Episode 35: Fear Free Practice with Dr. Leanne Lilly

This week on the Good Dog Pod, our host Laura Reeves is joined by Dr. Leanne Lilly, an Assistant Professor of Behavioral Medicine at the Ohio State University, as well as Susan Patterson and our very own Dr. Judi Stella.

Veterinary visits are not always a walk in the park (no pun intended). They can be anxiety-inducing and create fear for our dogs. The idea of Fear Free veterinary visits was introduced to explore what data and tools can be used to decrease or even eliminate the stress our dogs experience during veterinary visits. Doing so can result in more accurate test results, faster wound healing and other medical benefits. 

Unsure how to tell if your dog is anxious? Body language is the best indicator to gage where we are on the pet's scale of fear and anxiety. Here are some body features to look out for:

• Eye-Contact. Where is your puppy looking at? Averting gaze can imply fear, while intently staring into your own eyes can also convey worry. 
• Tail. Where is the tail? How is it moving? A stress-free tail is moving in a slow flowing motion.
• Facial Expression. We are looking for the area around your dog’s face and eyes to be soft. If facial tension is present, we have an uncomfortable dog.
• Fidget Behaviors. Lip-licking or licking their owner can be a fidget behavior which is used to get rid of nervous energy. 

For more tips on creating smoother veterinary visits, give this week’s episode a listen!

Transcript

Laura Reeves [0:40] Welcome to the Good Dog Pod! I am your host, Laura Reeves, and I’m super excited to be joined today by Assistant Professor of Behavioral Medicine, Dr. Leanne Lilly. She’s at the Ohio State University Veterinary Medicine Department. Dr. Lilly is joining us with Dr. Judi Stella, Good Dog’s Head of Research and Standards and also our Breeder Advisor, Susan Patterson. We have a wonderful group of guests today. We are going to be talking about something that I think a lot of people may not be familiar with, which is called Fear Free Veterinary Visits. Dr. Lilly, can you take us through what this is, actually, and why it’s important for all of us—whether we’re dog breeders or dog owners or whoever?

Dr. Leanne Lilly [1:30] Yeah, sure! Happy to do that. I think that’s a good place to start. Fear Free is an incorporated program that actually has a lot of different fingerlings: Fear Free Veterinary Visits, Fear Free Happy Homes, Fear Free Shelter. But it’s this idea that those types of environments and interactions and veterinary care can actually be very, very stressful for our patients and that’s well-supported in the literature. That’s actually a key reason why cats may not even go to the vet, because it’s so stressful for them. We have data and tools and research and know-how to change that. We may not be able to make it zero and we’re not going to make going to the vet the most fun experience for every pet on the planet—it’s not going to necessarily be their favorite compared to, say, playing fetch—but it doesn’t have to be a mortifying experience for them. That’s one side of it from that welfare; that’s the whole reason we get into this business from a veterinary perspective. But we also know that you get better results from a medicine standpoint. You get better laboratory results, you get more accurate vital information, you get better wound healing when patients are not stressed. All of those things are also really important to us as primary veterinarians. How do we make our medicine better? It’s this idea of taking all that information and funneling it into that approach to medicine and shelters and expanding out into pets at home, too. 

Laura Reeves [3:03] Absolutely. This starts with just bring your puppy home, go to your first vet visit to introduce your puppy to the veterinarians. What are the processes specifically that both the veterinarian and the owner can do to help incorporate this Fear Free into their visit?

Dr. Leanne Lilly [3:22] Some of it starts the moment you pick up the phone and talk to your veterinarian or your veterinary clinic. There are training modules and pieces of information that can be imparted from the reception staff, things like the use of pheromones are well-supported for cats or dogs to help make their transport less concerning, and bringing their favorite treats, and maybe their favorite toy as well. Maybe they’re a toy dog and maybe they’re a treat dog, but have both on hand. Why pick when you can have both? Have your cake and eat it, too. Starting with those types of little conversations before you even brought your pet to the vet. From the veterinary side, there’s a whole host of things that are being done and that can be done. Some of those are environmental: how we paint our clinics, how we set up our clinics and our flow—although that’s all been changed again with Covid. We’re trying to navigate the new normal. 

