How to manage an anxious dog at the vets7 March 2023
Written by Rosie Bescoby, Certified Clinical Animal Behaviourist, BSc (Hons), PG Dip CABC, CCAB
Reviewed by Dr Jill McMaster BVM&S MBA MRCVS, Veterinary Surgeon and in-house expert at BorrowMyDoggy on 7 Jun 2023
Introducing Rosie: Rosie Bescoby BSc (Hons), PG Dip CABC, CCAB is a fully qualified clinical animal behaviourist. She has a degree in Zoology and Psychology from the University of Bristol and a postgraduate diploma in Companion Animal Behaviour counselling from Southampton University. She's an ASAB certified clinical animal behaviourist, a full member of the Association of Pet Behaviour Counsellors and a member of the Professional Association of Canine Trainers and registered as both a clinical animal behaviourist and as an animal training instructor with the Animal Behaviour and Training Council.
So let's just start off with thinking about what is difficult for dogs about the veterinary practice. Obviously dogs navigate their world through scent and I think one of the one of the biggest things when they enter the vet practice is the influx of olfactory information.
What is difficult for dogs about the veterinary practice?
- olfactory information
- unfamiliar people
- other animals
- unusual appearance of unfamiliar people
- restrictions in behaviour
- lack of consent in being touched/intense handling
- pain is present or caused
- separation from caregiver
What is frustration and why is it relevant?
Be mindful of how our behaviour can induce frustration.
Ladder of aggression
How a dog responds to a threat
- growls/lip curls
- rolling over/urinating
- jumping up
- frantic tail wag
- turn away/run away
- ears back
- head turn
- paw raise
- shake off
The flight response is turning their head away from something but alongside this type of behaviour, there's curving. It's this constant curvature behaviour that a dog will do to indicate that they're not a threat.
- C in posture or direction of travel
- frequent looking away
- blinking/squinty eyes
- lip licking
- ground sniffing
- lowering head/body
- slow movements
Yawning is a measure of stress or conflict. Sometimes a yawn is just a yawn. But if the yawn is in response to social pressure, it's probably a calming signal.
It is often observed due to anxiousness, indecision, or conflict.
A yawn could be considered an exaggerated lip lick.
Sometimes it is a self-soothing mechanism.
Dogs will pant when the ambient temperature is warm or when they've done some physical exercise. But if neither of those things are true and the dog is panting, I would always be questioning whether it's a stress response.
You can tell a stress pant from a non-stressed pant because the stress pant involves other body language signs associated with stress.
The corners of the lips are generally pulled much further back; there's a lot more tension around the mouth and the face. You might see the back molars because of how pulled back the corners of the lips and gums are.
Eye contact is threatening in dogs. It's near the top of the aggression ladder. It's the last stage effectively before they go into what we would label an aggressive response.
With 'hard eye', the pupils dilate, there's no blinking and there's quite fixed eye contact. The whites of the eyes are showing.
The opposite of the 'hard eye' is soft eyes. In this situation, there's no facial tension and the whole body language of the dog is soft; there's no tension. There's no staring, no intent and there's nice floppy heads.
This is the biggest pre-bite warning a dog will issue.
If the dog's mouth is open and it closes.
If a dog is panting and stops.
If his tail is wagging and it stops.
If he was moving and he suddenly becomes a statue...
Most people interpret this as "I'm going to bite you." Perhaps more accurately, it would be "Don't make me use these."
Confidence - everything is forward, icy calm. Pupils are not dilated.
Threat displays such as this are designed to AVOID physical conflict.
Every single dog's body language is a balancing act and every dog responds very individually when they are feeling stressed.
Mouth and drooling
Let's look at a mouth for example. The optimum is for the dog's mouth to be quite moist, but on either extreme of that you can have a dog whose mouth has become very dry as ours does when we get anxious. We get a dry mouth to generate saliva that often leads to the lip licking behaviour. Equally you also get very anxious dogs that excessively salivate and drool.
You have dogs that come into the consult room that will take a treat nice and gently, that's the optimum. That's often a good sign that the dog is not feeling stressed. If you've got a dog that's unable to take treats or is grabbing at treats, those are both signs that the dog might be getting aroused and stressed.
Similarly on walks or at home, you want the dogs to be able to play appropriate fun short games. If you've got a dog that would normally show an interest in a toy or a game, but is now showing reluctance to play or has become quite obsessive about it, those can be coping strategies.
Ideally, we want nice, mobile, relaxed, floppy ears. If they're pulling their ears back against their head or they're very very high set and tense, those again are both signs of a potentially stressed dog.
