Embracing Behavior as a Core Discipline: Creating the Behavior-Centered Practice

Chapter 1

Embracing Behavior as a Core Discipline

Creating the Behavior-Centered Practice

Why Care About Behavior?

Behavioral problems are still the primary reason why cats and dogs are abandoned, relinquished, or euthanized, and most of these cats and dogs are less than 3 years of age. This means that the average practice loses $2200 per relinquished cat and $3300 per relinquished dog, on average, in the most simple, basic services that are not delivered over an average 15-year lifetime. These estimates are based on the 2011 American Society for the Prevention of Cruelty to Animals (ASPCA) estimated costs for minimum, basic, routine veterinary care.* These estimates do not include grooming, boarding, products of any kind including food, any surgery including neutering, first-year care, or any emergency care. Even at this minimal estimate, you don’t have to lose many patients to behavioral issues to realize lost income that could equate to the cost of equipment, a technician, a retirement plan, or an associate. More information about the role that behavior plays in pet loss and debility can be found in the Preface.

Clients recognize that their animals are ill based on their behavioral changes. If we use any aspect of behavioral change to inform us about somatic illness, we should also be using such changes to inform us about behavioral illness. Unfortunately, clients may not know enough about behavior to identify the concerns of their cats and dogs. As noted in Figure 1-1, clients may not notice all of the behaviors exhibited by their dogs or cats and may report to the vet only behaviors they do not like, whether or not these are “abnormal.” For veterinarians to deliver the best holistic care possible, where they treat the whole dog and whole cat, they must understand when behaviors deviate from normal and how to help clients identify behaviors they like or dislike in a context that is meaningful for the dog or cat.

Evaluating the Patient: How Often Should You See Clients and Their Pets?

If we are to help clients raise and live with behaviorally healthy animals, we must be able to evaluate the normal behaviors of the dog or cat and any deviations from these. Ill animals are not behaving “normally.” In fact, clients recognize that the dog or cat is physically compromised because of some change in his or her behavior. Behavior is at the core of the practice of veterinary medicine (Martin and Taunton, 2006) and specialty practices that include behavior encourage the use of other specialties (Herron et al., 2012). The same is true for general practices.

The opportunity to evaluate each patient in his or her “normal” baseline state occurs at new puppy/dog and kitten/cat visit and at wellness exams. Wellness exams should occur every few months through the first year of life; twice a year during the second year; and once a year until the dog or cat is segueing into later middle age or beginning older age, when evaluations should occur at least every 6 months (Table 1-1). This is more visits than is routinely recommended during the first 2 years of a dog’s or cat’s life, but this period of time is when the patient and his or her behavior is changing most profoundly. We need to observe cats and dogs during this time; teach clients how to observe them; and evaluate any behaviors or changes in behaviors that scare, worry, or concern clients or any member of the veterinary team.


Suggested Visit Frequency with Age for “Wellness” Appointments

Age Frequency of Veterinary Checks Behavior Landmarks of Interest
Through 16 weeks Every 2-3 weeks or more frequently if concerned; consider weekly appointments if client is inexperienced in any manner (i.e., novice pet person, new species, new breed) Housetraining/use of litterbox, development of appropriate inter-specific play behaviors; leash/car manners (cats, too); social exposure to novel humans and physical exposure to new environments and stimuli
>16 weeks to 1 year Every 2-4 months Sexual maturity from ~6-9 months of age; marking behaviors; onset of social maturity can be 9-10 months of age for some dogs
1-2 years Every 6 months, minimum Period of social maturity for most cats and dogs; end of social maturity for some dogs can be 18 months; cats may not be fully socially mature until 3-4 years; onset of most behavioral conditions
2-~8 years (depending on breed and size) At least annually Behavioral maturity; by 2 years of age, most behavioral conditions are becoming fully developed and will worsen without redress; at about 6 years, evaluate cognition and decide whether to initiate supplements or behavioral diets
≥8 years At least every 6 months Behavioral conditions associated with chronic illness or aging; consider supplements, diets, nutraceuticals; rehabilitative and cognitive therapy to keep the patient’s body and mind flexible
≥12 years At least every 3-4 months; more often if chronic condition identified Possible cognitive changes associated with aging; may be painful because of degenerative changes; consider household, diet nutraceuticals, supplements, conditioning, accommodations for changes in elimination behaviors/mobility, conveyances (steps into car, slings for stairs, buggies, special bedding or flooring)

