Canine Handling in a Clinical Setting

Recent graduates of veterinary schools and veterinary technician schools tell me that they are still being taught that you have to "show the dog who's boss" by applying fear-based techniques when confronted with an uncooperative pet. This is based on a presumption that all dogs should display a submissive posture to all humans.

Growls, bites and attempted bites, and resistance to restraint are labeled "dominance aggression". I believe that we see very little dominance aggression from dogs when they are being handled by strangers in a clinical setting. Most of what is described as dominance aggression is fear or defensive aggression.

There is a simple formula that applies to any kind of canine aggression. Aggression + aggression = more aggression. The exception to the aggression formula is the rule of aversives.

For punishment to be successful it has to be strong enough and severe enough to extinguish the behavior completely. If we choose to use punishment we have to know the dog well enough to know what "severe" means. In some dogs, the owner need only say "stop that!" to put an end to defensive aggression during a nail clip. The dog has a history with the owner that tells him he might be uncomfortable, but he's not going to be harmed.

Dogs don't generalize well, so the same reaction from a stranger ("stop that!"), may not work. The dilemma of how to handle uncooperative patients now becomes a moral one. How far are we willing to go to find the aversive that extinguishes defensive reaction? We can do harm to our patients in an attempt to inhibit or extinguish their defensiveness or we can try to find a humane way to handle them.

In the absence of severe punishment (which could mean bodily injury to the patient) our use of aggression has no benefit. If a dog reacts to our demand for cooperation in an aggressive manner and we become aggressive in turn we are creating in the dog a stronger aggressive response to that situation. The next time that dog is in the clinic the environmental cues (white coats, odor of alcohol, other animal sounds and smells) will trigger a defensive/aggressive response.

In the present situation the dog may freeze, but the next time he has to be handled by medical staff his aggressive response is likely to be twice as strong. The end result is a dog that's unable to be handled at all.

Why should the dog cooperate? Because we're human and, therefore, superior beings? That, believe it or not, can happen, but it has nothing to do with our superiority. There are dogs that defer to almost all humans in almost all situations.

That, however, is not a learned response from the dog, it's an inherent part of his temperament based on many generations of breeding for low reactivity. Many retrievers and hounds, for example, will defer to humans because they are hardwired to do so. They will also happily defer to cats, the sound of gun shot and a John Deere lumbering by, so we shouldn't think we're special.

Asian breeds (Shih Tzus excepted), on the other hand, are known to have a very narrow "personal space" area. You can get very close without offending them, but then, seemingly out of nowhere, you've crossed that line and triggered their defensive drives.

The reason that most dogs can be handled by most humans is their juvenile mentality. Domestic dog behavior is comparable to juvenile (not adult) wolf behavior. Therefore, a well reared, well socialized dog, may very well see the entire human race as "parent" figures and find objection to very little we do.

For some dogs, all they know about you is that you are not part of their family (pack), and you intend to assault them in some way. There is no good reason why a dog shouldn't see nail clippers, thermometers and otoscopes as instruments of assault.

When handled by a family member (which is not recommended), a dog of stable temperament should cooperate with all but the most painful of procedures. When handled by a stranger, or when handled in an environment known to the dog to be "dangerous", I think it's unreasonable to expect stoic cooperation.

A dog has three primary options when in a fear state -- fight, flight or freeze. Your options are to escalate your own aggressive reactions until "freeze" occurs (often accompanied by loss of bowel/bladder control) or take some time and try to earn the dog's trust. The latter may not happen, or not happen quickly.

The dog may be too frightened, based on prior experience, to trust anyone in a clinical setting. The dog may have developed a conditioned fear response to anyone in a white coat or to the smells of a veterinary office. This dog can be brought around if you have the motivation to do so. It's a long road that requires owner compliance, but it's worth traveling.

