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Nutrition Cheryl Holloway, RVT, Nutrition Services The Ohio State Veterinary Teaching Hospital, Columbus, Ohio The Technician's Role in Veterinary Nutrition
Proper nutrition for pets is essential for maintaining healthy coats, prevention of diseases and helping to allow for speedy recoveries from illnesses or surgeries. Nutrition and how it affects the lifestyles and lifespan of animals is currently the "hot" topic among pet owners. To stay current, veterinary clinics need to be able to offer a variety of nutrition related services that will help satisfy the clients increasing need for nutrition related information. In most busy animal practices, the average appointment time per client is 15 minutes. This can make it very difficult to commit the time needed to adequately cover these services. By utilizing their veterinary technicians, veterinarians will be able to provide these services as well as increase revenue for the clinic. The following are examples of some nutrition related services that can be delegated to a registered veterinary technician: Pet feeding recommendations - One of the most common nutrition related question for veterinary staff is "How much should I feed my pet?" This is an area that can easily be covered by a registered veterinary technician. Diet histories - This very important step in diagnosing a nutrition related disease can also be a very time consuming one. By delegating this task to a registered veterinary technician, important information will be gathered. Pet food library - Keeping track of the large variety of pet foods that are currently on the market can be challenging. A veterinary technician will be able to create and maintain a pet food nutrient information file. Obesity clinic - With obesity currently affecting ~ 30% of our pets, offering a clinic specializing in this area is a great need in most communities. After consulting with a veterinarian, technicians can enroll a patient into the clinic where weigh-ins, and client communication are done on a monthly basis. Continuing education seminars - Seminars can be offered to the public on various pet nutrition topics such as reading pet food labels, increasing pet activity and feeding in multi-pet households. Clinical Nutrition - In a busy hospital, technicians can help out by taking the time needed to coax feed an anorexic animal, placing a nasogastric tube, feeding animals with gastrostomy tubes and implementing TPN. You can find more ideas and how to implement them on our website, www.nssvet.org. Nutritional Support For Hospitalized Patients
Veterinary technicians are faced with many challenges each day, including trying to get patients that have been admitted into the hospital to eat. Decreased food intake is a common occurrence in sick animals; proper nursing care and techniques can play a key role in the nutritional outcome of the patient. This article provides guidelines and methods to help determine and implement the best way to meet the nutritional needs for hospitalized patients. Why is nutrition important to recovering animals? Living animals require constant input of glucose, fatty acids and amino acids. If nutrients are not consumed voluntarily, or provided by the caregivers, they will be drawn from the animal's own body mass. By providing the nutrients needed for metabolic activity and other body functions, nutrient depletion can be avoided and recovery time possibly shortened. What causes inappetance? Disease-induced inappetance results from interruption of the normal mechanisms that control food intake. Loss of appetite can be caused by a wide variety of medical problems, including fear; stress, organic disease, inflammation, trauma, and neoplasia. Patients with chronic diseases often lose their appetite and become nutrient depleted as the disease progresses. Animals with facial injuries or obstruction of the gastrointestinal tract may not eat because they are physically incapable of taking in, chewing or swallowing food. What problems can inappetance cause in a sick animal? Inadequate nutrition due to disease-related inappetance has a number of adverse consequences, such as impaired immunity, decreased resistance to infection, inability to withstand shock, surgery, and cytotoxic drugs, decreased wound healing, muscular weakness, organ failure, and death. Food intake is also necessary to maintain total mass, protein, and deoxyribonucleic acid content, and disaccharidase activity of the gastrointestinal system. The likelihood of these adverse consequences increases with the severity and duration of the illness as time passes, which explains why inappetance is an associated problem of disease that must be recognized and treated. Determining the severity of inappetance Many questions are raised about how long animals can go without eating before intervention should occur. This really depends on the nutritional status and health of the patient before the illness, and the severity, duration, and treatability of the problem. For a young well-nourished animal with a moderately severe, treatable acute injury, a week is safe. For an old, chronically ill patient with an acute insult, the sooner the better. One way to judge is to ask yourself,"why are we starving this patient?" rather than, "why should we feed this patient?" Treating inappetance When faced with an animal that is not eating in the hospital setting, it is best to start with the least invasive