In years past when my blood pressure was high at my doctor’s office, the nurse or physician would often say, “You’re probably just stressed being here.” They call it “white coat syndrome,” the anxiety response many people exhibit in medical settings. Little touches like artwork taped to the ceiling over the exam table or a cheerful bedside manner help, but then doctors have to get on with the practical business of practicing medicine.
I’ve never been on the inside of human medicine, but I suspect pediatricians are most like veterinarians when it comes to certain challenges we both face. Both our patients come with protective, loving adults who have to understand and approve decisions about care. Our patients are not always able to tell us what’s wrong. They don’t always understand we don’t mean to hurt them, that we’re trying to help. As a result, our patients may occasionally need to be physically held in order for us to treat them.
I imagine pediatricians even get bitten sometimes. But only veterinarians are faced, day in, day out, appointment after appointment, with patients who have such a high potential for causing us and our assistants serious injury. Hence our job becomes not just about using our training to examine, diagnose, and treat, but about reducing anxiety for animals and owners, while also keeping everyone safe. That’s no easy task. Since dogs and cats are so different, psychologically as well as physically, today we focus on Sigmund, the Siberian husky, and leave our feline friends for a future column.
Sigmund’s trip to the veterinarian begins at home, where it helps if he has an interesting, active life. We hope he is already well-adjusted, can heel on a leash, ride happily in the car, socialize appropriately with people and other dogs, and has basic obedience skills. Sit, stay, lie down. Not every dog fits this picture. If you know Sigmund has a particular issue, call and discuss it with your veterinarian in advance. We might advise tranquilizers or anti-anxiety medication in the short term, and training, behavioral modification, and environmental enrichment in the long term. If he’s a high-energy dog, maybe a hike before his visit will calm him. In any case, Sig should arrive on a leash with a well-fitted collar or body harness. Alert us before coming in if he’s not good with other dogs, so we can manage our waiting room appropriately. If he gets anxious in the waiting room, he may do better staying in the car until we are ready. I had one patient I routinely examined on the porch because he was fine outside, but if he came into the office his stress reaction invariably triggered a seizure, no matter how friendly I was.
Once Sig arrives, we want to make his experience as positive as possible. Let staff know any special needs:. “He doesn’t like his ears touched,” or “He has food allergies, so no cookies, please.” Every practice is different, but at my office an assistant usually welcomes you and Sig in, then takes a weight, temperature, heart rate, and history. Getting this baseline information annually documents what is “normal” for Sig and can also alert us to hidden problems. If you’re uncomfortable with this routine, speak up. Most veterinarians are glad to explain things, modify protocols, and accommodate as best we can to make you and Sigmund happy.
Every veterinarian, is different but once I arrive, I generally offer you a chair at a comfortable distance from my table. Here’s why. The more relaxed you are, the more relaxed Sig will be. If you look like you’re cool, settling in for a nice chat with me, Sig senses “Everything is OK.” If you hover over him anxiously, watching me suspiciously to be sure I don’t traumatize your baby, Sig hears “Danger, Will Robinson!” (Ask your parents.) That little bit of physical distance from their owners is often calming for dogs. Some do even better if their owners leave the room entirely. Is this true for every dog? Of course not. Every dog is different. We need to work as a team to discover what is best for yours.
Exam tables allow veterinarians to look Sigmund over completely. Working on the floor, although sometimes unavoidable, can affect both safety and thoroughness. Owners seem to be far more worried about the table than dogs, who I think are just surprised because at home they get yelled at if they climb on furniture. Most dogs respond to an atmosphere of calm, benign authority. Like little kids, they do well when we set limits with love. We start with treats, praise, pats, soft holding. Sometimes that is not enough. A muzzle can be a humane tool that allows us to take care of Sig quickly and safely. Don’t worry. It doesn’t hurt. He can breathe just fine, and, most important, it allows us to be as gentle as possible with the rest of our restraint.
For other dogs, we may find “less is more.” These dogs do best if we use the minimum amount of holding we can safely. The key word there is “safely.” After witnessing and personally experiencing serious injury, I am always keenly aware of protecting the welfare of the people in the exam room, as well as the pet. If Sigmund is just too worried by the car ride or veterinary office, he may do better if Mohammed goes to the mountain. (Ask your parents.) Many veterinarians, myself included, make house calls. In my experience, this is a good option for dogs who are anxious but not aggressive. Try to trust your veterinarian’s judgement. We really care about our patients, and do our best to balance compassion, good medical practice, and safety.
As far as my blood pressure goes, I told the cardiologist, “Actually I’m more relaxed here than I am at home. No telephones ringing. No sick dogs. No kids.” He nodded and prescribed medication. My blood pressure is now normal both at his office and at mine.