Previsit Medications

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Scared pets at the vet are displaying perfectly normal fear responses, but it doesn’t have to be like this. Pre-visit medications can be part of a plan to minimize fear, anxiety and stress when your dog or cat needs veterinary medical care. This episode focuses on how pre-visit medications, such as pheromones, gabapentin, and trazodone, may help make your trip to the vet as pleasant as it could be.

[00:01:05] Dr. Lancellotti: Thank you, everyone, for joining us on the Your Vet Wants You To Know podcast. I am excited to talk about pre-visit pharmaceuticals today. These are medications that we use to decrease stress in pets before they come to the visit. Hence, “pre-visit.” With me today, I have a very special guest, Dr. Hope Jankunas, and she is going to help talk about what these medications are and what they mean for your pets. She is a veterinarian who earned her degree from the university of Florida. Then, she completed a rotating small animal internship at the Animal Medical Center in New York City, where she and I both worked for a brief period of time. She practiced in New York City for a few years and then relocated to the Hudson Valley for her husband’s career. He is also a vet and an equine internal medicine specialist. Tell me about the hospitals that you have, Dr. Jankunas. 

[00:01:57] Dr. Jankunas: Sure. Together we own Companion Pet Hospital, and we have two locations in the Hudson Valley.  Initially, our motivation for wanting to own our own hospital was because we wanted to be able to practice veterinary medicine in a really gentle and stress-free way and saw that there was an opening in the community for that.

Creating a Positive Experience for Pets

[00:02:17] Dr. Lancellotti: That’s great. Providing animals with a stress free experience is so important, and it’s really been this great movement that we’ve seen occurring throughout veterinary medicine. I’m happy that pet owners are getting the benefit of that too. Tell me a little bit about the training that you did with being able to decrease stress in the animals’ visits. 

[00:02:37]Dr. Jankunas: Okay. I was feeling sort of upset that pets that were coming to see me were scared of me, even though I was there to help them. So what we learned, initially, was that the fear response is totally normal, and it is something that we can do to help them not be scared of us. We did some training with Sophia Yin (veterinary behaviorist), then we completed a Fear Free certification, which is a relatively newer program for veterinarians, veterinary technicians, receptionists, or anybody working in the practice.

[00:03:12] Dr. Lancellotti: Excellent. As a general practice vet, tell us a little bit about what that means as far as a relationship that you have with the pet owners and the pets.  

[00:03:20]Dr. Jankunas: I get to see a variety of cases (which I really like because I never get bored), and one of my favorite aspects of the job is the client education and communication. A lot of people think that we get into veterinary medicine because we actually don’t like people that much, but that’s not true. Over the life of a pet, we build really strong relationships with the pet owners, and that’s the part of my job that I find the most professionally fulfilling.

[00:03:46] Dr. Lancellotti: Yeah. It is really wonderful to establish that relationship when they bring a really young animal in for that first puppy or kitten visit, and then you get to see that animal grow and go throughout the course of the animal’s life with the pet owner. 

[00:03:59]Dr. Jankunas: Yeah, I agree. I love that. 

Russell Sprout, the Your Vet Wants You to Know mascot

[00:04:01]Dr. Lancellotti: To talk about today’s episode a little bit, we’re going to be discussing pre-visit pharmaceuticals, which are medications that are used to decrease stress when the animal comes in to see the vet. Many of the listeners are familiar with my dog, Russell Sprout. He is the Your Vet Wants You To Know mascot. He’s got environmental allergies, he’s on allergy immunotherapy, and he was diagnosed with Cushing’s Disease, so I’ve talked about him quite a bit in some of the other episodes of the show. Also, he is not the most relaxed dog. Our family frequently describes him as being as feisty as he is ugly. Because of these chronic skin and chronic ear problems, he needs to go with me a lot to the hospital to get care. So it was really important for me, as an owner, as well as for my staff, who have to safely work with Russell and keep all of their fingers attached while doing so, that I do everything possible to minimize his stress when he comes in. One of the most helpful tools that I’ve found for Russell is a medication called Trazadone (anti-anxiety med) that just helps take the edge off when he goes to see the vet. It’s made a world of difference with making him more comfortable as a patient, making me more comfortable as his owner, and making my staff a lot more comfortable in handling him. So I’m really excited to discuss this topic because it’s one of those things it’s really personal for me. Plus, I think it’s really important, just as a lot of human healthcare professionals are working to de-stigmatize mental illness, that we, as veterinary professionals, are also trying to de-stigmatize anxiety and stress as mental illness in our pet patients, so that we can, overall, improve their quality of life. 