Appointment Length and Behavior-Centered Practices

Veterinarians have often made the mistake of charging for products and not charging for their knowledge, skills, and time. Behavioral medicine provides the veterinary team with an opportunity to change this unfortunate practice. There are numerous ways to structure fees for preventive appointments and consultations for behavioral concerns, but none of these fit well into a 15- to 20-minute appointment plan because you are doing more than evaluating the patient: you are educating the client, establishing a working partnership, and investing in the client’s future willingness to invest in the health and care of their dog or cat.

For initial puppy and kitten wellness appointments, 40 minutes is sufficient time to:

• Accustom the puppy/kitten to the exam room and exam process

• Listen to the client when you ask if he or she has specific concerns or questions

• Review husbandry and care patterns in which the client is currently engaged

• Make recommendations about how to amend these patterns, if needed

• Provide some targeted education information; keep in mind that you will have at least two or, ideally, three puppy or kitten visits of this length and customize this information for each patient—if housetraining is the issue, your focus will be housetraining at this appointment; if chewing is the issue you will focus more on toys, supervision, and humane containment of damage at this appointment

• Examine and vaccinate the puppy/kitten

• Play with the puppy/kitten before and after examination; this is very important because the vaccine must come at a time when the patient is having a good time with enough time afterward to continue to have a good time

Subsequent puppy and kitten wellness appointments may take 30 or 40 minutes depending on whether the patient is attending a kitten or a puppy class and how well the integration into the household is going. If the patient is attending a class and everything is going well, you may be able to have a shorter appointment, but do not forget that part of the appointment’s purpose is to accustom the patient to the people, to the practice, and to new experiences in general. Let these young animals explore the reception area, bathing area, treatment rooms, and exam rooms. If you are offering puppy or kitten classes, the exploration of all areas of the hospital can be a class exercise. For the puppy/kitten, having as much information as possible is a great buffer against fear.

Initial examinations for newly adopted adult dogs and cats take about 30 to 40 minutes. This is sufficient time to observe the patient, learn how he or she walks on a lead or moves around with unfamiliar people, review information about behavioral changes in new households, and discuss the common behavioral reasons that render adult animals available for adoption. You will also need to observe the patient and listen to how clients offer information and respond to questions you ask. Clients need to understand that “recycled” pets may have been relinquished at least in part because of a behavioral concern and that the entire range of the animal’s behaviors may become clear only over the course of months. The veterinary team should make clear to the client that one of their goals is to help facilitate the transition.

Follow-up examinations may be successfully done in 20 minutes for adult animals, but this estimate assumes a healthy animal and a completely non-inquisitive client who truly needs very little information. Practices can best partition their time if they use a standardized questionnaire (see the end of this chapter) to survey the patient’s behaviors at all appointments, if some members of the staff receive special training in choosing and fitting head collars and harnesses, and if early intervention and management-related advice is provided. Depending on the problem, support staff can take the patient and client into a less busy area and help them on the spot. Otherwise, the support staff can schedule a 15- to 30-minute appointment for a harness fitting or to review a housetraining handout (Table 1-2).

• It is optimal if someone on the staff, who is knowledgeable about and trained to play this role, is always available during normal working hours. Asking people to come back when their lives are already over-booked poses a risk.

• If practices are going to bill for the time of the staff, all fees should be disclosed and posted and based on time. There is no mandate that posted fees are charged, but charges must be transparent in advance. Posting the cost for expertise in providing behavioral advice legitimizes the value of the service, but the fees must be commensurate with job description, talent and training, and information provided.

• Some practices prefer to bundle all the fees for examinations, behavioral evaluation and coaching, and vaccinations for kittens and puppies into one package over some pre-agreed time period. If you are going to do this, make sure you post exactly what is included in the package. Are unlimited question-and-answer (Q & A) visits with the staff included for the first 3 months? Can clients see the veterinarian at no additional cost more often than for appointments scheduled with vaccines if they have concerns about physical health? What services will incur additional costs (laboratory evaluations, medications to treat illness, et cetera)? Package plans can be great practice builders and encourage terrific dialogue about behaviors.

