Fear Free principles – State of the Art and State of the Heart

“We take the pet out of petrified,” says Dr. Marty Becker, a slogan that has become a rallying cry among enlightened vets. 

Dr. Becker has been a veterinarian for almost four decades, a fulfilment of his childhood dream—he wanted to be a vet from the age of six. He’s owned part or all of eight veterinary hospitals in three states and has been known almost his entire career for celebrating, protecting, and nurturing the human-animal bond.

Still, Dr. Becker’s ‘a-ha’ moment didn’t occur until 2009 when he was at a large veterinary conference in Victoria, BC. He attended a talk by veterinary behaviourist Dr. Karen Overall, who spoke on how pets were almost always taken against their will for vet visits, grooming, boarding, and training. 

Dr. Overall argued that those who care for animals (veterinarians, nurses, trainers, groomers) were causing repeat, severe psychological damage to pets by what they were doing—or not doing. It was a light-bulb moment for Dr. Becker.

“Before Overall’s talk I thought the signs I saw of fear, anxiety and stress (FAS) were just collateral damage, an unfortunate part of working with animals,” says Dr. Becker. “After her talk, I knew that if we wanted to match up with our veterinary oath to prevent or relieve animal pain and suffering, we had to change the way we practiced. Loving animals and being compassionate were not in themselves looking after the emotional wellbeing of animals. Overall said, ‘Fear is the worst thing a social species can experience, and it causes permanent damage to the brain.’ That very day I thought, if fear is the worst thing, then Fear Free would be the best thing.”

Fear Free, begun that year, would become Dr. Marty’s passion project, one that would dramatically change the way pet professionals interacted with the animals in their care.
 

In 2016, FearFreePets.com, an online education company for pet health professionals (veterinarians, nurses, trainers, groomers, etc.), was launched, followed by FearFreeHappyHomes.com, a free resource for pet owners looking to optimize their pet’s physical and emotional wellbeing and provide enrichment.

To date, almost 60,00 pet professionals (vets/nurses, trainers, and groomers) have paid and are registered for certification; of those, 37,000 have completed certification, and it’s transforming practices and lives of pets. 

“Fear Free is clearly the biggest game changer in our practice in my career—and I have been practicing for 33 years!” says Dr. Robin Downing, an animal pain expert, founder of the International Veterinary Academy of Pain Management, and owner of Windsor Veterinary Clinic and The Downing Center for Animal Pain Management in Windsor, Colorado. “The idea of seeing the veterinary visit through the eyes of the patient is something incredibly novel in the veterinary profession, and yet, once you think it through, it seems pretty self-evident. Once we understand all the ways that we unthinkingly come across to the pet as threatening, like a predator, it opens the door to a completely different interaction.”

Inside a Fear Free-certified veterinary practice, the receptionists avoid eye contact with the pet and start giving treats right way. They provide the pet parent with a warm fleece blanket or towel with species-specific pheromones on it, as well as a pheromone-impregnated bandanna to put on their dog or pheromone-impregnated cotton ball to place in the cat carrier. Once in the exam room, the pet and pet parent are left in the room to listen to calming music, let the pheromones work their magic, and find where they want to be examined—on the owner’s lap, on the floor on a yoga mat, in the bottom half of carrier, inside the sink, cradled in the scale, or up on the table. (Most exams are done with the pet on the floor.) The nurse/vet avoids prolonged eye contact with the pet and starts giving treats as soon as they enter, with a goal to give about 60 tiny treats in a 15-minute exam. 

“We are like Grandma or Grandpa,” laughs Dr. Becker. “We spoil these pets and by doing so, put the treat into treatment!” 

Everyone in the practice is wearing pheromones—the dog-pheromone Adaptil below the waist and the cat-pheromone Feliway above the waist. They make sure the pet is on a warm, non-skid surface, and use techniques such as considerate approach (avoid eye contact, turn sideways, and crouch down), gentle control (getting positional compliance in a way that doesn’t scare or harm the pet like restraint does) and Gradient Touch (making sure they let the pet smell instruments like stethoscope or otoscope, which have been cleaned and wiped down with a pheromone wipe after each use) then touch the area they’re going to examine—like the chest to hear the heart and lungs or a back leg to vaccinate—a couple of times before they apply the instrument or stick with the needle.

“Basically, it’s like treating tiny horses,” says Dr. Becker. 

If a pet’s fear/anxiety/stress levels are too high to begin with or keep rising, they’ll stop the exam/procedures and re-evaluate with three options: retreat and come back another day (“A different day and different way,” says Dr. Becker); give an oral chill pill (like generic Xanax or an FDA-approved product like Sileo) and wait 30 minutes for it to work; or go straight to sedation. “Fear Free practitioners think of sedation as a first option not a last resort and sedate early and often,” says Dr. Becker.

At Dr. Downing’s practice, they employ pre-visit pharmaceuticals to get a jump on the anxiety vet visits can provoke. “One very important addition to what we do is the liberal use of PVPs—pre-visit pharmaceuticals,” says Dr. Downing. “By using PVPs we actually prevent our patients from escalating to the torture of FAS.”

“We give a treat when they step on the scale to be weighed. We give a treat when they walk into the consult room,” says Dr. Bloom. “Owners tell me that I’m spoiling their pet. I tell myself that I’m conditioning them!”