We're looking for fluid calm movement as opposed to freezing and shutting down or just manic behaviour which is part of that faffable behaviour.
And we're looking for a nice relaxed body posture as opposed to everything's upright and erect or cowering and rolling over and again.
It's all about the context so when like I said about the yawning I don't want people paranoid and reading into every little body language that we've just talked about because it all depends on context.
So lifting a paw in response to a social approach, that is very often a sign that a dog is feeling worried by something. They're getting ready to move away and they're also communicating: "please be nice to me I'm making myself look vulnerable on three legs".
So now we've just talked about dog body language and how dogs communicate with each other, we're going to just move on to how dogs are probably translating our behaviour. When we're trying to be nice to dogs we can actually potentially communicate with them in dog body language the same as when one dog goes up to the other and puts their head over the other dog's neck and shoulders in a t-shaped manner which is a challenge or a signal of intent to mount. So when we go up to a dog and loom over them and get into their space in that similar way most dogs don't particularly like it because it is likely mirroring what a dog will do when they are challenging another dog. Things like hugging or greeting behaviour where we lean right over into the dog's space, you can see dogs responding with that curved body language response and in the image in the recording, the lady on the other side is attempting to call her dog towards her so with her voice she's trying to attract the dog to come to her but everything about her body language is telling the dog to stay away she's leaning into that dog's space she would have a much better success of calling her dog to her if she stood upright and even if she walked a few places backwards as she called her dog so she's conflicting the dog probably in what she's asking and what her body language is asking. So we want to try and make sure that we are greeting dogs in a way that doesn't set them off on the wrong foot so we're doing a nice polite greeting in terms of dog body language which means being side on as much as we can.
You can see this lady here is side on to the dog. She's leaning away out of the dog's face. She's touching the dog's chest here rather than the top of its head. Dogs will generally struggle with this because the hand is disappearing. They can't see where that hand is going and at best I often see dogs kind of tolerating it but their head is dipping as the person's stroking so try to avoid head stroking and move down to the chest. Instead where the dog is confident that the hand is in front of them, make sure that the eye contact is not direct. I say relaxed and friendly but that doesn't mean much but just trying to avoid a direct front-on approach and direct eye contact.
So I just wanted to explain a bit of a concept called trigger stacking and I use an analogy here of a sink or a basin and all of us including dogs have only got the capacity of a sink before we overflow and the volume of our sinks differs so some of us have got great big massive industrial sized sinks and some of us have got tiny little shallow basins like this one. So for some of us it takes a lot of water in the sink before we overflow and for others it's not going to take much for our sinks to overflow and we've all got a hot tap which is negative arousal so fear, stress, anxiety, pain, illness and we've all got a cold tap which is positive arousal so things we enjoy but it makes our adrenaline right up here and it's not something most of us can cope with doing every single day.
So human examples would be things like skydiving, going on a roller coaster, going to a rock concert so we we enjoy them, some of us enjoy some of those things but I can't come home from a rock concert and go straight to sleep because my adrenaline's pumping and we've all got a plug which is how we drain our sink and depending on unless we've got chronic stress or chronic illness we all wake up in the morning with an empty sink and then depending on what we do throughout the day our taps get turned on and our sink fills up a little bit at a time and again. Each of us have different coping strategies of how we drain our sink and pull the plug out. But if we don't have the opportunity to pull that plug out the sink just becomes fuller and fuller and ends up in overflow. And with the hot tap if the sink overflows from a hot tap there's also the potential to get burnt. The cold tap is good in small amounts because it keeps the temperature of the water so that you're not going to get burnt, but it still contributes to the volume increasing and I just want you to think about this concept as we now move into the vet practice and how a dog’s sink fills up every little step along the way and what we can do to either reduce the taps getting turned on in the first place or help them pull the plug out when the sink inevitably does fill up a little bit.
So let's start in the reception area. This is the very first step of the insult of olfactory information. As soon as they walk in the door the flooring, the different people and animals in the reception area etc. So I think most practices now the way is you've got the space with separate areas as much as possible but even if it's within the dog area are trying to encourage clients to like if Mr Jones is sitting there with his dog try and encourage Mrs Smith to sit over there with Ray. Just give each dog as much space as possible. If the reception room is empty you can say to the owners don't feel like you have to sit down if you don't want to because like we've said dogs struggle with sitting or standing and doing nothing so keep letting them mooch around the reception area can sometimes be useful. You might just need to say if another owner comes in you would need to take a seat but feel free to mooch around and let the dog sniff around the reception area and gain some information about their environment and if they are sitting down and they're trying to push the dog's bottom and say sit sit down sit down, that's putting a huge amount of pressure on that dog before they've even got into the consult room the dog's sink's going to be filling up by the owner trying to force them to sit again in reception. It might be worth saying oh don't worry too much, if he's happy to just stand he's happy, comfortable standing, try and give them a bit of a hint that they don't need to be enforcing so much on their dog. They're probably feeling a little bit worried about what's about to happen if they're particularly stressed dogs so they're really going up that ladder. If they pant, start vocalising, do they need to be in the building? Can we ask them if they'd like to wait outside in the car or in the car park and we'll call them in when they're ready or there might be a back entrance that we bring them in through if they're for example aggressive to other dogs.