• Some practices prefer to have staff or a trainer hired for the purpose of giving weekly evening classes for clients and charge on a per-class basis (e.g., maximum of six dogs and families per 2-hour session; weekly sessions for Q & A and fittings for and coaching for use of harnesses and head collars at $25 per session). See Brammeier et al. (2006) for advice on finding and utilizing trainers in veterinary practices.

• Some practices hire a trainer who will charge by the course. Courses can be divided by age and size but are best kept small (e.g., no more than six dogs or cats, with preferably two staff members). If the practice has the space to have a trainer offer basic manners courses for dogs and cats at the practice, these classes provide an income stream for toys, harnesses, and food and engage the practice staff in the commitment to behavior.

• Many practices hold group classes (e.g., two kitten classes, each separated by 2 weeks, and two to three weekly puppy classes of 1 to 1.5 hours’ duration) as a “free bonus” for clients in the practice. The sole purpose of these classes is to answer questions and to allow the puppies and kittens to play and begin to learn about each other in a safe environment. The hidden advantage of this approach is that many clients have the same questions, and the group discussion of the answer is extremely informative. These clients may become their own support group while bonding to the practice.

• If the practice has a lot of first-time pet clients or a lot of clients with mild or management-based problems, it may be best to hold at least one session where the pets are not present so that the clients can focus on the information delivered and the veterinary staff running the session can listen to the clients.

Choice of strategy is largely a manner of practice style, but whatever strategy is chosen, everyone will benefit.

Basic appointments should include a discussion of reasons some toys are preferred over others and the advantages and disadvantages of the various collars, harnesses, halters, leads, et cetera. If you have a display of these items, the display can serve to educate the client in appropriate choices and provide an income stream (Fig. 1-2), but you must also have samples available that show clients how the toys work and the harnesses fit. This approach requires that a knowledgeable and helpful staff member is always available. (If you cannot fit the harness or show how the toy works or how to clean it, a client may wonder what else you don’t know.) See Table 1-2 for a list of tasks for which technicians can be trained to act as consultants, ensuring that clients get individualized attention and the most up-to-date, accurate information.

Having toys available in the exam room that encourage cognitive stimulation in cats and dogs can pique interest and engage both clients and pets. Whether the dog or cat shows interest in or plays with these toys may also tell you something about their level of distress.

For every harness, head collar, collar, halter, or wrap that is meant to help manage dog and cat behavior, laminate the illustrated fitting and use instructions and hang them on hooks in the exam rooms and waiting room. Even as we move to a paperless veterinary record, these materials provide tangible, pictorial information and give people a focus for the time spent waiting. Having these illustrated instructions instantly available also allows you to explain a tool that could help the client and patient as a segue to demonstrating the tool. This way there is no lapse in time between the suggestion and starting to implement helpful change.

Listening to Clients

Recent studies have shown that veterinarians, similar to physicians for humans, are not taught how to talk to clients in a manner that extracts important information while showing compassion and empathy. Clients cannot evaluate your medical skills; however, they can evaluate your ability to convey information, understand their concerns, and show empathy, and they do so on the basis, in part, of how well you listen. In one study, the median and mean lengths of time clients talked before being interrupted by the veterinarian were 11 seconds and 15.3 seconds (Dysart et al., 2011). Be conscious of this finding. Set a timer for a minute and see if you can allow the client to speak that long without interruption. If you are having trouble not interrupting, try sitting down. It’s easier not to interrupt if you are not standing.

The main reason clients provide incomplete information to closed-ended questions is interruption by the veterinarian. Quite simply, clients are almost never provided with adequate time to talk about their concerns. As a result, the major concern or key piece of information is often delivered at the end of the appointment, when such concerns are least able to be competently handled.

Anyone who wishes to be good at behavioral medicine must be good at listening. One function of a standardized questionnaire is to start the discussion with the client. Questionnaires, especially if they allow for both open (e.g., “What concerns you about this behavior?”) and closed (e.g., “How many times has the dog bitten?”) responses, give clients some vocabulary for their concerns and some structure for thinking about related behaviors about which the veterinarian should know. Questionnaires also act as a form of note taking; rather than having to write everything down, the person interviewing the client can make notations to the client-provided report.

