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Tag: Veterinary Nutrition

It’s time to hydrate: nutritious hydration solution hits veterinary wholesalers!
They’re not eating. They’re not drinking. And they’re turning their nose up at everything you offer. Add post-operative food aversions to a need to initiate voluntary fluid and food intake, and it can feel like an uphill battle of wills.

What have you got that supports hydration, is easily digestible and is palatable enough to encourage eating and drinking in your hospitalised and at-home patients?

Furr Boost has the answer…

It started with the bladder

Encouraging her poorly beagle Phoebe to drink is a battle Louise Toal faced after her vet diagnosed urinary issues. She just wasn’t interested in drinking. Luckily for Phoebe, Louise is a Food Technologist and began experimenting with protein shakes for dogs, to bolster hydration and combat inappetence. This is when Furr Boost was born.

It’s more than a hydration drink; it supports healthy digestion, immunity, metabolism and anxiety… plus, it’s delicious.

Furr Boost has taken the pet market by storm and even braved the Dragon’s Den dragons. Now, this highly palatable, nutritious hydration solution has hit your wholesalers for use in clinic!

What is Furr Boost?

In short, it’s a nutritional superfood smoothie for your canine and feline patients. Packed with 100% natural, functional ingredients and no fillers. It’s a low fat, but irresistible blend of meat, fruit and vegetables to use as a drink, food topper or boredom breaker.

Low in purine, protein, sodium and phosphorous, it’s ideal for encouraging inappetent patients to eat and hydrate post-operatively, during hospitalisation, and at home.

Hydration

Water… but tasty! More than 75% moisture content to replenish lost fluid and nutrients.

Healthy metabolism

Contains low-fat protein sources plus a blend of oils to provide energy for metabolism and to support a normal recovery.

Immunity

Packed with ingredients to support a robust immune system.

Digestion

Pre-biotics and dietary soluble fibre aid normal digestion and maintain healthy gut motility.

Anxiety

B vitamins and water combat anxiety. Use frozen or on lick mats to distract anxious patients.

Skin and coat

Full of naturally occurring fatty acids and omega 3 and 6 for hydrated, healthy skin and a glossy coat.

Furr Boost case study – meet Ozzy

Meet Ozzy the Saluki who was diagnosed with canine meningitis on 24 June, weighing in at 16Kg and was stabilised by the wonderful medical team who treated him.

Owner Jayne was very worried for her beloved pet and could see the visible signs of not only his weight loss after his ordeal, but also his mood.

Jayne said: “When he came home he was so skinny, dehydrated and reluctant to engage with food and drink despite what I tried. Then I discovered Furr Boost and imagine my delight when he absolutely lapped it up with real enthusiasm. He absolutely loves it!

“I was struggling to get him interested in eating anything to try and build him up while he was taking seven steroids a day. A Furr Boost a day has aided his progress I am sure. He is still on four steroids a day but his weight is now a healthier 22kg. Hoping for dose to reduce to two per day next week.

“It’s been a long job and he is very flat with the medication, which hopefully will start to improve. I was just so grateful to find your drink when things were looking very grim for him.”

While Furr Boost is mainly for hydration, the all-natural and human-grade ingredients are used to entice the dog to drink or eat if used as a topper. Our highly palatable formula is irresistible to even the fussiest of dogs and is packed with oils and nutraceuticals to get dogs back on their feet. Our drinks can be used in their pourable form or, for dogs who are not drinking, watered down by up to 50% to push fluids*.

* We recommend dogs drink 50ml of fluid per body weight and in extreme cases fluid intake should always be monitored.

Where does Furr Boost fit into your practice?

Whether it’s in the kennels, in recovery, or to recommend to your clients, Furr Boost is a highly palatable, convenient source of hydration and nutrition. Give as a drink to replenish lost fluids and nutrients, or feed it to encourage voluntary enteral eating and drinking, and to support normal gut motility.

If patients are food-averse, or the palatability of recommended diets is causing food refusal, add Furr Boost as a topper to soften kibble and entice their tongues back into action, with a range of lip-smackingly delicious flavours.