Dominance Theory

The Monks of New Skeet were one of the first to bring discussion of dominance theory to the general public. They advocated the "alpha roll" as a means of letting a dog know that his human is his leader. The monks no longer advocate this technique as it has been proven to not only be ineffective, but can actually create increased aggressive responses (particularly fear aggression) in many dogs. If a dog sees you as a fair and effective leader there is no need for physical domination, such as the alpha roll. If a dog does not see you as his leader no amount of alpha rolling is going to convince him.

Dogs use aggressive displays (posturing, growling, teeth baring, staring) to communicate. Aggressive displays are not the same as aggressive actions. In a stable pack situation there is rarely aggressive action. It's not good, from an evolutionary standpoint, to kill off your relatives. On the other hand, it's quite good, evolutionarily speaking, to insure that *your* genes, not your sister's, are the ones that are passed on.

When aggression occurs it means the pack is in trouble or in a state of change. It could be that there is an ineffective or old/ill alpha that's about to be demoted, or a young adult male may be about to be ousted from the pack. Aggressive actions, and the energy it takes to carry them out, are generally reserved for hunting, dealing with trespassers, enforcing breeding rights and for pack reconstruction.

A true alpha has attitude. He uses his eyes and body language to communicate, not his teeth. Only middle ranked dogs get into physical confrontations, so what are we telling a dog when we get physically aggressive? That we're in charge of the situation? No. The message is that we are also middle ranked.

All animals that live in social groups have a need for stable family groups, not chaos. Most dogs will go out of their way to communicate their fear or displeasure without resorting to aggression.

If we pay close attention we can "hear" what they're saying and respond in a way that helps them cope with what's happening to them. If we ignore their attempts at communication, or respond aggressively to them, we lose any hope for cooperation from them, maybe forever.

Dominance Theory Applied to the Clinical Setting

Living with dogs means living in a world of interspecies communication. It's really quite remarkable that we can communicate at all with other species. To be able to communicate a specific thought, one that creates a memory or visual in another species ("Wanna go for a ride?"), is downright mind boggling. When our patients attempt to communicate with us I believe we owe them the courtesy of listening. Dogs have a myriad of ways to say:

"I'm frightened, but I want to avoid confrontation".

"I'm so frightened that I believe biting is my only way out of this situation".

"I don't know you, you're not part of my pack, so I don't feel any obligation to allow you to touch me."

"I love everyone, are we having a party?"

"I have little exposure to people, in general, or to new things and this is all way too much for me."

"The last time I growled and snapped people went away, I need for that to work again here."

"The last time I was here I was scared and I'm twice as scared now"

A dog can be generally submissive to humans, but confident enough to draw his lines when he feels threatened. In many cases where a dog displays aggression, the dog is reacting to the clinician's aggression (restraint, slip collar, etc.) in a defensive or fearful manner.

Even dogs that have truly dominant personalities (and these are rare) generally don't initiate aggression in a clinical setting, they simply respond to demands made on them that they feel are inappropriate.

How the dog lives will effect how he behaves in a clinical setting. If he lives a solitary life, with little socialization to people or other animals, the veterinarian's office can be an overwhelming sea of stimuli. If a dog lives with the daily stress of dominance confusion (e.g., owners who continually give the dog mixed messages about his pack status) he's going to be equally confused about how to behave during an exam or procedure.

Restraint

Dogs respond to physical restraint by being still, if they intend to submit, or fighting back if they don't. A dog may use dominant behavior, including aggression, to get control of the situation -- not necessarily the person. If the overwhelming emotion is fear, combined with a lack of confidence in their ability to disengage themselves from the aggressor, they freeze.

The rule is that being still and averting your eyes (submission) is what ends the aggression. If the aggressor continues the restraint after the dog has submitted then the dog has every reason to believe that the aggressor intends to kill. When we restrain a dog and he doesn't object at first, we can't assume that he's not going to fear for his life within a few seconds of his discovery that his submission did not end the restraint. If we reassure him, right from the beginning, that our continued restraint is not going to be dangerous to him, we may be able to earn his cooperation and trust. This can be done using calming signals (discussed below), food, forehead massage, talking softly or a combination of these things. Alternatively, if we lessen the restraint in response to his submission we may be able to continue without incident. This is where our skills, as animal professionals, come into play. We must be able to read, as best we can, the clues the dog is giving us about his state of mind.

