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Feeding patients with concurrent diseases

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01 April 2017, at 12:00am

“WHAT SHOULD I BE FEEDING MY DOG?” is the question most frequently posed by pet owners to a veterinary nurse – yet sometimes there is no easy answer, VNs attending the nursing stream at VetsSouth 2017 were told. 

Nicola Ackerman, senior medical nurse at the Veterinary Hospital, Plymouth, outlined a strategy for dealing with those patients with concurrent diseases in which the ideal diet for one condition is contraindicated in another. 

A typical example would be a kidney disease patient for which the specialised renal diets normally recommended may contain high levels of fat that are likely to exacerbate any co-existing problems with pancreatitis, she said. 

There are no blanket recommendations applicable in every situation and so it is necessary to adopt a “holistic approach” geared to the specific needs of the individual animal, she said. “We need to fully understand the different disease processes going on in that patient and create a nutritional profile for that specific situation.” 

Any dietary choices should be based on the same thorough history taking and laboratory analyses that are essential when investigating any medical condition. But as she pointed out, information on the product label may not contain all the information needed by the VN to assess its suitability for that particular patient. 

“The label will be worded to satisfy the legal obligations of the manufacturers, not the clinical questions that we may want to ask. So the label may tell you how many calories per 100g the food contains, but it won’t always tell you how much of that comes as fat, how much as protein, etc.,” she said. 

Usability questions

Where there are any questions about the suitability of a product, Mrs Ackerman recommended calling the manufacturer’s technical helpline. If the staff cannot provide the information needed, then that may well tell the nurse all she needs to know about the quality of the product. 

It is also worth asking whether the food is produced to an open or closed formula, she said. In the former, the product may be based on the same proportions of different ingredients, but these may come from different sources and so the quality and taste of the food may vary from batch to batch. 

“Consistent quality will be extremely important when you are managing a diabetic patient, for instance, as changing the ingredients can have a significant impact on the bioavailability and digestibility of the nutrients that it contains.” 

Once the right product has been selected, it is essential for the VN to persuade the client to use it as recommended. That will mean giving the animal an appropriate quantity of the prescription diet and restricting the patient’s intake of other food items.

Mrs Ackerman pointed out that owners will often give a dog additional vegetables in the belief that they are a healthy addition to its diet. “They must appreciate that vegetables are not necessarily benign – brassicas like kale and cabbage contain high levels of calcium oxalate which may not be suitable for a patient with kidney stones, while carrots are rich in phosphate and that may not be recommended in other renal diseases.” 

Clients will also give treats to their pets more frequently than they are usually prepared to admit. “I have reached the conclusion that nobody tells the truth,” she warned.

This will be especially important when trying to manage a common condition that will complicate the treatment of many other diseases – obesity. The nurse should use various tactics to ensure that the client follows advice by pointing out the beneficial effects on the pet’s quality of life of even relatively modest weight changes. 

They can also appeal to the owner’s parsimony: “Everything that we dispense is based on the animal’s weight and so if their pet is slimmer it can save them quite a lot of money.” 

But it is not always possible to overcome the emotional bond between human and animal. “We are dealing here with chronic diseases that will never be cured. So they think, ‘If the pet is going to die anyway, why can’t we make him happy by giving him what he wants?’ That is a big challenge when you are trying to achieve good compliance,” she said.

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