Enhancing well-being by minimizing stress

Photo: Vadim Guzhva/Adobe Stock

Veterinary visits can be stressful for both pets and their caregivers.^1-3 This is particularly true for cats with their unique behavioral needs.^4-6 Although it is unrealistic for veterinary visits to be completely free from fear and anxiety, implementing proper handling strategies can help minimize injuries, significantly reduce stress, and enhance both the comfort of feline patients and cooperation from their caregivers.^2,4-10

Understanding protective emotions

Recognizing the protective emotions of fear, anxiety, frustration, and stress that cats may experience during veterinary visits is important.^4-6,9,11-14 A cat’s behavioral responses are a direct indicator of their emotional state.^4-6,9,11-14 By understanding these emotional responses, the veterinary team can adjust their approach to each individual cat, thereby reducing stress and avoiding escalation towards a more dangerous defensive response.^{4-6, 9-14}

Avoid labels

Labels such as aggressive, feisty, difficult, spicy, angry, and spiteful should be avoided.^4-5,9 Instead, use objective terminology such as ear position, pupil size, tail position, body positioning, and more to describe body language.^9,14 Descriptive observations help to identify the true emotional state of the cat and the subsequent behavioral response.⁹

Be sure to educate clients about what is being observed.^4-5,9 By doing so, empathy is more likely to occur, which then leads to a higher level of comprehension about the true motivations behind behavioral responses and improved adherence.^9,15-18

Low stress environment

To reduce feline stress in clinics, use species-specific pheromones and provide a cat-only entrance and waiting area.^4-6,9,19-21 Separate appointment times or days for cats and establish a dedicated “cat-only” room that is regularly cleaned to reduce potential presence of pheromones left by other stressed patients.^4-6,9-10,22

Soundproofing, door draft protectors, and playing cat-friendly music helps to minimize outside noises and create a calmer environment.^4-6,9-10,23 Stock the room with all necessary equipment and supplies, including a litter box, fresh water, toys, syringes, needles, butterfly catheters, blood collection tubes, and portable ultrasound for guided cystocentesis.^4-6,9-10

Recognizing that cats are often stressed by movement and changes in their environment, therefore, limit the frequency of entering/exiting the room.^4-6,9-10 Avoid separating cats from their caregivers unless absolutely necessary. In cases where removal is required, consider asking the client to wait just outside the door instead of removing the cat.^4-6,8

Greetings

In cats, protective emotions can often be triggered by environmental changes such as movement, noises, smells, and touch.^4-6,9,11-13 To prevent startling them, approach with low voices and slow movements.⁹ Interactions should never be forced; the cat should have the opportunity to choose when and if to engage.^4-6,24 Begin petting with a gentle massage at the temples or chin. Avoid petting or stroking down the length of their back, and never tap on their head as a distraction technique as many cats find this aversive.^4-6

Examination

During the history taking process, place carriers on the floor, open the door, and let cats exit to explore at their own pace. Do not pull, shake cats, or otherwise force cats out of carriers. Start the initial exam from a distance to check mobility and look for signs of disease, such as discharge or hair loss.^4-6,9

Examinations should take place where the cat feels most comfortable.^4-6,9-10,25 Begin with less invasive methods, like auscultating the heart and lungs, before proceeding to abdominal palpation and later, examining the ears, eyes, and mouth. Avoid or postpone temperature checks, premedicate for pain before examining painful areas, and sedate if needed.^4-6 Use minimal handling and observe the cat’s body language throughout the entire process.^4-6,9-25

Handling protocols

Warming towels infused with pheromones can offer cats a sense of security, allowing them to hide if they choose.^4-6,9,27 Allowing a cat to stay in the lower half of their carrier, beside their caregiver on a bench, on the scale, or perched on a countertop can help minimize stress.^4-6,9 When handling is necessary, familiar cues such as touch, sit, and place, and food distractions should be used first.^4-6,9,25,28 Manual manipulation and methods like scruffing or full-body restraint should be avoided, as they can be painful, induce stress, and may trigger protective emotions.^{4-6,9-10,26,29-32}

Towel wraps

When restraining, avoid using tight towel wraps or commercial cat wraps.^4-6 These methods restrict the cat's ability to make choices, such as the ability to move away.^4-6,28-33 Although a cat may outwardly seem fine or compliant, they often are not.^4-6 Cats restrained using these tools and techniques may be just as fearful as those displaying more aggressive behaviors but express their fear through immobility and emotional withdrawal.^4-6,28-33 This is often evident in their facial expressions, ear positions, and body tension.^{17, 28-33}