It is my opinion that chemical restraint is grossly underutilized. It is far better to traumatize a pet briefly, in order to anesthetize or sedate, than it is to subject him to a prolonged traumatic event in the name of "time". Our profession demands that we take the time to attend to our patient's well being, mental and physical. Working with animals requires patience, compassion and a willingness to do whatever is deemed to be in the best interest of the pet, not the best interest of the staff. That said, there are many times when we have to just get the job done. That can also be done with a minimum of trauma to the pet. If you take even a short amount of time to gain the dog's trust it will pay off. If the situation is such that you have to proceed with treating the animal in spite of his objections, just do it. There is no need to yell, hit or otherwise lose your sensibilities. Aloofness works, too. Use it.

Rescue Remedy, aka Bach flower essences, has the delightful (or frustrating, depending upon your point of view) advantage of either working very well, or doing nothing at all. I know of no reported incidences of adverse reactions to this mixture. A few drops of Rescue Remedy, placed on the tongue, fifteen minutes prior to performing an unsettling procedure can reduce a dog's anxiety level considerably. This can be done when the owner and dog first come into the room to ensure it's effectiveness by the time the procedure is initiated. Rescue Remedy is also effective in cats and birds.

Calming Signals

Two dogs, strangers to each other, meet at the park. Rover slowly blinks as he averts his eyes and sniffs at the grass. Fido yawns. Rover looks toward Fido, flicks his tongue and then moves in a wide half circle towards Fido. Fido flicks his tongue in response, then approaches Rover and sniffs him. Rover stands still until Fido is finished and then he sniffs. Fido goes into a play bow (front legs extended, butt in the air) and the party is on. They romp and play and growl and bite and have a wonderful time. Neither has had enough exposure to other dogs to be well skilled in social nuances, just enough to send calming signals and an invitation to play. More experienced dogs will produce an entire range of eye movement and body language in a few seconds, communications that most humans don't even notice, and commence to playing (or fighting!) in quick order.

We can use these signals to our advantage. Tongue flicking appears to have a number of closely related meanings. Frantic flicking can mean "I'm very, very nervous! Please calm down!". Less frantic flicking seems to ask "I'm nervous, but I'm coping, are you OK?". Dogs noticeably relax if their tongue flicking is answered in kind. A simple lizard impression on our part can go a long way towards telling the dog that we mean him no harm. When handling a very nervous dog a stronger way to get the "I'm OK, you're OK" message across is to tongue flick and slowly blink, or blink and yawn or any combination of these things.

Some dogs never see anything other than their own homes, their own back yards and their own people. The social skills of these dogs are going to be poor. They may not recognize calming signals since they've had scant opportunity to learn them or practice them since leaving their littermates. They may also be so overwhelmed by the strange atmosphere and people that they are incapable of calming down even if they do recognize the signals. Conversely, a dog who's been throwing signals at people for years and receiving intermittent (even if unintentional) positive responses may over-exaggerate his body language and calming signal usage.

Forehead massage is a very effective means of calming. I think it is a successful method because it feels good and is an indication that no harm is intended.

What must they think of us? Why would any dog allow himself to be put on his back on an x-ray table, by two strangers, and have his legs stretched out? Why in the world would any animal allow us to poke needles into his skin? I've come to believe that well socialized dogs learn that humans can sometimes be very weird. We do completely outrageous things without adverse effects to the dog. They learn to be tolerant of our weirdness. Those that are not tolerant are only displaying normal canine behavior, not something odd. We're the ones being odd.

The bottom line is that we are strangers to the dog. We are not pack mates. We are not a known quantity. We are the unknown, the unsafe, a perceived danger. We cannot arrogantly demand that they cooperate with our efforts to put them in very uncomfortable situations. If we try very hard, what we can do is communicate our promise to "First, do no harm".