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55 ACVN NutritioN Notes | July/August 2014 today's Veterinary Practice tvpjournal.com ADDITIONAL CONSIDERATIONS Appetite The waxing/waning appetites of patients undergoing therapies for cancer can significantly impact the onset of malnutrition. Therapeutic appetite stimulants are available for pets, including mir- tazapine and diazepam. Specific oral probiotics have been noted to enhance food intake in chronically ill cats and dogs; however, these effects are undocumented in veterinary literature. One such product, canine or feline FortiFlora (purinaveterinarydiets .com), is a powdered probiotic suggested for use to protect microbiota prior to, or replenish microbiota following, chemotherapy and/or radiation therapy. Acupuncture, acupressure, and directed massage are nontradition- al approaches to appetite stimula- tion. The appetite pressure point is located at the juncture of the nasal tissue and hairline on the dorsal as- pect of the nose. Gentle, directed pressure for 5 to 10 minutes prior to feeding has been noted to stimulate appetite once food is offered. Dietary fat, protein, and sodium are known palatability enhancers for pet food. In patients with hyporexia, higher fat and protein diets that are not sodium restricted may be more enticing. In cases involving concur- rent pancreatitis, cholangitis, or hy- perlipidemia, restricted dietary fat is recommended. Taste & Food Aversions In humans, altered taste is a com- mon side effect of chemotherapy that may be present, but challenging to ascertain, in pets. However, food aversions have been observed in pets undergoing chemotherapy and/ or radiation therapy. To help over- come these aversions: • Use glass or porcelain feed and water dishes in place of metal dish- es, which reduces the metallic taste associated with platinum-based chemotherapies; this taste is often reported by human cancer patients. 15 • Alternate the main protein source in the diet, which influences smell and taste and helps overcome aversions. SUMMARY When nutritional support is over- looked in pets with cancer, malnu- trition can develop and jeopardize patient health. While the catabolic– cachectic state in chronic cancer patients is not reversible, progres- sion can be slowed through appro- priate nutritional support. • Begin nutritional support at diag- nosis, and continue past remission for at least 6 to 9 months, or lon- ger; residual alterations in nutri- ent metabolism associated with presence of neoplastic cells per- sist for varying time periods past intervention. • Work closely with the caregiver to develop realistic nutritional sup- port goals. • Assess the pet as often as needed to ensure its needs are being met. • As the pet's clinical picture chang- es, revise the nutritional support plan accordingly. n AAFCo = American Association of Feed Control officials; AoX = antioxidants; CHo = carbohydrate; Der = daily energy requirement; DHA = docosahexaenoic acid; ePA = eicosapentaenoic acid; Gi = gastrointestinal; GlN= glutamine; GMo = genetically modified organisms; otC = over the counter; rer = resting energy requirement Weight management that works in the real world. 1 Data on fle. Hill's Pet Nutrition, Inc. ©2014 Hill's Pet Nutrition, Inc. ®/™ Trademarks owned by Hill's Pet Nutrition, Inc. [ canned + d r y + t r e at s ] Available in canine and feline formulas ExpEct SomEthing Different now with our most advanced antioxidant formula ever! Korinn E. Saker, MS, DVM, PhD, Dip- lomate ACVN, is an associate professor of nu- trition and direc- tor of the nutrition program at North Carolina State University College of Veterinary Medicine. She received her MS in animal nutrition from Clemson Univer- sity and her DVM from Universi- ty of Georgia. Following 5 years in mixed animal practice, she completed her PhD and clini- cal nutrition residency at Virginia Maryland Regional College of Veterinary Medicine. (References continued on page 78)