Laura Reeves [4:15] You know, we can put a Covid conversation in here because for many of us, the pandemic has changed how we interact with our veterinary clinic. We’re not able, in many cases, to even go in with our pets. Relate the Fear Free and the work that the owners can do at home and how that transitions to being in the veterinary clinic without the owner. 

Dr. Leanne Lilly [4:37] Things like preparing your pet to be separated from you—whether that’s because you’re finally going back to work or you’re going to the grocery store or you’re going to the vet’s office—are things that clients can do at home. From the veterinary standpoint, for dogs and cats who are already well-established in a veterinary clinic and they’re not new homes during Covid-19 quarantine, then if those cats and dogs have a positive experience with veterinary staff and handling (or as positive as it can be—no one goes, “Yay! Women’s wellness exams!” so it’s okay if our pets don’t either), if they go, “Yeah, that’ll be okay. There’ll be some really great Squeeze Cheese. Most people are a little weird; they don’t pet me like normal people, but it’s okay,” then if they have to go in without their safe haven person or their guardians, then they’re going to be much better equipped to deal with that change and allow those veterinarians to still provide the care they want to provide without the increase risk of bringing Covid into their workspace. Both sides of that can really help those animals. 

Laura Reeves [5:40] Absolutely. Let’s talk about a dog (or we can talk about a cat?) that’s already nervous to go to the veterinarian. What are some really concrete steps that we can do ahead of time as an owner or as a breeder to make that pet more able to cope with the experience?

Dr. Leanne Lilly [6:05] Recognizing body language is really one of the first things, so that we can gauge where we are on that pet’s scale of fear and anxiety and stress, so that we know we’re trending in the right direction. If we’re not paying attention to those things, we could think we’re doing a really good job making it better, but we could inadvertently make it worse, and nobody wants that. That’s the exact opposite of our goal. Little things like watching for the moment that they start to become uncomfortable and changing how we approach that, whether that’s at home or in front of the veterinary clinic, can be helpful: saying, “Oh, that’s the part that you don’t like? Let me add in cheese at that part so that you like that part better” and practicing handling pets in ways that are closer to how veterinarians handle pets at home (when they’re already comfortable with you). They’re just like, “Well, you don’t normally look at my ears but whatever. I love you. This is fine.” That can be helpful as well. We have to make sure that your pet is actually comfortable with that with you because, again, most people don’t pet their dogs by flipping their ear up and looking around in it and—

Laura Reeves [7:07] Looking in their mouth.

Dr. Leanne Lilly [7:07] Right, and turning their ear inside out. But if that’s something that your dog just thinks people who are friendly sometimes do and then you get a treat afterwards, then when your veterinarian does it, it’s much less scary. There is still an unfamiliar person and an unfamiliar setting, but we’ve at least taken out the weird handling compartment of it. Working with your veterinary staff, whether that’s their technicians or their recommended trainer or your veterinarian, say, “Okay, what does it actually look like for you to handle an ear versus what do I think as a client about what ear handling actually looks like?” Because those two things might not line up, and having those conversations is really helpful as well. And then practice. Practice taking your dog to the parking lot and giving them a treat and then going home. Suddenly, the parking lot doesn’t mean the weird scale and the other barking dogs and the veterinary handling and the needle pokes—let’s not forget the needle pokes. Veterinarians are so mean! So many needle pokes, right? Instead, the parking lot means, “Oh! We have peanut butter. Well, I like this parking lot now.” Those little things can build up to better and better veterinary visits and don’t necessarily have to involve all the time and planning of an entire appointment. 

Susan Patterson [8:15] From a breeder perspective, I prepare my puppies to go home. The last two weeks for me (the 6, 7, and 8 weeks) I do a lot of socialization. A lot of handling. It sounds like you’re encouraging breeders to incorporate: look at your puppy’s mouth and ooh, yay, a little bit of peanut butter on the finger or check the puppy’s ears. These are things you would normally do but to incorporate it into our handling and then work with our new owners so that they kind of do this continuity of exposing and handling that the veterinarian would do in order to help make everybody more Fear Free. Did I hear that right?