intervention, such as coax feeding, and work your way up to more invasive methods such as enteral and parenteral feeding. In this article we will begin with coax feeding and work our way through enteral and parenteral feeding similar to the way we would start intervention with an inappetant hospitalized patient. Enteral Nutrition (feeding via gut) If the gut is functional, and there is no evidence of vomiting, diarrhea, or lack of motility, it is always best to use it. The enterocytes and colonocytes that make up the mucosal surface of the gut are fed directly through the lumen. Lack of nutrition will cause these cells to shrink and die thereby reducing the surface area of the intestines. This will also decrease the barrier to bacterial translocation. Coax feeding If food intake is less than desired, and the animal is physically able to eat, you may try to coax the animal into eating. The goal of nutrition support of hospitalized patients is to have the patient voluntarily eating it's own food at home. The next best thing is for the patient to eat it's own food in the hospital. This means that getting an accurate diet history (figure) from the owner is very important. If the patient is offered a food it is unfamiliar with (i.e., offering canned foods to a patient that has always eaten dry), it may not recognize it as food. Encouraging owners to bring favorite foods and feed their hospitalized pets should also be considered. Taking the pet to a quiet room if possible and allowing it to spend some time with its owner may be all that is needed to coax an inappetant animal to eat. Nursing techniques that may help improve food intake include spending time with the patient, and petting it and using vocal reassurances while handfeeding if necessary. Try to schedule feeding times in between other treatments so you can dedicate extra time if needed. Warming food to body temperature is also recommended, this is a good way to enhance the aroma of food, which may encourage the animal to eat. Make sure the patient's nasal passages are clear; if olfaction is impaired this may inhibit the patient from eating. If the patient's nasal passages are occluded, clean them with warmed saline to improve olfaction. It is also a good idea to check the mouth to make sure there are no oral ulcers or tooth abscesses that may inhibit eating. Placing a "smorgasbord" of foods in the animals cage to try to entice it to eat is not recommended. This may actually cause a learned food aversion, wherein the animal associates the smell and taste of the food with it's discomfort and will refuse to eat the food even when released from the hospital setting. Never try to introduce a new food while the patient is in the hospital that he or she may need to eat on a long-term basis such as a low protein, phosphorus food for chronic kidney failure. If a learned aversion forms, one has less food choices to offer the client when the pet returns home. In most cases, animals that will not eat at least 20 kcal/pound per day should receive appropriate nutritional intervention. The decision to begin intervention however is different for every patient's unique situation, taking into consideration the patient's overall prognosis, the owner's financial situation, and the general affect of the animal (i.e., if it is fearful or depressed it might do better just going home.) Sedatives Diazepam, oxazepam, and cyproheptadine are sedatives that may be used as an appetite stimulant if the animal is not eating due to anxiety. Although any of these drugs may work sometimes, none work predictably. And unfortunately, they may motivate a patient to eat a small amount immediately, which may delude one to conclude that the patient's food intake is adequate. Because of this, these drugs should be restricted to cases where food intake is being measured. Force Feeding If attempts to coax feed and appetite stimulants fail, force-feeding may be attempted for a day or two. This is another area where nursing technique can make a big difference between the success or failure of the procedure. Most force-feeding is done using the "syringe method" where a food is placed in a syringe and placed in the mouth so the animal has no choice but to swallow it. It is very important to use the same methods of petting the animal and using vocal reassurances as well as going very slowly when administering the food. Take several breaks if necessary to let the patient rest. One helpful hint that I have found is to place the syringe in the corner of the mouth instead of entering through the front of the mouth. This places the food closer to the esophagus so there is less of a chance of the patient spitting it out. If the patient struggles in any way it is best to discontinue at this time. Measuring the amount of food before and after feeding will allow you to accurately assess the patient's food intake. Force-feeding provides some nutrition, but the inconvenience, and the possible stress imposed on the patient during repeated force-feedings, makes the technique one of limited usefulness. After trying the previous non-invasive methods with no success, or if the animal has a physical impairment that inhibits them from eating, this is the time to consider placing a feeding tube. The following are some descriptions of the three popular tube-feeding methods that are currently used for dogs and cats. Nasogastric Tube Placing a nasogastric tube can provide fluids and nutritional support for short term feeding. It