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CONTINUING EDUCATION JULY/AUGUST 2018 25 temperature, hyperglycemia, neutrophilia and elevated blood pressure. 19,20 Preventing stressors reduces potential for physiologic changes, allowing more accurate exam and diagnostic findings. Emotions and Communication Stressors trigger emotional responses in the brain that mediate functions contributing to the survival and well-being of the individual. 17 Both positive and negative emotions occur in cats and the veterinary team can influence both. The negative emotions seen in the veterinary practice are fear, anxiety, frustration, and pain. 18,21 More than one negative emotional system can be triggered at the same time, such as pain and anxiety. Fear and anxiety are part of the same emotional system and are normal emotional responses to what the cat considers a threat. 22 Fear occurs in response to a potential threat that might happen during a veterinary visit. Anxiety is the anticipation of a threat, such as a cat anticipating that handling will cause pain because of a previous experience. As territorial animals and solitary hunters, cats need to protect themselves continuously and they become fearful or anxious in situations that are unfamiliar and unpredictable, whether at home or in a veterinary practice. There are three different behavioral responses associated with fear or anxiety. With mild fear, a cat freezes (also known as inhibition). With increased intensity of fear, they may flee (avoidance), and if they continue to feel unsafe, aggression (repulsion) will occur ( FIGURE 2A AND 2B ). 16,22 The fear responses can escalate quickly based on the response of veterinary teams. Remember that as a solitary survivor, the cat does not want to fight because it can threaten its own well-being and aggression is the last resort. Frustration occurs in two different situations. The first is when access to safety is not possible, such as with tight restraint or removing a cat from a cage or carrier against its will. 23 This can quickly escalate to aggression. The second situation is not receiving the anticipated reward, such as desired attention. 24 In this situation, the frustrated caged cat will either paw at or through cage bars ( FIGURE 3 ), pace, or disrupt the cage (e.g., tearing or disrupting papers or towels placed on the cage floor or tipping water, food, or litter). Pain is both a sensory and an emotional response, which impacts both physical function as well as the FIGURE 1. This cat was previously grabbed with a towel by someone standing in front of her. She is now highly frightened of veterinary personnel and towels held towards her. FIGURE 3. Frustration from not receiving the human attention that he wants causes this caged cat to paw through cage bars. Lower right: Courtesy of the AAFP FIGURE 2. (A) While Ivan's ears are erect, they are planed to the sides, and he's looking down to avoid eye contact. He's giving you a clear signal to leave him alone. (B) The handler's further approach increased the intensity of fear and concern for lack of safety, leading to the aggressive response. A B

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