Fearless columnist Natalie L. Marks is an educator, consultant and practicing Chicago veterinarian. Dr. Marks is a leader within the Fear Free movement, was a member of the original Fear Free advisory board and is Fear Free Certified Elite. She passionately believes that all veterinarians should be committed to the physical and emotional health of their patients.Read Articles Written by Natalie Marks
As veterinary practice owners and scientists, we rely heavily on data and analytics to assess how our clinics’ financial health fares month over month and year over year. For example, take average client transaction, a common key performance indicator. For associate veterinarians, the KPI number typically doesn’t include medication refills or therapeutic diet purchases. However, food can take up a large part of your inventory and is the backbone of nutrition, one of the most discussed topics at patient exams.
Many pet owners are incredibly passionate about their dog or cat’s diet and have questions concerning everything from the food brand to the protein type. When we empower our teams to take ownership of some diet recommendations, we see better patient outcomes, healthier practices and clients more bonded to the clinic.
Here are five lesser-known tenets for achieving our patients’ best physical and emotional health.
1. The 10% Rule
Treats play a huge role in the training, distracting and positively reinforcing of pets in the home and hospital. Treat administration is a common source of stress reduction in pet owners and veterinary teams. However, treat consumption can quickly spin out of control, drastically exceeding the rule that no more than 10% of a pet’s daily kcals should come from treats. And it shouldn’t stop there. Attached to the recommendation should be the results of research conducted at Ohio State University that found the treat size need be no larger than your pinky fingernail. If more pet owners knew that guideline, more patients would have happier brains and leaner bodies.
Want a bonus tip for your exam rooms? Research shows that positive association and stress removal are best when we administer 60 tiny treats in 15 minutes. Take the challenge!
2. An E Tube Should Not Be the Last Resort
When I graduated from veterinary school and started practicing, feeding tubes were rarely considered when a diagnosis strongly indicated a caloric deficit. Many of my colleagues were reluctant to place an esophagostomy tube because of their lack of experience. In addition, pet owners resisted authorizing E tubes because of the stigma behind the process and the physical look. Most importantly, the veterinary industry generally overlooked an animal’s emotional health and how chronic medication administration and restraint can trigger fear, pain and stress, destroying the joy at home.
Unfortunately, we were completely off course. An E tube allows a pet owner to administer all the daily anti-nausea and prescribed medications without creating stress, pain or triggered memories in their cat or dog. This option often can be the difference between a patient recovering with a better quality of life and a pet owner choosing to end a life because of the erosion of the human-animal bond.
Whether your patient has full-mouth extractions, oral cancer, chronic kidney disease, hepatic lipidosis or facial trauma, plan for an esophagostomy tube during the initial sedated procedure. Give patients easy pain med delivery and nutritional support, which will reduce anxiety and stress and help the pet improve clinically.
In addition, your treatment plans should communicate to clients the importance of physical and emotional health so that everyone is on board as part of the medical team. When pet owners feel in control and see their family members feeling better (increased energy, weight gain and more interaction), we reduce their stress as caregivers and strengthen the human-animal bond and veterinarian-client-patient relationship.
3. Feed, Don’t Fast, Before Anesthesia
Until recently, we asked pet owners to withhold food and water the night before any anesthetic procedure to avoid regurgitation and vomiting. Unfortunately, the somewhat universal rule wasn’t foolproof because of the significant variability in gastric emptying in dogs. Some patients still vomited, and, as we all know, not every pet owner is fully compliant with our instructions.
Thankfully, experts questioned the recommendation and prioritized this golden rule: Every patient undergoing anesthesia should have their airway protected with an endotracheal tube.
Why is that important? Because airway protection is one of the best preoperative ways to prevent the complications of regurgitation and vomiting. In addition, we’ve seen evidence that withholding food can lower the stomach pH, increasing the possibility of reflux esophagitis and regurgitation.
Knowing the variables, let’s instead recommend a small meal or a few treats when a patient encounters a stressful trigger such as a carrier, car or veterinary hospital. Not only does that idea create a more positive association with the experience, but it also allows us to start medications at home before a procedure, such as anti-anxiety therapy and anti-emetics or drugs like gabapentin, trazodone, and alprazolam.
4. Reduce PONV
In human medicine, clinicians are familiar with PONV, an acronym developed by the National Library of Medicine. It stands for postoperative nausea and vomiting, one of the most common and serious conditions following anesthetic events. PONV doesn’t just describe gastrointestinal changes; it also can worsen pain in pets, create anxiety, harm the human-animal bond and reduce client satisfaction during the recovery period. The vicious cycle is hard to stop once emotional conclusions are made, leading to client distrust in the clinic.
The lesson learned from human medicine and a similar 2017 study is that pet owners are concerned enough about PONV to pay extra to prevent it (in this case, with the use of maropitant). A 2014 study demonstrated that 93% of dogs receiving maropitant returned to normal feeding compared with 46% of the control dogs.
The quick return to normal appetite improves healing by restoring hydration and electrolytes and fulfilling caloric needs. Anorexia is a condition that can lead owners to think their pets’ quality of life has decreased.
5. We Bore Our Cats
Although many of us are proficient at diagnostics and nutritional recommendations, as an industry, we consistently fail to educate clients about how cats like to be fed. Cats develop whisker fatigue from shallow bowls, which can cause food aversion and inappetence. In addition, their emotional health can wane when kibble is dumped in a bowl every three days.
Instead, according to Dr. Liz Bales, cats need to “Go through seeking and finding their prey, or the hunt. The pounce and eat is only a fraction of the process.” (Read more at bit.ly/3s9kBpQ.)
What are we missing? Veterinary teams should encourage the active, not passive, feeding of cats. I strongly support food puzzles, and most veterinary behaviorists do, too.
Many veterinary nutritionists believe that nutrition should be the fifth vital sign as it’s such an essential component of patient histories, exams, and wellness or therapeutic plans. Implement the recommendations above to improve the health of your patients and practice.
For additional feline feeding recommendations, visit bit.ly/3sYjOaC to read the American Association of Feline Practitioners’ consensus statement, “Feline Feeding Programs: Addressing Behavioral Needs to Improve Feline Health and Wellbeing.” The highlights include:
- Urinary tract infections and obesity can develop when normal food-related behaviors are not encouraged or allowed.
- Cats need play and predation and the consumption of food and water in safe spaces.
- Cats should be fed enough to maintain a moderate body condition score (2.5 or 3 out of 5 or 4 to 5 out of 9).