After reviewing the questionnaire, the veterinary staff can follow up with both specific questions (e.g., “Do you know if the cat uses the litterbox immediately after it is cleaned?”) and more open-ended ones (e.g., “What outcome are you hoping for?”). If the client is provided the time at the beginning of the appointment to answer the questions fully, while the person taking the notes highlights points to which they need to return later, the client will provide much of the desired information. It’s acceptable to interrupt if something is sufficiently unclear that it will be impossible to understand the next information, but the person taking the behavioral information must be able to guide the client back to his or her place in the discussion.

At the end of every appointment or visit, good listeners do one final thing: they ask if there is anything else that they should know and if there are any questions. As listening and communication skills improve, this last solicitation will tend to yield only small amounts of information. Regardless, it is essential to ask.

Questions to Ask of Clients with New Dogs or Cats That May Elicit Concerns or Gaps in Knowledge

New pets provide an opportunity to establish a dialogue with clients that will help ensure that the quality of that pet’s life is the best it can be. Sample questions that may help you to learn where the client might need help follow:

• How did you get this cat/dog/puppy/kitten? Impulse buys or emotionally impulsive adoptions can work out, but it’s important to assess whether the client has the knowledge base to care for the animal.

• Where did you get the pet? There are good public health reasons for asking this question. If the client has young children and a kitten is wormy and flea infested, both Toxocara and cat-scratch disease could be concerns.

• Why did you choose this specific animal (i.e., type of pet or breed)? Many people didn’t make a choice, but if they did, chances are you will learn about something that is important to the client by asking.

• What are you feeding your new pet, and how do you think he or she is doing on that diet? This gives you a chance to combine behavioral advice (e.g., perhaps the kitten could have some or all of his dry food in a food ball) with nutritional advice.

• Have you noticed any problems with elimination? This question allows you to combine behavioral and medical advice and observations.

• Are there any behaviors about which you are concerned? Combined with the previous information, this question will help you to round out your understanding of the client’s needs and knowledge base.

• Do you have any questions about anything pertaining to this new pet? Listen first. Probe and respond second.

Providing Quality Information at Classes and Appointments

Regardless of how you decide to handle your “new pet” appointments, consider putting together an individually customized packet/bag for each class/appointment. The packet/bag should include sample items and information in a folder with the pet’s name. Creation of these packets/bags should be the responsibility of one or a few specifically chosen staff members.

• Samples of size- and style-appropriate toys can be included.

• Consider including the following handouts:

• Treats and foods chosen for the breed and size of dog/cat can be provided in a small bag. Sources can be provided on an information sheet.

• Information on housetraining/litterboxes and choosing and using leads, harnesses, collars, et cetera, can be very helpful.

• Consider including the following handouts:

• Include vaccination schedules, wellness schedules, and appointments already made in a calendar form that will encourage clients to add these to their calendar and/or stick them on the refrigerator.

• If the pet is of a type that might need a lot of grooming or special grooming, samples of dermatologically friendly shampoos can be included, along with a list of websites where good grooming products can be found.

• Suggestions for exercise should be tailored to the individual pet, but locations of dog parks or websites with information on hobby sports (yes, agility is a sport for cats, too) can be prepared by your practice staff and included for each new patient.

• Microchipping can help keep pets safer. Include information early in the sequence of visits and remind clients that shelters scan for microchips and will hold identified patients.

If these bags/packets are well tailored to the individual patient, you will have provided the client with an excellent foundation that should decrease the probability of a recycled or abandoned pet, while increasing the probability that if the pet displays problem behaviors, you will learn of them early on, not later or too late. Note that the emphasis here is not on random, free samples. You may choose to provide some samples, but what you are delivering is thoughtful information targeted and personalized for each cat or dog. This practice encourages clients to understand that they are paying you for your knowledge—not as middlemen for products. For this reason, any product sample you provide should be coupled to the pet’s needs.

Appointments for Older Pets

A word on appointments for older pets is warranted. People who have aging or geriatric pets often fear their loss. These clients are already committed to quality and quantity of life for their pets and have a high probability of cooperating with recommendations.

We have more tools than ever before to help mitigate the effects of aging. As pets age, they and their humans will benefit from the same types of in-depth care and creative suggestions provided at puppy/kitten and new dog/cat appointments.