is a good choice if you think the patient just needs the stimulation of nourishment to begin eating on their own within a few days, or if the patient is at a high risk for being put under anesthesia. Gastrostomy Tube Gastrostomy tubes are used for patients that will require nutritional intervention for 2- 3 weeks or more. They are specifically indicated for patients that are comatose, or that require bypass of the oral cavity, larynx, oral pharynx, and esophagus due to neurologic or neuromuscular diseases, dysphagia, neoplasia, obstruction, inflammation, or stricture. These tubes can be placed surgically or endoscopically. Gastrostomy tubes are ideal for home care as they are easy for clients to use. Esophagostomy tubes Esophagostomy tubes, like gastrostomy tubes can be used for short or long term feeding. They can be placed simply most often with a short general anesthetic, and are a good choice for practices that do not have an endoscope, or if the patient is not a candidate for surgery. They are placed in the esophagus, and are similar to gastrostomy tubes in regards to care and maintenance. Parenteral Nutrition (feeding via vein) If the animals gastrointestinal tract is not functioning, parenteral nutrition (PN) should be considered. PN is useful for short-term metabolic and immune system support of patients until gastrointestinal function returns; however, administration of PN for periods of less than five days is seldom justifiable. Feeding guidelines for Enteral and Parenteral nutrition methods Enteral diets should supply the nutrients required by the patient without causing digestive disturbances. They should be easy to administer, yet palatable enough to be eaten, and patients should not lose weight while being fed at the prescribed doses. Before starting any feeding program it is important to estimate the patient's energy needs. We estimate the energy needs for most hospitalized patients at ~ 20 kcal/pound per day. If the animal has not eaten in several days we start feeding it at half it's basal energy needs and gradually increase the amount as tolerance allows, with a goal to meet total estimated basal needs within 24 hours. It is safer to slightly underfeed, than to overfeed and induce an adverse reaction that would require stopping feeding altogether for awhile. Feeding Food or water may be provided as soon as tube placement is confirmed or soon after the patient recovers from anesthesia. Total fluid and nutrient needs are delivered in four to six feedings over the 24 hour period. What to feed For nasogastric tubes, liquid diets such as Abbott ClinicareŽ are best suited with varieties in canine, feline, and renal formulas. For gastrostomy and esophageal tubes, a satisfactory diet can be prepared by blenderizing a canned pet food that meets the specific needs of the animal with water to reach the desired consistency to flow through the tube. Parenteral Nutrition Total Parenteral Nutrition can be made at the clinic or bought ready-made through some pharmaceutical companies. Most solutions provide approximately one kcal/ml, and are usually administered with a fluid administration pump using the above guidelines for rate of infusion. Returning to normal food intake Each patient is unique in regards to when to begin weaning him or her off enteral or parenteral nutrition and to resume normal feeding. Many factors play a role in deciding when to start cutting back that are similar to those that were discussed when deciding when to begin intervention (i.e., patient's overall prognosis, owner's financial situation and patient's affect.) Coax feeding can be used with most disease processes in conjunction with enteral and parenteral intervention methods. Each case is different as to when the best time to begin oral feeding would be, but once it has started, this is a good way to evaluate the food intake of the patient and decide when it is appropriate to begin the weaning process. Enteral nutrition can be stopped at any time, whereas PN should be weaned over a day or two depending on the situation. Conclusion Proper nutrition for animals in the hospital setting is an ongoing challenge in veterinary medicine. Every animal is unique with his or her disease process and nutritional status. By using current nutritional intervention methods and quality nursing techniques these challenges can be overcome and animals can benefit from getting the maximum nutrition needed to help improve their physical condition and possibly get them out of the hospital sooner. Nutrition and Canine Reproduction
Healthy dams of good breeding produce healthy offspring. The probability of producing healthy, vigorous puppies can be improved by breeding animals from lines known to be free of genetic problems, avoiding inbreeding, and by breeding females between two and six years of age. When these criteria have been met, success depends primarily on the diet and feeding management of mother and offspring. Feeding During Gestation and Lactation Before breeding, the dam should receive a physical examination and get updated on vaccinations and worming as necessary. She also should be of normal body weight and moderate body condition; excess weight may predispose to dystocia, whereas underweight females may have difficulty conceiving. The time to attain moderate body condition is before breeding to avoid problems later. Owners should be asked to measure the dam's usual food intake at this time; it will be important to remind them of