[00:05:49] Dr. Jankunas: I hear you 100% and I could not agree more. I have a lot of patients that sound just like Russell, so it is one of those topics that I really appreciate the opportunity to talk about. It’s also super important to me and my practice, and anything that we can do to help inform listeners out there so that we can all get together and help their pets, I’m really happy to do that. 

Dr. Jankunas listens to a puppy's heart while the puppy licks food
Dr. Jankunas performs an exam on a dog while it enjoys treats from a lick mat. Photo courtesy of Dr. Jankunas

Benefits to relaxed dogs and cats at the vet

[00:06:12] Dr. Lancellotti: That’s great. So we’re going to have a couple of different goals for the episode today. First, we’re going to talk a little bit about what some of the benefits are to decreasing their anxiety and why you and I feel so strongly about this. Then, we’ll touch a little bit on the different anti-anxiety medications that are commonly used, the risks of those medications, as well as the benefits, and what the pet owner can expect when they’re using those and bringing the pet to the visit with those medications on board. I’ve talked, in the previous episode, on methods to decrease stress when bringing a pet to see the vet. What would you say are some of the most important reasons to make sure that pets are as relaxed as possible?  

[00:06:54] Dr. Jankunas: Relaxed pets are going to have a better experience, and ultimately, they’re going to receive better quality veterinary care. I think we can all agree that stress is unpleasant, and so over time, repeated stress or repeated fear can actually be damaging to your health. It can suppress your immune system, and if you’re fearful about having the same sort of repetitive experience, you could actually develop really unhealthy phobias. That’s something that we’re trying to avoid in pets that are coming to see us. One of the things we’ve recognized is that pets that are scared to see us once, if we don’t address that, the times that they come and see us in the future are actually worse for them. So, in our practice, we like to talk about the 4 F’s of the fear response- fight, flight, freeze and  fidget. Some pets’ response to fear is that they’re going to try to flee. They’re trying to get out of the room. They’re pawing. They’re scratching. They’re really upset. Some can be aggressive, so I think it makes sense that pet owners, who are seeing their pets act this way, are going to try to avoid it by not bringing their pet to the vet. So ultimately, some of these pets don’t come to see us for routine care. The owners just don’t want to put their pet through that, so instead they don’t come, but there are other ways to get around it so that we can address the fear and get them into the office in a calm way, rather than just avoiding 100%. That’s one of the ways that it can impact the quality of vet care- if your pet owner can’t even bring their animal to the vet because they don’t want to have to go through that. Lastly, when a pet is relaxed, we can do a really thorough physical exam if they need any treatments. Like with Russell- cleaning the ears, things like this- we can do those treatments in a pet that’s relaxed. It’s a lot more difficult to do what we need to do if they’re stressed out or fearful. 