Dr. Leanne Lilly [9:00] Yes, absolutely. That is a great, great point, right? This can start before the veterinarian. This can start before the long-term home, which is kind of cool. We certainly incorporate exactly what you’ve just discussed into our puppies’ socialization classes, but it doesn’t have to start with us! It can start before us. There’s no reason it can’t. The earlier you start and the more positive it is when you start, the better it is. You never get a second chance to make a first impression. That’s true with our cats and dogs, too. 

Laura Reeves [9:31] Dr. Lilly, we’ve talked about this on other podcasts, but let’s talk about those fear imprints and those early, early days that we can do so much—what Susan was just talking about—as breeders with our puppies.

Dr. Leanne Lilly [9:45] I would love to. Try to keep me off my soapbox here! Socialization is probably the first period that we talk about in those instances, and that’s the sensitive period in cats and dogs. In dogs, it’s from about 3 weeks of age to 12-14 weeks of age. That means that a big chunk of it happens at the breeder’s, which means that most owners get a third of it maybe. Everything we can do before that is money in the emotional bank for that reason. Part of the really important part of that, too, is when we typically send puppies home (around that 8 week weaning mark) is actually the timeframe that a first fear period starts, inside that socialization period. This is a timeframe as they’re experiencing the world for the first time and lumping things into columns. Column A: this is great, this is an opportunity, I like this. Column B: this is neutral, I don’t really care about this, I can ignore it. And that should be a big category of lots of things—wind, leaves, whatever, toilets flushing. And then there’s that Category C: the things that we’re concerned about or potentially afraid of. When things get placed into Category C in that fear period, you’re much more likely to get broad, sweeping generalizations, so it’s not just exactly that one person with glasses and a white coat on that one exam table in that one veterinary hospital in that one day. It’s people wearing white coats in strange places are suddenly now all scary. Anything we can do to hedge our bets against that from before those puppies go home or before those kittens go home is a good idea for their long-term welfare as well as, certainly, for building resilience in those animals. 

Laura Reeves [11:29] Absolutely. Judi, you had a question I thought was really, really apropos that we could talk about for our breeders taking their pregnant bitches in for veterinary exams, prior to whelping. Can you address that topic with Dr. Lilly for us?

Dr. Judi Stella [11:45] Even before we get those puppies and we’re starting socialization, things happen in utero. We want to minimize the stress. I’m always talking about how we get Fear Free Homes in how we’re handling our pregnant bitches. We do have to take them in for veterinary care as well. Sometimes X-rays at that last end of the last trimester. How can we incorporate Fear Free to minimize the stress and protect our puppies even in utero? 

Dr. Leanne Lilly [12:11] That’s a great question. Certainly, yes, we think about puppies as blank slates when they’re born, but they’re not. They’re the sum total of their genetics and the experiences they had in utero, the moment they’re born. We do need to protect our puppies, as well as the welfare of the bitch pre-whelping. There’s no reason to leave her out of the equation. It can be a little bit more challenging because we don’t want to use some of the same things that we might use in an otherwise un-pregnant adult dog, aka medications. But we can still do things like considerate approach, use food. If we have a dog that we know is otherwise really gregarious and loves people but gets worried at the vet visit, we work on having them meet those people in an exterior context first. Maybe we do our meet and greets in the parking lot instead of in the exam room, where they’re already nervous. So they go, “Oh! You’re a human. Oh, I didn’t know you’re a vet human. But I kind of already like you now, so maybe it’s okay.” We can do little things to change that type of thing. We can try to make X-ray tables more comfortable using padding and warming mats. Put a warm towel down before so the table is warm, pull it out of the X-ray so it doesn’t interfere with the images, but now you have a warm table instead of a cold table. Little things like that can help add to their comfort and their sense of relaxation as well. 

Laura Reeves [13:30] I like that. I think that Judi’s point is so, so important. Even as breeders, we sometimes forget that all of this is like a full spectrum. I really would like it if you could touch on, for some of our people who are—maybe they just got their first pandemic puppy or maybe they’ve wanted a dog forever and they’re just not as familiar with how dogs express or show their fear. What are some really good signs for people to be looking for that says, “My dog is scared. How should I address that?” 

Dr. Leanne Lilly [14:05] That’s a great question because, again, those are so key to how we know where we are on this journey.

Laura Reeves [14:10] Right, you talked about body language. Let’s actually describe what that body language is. 

