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
When pet owners and veterinarians review a patient’s quality of life assessment, “not eating” is universally considered poor quality of life. It’s one of the top reasons clients call us, bring in their pets, and sadly, euthanize them. While that clinical presentation is common, it’s sometimes poorly characterized and has significant consequences for the patient, client retention and the practice’s health.
Let’s refresh on the concept of inappetence. The term is relatively new in the veterinary space — I wasn’t taught it a mere two decades ago — but it’s essential to everyday small animal practice.
The three subtypes of inappetence to recognize are:
- Anorexia: Many veterinarians and veterinary nurses tend to classify any patient that isn’t eating as anorexic. However, true anorexia is a complete loss of appetite.
- Hyporexia: A decrease in appetite, even in minor increments.
- Dysrexia: A change in the pattern or behavior of eating. For example, a cat that normally demands food at 4 a.m. waits until 3 p.m. Or a dog that typically finishes a bowl of food in six seconds now takes two hours. These pets might eat the same amount of food, but the small changes in behavior and patterns could indicate more significant internal issues.
While easy for pet owners to identify, inappetence can be challenging to fix. Asking a lot of history questions will help guide the diagnostic and treatment journey. For example, when did the inappetence start? Has the pet’s water consumption changed? What about other gastrointestinal signs? Did the pet’s weight change? What are the pet’s traditional and new eating patterns? Did the diet, kibble size or food texture change?
The Causes of Inappetence
We know that many conditions, including organ dysfunction and inflammatory, infectious, metabolic and neoplastic diseases, are responsible for appetite changes. But don’t forget the many other causes of inappetence, some due to pain, some behavioral and some of our own doing.
Let’s look at ourselves first. Although veterinarians always have the best intentions with their therapeutic plans, some medications can affect a patient’s stomach and other parts of the intestinal tract, causing inappetence. Other pharmaceuticals can trigger decreases in the hunger hormone within the brain. Still others can produce esophagitis due to incorrect administration of the medication. We must ensure that our practices teach new pet owners to pill a dog or cat safely.
Next, we sometimes overlook pain, anxiety and stress as the reasons behind intermittent or chronic inappetence. A thorough patient history and open-ended questions can help identify recent environmental changes, such as new surroundings, a boarding stay, a new home, a new baby or even a noise phobia, as the cause of inappetence. This is also the time to screen for separation anxiety, a category all to itself. Separation anxiety is the No. 1 anxiety we see as veterinarians and the most difficult to manage. A detailed history and physical exam are the first steps in diagnostic testing.
3 Calls to Action
So, in an industry where most of us have a good handle on diagnostic workups and treatment plans, why spend so much time on inappetence? Because when we take a passive approach, we forget the ramifications to our client base and our practice’s financial health. I remind myself frequently of three main points.
1. Stop the “phone fix.”
Our profession has become accustomed to quickly giving out advice over the phone when a client calls because of a change in a dog or cat’s appetite. While hearing “Try some canned food,” “Top it with tuna” or “Use some chicken and rice” might appease a worried client for a few days, several negative consequences are possible, unfortunately.
A 2015 study published in the Journal of Feline Medicine and Surgery found that 43% of the owners of cats with chronic kidney disease reported an abnormal appetite in the animal. And in a 2016 study published the Journal of Veterinary Internal Medicine, weight loss was detected up to three years before the diagnosis of feline CKD. A client’s call about inappetence deserves two responses: a thank you for monitoring the animal and reporting the issue and a recommendation to schedule an exam and possible diagnostic testing.
2. Pay attention to inappetence in hospitalized patients.
Ill patients frequently are in a hypermetabolic state, so calorie management is imperative for weight maintenance, efficient wound healing and a functioning immune system.
Consider your post-surgical patients. We commonly see hyporexia or anorexia in them because of the procedure, the pain or the stress of being hospitalized. While many veterinary professionals are accustomed to a wait-and-see approach before a patient discharge, we need a more active mindset. Assess the patient, look for objective signs of pain and treat accordingly. Concurrently, we can administer anti-emetics if the patient shows signs of nausea, but more importantly, an approved and targeted appetite stimulant might be appropriate. If the patient is still anxious or fearful, we can address the issue through supportive strategies that relax the hospitalized patient, especially if the anticipated stay is several days. These could include pheromone therapy, soft music, warm towels, hiding spaces, compression garments, natural supplements and pharmaceutical intervention.
3. Build client trust.
A phone call to our practice is often a request for guidance about a problem. When a dog or cat’s appetite improves temporarily but then regresses or doesn’t improve at all after a phone call, the owner can become frustrated, more anxious and potentially angered. That can cause a client to leave your practice and potentially leave a negative online review, which can be more devastating.
Our profession leans toward being cost-conscious when working with clients, and I agree. However, we shouldn’t shortchange the pet and skip active intervention when we know that the animal’s inappetence means something is off. Instead, tell your client about the possible reasons for the inappetence and what can be done, and let the pet owner make the final decision.
As we look at our appointments, phone messages and emails, I challenge you to take a proactive, not reactive, stance at acknowledging, investigating and treating inappetence quickly and consistently. Not only will your patients feel better, but so will your clients and practice.
THE OPPOSITE PROBLEM
Polyphagia is the excessive consumption of food, and pica is the intake of nonfood items. The Merck Veterinary Manual advises: “Although some dogs with pica and polyphagia have compulsive behaviors, many dogs, especially puppies, begin to chew and ingest nonfood items as part of investigative and exploratory behavior.”