this information when the puppies are weaned. { Insert illustration 2a} The dam should be fed an excellent quality commercial diet during gestation. During the first 6 weeks of pregnancy she should maintain her normal weight and feeding schedule. A decrease in food intake commonly occurs during the third to fifth week after breeding, and is a good indicator of pregnancy. During the final 3 weeks of gestation, the dam's weight should increase to approximately 25% more than at breeding, depending on the size of the litter. She may be gradually switched to a puppy growth diet during this period to meet the increased nutrient needs of late pregnancy and lactation, to avoid an abrupt diet change at parturition, and so the pups can have the food available to them when they start eating on their own. It may be necessary to increase feeding frequency during this period to ensure adequate intake if a large litter is present. Carbohydrate-free, meat only diets should not be fed during this period to avoid the risk of hypoglycemia and decreased puppy survival at birth. Figure 2-1 shows body weight vs time. Lactation is the time of great nutrient stress in the life of the dam (unless she also is a racing sled dog!). In addition to meeting her own nutrient needs she must supply all the necessary nutrients to a litter of pups that will double in body weight in ten days. Her nutrient needs increase to approximately three times maintenance by the third week of lactation, depending on the size of the litter. Because the dam is "eating for many", she needs to be fed the best food available to her owners, free choice. Pups should be encouraged to begin eating by 3 weeks of age. This will reduce the lactation demand on the dam, and prepare the pups for weaning. Allowing the pups to "play" in a thick gruel of the dam's food mixed with water will soon give them the idea. Hot tap water should be added to the food ~ 20 minutes before feeding to improve digestibility, palatability, and water intake. Puppies should be weaned when they are 6-8 weeks old. On the day before they are to be removed from the dam, she should be separated from the pups for the day. The pups should be fed, and food (but not water) should be withheld from the dam. The puppies should be reunited with the dam overnight, and food (but not water) should be withheld from both dam and puppies. The puppies are removed from the mother and weaned the next day. This technique helps the dam "dry off" without problems. After weaning, return the dam to the diet she was consuming prior to breeding at half the amount the owners measured, increasing her food intake to her usual amount over next two to three days. See Appendix A for nutrient comparison tables for gestation and lactation foods. Puppy Care and Feeding The first week of the puppies' lives is the most critical to their survival. Newborn animals are physiologically immature; body fat percentage is low; 1-2% compared to 12-35% in adults, and they do not develop adequate glycogen reserves until after the first few days of nursing. Puppies have rapid respiratory rates: 15-35 breaths per minute from 24 hours to 5 weeks, and heart rates: 200-220 beats per minute from 24 hours to 5 weeks of age. The first nutritional concern for puppies is that they receive colostrum immediately after birth; all pups should be held up to a nipple to be sure they get colostrum within 24 hours of birth. The next priority is that they stay warm. Neonatal pups cannot regulate their body temp (94-97oF for the1st 14 days) early in life. They need to be kept in an 85-90 degree environment during the first week, and 80-85 degrees during the second week of life. Hypothermia makes pups unable to eat, which may result in rejection by the dam. A good way to ensure that pups are eating and developing normally is to weigh them daily. Pups should gain 1 -2 grams per day per pound of anticipated adult body weight. For example, if the anticipated adult body weight is 50 pounds, the pups should be gaining 50 - 100 grams (1.5 - 3 oz.) per day. Surveys indicate that a high percentage of deaths before weaning are due to a relatively low number of causes: infectous diseases, congenital defects, and malnutrition. The malnutrition usually results from the death of or neglect by the mother, lactation failure, or a litter that is too large for the milk supply. When these diet circumstances occur, milk substitutes must be used to feed the puppies. As shown in Table 2-1, the composition of cow's milk is quite different from that of dog and cat milk, and should not be fed by itself. Several companies have developed milk replacers for dogs and cats; until a commercial formula can be purchased, the combination of 1 quart (450 ml) whole cow's milk, 4 egg yolks, 1 tablespoon (15 ml) corn oil may be fed. A homemade recipe can be used for a day or so. {insert illustration 2b} Orphaned puppies can be fed 4 times daily if they are maintained at an appropriate feeding environmental temperature. Every six hours is optimal, but feeding at approximately 8:00 am, noon, 4:00 pm and 9:00 pm (do not wake pups to feed them) is adequate if pups are kept at the proper temperature. Most milk replacers supply about 1 kcal/milliliter (ml). Puppies need approximately 15-20 kcal (milliliters) per 100 grams (3.5 oz) body weight per day. The milk and equipment used for feeding must be as clean as possible. Larger puppies can be fed from a small baby's nipple; smaller puppies, a doll nipple