Dr. Leanne Lilly [14:15] In general, you want to look at the entire animal, so it’s not just the tail or the ears or anything in between. You want to take all of it together in a picture, as well as what is the whole animal doing with its entire body? Some of the most subtle things are going to be specific body features. Is the dog or puppy looking at you or is it looking away? Averting gaze is a very subtle distance-increasing behavior that says, “Maybe I’m not into this.” But the reverse can also be true. An intently staring puppy might be staring because it’s worried, so we want to look at both sides of those. Approach and full-body posture is another thing that we really look at. Not only does a puppy or a dog walk up to you but how does it do it? Does it slink down and practically army crawl or does it move really, really slowly like it’s moving underwater? Those are signs that that dog is not comfortable. If the entire body is loose and wiggly like the jowls on a St. Bernard running at full speed, you now have images of super floppy information in your head, then that puppy is relaxed. We want to look at where the tail is. We want the tail to be at hip height or a little bit below, depending on the curl, and in motion. We want that to be slow, fluid motion. We don’t want stiff tails, we don’t want metronome tails, we don’t want tucked tails. That’s a lot of tail information, just in that one body part, but you can have conflict (just like we can have conflicting emotions). If the dog’s tail is in that ideal position and it’s moving side to side and it’s sort of level with the hips but it’s slinking towards you in slow motion, you have a dog who is not really sure how they feel about the situation. We want to take all of that information in. The face is another good one. We say that the eyes are the windows to the soul. We talked about looking away. Facial tension, around the eyes, is another good sign. That can come with practice. It can also be hard to assess because we don’t want to stare at a dog’s eyes, because that’s considered a microaggression. You have to look around their eyes and then look away so that you’re not being the rude staring person in the room. Again, want to think about that quintessentially soft, floppy dog expression that you see in pictures of dogs who are upside-down or carrying three tennis balls in their mouth. The area around their eyes is soft. The area around their face is soft. They look like if you touch their cheek or the eyebrows (and I don’t recommend you do this), it would move like Jell-O. If they look like they would move like Jell-O, they’re not tense. If they look like you can bounce things off it (again, don’t do that to test it, just look), then we have facial tension, and we have an uncomfortable (to some degree) dog and puppy. 

There’s also this whole other set of behaviors that we talk about as fidget behaviors that I think can be important to recognize. Those can often be misinterpreted as positive excitement or engagement with people. Lip-licking is one, or licking the person or another dog, can be a fidget behavior—something to do to get rid of some nervous energy. We can see scratching as a displacement behavior. We can see jumping. We can see mouthing. That can be a normal puppy behavior, but it can also be a sign of anxiety, and then we need to pull that apart and say, “Well, why is this dog anxious? Or why is it mouthing? Is it teething? What’s going on there?” If it’s reliably happening in one specific situation (like, I do X and the dog mouths or when we go to BLANK, the dog mouths) then that’s probably a sign of anxiety, and we need to consider that in that situation. It’s a whole lot of things to try to keep in your mind. Really, one of the best ways to do that is to actually look at pictures. Those of you who are live on the call are getting to watch me act them out… The pictures that are available through a wide variety of resources—through the Fear Free Happy Homes, which is free—I actually have a really nice set of both static images and some pretty good cartoon videos and live videos as well to help you. 

Laura Reeves [18:05] We’ll be able to put links to a lot of this resource material. When the podcast goes up, there will be a little blog post. We’ll make sure there’s links to that stuff as well. 

Dr. Judi Stella [18:16] Could you just touch on food and how feeding dogs can also be a cue of when we’re overstepping and they’re starting to get a little uncomfortable? You know if you’re feeding, feeding, feeding, and then we get hard mouth or we stop eating—those types of things and how we can use that also as a cue?