[00:08:56] Dr. Lancellotti: Yeah. You definitely bring up a great point about receiving better veterinary care. If the pet is relaxed and comfortable with me, I can really get a great look at all of those areas of the body, where things may be hiding from me, that I won’t be able to see if the animal’s too nervous to let me touch. And stress, in and of itself, can cause problems. That stress hormone, cortisol, really has a negative effect on a lot of different body systems. If you want to hear about all the negative effects cortisol can have on the body, just listen to the episodes on steroids and Cushing’s Disease. Those animals are definitely suffering, so being able to minimize that stress is really important for their overall health. And you bring up a good point about pet owners not wanting to bring the pet into the hospital because they think it’s going to be too stressful of an experience. You, as a general practitioner, a family veterinarian who sees pets throughout the course of their life, and I, as a dermatologist, who sees pets that have these chronic skin and ear conditions- we don’t want a pet owner seeing that something’s wrong with their pet and thinking, “Well, is it worth it? They’re going to be so nervous. They’re going to be really anxious. Do I really need to bring them in?” We just want them seeing that something’s wrong and thinking, “Okay. My pet needs to be seen. We’re going to bring him in. It’s not that big of a deal if they do great.” So that’s really important for me. 

[00:10:19]Dr. Jankunas: I agree completely. 

[00:10:20]Dr. Lancellotti: The other thing that I think is important to mention is that by lowering the animal’s anxiety level before they come to the hospital, when they have to have some type of procedure where anesthesia or sedation is needed, we can actually lower the amount of other medications that we need to perform the anesthesia. And that goes a long way towards making those procedures safer for the pet. Oftentimes, if I have a pet that’s really anxious and I know that either I need to sedate them for a skin test or I need to put them under anesthesia for a biopsy, I’ll make sure that the owner has these pre-visit pharmaceuticals to help lower that stress level to make my procedure safer.

Trazodone, gabapentin, and pheromones

Dr. Lancellotti: So when we’re talking about the different anti-anxiety medications that are used there are different things that we do for different types of animals. Can you describe, for pet owners, some of the most common anti-anxiety medications that a veterinarian might recommend?

[00:11:20] Dr. Jankunas: Sure. First, before we go to the pharmaceuticals, we do always encourage the owners to use pheromones in the home for calming purposes and to work on some of the desensitization and counter conditioning, so that their pets are less fearful of the carrier getting in the car. Then, in cases where that’s not providing enough of a relaxation, we do reach for the medications. In dogs, my first choice is Trazadone. In cats, I typically reach for Gabapentin first.  We find that some pets need a combination of the drugs- either those two or adding in something different. In extremely fearful pets, we sometimes need to use sedatives injectably in the hospital to heavily sedate them for certain procedures. 

[00:12:15] Dr. Lancellotti: Yeah. These are my two favorite medications to use as well. You know, I mentioned Russell does great with Trazadone and we use that before he comes in for his veterinary visits, but also when we have people over to the house (which hasn’t been happening much nowadays because of COVID), we’ll use that in the home as well. Any situation where he’s really anxious, I think this is great therapy for him with just helping him cope much better. So, for dogs, Trazadone is a great anti-anxiety medication that has minimal sedation. And then with cats, Gabapentin is fantastic as well. We generally use this as a pain medication, but it also is really good for helping with their anxiety. And I don’t know if you noticed this as well, but I definitely find that Trazadone and Gabapentin both do a lot for helping to make the animals more inclined to eat food when they come to see me. This really helps with creating a positive experience when they’re in the vet’s office anyway, so if I can lower that anxiety level enough that they are interested in eating, I have a better chance of making that visit pleasant and making them happier to come to see me in the future. 

[00:13:28]Dr. Jankunas: Yeah. You’re right. I find that when I have a pet that comes in the office and they are refusing my super high quality treats (and we’ve got a lot of good stuff to offer), they absolutely need some sort of pharmaceutical. Typically, when they come in with either Gabapentin or Trazadone on board, they are happy to take those treats. 

kitten licks food during a vet visit
A happy cat enjoys a happy treat during its trip to the vet. Photo courtesy of Dr. Hope Jankunas.

Safety of gabapentin and trazodone

[00:13:46] Dr. Lancellotti: Absolutely. So, I talk a lot about benefit vs. risk on the show. It’s an overarching theme in how I approach the treatment of each pet, no matter what aspect of their health care I’m dealing with. Tell us some of the risks associated with these particular medications. Does the benefit of using things like Gabapentin and Trazadone outweigh the risk? 