Furr Boost is suitable for:
- all dogs and cats over the age of eight weeks
- pregnant and whelping bitches and queens
- recovery
- dogs requiring a low sodium, protein, phosphorous or purine diet
- maintaining hydration
- supporting weight management or low-fat diets
- encouraging inappetent dogs
- end-of-life support
- distraction and enrichment, particularly for anxious or immobile patients
Get your free sample at The London Vet Show

Have you got a patient in mind that Furr Boost could support? Would you like to test it in your clinic?

Come along to stand F66 at the London Vet Show on 14-15 November 2024 to grab your free carton!

Not going to be at the show?

No worries, Furr Boost is now available via MWI Animal Health, Covetrus, and IVC Evidensia, or you can order directly at www.furrboost.com/veterinary where our team is also available to answer any questions.
October 18, 2024
Ionised hypocalcaemia, pt 2: eclampsia
As discussed in part one of this blog series, a myriad of disease processes can lead to ionised hypocalcaemia (iHCa).

Despite this, only hypocalcaemia caused by eclampsia and hypoparathyroidism (primary or iatrogenic – post-surgical parathyroidectomy) are severe enough to demand immediate parenteral calcium administration.

Hypoparathyroidism is quite rare, so this blog will not explore the detailed pathophysiology behind this syndrome. However, it is worthwhile mentioning – aside from primary hypoparathyroidism – no other disease state requires long-term calcium supplementation.

Eclampsia, on the other hand, is the most common cause of clinical hypocalcaemia in dogs and cats. Multiple factors can predispose animals to the development of this phenomenon, so understanding the pathophysiology behind this potentially fatal disease will not only help with future diagnosis and treatment, but also help prevent this issue.

Periparturient occurrence

Eclampsia – also known as puerperal tetany or periparturient hypocalcaemia – occurs in the periparturient period anywhere from the final few weeks of gestation to four weeks postpartum, with the latter being the more common time frame of manifestation.

The serum concentration of ionised calcium (iCa) is often less than 0.9mmol/L in bitches or less than 0.8mmol/L in queens. It presents as muscle fasciculation and tetany, but not usually in seizure since most patients maintain consciousness. Exceptions occur when these patients are left untreated – these patients may develop refractory seizures, cerebral oedema and death.

The increased muscle activity generates a lot of heat and uses a significant amount of glucose; therefore, hyperthermia and hypoglycaemia are common sequelae in patients with delayed presentations.

Reduced iCa

Eclampsia occurs as a result of reduced iCa in the extracellular compartment. In lactation-associated hypocalcaemia, it is the result of the body’s inability to maintain serum iCa through increased osteolytic activity and gastrointestinal calcium absorption, and reduced renal calcium excretion to compensate for the loss of calcium through milk production.

Other factors often predispose animals to developing eclampsia. These can include poor periparturient nutrition, excessive calcium supplementation and large litter size.

Excessive calcium supplementation in the prenatal period causes parathyroid gland atrophy, preventing parathyroid hormone release – resulting in reduced gastrointestinal calcium absorption and osteoclastic activity, and increased kidney calcium loss.

Clinical signs

Clinical signs can progress rapidly and become fatal if left untreated.

In the early phases, non-specific signs can present as:
- facial pruritus
- hyperaesthesia
- panting
- tremors
- muscle fasciculations
- paresis
- ataxia
Within a few hours, these clinical signs rapidly progress to rigidity, and tonic and clonic spasms with opisthotonos. By this stage, animals will develop severe tachycardia, tachypnoea and hyperthermia. Without treatment, a high mortality rate exists.

“Early supplementation of puppies and kittens with commercial milk formula will significantly reduce the lactation demand on the dam.” Image © Dobroslav / Adobe Stock

Patients presenting with eclampsia require immediate medical intervention, as well as concurrent supportive therapy. The acute management of clinical iHCa is the same, regardless of the cause, and will be discussed in detail in part three.

Supportive therapies required to manage and prevent a patient relapsing in eclampsia often include active cooling and glucose supplementation. In cases that seizure, anti-seizure medications – such as diazepam and barbiturates – and mannitol for cerebral oedema may be required.

Prevention

Even before getting to the stage where an animal requires treatment, all effort must be taken to prevent a dam from developing hypocalcaemia. This can be easily achieved by improving the calcium content of the food during the perinatal period, as well as reducing the milk demand by early weaning kittens or puppies. This is likely particularly helpful for those with a history of eclampsia or with large litters.

