Features December 2015 Issue

Step-by-Step Training for Your Dog's Next Vet Visit

You can (and should) teach your dog to love those trips to the veterinary clinic!

There is a gentle breeze of change wafting through the veterinary community, led by noted veterinary behaviorists Dr. Karen Overall and the late Dr. Sophia Yin, and veterinarian Dr. Marty Becker. All three of these veterinarians have long been outspoken advocates for a kindler, gentler approach to handling animals at veterinary clinics, to combat the widespread challenge of dogs (and other animal companions) who become increasingly fearful, difficult to handle, and even seriously aggressive with repeated visits to the animal doctor.

a happy dog at the veterinary clinic

ďItís true! I love my vetís office! Iím happy to be here!Ē Thatís what this middle-aged dog told the photographer in the waiting room
of Creature Comfort, a holistic veterinary practice in Oakland, California.

Your dog may be one of the many thousands who went to his first puppy checkup with his tail wagging, happily kissing the face of the tech who lifted him to the table, but has since morphed into a demon-possessed candidate for a remake of the Exorcist. Or perhaps he started out a little fearful and somewhat resistant, and his behavior has deteriorated to the point that you need to take a sedative before making that dreaded trip with him to the vet hospital. Either way, you know things are only going to get worse. There are many vet visits in your dog’s future, even if he stays perfectly healthy and only needs to go in for his annual well-pet checkup.

Do I have some good news for you! Not only is it possible for you to give your dog a happier opinion of all the various veterinary procedures he is likely to face in the coming years, but the aforementioned winds of change make it easier and easier to find a veterinarian whose handling procedures won’t terrify your dog. Plus, the now readily-available materials on modern, gentle veterinary handling techniques, combined with your own strong advocacy for your dog, give you tons of powerful ammunition with which to convince your current veterinarian to join the low-stress handling revolution. That’s a huge plus for all the other dogs she sees, as well as your own dog.

Advocacy

Let’s start with the advocacy piece. That’s easier, because all you need is the fortitude to be willing to stand up for your dog when he needs you the most. Here are some examples of situations where and how you can, and have every right to, intervene on your dog’s behalf:

1. Stay in the Room

Some vets insist that their clients’ difficult dogs are better behaved when the owner isn’t present. They have the tech whisk the dog to a back room where the vet does whatever needs to be done, then return the dog to the owner, claiming the dog was “fine.” While it’s possible that some dogs are calmer when not in the presence of a stressed owner, there are several other explanations for this, none of them acceptable:

A fearful dog may, indeed, shut down when taken away from the owner. While a shut-down dog may be easier for the vet and her staff to handle, it is likely that the dog is becoming more stressed and fearful during the procedure, and will likely be even more stressed (and harder to handle) the next time he needs to be examined, vaccinated, or treated, by the owner as well as the veterinarian.

When the owner is not there to watch, vets and clinic staff may be less inhibited about using significant force to compel the dog to accept the handling. In extreme cases, some veterinarians have even been caught on video hitting dogs and worse, throwing them against a wall in response to their resistance. If you are present, they are likely to at least moderate their use of force.

When the owner is present, not only might the clinic staff feel less free to use forcible restraint methods they “know” will work, they also may have to explain and defend what they are doing, at the risk of upsetting the owner and losing a client.

2. Ask for Sedation

For the dog, not for you – although some owners might benefit from a little medication as well! If your dog resists to the point that your veterinarian feels inclined to use forcible restraint, ask that she use drugs instead. Unless there is a medical reason preventing your dog from being sedated, this is a far easier, less stressful solution for all concerned, both human and canine. Yes, it will cost you a little more, and yes, there is a slight risk, even for a healthy dog, but well worth both, in my eyes.

Please note: Many veterinarians administer acepromazine (“Ace”) as a sedative when clients request medication. Dr. Karen Overall vehemently argues against the use of acepromazine for dogs.

“I know that the common ‘treatment’ for storm and noise phobias and veterinary office visits is acepromazine,” she says. “In truth, I wish this medication would be placed at the far back of a top shelf and used only exceptionally. Acepromazine is a dissociative anesthetic, meaning that it scrambles perceptions. Ask yourself if a scrambling of perceptions will make an anxious or uncertain dog worse or better.”