The weighing scales can often be a real pinch point and it really doesn't need to be so dogs who are really suspicious of getting on and we end up manhandling them on again remember the sink analogy, it's another trigger. The hot tap's getting turned on so we can make all of these smaller things much easier for the dogs and prevent that tap getting turned on in the first place. This is a really nice photo here of weighing scales in a practice, they've obviously got a really nice area where they're using this corner and they've got treatpots above and every single dog just walks straight on because they're not thinking about the weighing scales they're focused on the treat pot and the owner just feeds them once they're sitting or lying. Encouraging owners to bring their own mat, again you can see here they're much more likely to do that because it smells of them, it's a nice texture under their feet rather than that unfamiliar flooring we talked about and that mat is probably associated with dogs lying down and being relaxed. Getting owners to bring their bedding also comes hand in hand with coming to stay in kennels but even for the consult room it can be super useful, so do say to owners if you want to bring him out with them and again if you want to pop in and just pop your dog on the scales with your mat and practise that behaviour coming into the vet, sitting there having a treat out the treat pot off you go again
So here's a nice photo of my old dog Holly dog and my brilliant Lexi and she's doing a really nice example of how you can examine a dog without face-on head-on approach so when you're approaching and examining, try and avoid being in front of the dog leaning over them try and crouch yourselves down if your if your knees allow it keep the dog on the floor. It's extremely extremely difficult for dogs of any size, even the chihuahuas, to be picked up and put on the table so if you're able to, do it on the floor. Cats great pick him up on the table, dogs and rabbits please keep them on the floor to do your examining and treating as much as possible. If you can, when you're taking the history from the owner you could let the owner know it's all right to feed them some treats. You can be throwing some treats down on the floor too so the dog's just starting to chill out sniffing around the room eating some food. You're also kind of assessing how anxious that dog is because if they won't eat the food that's a good sign to you that they might be feeling a bit stressed. If possible see if that dog comes up to you and says hello and gives you a nudge and says can you stroke me please in which case great you've got that invitation for interaction. Obviously the dog may not have asked for any interaction by the time you're ready to start examining that dog and you will have to touch that dog and examine them without their consent, but if you are as unthreatening as possible in your body language and doing that like in this photo you're at least making that as easy as possible for them. And we want to try and keep as hands off as possible in our examination and you will probably find within your practice that the more hands off and the less restraint you do as you go into hard restraint and you know hard holding legs and heads up like this the animal immediately is going to become tense, it's going to become stressed. They're going to feel like they've run out of options on that ladder and they've got no other choice but to escalate to the top part. So I said dogs on floor if possible, look out for the more subtle body language signs of avoidance, the freeze, if you can just every time you notice these signs creeping up the ladder if you can just stop for a second, give them a break in between listening to their chest, listening to their heart and then doing something else. Just give them a little gap in between and what you might well notice in that gap is the dog doing a nice shake off and this is their way of one of their ways of pulling the plug out of their sink so it's kind of a doggy way of going oh phew oh I'm alright now. It's like a reset button, so if you can and particularly when you brought a dog out the back and you've got them in for a procedure and you've got a bit more time you're not so pushed for time with an owner there and you've got your next client waiting in particular if you can just give that dog a bit more time in between everything you're doing with it and give them that chance to recover in between each step you're less likely to get the overflow. This is because as the tap turns on the plug pulls as the touch turns on the plug gets pulled.
If the dogs escalate to the top of that ladder and start showing aggression it's really important that we don't respond with aggression back and try and punish that dog. It's already feeling stressed, threatened and frightened and if we respond by attempting to tell the dog off or pin it down harder you're not going to get near that dog the next time it comes in. So for the longer term benefit as well as what we're communicating with the dog it's really not appropriate to respond with any sort of verbal or physical aggression back towards the dog.