From the second half of gestation, it is recommended a commercial formulation of puppy/kitten food (1% to 1.8% calcium and 0.8% to 1.6% phosphorus) is to be fed to the dam without any additional minerals or vitamin supplementation.

Postpartum calcium is similar to the second half of gestation, requiring a diet containing at least 1.4% calcium with a 1:1 ratio with phosphorus (most balanced growth formula for puppies and kittens).

Less demand

Early supplementation of puppies and kittens with commercial milk formula will significantly reduce the lactation demand on the dam. Together with this, starting at aged three to four weeks, solids can be introduced at this time. These techniques will be particularly helpful to those with a history of previous eclampsia or those with large litter sizes.

Aside from the parenteral calcium supplementation required, other supportive therapy – such as active cooling, IV fluid therapy and glucose supplementation – may be required.

Long term, the dam’s nutritional content of calcium must be optimal from the second half of gestation. All additional calcium or other vitamins and mineral supplementations should not occur prior to parturition.

In the postpartum dam with a history of eclampsia or that is at risk, changing to a nutritionally balanced commercial food aim for growing puppies and kittens is ideal. Early weaning – or abrupt weaning if hypocalcaemia is severe – may be required in severe cases or those with a high risk of relapse/development.
February 6, 2024
Pancreatitis, pt 2: treatment and prognosis
Last week we covered diagnosing pancreatitis and the challenges associated with doing so. This week we look at management.

The treatment of pancreatitis largely involves supportive care and monitoring for potential complications. Here, we recap the fundamentals.

IV fluids

IV fluids are critical in the acute phase to restore perfusion to core organs and correct hydration deficits. Once achieved, the goal is then to cover maintenance requirements and ongoing losses.

Hypoproteinemia can develop due to a combination of haemodilution, increased losses in to inflammatory exudates or into gastrointestinal tract, and decreased production due to reduced intake.

Colloidal therapy or plasma can be considered, but enteral nutrition is more effective and has numerous other benefits.

Pain relief

Pain relief largely involves the use of opioids.

Pure opioid agonists, such as methadone, fentanyl constant rate infusions (CRIs) or fentanyl patches, are most commonly seen in dogs. In cats, partial agonists, such as buprenorphine, are favoured as the condition is generally less painful compared to dogs.

NSAIDs should be avoided due to concerns of poor perfusion, concurrent kidney and gastrointestinal involvement.

Antiemetic therapy

Metoclopromide CRI and maropitant are the mainstays. Antacids, such as esomeprozole, are included to help reduce the risk of gastric ulceration from stress.

Early enteral nutrition

Numerous studies have demonstrated the benefit of early enteral nutrition and patients should be encouraged to eat a low-fat diet as soon as possible. Enteral nutrition has been shown to be more beneficial than withholding food as it reduces recovery times and helps maintain enterocyte health.

If there has been a protracted period of anorexia then a nasogastric or nasoesophageal tube should be placed. A nasoesophageal tube has the added benefit of allowing excessive gastric secretions to be suctioned, as well as for feeding. Due the chronic nature of the disease in cats, oesophagostomy tubes are often placed so that nutritional support can be delivery for prolonged periods of time.

Antibiotics

Antibiotics are generally not indicated in canine pancreatitis unless markers of sepsis or if a septic exudate are found (this is an indication for exploratory surgery). In which case, triple antibiotic therapy consisting most commonly of amoxicillin, enrofloxacin and metronidazole are indicated.

It has been reported 35% of feline pancreatitis patients have bacterial infections; therefore, antibiotics are often included in the treatment of feline pancreatitis.

Exploratory laparotomy

This is indicated when the following has occurred:
- Extra-hepatic biliary obstruction that does not resolve with medical management.
- Septic abdomen (as mentioned above).
- Pancreatic abscessation.
Prognosis

The prognosis for pancreatitis is variable and dependent on the severity of the disease.

In mild to moderate canine pancreatitis (which is the most common), the prognosis is generally good as they will normally respond well to supportive therapy and resolution of clinical signs occurs within several days of initiating treatment. However, with severe acute, necrotising pancreatitis, the prognosis is guarded as it can progress into systemic inflammatory response syndrome, disseminated intravascular coagulation and multiple organ failure – which has a high mortality rate.