or one made for puppies. Feed milk, at least initially, at body temperature. If diarrhea develops, maintain the amount of fluid given, but reduce the solids by diluting the formula 25 to 50%. As with puppies raised by their mother, orphan pups should be encouraged to eat from a pan by three weeks of age, and complete the transition to a growth diet by six to eight weeks. See Appendix A for nutrient comparison tables for puppy milk replacers. To ensure that the orphaned or inadequately mothered puppies are maintained in an appropriate environment, an incubator can be constructed for them (see Figure 2-2). This can be made using a cardboard box, dry heating pad, thermometer, cloth towels, newspaper, and cup and a sponge. The heating pad cover should be pinned to the towel so the heating is secured under the towel and covers approximately half the floor area of the box so the orphan can choose a comfortable temperature relative to the heat source. The cup should be taped in a corner of the box and a moistened sponge kept in it to humidify the air. The thermometer should be hung in the box near the floor, and the top of the box covered to help retain the heat. Client Communication Points for Gestating and Lactating Dogs:
Pregnancy is one of the most nutritionally stressful times in a dog's life. Client education is a very important part to the successful outcome of producing a litter. The following guidelines are recommended:
Nutrition and Constipation in Dogs and Cats
Animals sometimes have difficulty defecating. Patients that pass stools infrequently, or that strain to defecate, may be constipated. Constipation is a clinical sign characterized by absent, infrequent, or difficult defecation associated with retention of feces within the colon and rectum. Constipation can result from a variety of diseases that must be investigated during the initial examination. For example, straining, or tenesmus, can result from colitis and urogenital disease, so these must be differentiated from constipation. Once the presenting episode has been resolved, follow-up treatment of uncomplicated constipation may include diet modifications and increases in activity. The two most commonly recommended diet modifications are increased water and fiber intake. Before making any diet recommendations however, be sure to obtain an accurate diet history so that the patient's current intakes of water and fiber can be estimated. Modifying the current diet by adding water and or fiber, or changing to a canned, fiber-supplemented food may be indicated if intakes of water and fiber from the current diet do not match recommended intakes. The recommended intake of water is 20-30 ml/pound weight /day. Maintaining normal hydration is an important part of managing constipated patients. A convenient and economical way of increasing water intake of dogs is to add one volume of water per volume of dry food fed. The water should be as hot as it comes from the house faucet, added 10-20 minutes before feeding to soften the food. There are also several methods to encourage the pet to drink more water. These include providing several bowls of water in the pet's environment, feeding canned rather than dry food, providing fresh water more often in a given day, and/or using a device like a pet water fountain to help increase water intake. The animal's fiber intake can be quickly estimated from the food label, which lists the crude fiber content of the diet as fed. For canned diets, the % crude fiber is simply multiplied by the number of grams fed (the net weight of the food in canned diets is provided in grams on the front of the label). For example, a 40-pound dog should consume about 10 grams of fiber per day. If the dog ate 2 cans (750 grams from the label) of a food containing 0.5% crude fiber, it would consume: 750 x 0.5% = 3.75 grams fiber ¸ 40 pounds = about 4 gm/day. To get to 10gm/day, one would add 6 gms, or about one tablespoon of fiber (such as Metamucil) to the diet each day. For a dry diet, the same dog might eat 2 cups (~ 200 grams) per day. If the diet contained 4% fiber, the dog would be consuming 200 x 4% = 8 grams fiber, so one would add about 2 grams/day (~1 teaspoon). Of course, the amount finally added will be determined by the clinical response; more or less may be needed to achieve the desired feces consistency. The most appropriate type of fiber to add for all gastrointestinal disturbances has not been determined. The choices include the (more insoluble) bulking fibers - the brans (wheat, corn, oat), and the (more soluble) bulking - fermenting fibers, such as psyllium. Canned pumpkin, which adds both water and fermentable fiber, has been recommended as a fiber source for constipated cats. If the fiber added produces flatulence, the amount may be reduced or another type chosen. Addition of fiber to foods may make them unpalatable to the pet. If this occurs, choosing a commercially available fiber-supplemented diet may be a better alternative. There are a variety of veterinary foods that have increased fiber content for dogs and cats, as listed in the Modified Fiber Diets Table in Appendix H and I. No clinical trials of any of these diets for treatment of constipation, or comparisons among the available diets have yet been reported. In humans, another factor that can aid in controlling constipation is increasing activity. Walking a dog immediately after feeding will often result in defecation. For cats, keeping a clean litter pan is an important environmental factor that will help encourage defecation. Obesity Therapy for Cats and Dogs