I've already said take the history as the dog’s acclimatising try and allow the dog to investigate the items so before you just shove your stethoscope on the dog's chest or heart let them see, let them have a sniff of that stethoscope, and before you um before you probably draw up the medicine see if they just want to sniff the end of the syringe and let them just work out everything. The auriscope and you know the all of those items, let them have a look first before you just go ear or eyes or start poking and prodding them with a certain item because again it will be like well what are you doing, what is that, if I hadn't had a chance to check it out first.
Be generous during procedures with treats if the dog's not coming in for any sort of operation. Be generous during and immediately after any procedure. If it's not that bad a procedure like a vaccination, we can definitely overshadow it by using tasty, delicious treats or food and that is what we should be doing. We should be overshadowing as much as possible so the dog barely even notices anything going on with them. Obviously there are procedures or very sensitive puppies and dogs that will still be aware so straight away as soon as the procedure is done yeah well done that was super good to make that end memory be something positive and pleasurable. Try and keep us hands free and at least possible restraint, take your time if possible for those dogs that can't have treats because they're coming in for an op. It can be really sensible in the freezer to have a load of plastic cups with a small amount of low salt stock made up in the bottom of them so it's still got a good smell. The dogs are still keen to lick at it but they're not actually ingesting much at all.
Removing from the owner is a debatable topic. I have no doubt that there are some owners who are so anxious and stress themselves, or hostile, some of the time that without doubt it's going to be easier for you and consequently the dog or even just the dog even if you're not bothered by being taken away from the owner. However with the general nice owner I wouldn't be doing it as standard because that dog is being taken away from their attachment figure and you're just adding another hot tap to their sink. The owner also I believe has a right to stay with their dog in the same way that I wouldn't want my baby or child taken away from me at the doctor. Obviously if you explain why you're doing it then I'm sure most will understand if there's a good reason for it but it shouldn't be standard protocol in the vet practice in my opinion. If you need to ask a nurse or a member of staff to come in and help and ask the owner to take seat in the consult room so they're still in the area but you've just got someone a bit more capable doing the hands-free, least possible restraint procedure as much as possible. If you've got time to make use of EMLA cream and you and the owner don't mind waiting while you pop a bit on let's see the next client and then call that dog in if they're particularly need or sensitive I would always recommend that.
Another couple of tips are when you're injecting or taking blood if your handler whether it's the owner or another member of staff can do some quite harsh scratching around the animals face and neck whilst that injection is being given and that can help overshadow as well. Food is difficult if you're having to keep the head in a position to draw blood but instead of really manhandling, holding that head in that position just be scratching them all over so they're really not aware of that needle then going in because it just becomes overshadowed with the scratchiness. And even the other thing I was going to say about treats is even when you have a dog in for giving some apple morphine because they have eaten something they shouldn't which I had with my 16 week old puppy yesterday, we still fed treats while it was being given because it's not particularly pleasant, it's a bit of a stinger and he's going to be sick anyway so just feed feed feed whilst that's being done. Ironically my sister's puppy also had to go into the vets on Saturday night because it had eaten some grapes and unfortunately she it was taken away from her and she could hear it screaming and howling whilst it was given the injection so much so that when it came out it had diarrhoea and lost control of its bowels. It really doesn't need to be like that so please think about the emotional welfare of the animals that we're treating and not just thinking about treating them physically for their physical ailments.
If someone comes in wanting nail clipping or any other routine or husbandry proceed procedures and the dog is getting stressed and not tolerating it, this is not an emergency and if we keep pursuing, attempting to clip this dog's nails or pin it down to do it we're going to make the whole situation a million times worse and when that dog does have something physically wrong with it that needs vet treatment you're not going to be able to to get near it to do it so make sure we don't escalate if it's very clear at the start that that dog is really not tolerating its nail clip. We really need to stop what we're doing if the dog doesn't feel safe, that's how they escalate up that ladder so even if we think oh this is ridiculous it's just a nail clip it's irrelevant how we think and what we feel about it, we've got a higher brain we obviously know what's going on the dog doesn't. If they don't feel they are safe, stop the situation if you can. If you can carry on by making use of overshadowing so you this is a nice um sticky bone that sticks to the wall you can safely washing up by simply smearing some GI food on on the sides on the table or on the floor for the dogs to look at or licky mats for example or just a pile of treats while you do something quickly, give the dog a chance say one foot at a time or one claw at a time. Let them have a shake off in between if you say to the owner I've only managed to do one foot today and it's taken me five minutes but go home, carry on practising touching your dog's feet and and if the owner's not confident clipping their nails that's fine, but just practise the procedure and bring the dog in again and send them home with homework. In other words just this is how a puppy vaccine should look like. I noticed it, they did notice it there was a very small tiny acknowledgement of it but the overshadowing was doing a job beautifully.