[00:14:08]Dr. Jankunas: In general, both of these medications that we’re talking about here are super safe. Gabapentin, as you had mentioned, is primarily a pain reliever. It’s also used as an anti-seizure medication. And I have prescribed it to pets that are geriatric, senior pets, pets that have other illnesses, where putting them on different classes of drugs might be unsafe and can use Gabapentin really safely in these patients. So, when we’re using it as a pre-visit pharmaceutical, it is a very safe drug. What Gabapentin does is very similar to this chemical in your brain called GABA- and that is responsible for relaxation and calmness. So when your pet is on that, not only is it addressing some pain, but it’s also relaxing them and making them really calm. Trazodone is also super safe. It is an anti-anxiety medication and produces some sedative side effects, as well. This drug works by increasing your serotonin, which is your feel-good chemical in the brain. The times that we can have some issues with Trazodone would be if your pet was taking other medications for an anxiety disorder. So you’d have to talk to your vet about this to make sure that it’s safe to use Trazodone. Sometimes, we would avoid it if your pet is already taking medications to increase serotonin, like Fluoxetine, for example. In describing Gabapentin and Trazodone, you’ll notice that we talked about how they’re producing some sedation and they’re treating anxiety, and it’s important to note that they do both. There are other drugs that just tranquilize a pet. It doesn’t alleviate anxiety.  A drug that comes to mind is Acepromazine, which can certainly be used in combination with another drug that is addressing anxiety. But using Acepromazine alone is something that we try to avoid, just because it will produce sedation or tranquilization, but your pet is still feeling anxious about what’s happening. So you can imagine that after the drug wears off, and if they’re in that situation again, they’re going to be pretty fearful about what happened to them. 

[00:16:23]Dr. Lancellotti: Yeah. I think that’s a great point to bring up. I think using these medications in combination with a conversation with your veterinarian is really important because not all pets respond to these medications the same way. There’s a pretty wide dosing range with them, so having that discussion about how your pet reacts to them, and what you can do to make adjustments to find the right fit, is an important part of having that relationship with your veterinarian.

What to expect with gabapentin and trazodone

Dr. Lancellotti: When a pet owner is giving these medications, what can they expect to see? Do you have advice as far as setting the pet and the owner up for success when we give them a pre-visit medication?   

[00:17:03] Dr. Jankunas: You can expect mild to moderate sedation. Some pets will be a little bit wobbly on their feet, so you certainly wouldn’t want to leave them unattended, off-leash outside. Some cats, in particular, will be extremely affectionate on Gabapentin, so pet owners may notice that, as well. But to be honest, some pet owners notice nothing, and they actually question whether or not the drugs are working, and we don’t notice that they are until the pet comes into the hospital and there’s a significant change in their behavior. But in the comfort of their home, they may not notice there’s any change at all. So, in setting up the best expectations for success, there’s a couple things that you’ll want to do. First, you’ll want to make sure that you try the medication at home prior to when you need it for the appointment, just because all pets do have a variable response to the medication. You just want to see how your pet would react, so that if dosing changes need to be made, you know that ahead of time from when the medication actually needs to be used. Next, you’re going to want to make sure that you give the medication at the right time. Both of these drugs will reach their peak about 2 hours after they’re given. You’ll want to have them on board about 90 minutes before you leave the house for your vet visit, so that they’re reaching their peak during the exam and that they’re on board when your pet needs them most. Some pets, will actually benefit from having an additional dose given the night before, or even the day before, having 2 extra doses on board if they’re really anxious. The last thing for setting up for success is to make sure that pet owners are putting in the effort to do that desensitization and counter conditioning for the car and for the carrier. 