Procedures

Depending on the individual cat, certain medical procedures, such as venipuncture, blood pressure measurement, cystocentesis, abdominal ultrasound, or radiographs, may be perceived as more invasive or stressful.^4-6,26 Keep in mind that most cats prefer a semi-lateral position and should never be forcibly placed in dorsal or full lateral recumbency.^4-6

Employing handling techniques that adhere to Low Stress Handling principles requires skill and patience.²⁶ However, these techniques focus on the cat's comfort and willingness to participate in the examination process.^4-6 By avoiding a forceful restraint, cats are more likely to stay calm and cooperative.^30-33

Unnecessary tools

The use of cat muzzles is not a recommended handling technique. Muzzles restrict a cat’s ability to receive and interpret sensory input from their environment, which can result in distress. The use of muzzles can elicit a similar emotional response, withdrawal and immobility, as scruffing, tight towel wraps, and commercial cat wraps. Additionally, muzzles may cause pain or discomfort, particularly because of pressure placed on the cat’s highly sensitive whiskers.^4-6

Additionally, gloves are not recommended for handling cats, except in specific instances where there is an immediate human safety concern during the sedation process. Even then, alternatives, such as a warm, pheromone-infused towel or blanket loosely wrapped or draped over the cat or administrating sedation while in a carrier should be considered.^4-6

If muzzles or gloves are deemed necessary for safety, sedation is the preferred method.^4-6 The focus should always be on the cat's welfare, clear communication, and preserving the cat’s ability to make choices such as moving away.^4-6,26,30-35 The same is true for other restraint devices such as Elizabethan collars and air muzzles.³⁵

Previsit medications and sedation

Pharmaceuticals, including sedation and previsit medications, are significant components of Low Stress Handling techniques.^4-6,9-10,27 However, it is essential to understand that pre-visit medications are not a green light for conducting a physical examination or performing diagnostics.^4-6,9 Instead, their main purpose is to reduce the onset of protective emotions such as fear, anxiety, and frustration, as well as the associated stress response thereby facilitating a more relaxed state in preparation for sedation.^4-6,9,11-13 Therefore, it is important to assess the urgency of each procedure and to prioritize sedation as “Plan A” rather than an afterthought.^4-6,9,35 When selecting medications, treat each patient as an individual, stopping all handling at the earliest indication of distress.^4-6,9,26 Depending on the urgency, a choice should be made to either reschedule or proceed with sedation.^4-6,9,36

Effective team communication

The initial contact between the hospital and the client can influence the entire veterinary visit. Customer service representatives (CSRs) should check the patient's medical records for an individualized handling plan to help keep stress to a minimum from the moment an appointment is made. Visits should be scheduled during quieter times of the day, such as the first or last appointment, and, if possible, arrange for the patient to see team with whom they have previously had positive interactions.⁹

In addition to scheduling, CSRs should identify the need for pre-visit medications and coordinate with the veterinary team to ensure these medications are prescribed and ready for the client to pick up ahead of the visit.^9,10 Once an appointment is scheduled, the veterinary team should be briefed on the patient's individualized handling plan, with a note attached to the appointment in the schedule.⁹

Education for the veterinary team

Education is a cornerstone for the successful implementation of Low Stress Handling, a training program that teaches the humane animal handling techniques mentioned in this article.³⁷ These techniques help professionals recognize escalating emotional arousal through the observation of their patients’ body language and to understand the significance of physiological changes associated with a stress response.^{4-6,9-10,11,17-18} Through regular practice, the veterinary team can develop and refine their skills, learning how to make appropriate adjustments for each individual patient, which promotes the most humane approach centered around the comfort level of their feline patients.⁹

Cooperative care

Cooperative care training combines training and behavior modification to improve communication and predictability.^{4-6,33-34,38-39} Positive reinforcement is used to condition cats to their carrier and foundational behaviors like targeting, including stationing, chin rest, paw, and nose touches.^33-34,38 Once cats become proficient, these “start button” behaviors enable them to signal their readiness to proceed or to request a pause, replacing defensive behaviors such as growling, swatting, hissing, and biting. Effective training requires reinforcing both options, clarifying to the cat that choices exist and that their decisions will be honored.^33-34

Once proficient at offering these behaviors, both at home and subsequently in the veterinary hospital, the next steps are desensitizing and counterconditioning with respect to injections, handling, positioning, and other procedures.^33-34 Although starting early in life has its advantages, this training is beneficial at any age.

Author Christine D. Calder DVM, DACVB, LSHC-S, is a veterinary behaviorist at Calder Veterinary Behavior Services, based in New England.

References

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