Muzzle training - we ideally want to have handouts in reception and muzzles for sale in reception so that if a vet or a member of staff at any time feels that they need to muzzle a dog. Ideally that owner would then go home with homework, with a handout of how to do it and train it at home so that the dog is happily putting their nose into the muzzle. So that next time it comes in it sees the muzzle as a brilliant treat bucket and it actually can, if it's introduced properly, it can actually help altering a dog's association with being at the Vets because it's delighted to see that its mum or dad has brought its food bucket with them and they're shoving their head in there and the owner is continuing to treat through the muzzle whilst the vets and nurses are doing their thing. A lot of this is about educating owners so teaching them that it's not a stigma, they're not their dog's not being judged in any way but that every dog if they're in in pain and stress have the potential to escalate and everybody in the practice has a duty of care of safety for each other.
If anyone has any doubt at all about a dog that you know is creeping up that ladder and you're noticing body language signs sneaking up then absolutely they need to be muzzle trained, you need to pop a muzzle on them. When I used to run puppy classes it was something I used to do with every single puppy class owner and it gave me the opportunity to explain to them that you might not believe it right now with your cute puppy that it might ever need a muzzle. It might not ever need a muzzle, but how much better is it for us the vet and our dogs and puppies if we can teach it to them in a nice positive way so that should they ever need a muzzle putting on them, it's no big deal. It's not contributing to that sink filling up.
Dogs in kennels, please let owners bring their own bedding. You might need to give them a warning that the bedding might get lost, but I would always be happy to take that risk. Some owners may not, but at least give them the choice and it's much easier for the dogs if you think about having some frozen Kongs or some licky something to encourage licking behaviour for when the dog starts to come round. If they're struggling in kennels just that oral behaviour of constant licking is good for self-soothing.
Just aware of the time, I'm just going to whiz through a little bit. When we tell owners to come into the vets regularly if they've got a dog that's worried about the vets and we say come in for desensitisation sessions that's brilliant if you offer those but please remember that these are only working to teach the dog that the vets is good if the dog feels safe at all times. The dog should be calm and relaxed at all times so what I'm saying by that is if the dog already is stressed in reception there is no point in you getting the owner to repeatedly bring the dog into the vets because all they're learning is that they're carrying on learning that the vets is a stressful place. You need to find the dog's starting point where it feels calm and relaxed and safe. For some dogs that might be on the way to the vets if the owner walks them there.
I've worked with dogs that as soon as they realise they're heading in the direction of the vets they put the brakes on so that is the starting point for that dog and owner. But for others it might be just outside the vets in the car park. If you've got a garden or a pavement outside, and for some dogs it might be that they're happy in reception, but as soon as the vet comes out they put the brakes on, so find that individual dog starting point and that is where you start and you want to teach them that on the way towards the vets or into the consult room or in on the way good stuff happens. The toys or the games happen and then you turn around we get the owner to turn around and walk out and it's very boring and they repeat that within one social session they repeat that in and out lots of times so the dog really starts to learn “oh great coming in is fab and going out is boring”. Coming into the consult rooms fab going out is boring as opposed to coming in and spending lots of time in the vet practice doing good stuff try and get those reps in. The positives should massively outweigh the negatives in both number and intensity. If you can allocate staff and time to provide this service I think it's hugely beneficial for all involved.
If you've got dogs who struggle with the vets I'm not a vet so I'm not going to dwell too much on this but the APBC I believe has got a handout in their Vets section on the website on psychoactive medication but please use it. Please use combinations of short-term medications for dogs who struggle with the vets as it will prevent them escalating up that ladder. It will allow you to do more, it will make the owner more relaxed.
Neutering - a very quick one I know this isn't about bringing dogs into the practice but just didn't want to miss out on it. So neutering we should ideally be delaying until a dog is behaviourally mature so socially and sexually mature. For behavioural reasons that would be my preference, be very aware of not advocating castration if the dog is anxious in any way because it may exacerbate any underlying fear or anxiety. If owners want to castrate straight away to calm the dog down it's likely to not help because it's not going to benefit exuberance and if anything if that dog is overactive in an anxious way because it's in constant faff about mood it may make the situation worse. If you're not sure you can always recommend the implant and with I'd again highly highly recommend a bit of practice CPD watching a phantom pregnancy webinar on the APBC website that may well get you to think about and change the timing of your spay protocol.
These are just all the benefits of the vet practice if we can provide a really behaviourally aware service for them and make it much easier and less stressful for the dogs involved sorry that I've gone over I always go over but I do have time for a few questions and if you all need to head off feel free to drop me an email.
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