[00:18:54]Dr. Lancellotti: Well, your cat, Mittens, is absolutely adorable. I’ve got a picture that we’ll put up on the website of Mittens hanging out in his carrier prior to a vet visit. Showing Mittens and the carrier there is a great example of what I talked about on the previous episode about getting that carrier out before the vet visit, and leaving it out, so that the cat gets comfortable- hiding some treats in there, so that they get really fond and very happy with their carrier. That’s a great way to decrease stress. So, there’s a very cute picture that we’ll have up on the website. 

cat hangs out in its carrier
Mittens hangs out in his carrier before his trip to the vet. Photo courtesy of Dr. Jankunas.

Watch for motion sickness

[00:19:26] Dr. Jankunas: Thanks. And I will note that my cat, Fiona, used to have a terrible time coming to the vet. She was yelling, scratching at her carrier, and she’d be foaming at the mouth when we took her out. Initially, she was not really responding fully to pre-visit pharmaceuticals until I realized that she was carsick. Once we added a medication for motion sickness to her pre-visit cocktail, she was like a whole different cat. So that’s something else for owners to be on the lookout for, as well. If their pet is carsick, addressing that too, will help with that general level of anxiety.

[00:20:05] Dr. Lancellotti: Yeah. Certainly, if I know that I’m going to get motion sickness from doing something, I’m going to be a little bit anxious about doing it. One of the things that I like to mention to pet owners when they’re giving that dose the night before (I know you said that sometimes the pet owner won’t notice anything with that medication on board), sometimes, we see that the pet will actually be a little bit sedated the night before, when they give that night before dose. The reason for that is because they’re in a non-stressful environment. That sedative effect may be a little bit stronger than when they come into the vet, where they’re a little bit more anxious, so the sedation’s not going to be as strong. And that’s okay. I equate it to the best man at a wedding having a beer or two before he gets up to give the speech. It’s not enough to make him sedated and falling over, it’s just enough to take the edge off and make it okay. In a non-stressful environment, they may be a little bit more sleepy the night before, but we want them to be comfortable when they come into the vet visit and not anxious to see us.

Scared pets are not bad pets!

Dr. Lancellotti: What are some of the big takeaway points that you want pet owners to remember when they’re thinking of using pre-visit pharmaceuticals for their pet?

[00:21:15] Dr. Jankunas: Well, I think at the top of the podcast when we talked about reducing the stigma- that’s how I feel. I want there to be a no judgment zone here. We are not saying that your dog is bad. Your cat is not bad. We recognize that these are scared pets and they’re displaying perfectly normal fear responses, but what we want you to know is that it doesn’t have to be like this. There is a better way and pre-visit medications can be part of the solution. As veterinarians, we care about the pet owners, we care about the pets, and we want be their partner in making a trip to the vet as pleasant as it could be.

[00:21:56]Dr. Lancellotti: Yeah. I definitely think that the more veterinarians are talking to pet owners about these medications, and the more that we’re addressing the mental health aspect of the veterinary visit, we’re going to see such a huge change in the pet owner’s willingness to bring their pet in when they notice something going on, and the pets, themselves, being happier and happier for us to provide them with good medical care. Overall, I think it’s part of a very strong veterinary client patient relationship. Do you have any other resources for pet owners as far as if they want more information about minimizing stress when their pet comes into the veterinary clinic?

[00:22:34]Dr. Jankunas: Yes. In the show notes, we have links to 2 blog entries that I wrote that are about, specifically, bringing scaredy-cats to the vet. It describes the visit to the vet from a cat’s point of view, which is kind of interesting if you put yourself in their shoes. They’re getting stuffed into this box and carried it into the vet office. It can be very scary if you think about it from their point of view, so it’s just talking about ways that pet owners can minimize that stress, starting in the home, prior to the visit. Then, there’s another article about how fear-free visits can actually promote better veterinary care, and those can be found on our hospital’s website. 

