Point-CounterpointTo feed or not to feed: Counterconditioning in the veterinary clinic
Introduction
In a survey asking 750 veterinarians about the emotional state of pets during a veterinary practice visit, some 20% stated that at least half the dogs displayed moderate to severe fear or anxiety, and the corresponding number for cats was about 65% (DVM 360 staff, 2014). In an observational study, over 78% of dogs visiting the vet clinic were fearful when on the examination table (Döring et al., 2009). When fear escalates, welfare is potentially challenged, risks to animals and staff increase, and many animal owners dread and avoid taking their pet to the vet (Hetts et al., 2004, Rodan et al., 2011).
Systematic desensitization in combination with counterconditioning (SD/CC or DSCC) is a powerful tool to reduce fear (Wright et al., 2005, Yin, 2009, Kakuma and Kinoshita, 2010, Westlund, 2014). This technique typically involves presenting an animal with a tasty treat while gradually introducing something scary, and if carried out successfully changes the animal's emotional state (Wright et al., 2005, Yin, 2009). The scary thing ceases to be frightening. The risks to staff and animals are reduced as fear diminishes because feeding treats reduces the risk of defensive aggression (Savage, 2010).
In the veterinary clinic, sparsely feeding treats to dogs and cats before, during, and after an examination could make the visit far less traumatic for animals, owners, and staff, but this is seldom done (DVM 360 staff, 2014) and to my knowledge, its use has not been systematically studied. It seems there are multiple reasons why treat feeding is avoided. First, there might be gastrointestinal upset after the visit. In addition, feeding treats may be seen as condoning “junk food”, which is especially problematic in obese patients. Finally, and perhaps most importantly, it appears that veterinarians assume that treat feeding would increase the risk of complications associated with sedation and anesthesia. Not only are animals scheduled for anesthesia not given treats, but the same principle applies across all animals, just in case they might need to be sedated at some point during the visit. It appears that most often, even nonsedated animals are not given treats.
In this article, I discuss the 3 objections apparently hampering treat feeding, examining the available data regarding the assumption that feeding small amounts of treats in the veterinary clinic would increase the risk of aspiration pneumonia (AP) after sedation. I also discuss the risk and benefit perspective of the 2 alternatives: feeding treats versus not feeding treats to reduce fear or stress in the veterinary clinic.
Section snippets
Treat feeding, gastrointestinal upset, and obesity
Some animals are allergic or intolerant to specific food types (Carlotti et al., 1990), and may suffer from gastrointestinal upset, pruritus, or dermatological problems later if inappropriate treats are used during a veterinary visit. Similar concerns may be raised for animals suffering from gastrointestinal illness such as pancreatitis. I suggest 2 ways of avoiding this problem. One approach is to have a plethora of different treat types available, including hypoallergenic choices and low-fat
Treat feeding and aspiration pneumonia
AP is caused by regurgitation or gastro-esophageal reflux (GER), where stomach contents leak back up and may damage the esophagus, trachea, and lungs. This may be brought about by certain diseases, vomiting, and as an undesired side effect of sedation (Kogan et al., 2008, Tart et al., 2010).
Sedation depth ranges along a continuum from minimum sedation (anxiolysis) to general anesthesia, gradually affecting responsiveness, airway function, and cardiovascular function (American Society of
To feed or not to feed: The trade-off
Veterinarians and veterinary assistants have a choice whether or not to use treats when interacting with their patients; indeed, an SD/CC procedure could be started the moment the animal enters the waiting room, and continue during weighing, consultation, and examination. Could it be that staff assess the potential costs involved in feeding treats, but not the costs involved in not doing so? Ideally, this decision should be a trade-off between the different risks and benefits involved in both
Conclusion and recommendations
Feeding treats at the veterinary clinic would improve welfare, reduce stress, and the number of sedations carried out on animals who are too aggressive or fearful to cooperate safely in some procedures. It would also facilitate full examination and correct diagnoses of diseases where stress reactions may be confounding factors (Rodan et al., 2011). Interacting with animals would be less of an occupational hazard for staff, and the owner would learn useful techniques to deal with fear in other
Acknowledgments
The author is very grateful to Eva-Marie Wergård, Mats Spångberg, Eva Bertilsson, and Ida Pettersson for proofreading earlier versions of this article, and an anonymous referee was also very helpful. The author also thanks Julia Albright, MA, DVM, DACVB, Assistant Professor, University of Tennessee College of Veterinary Medicine, for discussing the issue, providing her with food for thought, and the right search terms.
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