Dr. Leanne Lilly [18:30] Just like we gauge our interactions with other people by seeing not only what they’re doing but how they’re doing it, we can use eating as a gauge for dogs or cats and how comfortable they are. Of course, when I think of cats, the first thing that comes to mind is the cat that’s eating out of the canned cat food and growling at you at the same time. We call it angry eating. That cat is eating, which is a good thing (because not willing to eat is too stressed)—but that cat is not happy/relaxed eating. Eating is a threshold but in and of itself, it is not sufficient. How they’re eating is also important. Do you have a dog who’s chewing treats and then, if there’s a pause between one treat and the next treat, it’s just sort of loose and wiggly and evaluating what’s going on, or do you have a dog who’s snapping for a treat like a land shark and then looking for the next treat because it’s their only coping mechanism and they’re getting more and more stressed? We can also see: Are they stopping eating? Were we happily licking cheese until we got to one body part? That body part might hurt, or that body part is more private, depending on where that part on the animal is. Ask the owner: “Does your dog usually like being pet on this part of its body?” If the answer is yeah, then you might have touched on an ouchie spot, versus a personal bubble spot. We can use all of those to tell us how this animal is doing in this situation, above and beyond will eat or won’t eat. I do want them to be at a threshold where they can eat (too stressed and we don’t eat), but that’s not sufficient. 

Laura Reeves [19:58] Susan, did you have anything else that you wanted to add, honey? 

Susan Patterson [20:03] I did. I wanted to ask, because Dr. Lilly had mentioned in the beginning about pheromones, and I use Adaptil collars (I also have used the Adaptil plugins when there was a potentially stressful situation) and I didn’t know if rather than using a drug, if any of the stress-free (I think there’s a couple of manufacturers who make the stress-free chews)—what Dr. Lilly thought of those as tools for a dog who might just need a little more help relaxing in a situation? 

Dr. Lilly [20:41] The supplement product line for calming and relaxation has really been expanding in the last couple of years. There are some products that have some research behind them, and there are some products that have no research behind them, and there’s kind of everything in between. I think, unfortunately, we’re really looking at a lack of research about any of those in pregnant dogs. There are some that have some research in pregnant rats and mice, but we know that they're a little bit different and it’s not always a 1:1 correlation. In general, we tend to think of them as safer from a pregnancy standpoint or a side effect standpoint, but every now and then we get an animal who decides not to have read that memo. But they are a tool in your toolkit, and I think the best approach to that is talk to your veterinarian about which one they feel like they have the most information on, which one has the most published research on it, and would that be appropriate for that specific pet? One downside to the supplements is that they’re all flavored and most of those flavors, with few exceptions, mean that they come with animal proteins. So, if your pet has a food allergy, most supplements are probably not going to be a good option because of the protein potentially causing an allergy flare-up. That would, again, be a stressor that we’re trying to get away from. But they’re definitely a tool in our toolkit. 

Susan Patterson [22:05] So you would like the pheromones, like the Adaptil collars or the Adaptil plug-ins if we have a dog transitioning from one environment to another. As you said, reading body language—they might need an extra day to adjust and that might be a tool that an owner or a breeder could use. 

Dr. Leanne Lilly [22:24] Yes, absolutely. There is—I think it’s hit the market—I was looking at it in a Canadian line. There’s the Puppy Junior collar that’s soon to hit the market if it hasn’t already. It’s specifically for younger puppies struggling with the initial separation process. The collar is stretchy so that they are less likely to get it caught on things and injure themselves! What a good idea. I like the fact that it’s essentially side-effect-free. 

Laura Reeves [22:51] Judi, did you have anything you’d like to add at this point, my dear? 

Dr. Judi Stella [22:55] No, I think this was a great discussion. Thank you so much. Like I said, we’ll make sure we get all the information to link to Fear Free Home and Shelter and Veterinary, so everyone has access to that. I guess the only thing I would say is if people are looking to find a veterinarian that is Fear Free certified, where would they go to look for that?

Dr. Leanne Lilly [23:15] There is a directory on the Fear Free web page and not only for veterinarians. There are also Fear Free certified trainers and groomers out there. There are a shortage of Fear Free certified hospitals as a whole, because that’s a newer program and so many of your staff and veterinarians have to be individually certified first, and then you have to go through a second certification process, and then you have to maintain it, but that doesn’t mean that, say, all the vets might not be Fear Free certified individually but haven’t hit that hospital level yet. If you’re finding not much in your area, try changing what you’re looking for from practice to individual. 

Laura Reeves [23:50] Excellent, excellent! Dr. Lilly, thank you so very much. We appreciate you joining us here on the Good Dog Pod. 

Dr. Leanne Lilly [23:58] You’re welcome! It was great to be here. 

Laura Reeves [24:00] Look forward to future conversations!