Obesity in pets is a very common problem today, affecting as many as 40% of dogs and 30% of cats.1 Understanding the causes of this increasing epidemic and being able to establish a successful weight management program is essential for veterinary clinics today. Although there is no absolute answer as to the cause of obesity, there are some suspected factors, as well as known ones, that can lead to the development of obesity in our pets. There has been some research regarding the possibility of genetic influence on obesity, where 30% - 70% of the risk was attributed to heredity in dogs.2 Some breeds that have been shown to have a higher risk of becoming obese include: Labrador Retrievers, Cairn Terriers, Cocker Spaniels, Dachshunds, Shelties, Basset Hounds, Beagles, and King Charles Spaniels 2. Other common causes that may lead to obesity in pets include: overfeeding pet food; too many treats; stealing food; not reducing food level after spay or neuter; and a sedentary lifestyle for the pet. For all breeds and species however, probably the most important factor leading to obesity is the excess intake of calories and/or a decrease in physical activity. This is referred to as a positive energy balance, when the energy intake exceeds the energy output. Energy expenditure in animals varies depending on the breed, age, sex, neuter status, and the life stage of the animal. One also needs to consider whether the animal is a performance animal (e.g., sled dog, hunting dog), or if they are pregnant, lactating or fighting off disease or trauma. Animals utilize energy through basic body functions (basal metabolic rate), thermogenesis, and activity. The amounts of energy used for these functions will change throughout the animal's lifetime, which needs to be considered when calculating the correct amount of food to be given. There are many misconceptions about obesity and disease. Although the problem of overweight animals is common in both veterinary medicine and human medicine, obese animals are not faced with the same specific problems as obese humans. There are disease processes that may be correlated to both obese humans and animals that include diabetes, osteo-arthritis, cardiovascular problems, cancer, skin problems, and increased surgical risk. These added risks alone warrant establishing a prevention/weight management program. Prevention The best way to prevent pets from developing a weight problem is to educate the client about proper feeding techniques and how to evaluate their pet's body condition before weight becomes a problem. A good time to do this is at their first visit to your clinic. This is important at any life stage of the animal. The best time to do this however, is when the pet is still a puppy or kitten; proper intervention at the start of life can ensure a lifetime of optimum weight. One suggestion would be to provide "go home kits" that contain food samples, literature on proper feeding, and a body condition scoring sheet, so the owner can monitor their pet's condition themselves and adjust food as necessary. It is important to actually teach them how to assess the rib cage, abdominal tuck, and waist parameters so they can adjust their pet's food intake as necessary throughout its lifetime. It is also very important to remember that when an animal is spayed or neutered, energy needs decrease by about 25%, so this is the time to instruct the client to decrease the food offered, or change the diet to one of lower caloric density. Many people believe that if they have their animal spayed or neutered it will automatically become overweight. If they follow the above guidelines, assess their pet's body condition, and adjust food intake as necessary, this should not be a problem. Weight Management Program Incorporating a weight management program in your clinic is the best way to ensure success with your clients. This is something the veterinary technician is more than capable of instituting and maintaining and can be a valuable asset to the clinic. The following guidelines explain how to structure a weight management program in your clinic:
When making recommendations to increase an animal's activity, first make sure the owner and animal both are physically capable of doing so, and remember to keep the owner's schedule in mind so that you are not asking anything that they are not realistically able to carry out. Many animals lead sedentary lifestyles due to their owner's work schedules. One suggestion is to adjust the animal's environment to increase its activity. Placing food bowls off the ground so the animal has to climb or jump to get it can do this. Along the same lines, baby gates or similar barriers can be placed in doorways so the animal has to work to get in and out of rooms in the house. If a client is too busy or physically not able to run with their dog, there are ways to increase the animal's activity by means of playful interactions in the house. If activity is allowed for the animal, playing fetch by throwing a toy up the stairs is a good means of exercise. This is also a good way to offer treats (instead of just giving them one). Another favorite is to have your dog do "doggie sit-ups". Having them "sit" and "lay down" 4-5 times before giving them a treat does this. There are also a large variety of interactive toys for dogs and cats that promote increased activity. A good way to begin a new exercise program is to set a goal to increase activity by ten minutes per day. If this is successful, you can slowly increase the duration until the pet's activity is at the desired level. Conclusion Obesity is a major problem facing many pets today. The attributable risks involved with this disease warrant the need for intervention, which can be achieved at veterinary clinics through educating the clients about prevention and instituting a weight management program. The veterinary technician is a valuable resource that can be fully utilized to institute and manage these programs to further benefit the clients as well as the veterinary clinic. References:
Diet, Nutrition and Cancer
Cancers are common causes of disease in dogs and cats. They usually affect older animals, and so have become more common as pets live longer. As longevity continues to increase in our pet population, we may expect this trend to continue. The role of nutrition in prevention and treatment of cancers varies with the type of tumor and the stage in the progression of the disease. Because cancers also are common among humans, there is a wealth of data from epidemiological and laboratory studies of the effects of a wide variety of nutrients and foods on numerous cancers. Unfortunately, few clinical trials have documented that these results can readily translate into improved patient care. Results of some of the epidemiological studies found differences in the distribution of cancer types between industrialized and non-industrialized populations. For example, breast, colon, lung, and prostate cancers were more common in industrialized populations, whereas cancers of the cervix, esophagus, liver, oral cavity, and stomach were identified more often among members of non-industrialized populations. These findings led to the idea that diet may play a role in prevention of cancer, although it was recognized that many features of these populations other than diet also differed. Estimates of the prevalence of common cancers in dogs are presented in Cancer Table 1. Similar epidemiological estimates are not available for cancers afflicting cats. A comparison of estimates of the prevalence of the most common types of cancers in humans, dogs and cats In the US are presented in Cancer Table 2. With the exception of breast cancer, the prevalence of common tumor types in humans is generally greater than in dogs or cats. Diet and feeding may play a role in both prevention and treatment of cancers. Some of the factors thought to influence cancer risk in humans are shown in Cancer Table 3. Based on recommendations presented in the table, one might expect the risk of mammary tumors in dogs to be increased by rapid growth rate prior to puberty. In fact, studies of dogs generally agree with recommendations for humans, having shown that these factors also are relevant to canines. Epidemiological studies in dogs suggest that a thin body condition at 9 -12 months of age reduced the risk of mammary tumors in spayed dogs by more than 90%. Even in intact dogs the risk was reduced by 40%. Although early spaying has a greater effect on reducing mammary cancer risk than does lean body condition, the added risk reduction provides additional support for recommendations to owners of young growing dogs to maintain them in lean body condition during the period of growth. For adult dogs, the recommendations to avoid excessive energy intake and maintain a moderate body condition, and to avoid excessive intake of animal fats may be pertinent. Comparable results in cats currently are not available. Given the differences in metabolism between cats, and dogs and humans, it is difficult to predict which guidelines may apply to feline patients. It may be that maintaining a moderate body condition and avoiding excess animal fat pertains to cats as well as humans and dogs, because some carcinogens are fat soluble. Thus, they may be contained in the fat of animals exposed to them, and also retained in the adipose stores of animals consuming this dietary fat. Beyond the important reduction in mammary cancer risk by feeding growing puppies to a lean body condition, the potential cancer risk reduction obtained by following dietary recommendations has not been well documented in veterinary medicine. According to studies in humans however, "eating right", staying physically active and maintaining a healthy weight can cut cancer risk by 30% to 40%. These large benefits may be even more achievable in our pets, because we have more control of their diet and food intake Nutrition also may play important roles in treatment of cancers. Beyond the possibility of increasing survival, nutritional intervention might improve quality of life for the patient and client satisfaction with therapeutic efforts. The utility of recommendations depends on the risk/benefit of the intervention, and the cost of the therapy. Historically, the interest in the role of nutrition in cancer therapy has been motivated in part by concern about cancer cachexia. Cancer cachexia, the wasting of body substances observed in some cancer patients, occurs relatively commonly in people, especially with pancreatic and gastric cancer. Loss of both fat and muscle mass occurs, and depletion of muscle mass often exceeds that of viscera. Weight loss usually occurs early in the course of disease, and is often apparent at the time of presentation. Food intake usually is normal at this stage, suggesting that decreased