Appointment times and displays of helpful tools and toys should reflect the needs and commitment of these clients and the needs of cats and dogs in this life stage. The appointments should have the focus of keeping the aged dog/cat as healthy as possible and ensuring that the quality of life is as good as it can be. This may mean finding creative ways to exercise your patient’s mind and body. Traditionally, the focus has been on mobility. We need to add to this an emphasis on encouraging the older dog/cat to use his or her brain. Games and cognitive exercise tailored to older pets (e.g., softer toys that are easier to manipulate and carry; food puzzles that are easier to manipulate, swimming/wading using an underwater treadmill) will enhance the interaction between clients and their pets, improving everyone’s quality of life.

Evaluating “Normal”

The biggest problem that veterinary practices have with evaluating and discussing normal behaviors with clients is that no one in the practice sees the patient exhibiting either globally normal behaviors or behaviors typical for the pet. Most dogs and cats fear veterinary visits, so veterinary staff see these patients only when they are fearful.

One study examined the behavior of dogs at veterinary hospitals and found that 106 of 135 (78.5%) dogs were fearful on the examination table (Döring et al., 2009). Of the dogs, 18 (13.3%) had to be dragged or carried into the practice; fewer than half of the dogs entered the practice calmly. Dogs who had had only positive experiences were less fearful than others, and dogs less than 2 years of age—who see vets often—were more fearful than older dogs—who see vets infrequently, suggesting that repeated exposure to veterinary practices may enhance fear to a certain age.

We need to question the extent to which these fearful behaviors interfere with our ability to assess patients and provide the state-of-the-art care they deserve and to what extent we cause or contribute to the fears of dogs and cats.

Visits to veterinary practices can be scary for our patients: the floor is slick, there are strange sounds and smells, there is not enough inter-personal approach space, the table is cold and provides poor footing, their people are tense, et cetera. Any dog or cat who is not physically ill should be able to walk happily in the door of the hospital. If the patient is shaking, trembling, drooling, hiding, staying flat on the floor, scanning the environment, urinating, defecating, vomiting, or trying to leave, he or she is not happy. We need to change this response for three important reasons:

1. We need to distinguish patients for whom early fear is a true pathological diagnosis from patients who are just afraid of what we are doing to them and where we are doing it. If most of our patients are afraid, we cannot adequately evaluate their early behaviors.

2. Although we can man-handle puppies/kittens and—usually falsely—dismiss fear as “normal,” to do so sends the wrong message to the patient and to the client. We must realize that:

3. The delivery of veterinary care may teach cats and dogs that humans can be threatening. This realization will contribute to the development or worsening of any behavioral problem.

These three factors suggest that, unwittingly and without malicious intent, the delivery of veterinary care can be a causal factor in the worsening of patients’ behaviors.

Nothing in the experience of any puppy or kitten will have prepared it for the sensory overload that will occur at the first and subsequent veterinary visits.

• These babies will never have encountered the noise range and frequency that defines a busy veterinary practice.

• The general lighting is different and often invasive, and it’s unlikely anyone has looked in the patient’s eyes with a penlight.

• The global odor must be complex. Even if these puppies/kittens were born in a home with lots of animals, they have never faced so many and such diverse smells at once.

• Most puppies/kittens will never have had the social experience of encountering so many humans and animals at once and in such close quarters.

• Many puppies/kittens may be walking for the first time on flooring that will steal their balance and traction.

• Finally, if the client is clutching at the patient or at his or her “restraints” (e.g., leads, harnesses, carriers, collars), the patient can only take this as a signal to react.

Is it any wonder that most animals never show their true behaviors at most veterinary visits?

Arousal levels are key to understanding why patients are at risk for learning fear at veterinary offices (see Chapter 2).

• Learning of adaptive fear at the neurochemical level in the amygdala and the hippocampus is modulated by cortisol levels (see Chapters 4 and 6 and the “Protocol for Teaching Your Dog to Take a Deep Breath and Use Other Biofeedback Methods as Part of Relaxation”).

• As cortisol levels increase, brain-derived neurotrophic factor (BDNF) increases, which allows molecular memory to be made through the creation of new proteins (Peters et al., 2004) (see Fig. 3-5, A and B, in Chapter 3).

• This same process is involved in learning how to cope with arousal.