“We have for years conditioned dogs to LOVE coming to see us, and they now all head right from the front door to the walk-on scale,” says Dr. Downing. “As for cats, they are in a room with natural light coming in through a large window, and they have the opportunity to wander about in the Feliway-infused room before we actually start their examinations. Both iCalm Cat music and Rescue for disinfection  [a powerful yet gentle, odour-neutral and fragrance-free disinfectant] have made a tangible difference in their reaction and response to our handling. Everyone wins in this scenario—most importantly, the pet, but also the pet owner as well as all members of the healthcare team.”

One of the Fear Free principles that has proven particularly transformative for Dr. Downing is examining pets on the floor. “I see ALL my canine patients who are over about 12 pounds on the floor,” she says. “And the tiny ones aren’t typically on the floor anyway—they are most often on a lap or in their owner’s arms. Seeing dogs where they live—on the floor—has made an enormous difference in their level of cooperation with whatever we need to do, whether it is drawing a blood sample or trimming their toenails. 

“Pets are sentient creatures who experience many emotions—FAS, or Fear, Stress, Anxiety, for example—just as humans do,” Dr. Becker explains. “They also have an amygdala υ
[a set of neurons in the brain shown to play a key role in the processing of emotions] that stores negative experiences. Unlike humans, they can’t understand why a highly negative procedure is actually a good thing (benefits them) or anticipate or expect it be over even if it’s moments away.”

As a result of traumatic vet visits, “the pet develops maladaptive fear, where the pet doesn’t even have to be at the facility or receiving care/services to have the equivalent of a panic attack, PTSD, or freak out,” says Dr. Becker. “Just seeing the carrier being taken out of the garage or closet, being put in the car, driving down a certain road, or pulling up to the facility, causes an emotional blow up.”

That’s why introducing Fear Free principles begins at home. “Module 1, Level 1, is all about how the pet owner can get a pet from the living room to the exam room in a calm state,” Dr. Becker says. “Get the carrier out a week before a wellness visit (not the night before or the morning of the visit which often causes a pet to panic), start feeding high value treats in the carrier, start a magic carpet ride of pheromones that will go from carrier to car to clinic, withhold food for 12 hours before the visit (unless medically contraindicated) so that pets come in hungry and respond better to food rewards, preheat or precool the vehicle so that pets go from 72 degrees in the home, to 72 in the vehicle and 72 in the vet clinic, cover the carrier on three sides with a towel or sheet to reduce visual stimuli, play a specific channel of Sirius XM classical or reggae music on the way in, and don’t baby talk the pet. Once at the practice, leave the pet in the car, go check in, and go back out and wait in the vehicle until it’s your turn to be seen.” 

“I built my veterinary hospital 8 years ago,” says Dr. Julie Reck, owner of veterinary Medical Center of Fort Mill in Fort Mill, South Carolina. “It had four exam rooms and a large lobby. The large lobby made it easier for people with pets to wait. Fear Free practice has eliminated the waiting room because the goal is to reduce stressful patient/patient interactions. We now have a small lobby and seven exam rooms! We also have calming music piped throughout the hospital as well as built-in benches that prevent pets from cowering under the seating.”  

Dr. Jon Bloom, a partner at Willowdale Animal Hospital in Toronto, Canada, is also a Fear Free practitioner. “Currently, approximately 50 percent of pets have signs of FAS when visiting the veterinarian. The telltale signs are so common that most have accepted the signs as the new normal. But it doesn’t have to be that way!” he says. “Visiting the vet can be an amazing experience. When pets come to see me, they are wagging their tails and running to greet me. Dogs pull owners into my hospital and into my consult rooms. Cats come out of their cat carriers and wait for me to walk through the exam room door. They can’t wait to be spoiled rotten, all during the same time while I’m examining them and providing the care they need. They are excited to enter and reluctant to leave.” 

For Dr. Bloom, the Fear Free principle that was the most transformative was “partnering with clients: “We work together to make that visit to the hospital a great experience. When clients know that they have a willing partner, then the sky becomes the limit to what you can do!”

“We also encourage owners to speak up and be heard,” he says. “When a dog comes in trembling with its tail between its legs…we see this as an opportunity to improve healthcare. When I go to a restaurant, I have certain preferences and I make those preferences known. I tell them if I want to sit outside or inside. I don’t usually like to sit near the door or the bathrooms. I order my meal based on what I feel like eating. Dogs and pet owners have preferences too. If your dog doesn’t like other dogs, ask for a room without windows…If the hospital offers liver treats but your dog only likes cheese-based treats, then ask if you can bring them from home.” 

As with other Fear Free-certified vets, at Dr. Bloom’s practice they put the needs of the pet first. “If pets don’t like being up on high exam room tables, then we examine them on the floor,” he says. “If they don’t like liver-flavoured treats, then we offer them chicken-flavoured treats. If they feel more secure being near their owners, then we do their entire exam, vaccine, blood sample collection, etc. beside their owners.”

“Fear Free visits simply have a different approach, a different feel, a different vibe, and a different experience for everyone involved,” he says. “You know it when you see it. It’s healthcare at a higher level because it takes into account not just the pet’s physical well-being, but also takes into account the pet’s emotional well-being. It’s healthcare the way you thought it ought to be.”