If your vet agrees to sedate your dog, ask what drug she plans to use. If she suggests “Ace” for your dog, ask her to watch this video of Dr. Overall speaking about the drug. Alternatively, ask her to speak with a veterinary behaviorist to determine what might be the most appropriate drug for your dog for this situation.

3. Intervene as Needed

One of the reasons some vets prefer not to have owners present is that if the dog does continue to resist, they may opt to use restraint methods that many owners would find unacceptable. In the vets’ defense, they have a job to do, and muzzling and forcible restraint enable them to get the job done while ensuring their own safety and the safety of their staff. Unfortunately, it also ensures that your dog’s behavior will likely get worse and worse with each subsequent visit to the vet clinic.

However, most vet office procedures are not urgent, and if your vet explains what she needs to be able to do, you could conceivably go home and put a behavior modification protocol into practice that will, in a reasonable amount of time, enable you to bring your dog back for the next appointment, willing and able to tolerate routine veterinary procedures. Unless your dog is bleeding badly or suffering from some other life-threatening emergency, make clear to your vet that you won’t tolerate the use of force, and ask her to work with you to find alternatives. Be prepared to assertively stop clinic staff from doing anything to your dog that you are not comfortable with.

4. Choose Your Surface

Some dogs do great on the exam table – but even better if you bring a soft, familiar rug or blanket from home to put on it so it’s not so shiny, slippery, or scary. Other dogs do much better on the floor of the exam room. Stress can causes aggression (see “Understanding the Most Common Canine Behavioral Problem - Aggression!,” WDJ October 2010), so if you know that your dog will be less stressed on the floor than on the table, ask your vet to do the exam and procedures on the floor if possible.

5. Feed Treats

If you can keep your dog happy and distracted with super-delicious treats, there is just no good reason not to do so. And fortunately, many more veterinarians are starting to realize that “doing what works” without force just makes sense!

I recently had to take our 12-year-old Cardigan Corgi, Lucy, to our vet for an anal gland exam (excessive licking and scooting). I was a little apprehensive, as Lucy has been clear about her discomfort with vet exams in the past. I was seeing a new vet and had no idea what to expect.

Girding my advocacy loins, I walked Lucy into the exam room, and immediately started feeding treats to “prime” her (get her in a happy frame of mind) for the exam. To my delight, the doctor didn’t suggest they take Lucy to a back room, so I didn’t have to fight that battle. And when I advised him that she had been difficult in the past and would be happier if I fed her while he examined her, he said, “Well then, you just keep right on feeding her.”

vet technicians draw dog's blood

The same dog seen above, receiving an injection of a sedative prior to an invasive procedure. The blanket keeps him comfortable and prevents slipping; the techs are gentle and patient. All of these things help preserve his good feelings about coming to the clinic!

Modifying Vet Exam Behavior

In addition to having a plan, being prepared, and staying positive (as described on pages 10-11), you can set up your dog to succeed by creating very positive associations (classically conditioning) or changing negative associations to positive ones (counter-conditioning) with the various tools and procedures he will likely encounter during his vet visits.

To start, identify procedures and equipment your dog is already uncomfortable with. If your puppy or young dog doesn’t yet have any bad associations, you can still “inoculate” him against stressful vet visits by conditioning him from the start to think all these tools and procedures are wonderful. Your lists might look like this:

Tools:

Stethoscope, otoscope, thermometer, syringe, tooth scaler, nail clippers, etc.

Procedures:

Examining ears, eyes, teeth, and other body parts; having temperature taken; getting a shot; restraint for blood draw; nail trimming, etc.

Tool Protocols

Since the tools your dog finds aversive are used in many of the procedures he also finds aversive, you can start with the tools. Obtain a reasonable facsimile of each tool, and begin your counter-conditioning program. Ideally you will work for 15-20 minutes per session, as many sessions per week as you can fit into your schedule. Remember to subtract calories from his meals to compensate for all the yummy treats he gets!