• Fear can be almost instantly encoded because the amygdala is “pre-adapted” to respond to perceived threats. However, behaviors associated with learning to cope with arousal cannot be encoded at the molecular level if the cortisol level is too high.

• An optimal range of cortisol produces an optimal range of BDNF and cytosolic response element binding protein (CREB).

• True complex, associative, and adaptive learning will occur at the molecular level only when CREB and BDNF are within this range.

• This is why in situations scary to the patient we see an almost invariant version of avoidance and withdrawal behaviors associated with arousal.

Fortunately, we can intervene. Our mitigation should focus on decreasing arousal and on increasing affiliative behaviors. We accomplish these goals by using calm environments, teaching patients that going to the veterinarian need not be scary, and avoiding situations that are perceived by the dog or cat as punishing or scary and instead ensuring that these experiences are seen as fun and rewarding. Cats and dogs who live at practices or who regularly come to the hospital with the veterinary staff are not afraid of the hospital environment. Why is this? For these patients, good experiences are the rule, not the exception.

What Can We Change?

Door Entryway

Doorways should provide sufficient space that no dog or cat is constrained to come within its personal approach distance of another animal (Fig. 1-3). This distance is 1 to 1.5 body lengths and varies individually with the patient. Large doors with porches or entryways can accomplish such avoidance easily (see Fig. 1-3). Windows, glass doors, and large panels of glass in doors also help. In urban environments, a double set of doors with large panels of glass can help accomplish the goal of avoiding abrupt introductions. Staff can be schooled to help orchestrate safe and non-stressful movement through doors.

Figure 1-3 shows a panoramic view of an entryway that was well designed with the patients’ behavioral concerns in mind. Figure 1-3, A, shows that there are two double doors on each side of the reception area. This design allows dogs to go in one door and out another to avoid meeting each other, if needed. Regardless, everyone can see who is coming and going, so avoidance and orchestration of movement of animals by staff are possible. Figure 1-3, B, shows that the reception staff has a clear and global view of both doors and the waiting area. The high ceilings give the illusion of even more space than the already large floor plan provides, which helps clients who may worry about their dog’s reactions to other dogs. Figure 1-3, C, shows the wide open waiting area on one side of the reception area (note the large number of windows). There is a mirror image of this waiting area on the other side of the reception area, allowing dogs and cats or fractious animals to be separated. Figure 1-3, B and C, also shows that well-placed benches outside increase the amount of waiting area space and may allow many pets and clients to be calmer than they would be inside the hospital. Some exams and procedures may be best done outdoors where the patients can focus on other activities and not feel so entrapped.

Anyone who watches patients and clients in a waiting room is aware that few dogs, cats, or humans are comfortable. One study (Hernander, 2008) that examined the role of waiting rooms in creating stress in the waiting room reported a number of conclusions that are important to consider if we are to be successful in creating behavior-centered practices.

• Although there was no difference between male and female dogs in the level of stress displayed, dogs accompanied by both a male and a female client were more stressed than dogs accompanied by only one client.

• Dogs who had recently been to the clinic had higher stress values than dogs who had not visited recently. This finding has profound implications for the invasive nature of some of the care provided by veterinary staff as perceived by the dogs.

• Dogs who stayed in waiting rooms that were not chaotic and had sufficient time to calm were less stressed than dogs who were moved quickly.

• Weighing dogs on the scale is much more stressful than sitting in the waiting room. This finding supports the idea that we should teach dogs how to be weighed and design scales and placement of them so that the dogs have some control over their participation in the process.

The busier the practice, the more crowded the waiting room can become. Urban veterinary practices may have limited space and should use schedules, exam rooms, and treatment areas sanely so that no patient has to sit in the waiting room with their human hanging onto them for dear life. If the client looks or sounds worried, so is the patient. Action must be taken to decrease patients’ arousal levels immediately. Distressed patients often are calmer waiting in the car than they are in a busy and noisy waiting room. As an alternative, patients who are good with humans but might be afraid of other animals may be accommodated in the reception area through the creative use of barriers. Figure 1-4 shows a reception area with pass-through gates that can be closed, basically changing an open floor plan to one with concentric circles and visual barriers. Having such flexibility can be priceless.

We may do well to evaluate the stress level of each animal (and client), note these in the records, and use these to inform our handling procedures that day and to create a plan for reducing stress for handling and veterinary care in the future. The evaluation system used by Hernander (2008) is easy for any practice to implement and is presented in Table 1-3.

