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Managing nutrition when your veterinary patient has multiple diseases

Posted in Client Service @ Jun 9th 2022 - By Jessica Joosse, RVN, Animal Nutritionist and Blogger - Nutrition RVN
Managing Nutrition When Your Veterinary Patient Has Multiple Diseases

Which nutrients should you target when a patient has more than one disease?

A huge pain point for veterinarians is knowing what to recommend when you have a patient with more than one disease state. While every pet is going to have unique needs, these cases can be some of the most difficult when trying to choose what nutrients to target.

Disclaimer: I am not a veterinarian. As a Registered Veterinary Nurse I support vets in their clinical decision making. These tips are based on my experience in implementing nutritional therapies, and are designed to help guide vets to choose an appropriate diet for their patients with complex needs. This post is not a substitute for a veterinary consultation or meant to replace medical advice.

Start by making a list

When deciding what to feed a patient with multiple conditions, we must first sit down and really think about the case. What I find helpful is writing it all down – First, I list out the pet’s health conditions. Next, I take note of the nutritional factors for each condition. Finally, I note down any specific needs that patient has – do they have allergies? Do they only eat one type of food? Do we anticipate any challenges?

Note – I don’t expect this to be done within a consultation! I recommend asking if the owner will be comfortable for you to call or email them back later once you have had a moment to determine the best diet recommendation for their pet, as their case is complex and unique. Many pet owners will appreciate that you have taken extra time and care for their pet.

Then look for similarities

With all of these noted down, my next step is looking for similarities;

– Do any of the nutritional factors cross over with any of these conditions?

– Are any of these conditions triggered by any specific nutrient?

Many co-morbidities are closely linked to each other and sometimes one triggers the other, so nutritional management must take into consideration the pathophysiology of these conditions. Thinking about the ‘why’ of these conditions will help us understand how they are similar to each other and in turn, what we can do nutritionally.

Now determine priorities

After looking at similarities, next I look at what factors conflict with each other. Is there a nutrient that for one condition needs to be increased, but for another needs to be reduced? For example, if the patient is obese but has osteoarthritis, we would want to reduce fat content for the obesity but keep some level of fats in the form of omega oils to support the joints.

It’s with these cases that I look at two points;

  • which of the conditions is a higher priority, and
  • which can be managed with medication.

In the case of obesity and osteoarthritis, the obesity would be a higher priority as it cannot be medicated and it can be nutritionally managed which will in turn relieve some of the discomfort from the arthritis. The arthritis can also be medically managed, so the weight loss is more “important” in this case.

Is there a middle ground?

If you still cannot come to a consensus after looking over these points, you will need to look for a middle ground. When we look at nutritional factors, they are usually listed as a range – not a single number. This gives us some room to move when deciding on the values that are still going to be acceptable to our patient’s needs. For example, one condition may call for 20-30% protein on a dry matter basis, and another may want protein less than 20%; for this we can look at using a diet that is in the lower end of the range, around 20-25% which will likely still manage both conditions relatively safely.

My patient has developed a new condition, what do I do now?

If you’ve already implemented a nutritional plan for one or more conditions, and your patient has developed a new condition, you don’t always need to change the diet. Crazy, I know. But it’s important to once again think about the pathophysiology – did the disease or the diet cause the situation to change? More often than not when we change things in the diet, or treat a condition, it may uncover underlying issues we didn’t see coming. It doesn’t always mean you did something wrong. That being said, if you’re still stuck and not entirely sure what to do next, it might be time for referral to a Board Certified Veterinary Nutritionist, or Internal Medicine Specialist.

Still not sure? Ask me a question about managing multiple diseases down below!

This post first appeared on the Nutrition RVN Blog: Managing multiple diseases

About Jessica

BAnVetBioSci, RVN, AVN 

Jessica graduated with her Bachelor of Animal and Veterinary Biosciences from La Trobe University in 2016 and went on to complete her Certificate IV in Veterinary Nursing in 2018. She became one of the first few AVNAT Registered Veterinary Nurses in 2019, and obtained Accreditation in 2020. She has worked in the veterinary industry since 2010 in every role from Animal Attendant all the way up to Practice Manager.

Her passion for animal nutrition began as a child, when the family cat suffered from a urinary obstruction, and his lifelong treatment was dietary change. Diet can literally be life-changing and serve as a medical treatment, which is what motivates Jessica to improve the lives of pets through diet, and educate pet parents and professionals on the importance of nutrition as both a medical treatment and preventative health care. Armed with this motivation to improve other pet’s lives, she has undertaken countless hours of continuing education in the area of animal nutrition and is always studying! In 2020, Jessica started her blog, NutritionRVN.com, to reach more pet parents and help them make informed choices and wade through the marketing when choosing the right food for their pet.

She is currently studying towards Veterinary Technician Specialist status in Nutrition, preparing to sit her qualifying exam in 2023.

 

Click here to visit the Nutrition RVN Blog  |  Click here to follow Nutrition RVN on Instagram 

 

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