing with human hands at the veterinary clinic.   Minimal restraint is often the most rewarding to cats. Observe how the cat responds when less restraint is used.  Often they are less fractious and deescalate more rapidly when restraint is less intense and short.  These recommendations are different than what some animal restraint text books teach.  If you consider what the cat needs – to feel that they have escaped the threat- then you will understand why they often react against heavy handed restraint.  It seems when the cat is wrapped, they are not as reactive perhaps because they feel they have found an escape away from hands and other threats.  It is possible to give a cat that is covered in a blanket liver paste by syringe combining less stressful handling and rewards.

Muzzles are used for safety but also a way to deliver treats.  Either an open ended muzzle or basket muzzle can be used.  For a basket muzzle, load the front of the muzzle with soft chewie treats or peanut butter.  For the open ended muzzle, line the inner end where the mouth will go through with peanut butter.  Allow the dog to lick some of the peanut butter and then put it on the dog.  Peanut butter readily available for them to lick as soon as the face is through the muzzle and given continuously through the exam keeps the dog’s attention focused on the treat giver.  Small tidbits of chewie treats can also be given through the muzzle as well.  After the procedure, continue to reward the dog through the muzzle.  Allow the dog to lick the opening clean to further associate good with the muzzle.

After the examination and procedures, continue to reward the pet on the exam table and floor as well. Do not be in a rush to get them off the table.  This rushing reinforces that tables are bad an need to be escaped from.   A cat treat tossed into the carrier will help load the cat.  Tossing treats to a dog in the air to catch now allows play in the exam room further improving the experience for dogs.

As you use these techniques, you should begin to notice an improvement in the attitude of your patients.  If rewarding during exams is new for your clinic, start out simple.  Refine your techniques with the easiest patients.  As your staff becomes more confident, move on to the more difficult patients. 

An excellent resource for less stressful handling techniques is Dr. Sophia Yin’s book “low stress handling and behavior modification techniques of dogs and cats.” This book and DVD set has very clear photos and videos on ways to modify handling techniques to be less stressful and safe for the animals and staff. Learn more about this at her website dr.sophiayin.com

In my next article, I will show you how you can record what rewards work best for what pets, and how to know the best rewards to use for various procedures. 

Dr. Sally J. Foote is in general practice with a special interest in animal behavior and therapy. She has spoken and written about rewarding during the veterinary exam, and less stressful handling techniques at various veterinary meetings and in publications.

Sally J Foote, DVM  CFBC-IAABC
Okaw Veterinary Clinic Tuscola IL
drsally@drsallyjfoote.com

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