1. Sit on a chair with your dog in front of you – on leash if you think he will leave. Have a large container of high-value treats on a table next to you. I prefer chicken: baked, broiled, or canned/rinsed/drained. Most dogs love chicken, and it’s low fat/low calorie – healthier for them than some other high-value treats. Have a handful of chicken in one hand hidden behind your back, and one of the tools (let’s say the syringe) in the other, also out of sight.
2. Hold up the syringe, close to your chest. As soon as he sees it, bring out the chicken and give him a nibble. Then hide both hands behind your back.
3. Repeat Step 2 until, when you hold up the syringe, he glances at it and immediately looks toward the other hand for the chicken. This is a “conditioned emotional response” (CER) and it tells you that he is starting to happily associate the syringe with receiving chicken!
4. When he looks for the chicken each time you hold up the syringe, move the syringe a little closer to him with the next presentation. Work at each new increment until you have a consistent CER, then move it a little closer.
5. When he is comfortable with the syringe touching him, touch it to his fur in various places over his body, again establishing a CER at each new location before moving on to another.
6. Do this with each tool, until he is happy to have you touch him all over with each of the tools. Then bring in someone new – ideally someone who resembles your vet! Start over at Step 1, with the new person holding the tool and you doing the feeding, until he is delighted to have anyone touch him with the various tools.

Procedure Protocols

As you did with the Tool Protocols, you will start with tiny steps toward your goal of having your dog love all of his veterinary procedures. We will use “examining his ears” as our example.

Again, you will ideally work for 15-20 minutes per session, as many sessions per week as you can fit into your schedule. You can do this while you are working on your Tool Protocols ( for example, Tool Protocol in the morning, Procedure Protocol in the evening).

1. Determine where in the procedure your dog begins to be mildly uncomfortable. If you can touch or scratch his shoulder but he gets tense if you touch his ear, start with touching his shoulder and work up from there.
2. Sit on a chair with your dog in front of you. Have a large container of high-value treats on a table next to you. Put both hands behind your back, one holding a handful of chicken.
3. Touch him on his shoulder with your empty hand. As soon as you touch him, bring out the chicken and feed him a bit, then put both hands behind your back.
4. Repeat Step 2 until, when you touch him on the shoulder, he immediately looks toward the other hand for the chicken. This is a “conditioned emotional response” (CER) and it tells you that he is starting to make the happy association: “Touch makes chicken happen!”
5. When he looks for the chicken consistently, each time you touch his shoulder, start working your way up to his neck, then his ear, working at each new increment until you have a consistent CER, then moving a little higher.
6. When he is comfortable with you touching his ears, be a little more invasive, touching the inside of his ear, then moving your finger (or a cotton ball) deeper into his ear canal. Remember to establish a consistent CER at each new location before moving on.
7. Do this with a different procedure, until he is happy to have you replicate each of the identified procedures. If the procedure involves a tool, repeat the process with the tool in your hand, after he has been conditioned to love the tool, and after he’s comfortable with you going through the motions of the procedure without the tool in your hand.
8. Finally, bring in someone new, and start over at Step 1, with the new person mimicking the procedure and you doing the feeding, until he is delighted to have anyone performing the various procedures.

(Note: For details on modifying your dog’s response to nail-trimming procedures, see “Force-Free Nail Trimming Techniques for Your Dog,” August 2012.)

A Lot of Work

This may sound like a lot of work. The good news is that dogs can generalize these conditioning protocols, so as you move from one tool to the next, or one procedure to the next, your dog is likely to catch on more quickly with each subsequent one. In the meantime, you can also give your dog a positive classical association with your vet clinic by dropping in whenever you get the chance, and sitting with him in the waiting room or the exam room, feeding him some chicken, and then leaving, without having anything “bad” happen. It may take some work, but it will be well worth it when you walk into your vet clinic with your relaxed dog happily trotting by your side, eager to see the nice veterinarian and be poked and prodded, yummy treats happening all the while.

Pat Miller, CBCC-KA, CPDT-KA, is WDJ’s Training Editor. She lives in Fairplay, Maryland, site of her Peaceable Paws training center, where she offers dog-training classes and courses for trainers.†

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