food intake is not likely to be a primary cause. The etiology of cancer cachexia is not known. Tumor/host competition is not the most likely cause of cancer cachexia; some patients with very large tumors show no signs of cachexia, whereas cachexia has been reported in patients with tumors that are only 0.01% of the host's weight. In dogs, resting energy needs of patients with nonhematopoietic malignancies were not different from normal, and were not altered by removal of the tumors. Cancer researchers have conducted an extensive search for a "catabolic factor", but to date no single factor has been identified. Cytokines (tumor necrosis factor a, interleukins 1 and 6, and interferon ?) do not seem to be responsible, but recently identified lipid and protein mobilizing factors may play a more direct role, at least in mouse model systems. Although common in humans with cancer, cachexia is not common in veterinary cancer patients. Moreover, nutrition intervention in humans with cancer cachexia does not appear to be successful in replacing muscle mass, with weight gains occurring only in fat and water. Most of the research investigating the role of diet in veterinary cancer patients has focused on lymphoma in dogs. Some of these studies focused on analytical variables, and one investigated the effect of outcome of a diet modified in a variety of ways on dogs with lymphoma. Many of the analytical variables examined, such as serum lactate and amino acid concentrations, were found to be altered in dogs with lymphoma. Unfortunately, the differences identified, although "statistically significant", were unlikely to have been clinically important. Moreover, the differences persisted in dogs in remission after therapy, further diminishing the likelihood of their relevance. The potential therapeutic value of a variety of nutrients at "nutriceutical" intakes has been investigated for their potential as cancer chemotherapeutic agents. For example, supplementation of diets with n-3 fatty acids and/or arginine has been investigated in humans with cancer. Unfortunately, although reduced infection rates and duration of hospital stay were identified, the interventions did not improve survival times. Several years ago, Hill's Pet Products, Inc. introduced an interesting diet designed specifically for dogs with lymphoma. One published clinical trial found promising results, but data from randomized controlled trials comparing this to diets of similar composition are not yet available for evaluation. Because of the preferences of the oncologists at our institutions, we have not had sufficient experience with this diet to comment on its efficacy. Given the current state of knowledge of nutrition and cancer, we agree with the American Cancer Society's "Cancer Facts and Figures 2003": (this phrase is redundant) "The scientific study of nutrition and cancer is highly complex, and many important questions remain unanswered. It is not presently clear (i.e., we don't know) how single nutrients, combinations of nutrients, overnutrition and energy imbalance, or the amount and distribution of body fat at particular stages of life affect ones risk of specific cancers. The same is equally true of the role of nutrition and cancer treatment. Pending clinically relevant developments, our recommendations for nutritional care of cancer patients are the same as those for hospitalized and critical care patients, and for those with chronic diseases. In summary, we believe the most important role we can provide [in our respective practices] is to encourage and support our colleagues [clinicians, students and technicians] as they discuss (critical/serious) quality of life issues with clients. One of the most obvious concerns for owners of cancer patients is making sure their pet eats every day. This is not always physically possible for patients who've undergone surgery, chemotherapy, and/or radiation. The ability of the veterinary health care team to provide short-term or long-term nutritional support through feeding tubes has greatly enhanced the quality of life for many terminal patients, and thereby maintained the human-pet bond that is so crucial for our clients. Learning how to place and manage feeding tubes should be a part of any hospital caring for cancer patients. We are also advocates of pet support hotlines and pet loss support groups, and recommend them for both colleagues and clients who are working through the process of grieving. Tips for Client communications
Owners who have pets that have been diagnosed with cancer often need some extra time to discuss the best way to feed their pet. The Internet is filled with many homemade diets that are geared for pets with cancer, and may cause confusion on the owner's part when it comes to deciding what the "best" diet for their pet would be. As a technician, here are some ways you can help be prepared for these clients: For your vet:
Table 1. Prevalence of common cancers in dogs. 
Adapted from Kelsey, JL, AS Moore, and LT Glickman. (1998). Epidemiologic studies of risk factors for cancer in pet dogs. Epidemiologic Reviews 20(2):204-217. Table 2. Approximate prevalence of common cancers in humans, dogs and cats. With the exception of breast cancer, the common tumor types in humans are not common in dogs or cats. 
http://cancercontrol.cancer.gov/ocs/prevalence/prevalence.html#allsites Table 3. Nutritional effects on cancer risk in humans. 
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