We can expand this scale to address many aspects of veterinary care and intervention. See Box 1-1 for the specific scales found in the separate questionnaire, “Scales to Evaluate Stress Level of Dogs at Veterinary Hospitals.” A version of these scales for client use at the hospital or at home is available as a client handout (“Protocol for Assessing Pain and Stress in Dogs”). Similar questionnaires are available for cats and are discussed in Chapter 5.

Box 1-1   Scales to Evaluate Stress at the Veterinary Hospital (Based on Hernander, 2009; Döring et al., 2009)

Clinic Dog Stress Scale 1: Entry to the Clinic

Dog’s behavior on entering the veterinary practice and in the waiting room (this section can be completed by a member of the reception staff). A total of 5 points is possible. Dogs with a score of 5 are distressed and need help. Dogs with zero scores are calm.

Stress Level Dog’s Behavior/Demeanor
0 Extremely friendly, outgoing, solicitous of attention
1 Calm, relaxed, seemingly unmoved
2 Alert, but calm and cooperative
3 Tense but cooperative, panting slowly, not very relaxed, but can still be easily led on lead
4 Very tense, anxious, may be shaking or whining, will not sit or lie down if exposed (may do so behind owner’s legs), panting, difficult to maneuver on lead
5 Extremely stressed, barking/howling, tries to hide, needs to be lifted up or forced to move

Clinic Dog Stress Scale 2: Weighing the Dog

Dog’s behavior on being weighed (this section can be completed by the veterinary nurse or technician who weighs the dog). A total of 5 points is possible. Dogs with a score of 5 are distressed and need help. Dogs with zero scores are calm.

Stress Level Dog’s Behavior/Demeanor
0 Extremely friendly, outgoing, solicitous of attention, eagerly gets onto scale
1 Calm, relaxed, seemingly unmoved, and walks easily onto scale and sits
2 Alert, but calm and cooperative, can get onto scale but not sit on it
3 Tense but cooperative, panting slowly, not very relaxed, but can still be easily led on lead, gets onto scale only with encouragement
4 Very tense, anxious, may be shaking or whining, will not sit or lie down if exposed (may do so behind owner’s legs), panting, difficult to maneuver on lead, must be helped/encouraged to get on or stay on scale for 10 seconds to get reading
5 Extremely stressed, barking/howling, tries to hide, needs to be lifted up or forced to get onto or stay on scale for 10 seconds to get reading

Clinic Dog Stress Scale 3: Entering the Exam Room

Dog’s behavior on being brought into the exam room (this can be completed by whomever guides the client and dog to the room). A total of 5 points is possible. Dogs with a score of 5 are distressed and need help. Dogs with zero scores are calm.

Stress Level Dog’s Behavior/Demeanor
0 Extremely friendly, outgoing, solicitous of attention
1 Calm, relaxed, seemingly unmoved
2 Alert, but calm and cooperative
3 Tense but cooperative, panting slowly, not very relaxed, but can still be easily led on lead
4 Very tense, anxious, may be shaking or whining, will not sit or lie down if exposed (may do so behind owner’s legs), panting, difficult to maneuver on lead, avoids room
5 Extremely stressed, barking/howling, tries to hide, needs to be lifted up or forced to move into room

Clinic Dog Stress Scale 4: Examining the Dog

Dog’s behavior on examination (this chart can be completed by the veterinary nurse or technician, in consultation with the veterinarian, if needed). This chart evaluates body regions that are involved in the stress response. Having as much information as possible will allow the veterinary staff to suggest interventions and to use the behaviors noted to assess improvement or debility. Rather than trying to remember if the dog is “worse” or “better” than at previous visits, this tick sheet allows the veterinary team to collect actual data and to use it to improve the quality of the dog’s and client’s experience. A total of 36 points is possible. Dogs with high scores are showing signs of stress and may be distressed. Dogs with low scores may be less distressed. Dogs with zero scores are calm.


Clinic Dog Stress Scale 7: Trimming the Dog’s Nails

Restraint level: (circle 1)

Aug 15, 2016 | Posted by in SMALL ANIMAL | Comments Off on Embracing Behavior as a Core Discipline: Creating the Behavior-Centered Practice
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