Today's Veterinary Practice

MAR-APR 2018

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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Page 21 of 95

PEER REVIEWED 18 NUTRITION NOTES INITIAL APPROACH TO THE INAPPETANT PATIENT Start with a global assessment of the reason(s) for poor intake and address the most likely possibilities first. In many patients, hyporexia is a multifactorial process, and is shaped by psychological, environmental, nociceptive, pharmacological and physiological influences. Some of these are easier to fix than others, and a multimodal approach is often necessary. Psychological influences Hospitalized patients are unavoidably disoriented by the change in their environment and may experience substantial amounts of anxiety. This is often clearly apparent in our feline patients that often retreat under a towel and refuse to re-emerge. Appetite is suppressed by stress, particularly if patients are fearful, so we need to think of ways to mitigate the psychological impact of hospitalization. It may be helpful to have the owner come in and hand feed the patient or place an object such as a piece of clothing in the cage to provide comforting familiar scents. Depending on your staffing levels, try to have one person focus on food intake with a particular patient, while others do the "mean" tasks like placing catheters, administering injections, etc. Assigning one person to be the comforter and feeder may provide a feeling of safety for our anxious patients. Ask owners about food preferences and follow these when possible. If a diet change is medically indicated (eg, for renal or GI disease), do not make a radical change. Instead, gradually introduce the appropriate diet when the patient is eating consistently. In the short term, eating some of the wrong food is better than eating none of the right one. Ideally, cats should be housed in a separate room from dogs. If this is not possible, hang a towel over the front of the cat's cage and provide a hiding place (even a cardboard box will suffice!) within the cage. The feline pheromone diffusers are also helpful and one should be placed nearby. For cats, it is important that feeding areas are clearly separated from toileting areas. Feline- specific housing with raised platforms and separate rooms is ideal and can markedly improve well-being. An existing set of steel cages can be easily transformed into a condo with a simple plastic tube, allowing the cat to rest and eat in one side and eliminate in the other. Environmental influences Many people think that human hospitals smell bad, and I am sure that many of our patients think the vet hospital smells dreadful. If you are aware of a whiff of bleach or other disinfectants in your treatment areas or wards, this is probably overpowering to our patients. Consider changing products or cleaning cages with a chemical-free steam cleaner. Noises can also affect patient well-being and should be modulated as much as possible. Isolate barking dogs and try to keep sick patients away from boarding areas that tend to be loud. Simple additional sound proofing efforts can be rewarding. Also pay attention to background music. Nociceptive influences Pain is a powerful appetite suppressant and may impede a patient's ability to seek or prehend food. Even in the absence of overt manifestations of pain, it can be helpful to consider that discomfort is impacting intake and intervene appropriately. Choices about pain control can be challenging, as opioids can suppress intake and non-steroidal drugs are problematic in patients with renal or GI compromise. It may be helpful to have the owner come in and hand feed the patient or place an object such as a piece of clothing in the cage to provide comforting familiar scents. Studio

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