[00:23:19] Dr. Lancellotti: Awesome. Thank you so much. We’ll definitely have a link to that in the show notes, as well as on the episode page on the website. And there are some really cute pictures that you’ve provided with us. There’s an adorable puppy getting a Fear Free treatment, using a lick mat with peanut butter during his exams and vaccines. I love these lick mats. We use them quite a bit in our derm clinic. Also, I recommend that for dogs that are a little bit anxious in the bath (because I prescribe a lot of medicated bathing), the pet owners can use those in the bathtub too, to make bath time more pleasant. There’s a really cute picture of a kitten getting a Fear Free treatment of tuna squeeze-ups during his exam and vaccines. He’s so happy. Oh my gosh. The tuna has a smiley face for a happy visit. 

[00:24:07] Dr. Jankunas: That’s right. Oh, yes! 

Scratching the Itch

[00:24:09]Dr. Lancellotti: To end this happy episode with happy segment, we’re going to finish up with a Scratching The Itch segment. It’s a short segment that I like to have at the end of each episode that highlights something, whether it’s a human interest story, a product or a website that provides relief, or just makes people feel good. I would love to hear if you have a ‘scratching the itch’ for our listeners today.

[00:24:33] Dr. Jankunas: I sure do. I live here, as I mentioned, in the Hudson Valley in New York. This has been a growing area for craft beer, craft distillery, and wineries. My husband, my son, and I will visit them pretty often, and especially during the pandemic (because most of these places have outdoor), it’s been a great way to get out and support the local businesses. So, we noticed that there are often cats around these places, and when we talked to some of the employees at these breweries and distilleries, they were telling us that the cats work there. They call them ‘blue-collar’ cats, because they’re cats that have a job. Their job is mostly to be “mousers,” but they’re also super Instagramable- lots of adorable pictures of these cats can be found on Instagram. And they will socialize with guests as they wish, and some of them don’t, but I thought it was really interesting that these cats had jobs. So when I looked into it more deeply, I found that there are some local shelters that have pet cats that would not otherwise do well inside of a traditional home, for a variety of reasons. Some of them are semi feral or stray. Some of them have litter box issues. But they make really great working cats, so you can actually adopt a cat to be a barn cat or a blue collar cat. I thought that was really great because they’re helping these businesses by controlling pests without having to use any chemicals. And then, these cats are also getting to live these amazing lives, when they might not have otherwise been adopted. So, I felt like it was a really happy, feel-good story, and I bet if people went to local businesses in their areas, they would find a blue collar cats everywhere. 

[00:26:26] Dr. Lancellotti: That’s great. We always think of dogs as being working dogs or working animals, but I don’t always think of cats as having jobs, in that sense of the word, so that’s a very cool concept. I don’t think I would mind having working job on a winery or a brewery. 

[00:26:43] Dr. Jankunas: Yeah. It sounds pretty amazing.

[00:26:45] Dr. Lancellotti: Not so bad. Right? Well, thank you so much for coming on and talking to pet owners about pre-visit medications and decreasing anxiety and stress. I really hope this goes a long way towards helping pet owners and making their pets more comfortable when they go to the vet. 

[00:26:59] Dr. Jankunas: Yes. Thank you so much for having me. I really appreciate the opportunity to talk about this important subject, and I hope that owners will be able to get some of the information they need to help their pets. 

[00:27:11]Dr. Lancellotti: We’ll have a lot of links to different resources on the show notes for today’s episodes. Many family veterinarians are comfortable managing pets with anxiety, but if you are interested in talking to a veterinary behaviorist, there is a link to find a veterinary behaviorist near you on the website– if you want to consult with a specialist. Then, I would encourage you to join the Facebook group. Tell us about your experience with your pet’s anxiety (I can certainly sympathize, being a pet owner of an anxious pet), or what types of medications or changes have worked for you. Maybe something that’s worked for you could help somebody else out too. Follow us on Instagram @yourvetwantsyoutoknow. Thank you very much for listening today. Again, thank you so much to our guest, and I look forward to your next visit with Your Vet Wants You To Know.

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