The prognosis of acute feline pancreatitis is generally guarded due to the chronic nature of the disease and the propensity to involve multiple organ systems.
November 6, 2023
Nutritional healing power
Nutrition is a key factor in a patients recovery; in fact, numerous studies show getting patients to eat as soon as possible or providing nutritional support early has several benefits:
- Patients start to eat on their own earlier.
- They are less nauseous once they start.
- Reduced mortality.
- Improved wound healing.
All of these contribute to overall improved outcomes for the patient.

Encouraging patients

At Animal Emergency Service we treat the sickest of the sick so we work hard towards encouraging patients – just like the kitten pictured above – to eat as soon as possible. So, after they have recovered from their anaesthesia we make sure there are no contraindications, we address their nausea and pain, then offer food.

It is best for the patient and feeding to use as much of the gastrointestinal tract as possible, meaning it’s better if they eat on their own, otherwise the next best thing is an oesophageal tube, followed by a tube into the stomach, such as a nasogastric tube.

Focused approach

So, in combination with the management of pain, nausea and the underlying illness, we first encourage them to eat on their own. We begin with offering an assortment of different foods, warmed up to increase aromas, or ask owners to try to feed their pet.

If they are critically ill we will take a more focused approach with feeding tubes, as they are unlikely to eat on their own by themselves for several days.

We feel a proactive approach to early nutrition helps get our patients home to their families earlier.
December 12, 2022
Focus on GDV, part 4: the recovery
Postoperatively, gastric dilatation-volvulus (GDV) patients remain in our intensive care unit for at least two to three days.

Monitoring includes standard general physical examination parameters, invasive arterial blood pressures, ECG, urine output via urinary catheter and pain scoring.

I repeat PCV/total protein, lactate, blood gas and activated clotting times (ACT) immediately postoperatively and then every 8-12 hours, depending on abnormalities and patient progress.

Patient recovering in the pet intensive care unit. As well as standard monitoring parameters, GDV patients have constant ECG, arterial blood pressure and urine output monitoring to enable the early detection and correction of abnormalities.

I always repeat these blood tests postoperatively, as IV fluids given during the resuscitation and intraoperative period often cause derangements. I use the results to guide my fluid therapy, but also take it with a grain of salt.

IV fluids

I generally continue a balanced and buffered crystalloid. The rate depends on blood pressures, urine output and assessment of general physical examination parameters for perfusion and hydration, but I try to avoid fluid overload and reduce the IV fluids postoperatively as soon as possible.

Coagulopathy

Prolonged clotting times are frequently seen as a result of consumption in a dog with GDV. However, one should note it can also occur as the result of haemodilution.

As the underlying disease process has been corrected, and haemostasis achieved during surgery, I usually monitor ACTs, but may not necessarily treat with blood products as prolonged ACTs do not always translate to clinical bleeding. Unless clinical evidence of bleeding exists, I generally hold off treatment and monitor.

Hypoproteinaemia

Low total protein is also common. This is generally due to haemodilution from fluid resuscitation. However, a low total protein does not mean oedema will develop, or that it requires management. I generally track the protein levels, use conservative fluid therapy and try to correct it by instituting enteral nutrition as soon as possible.

Electrolyte imbalances

Hypokalaemia is a common complication of fluid therapy. This can be rectified with potassium supplementation in the IV fluids.

Hyperlactataemia

If present post-surgery, this is usually corrected with a fluid bolus. However, I always assess for other things that may affect oxygen delivery to the tissues, such as poor cardiac output (arrthymias), hypoxaemia (respiratory disease) and anaemia (from surgical blood loss).

Arrhythmias

Ventricular arrhythmias are common post-surgery. Accelerated idioventricular rhythms are the most common cause, especially if a splenectomy was performed.

Ventricular premature contractions are common postoperative arrhythmia.

Before reaching for anti-arrythmia medications, first check and correct:
- electrolyte abnormalities
- hypoxaemia
- pain control
- hypovolaemia or hypotension
If they are still present, despite correction of the above, consider treating the rhythm if:
- multifocal beats (ventricular premature contractions of various sizes)
- overall rate greater than 190 beats per minute
- R-on-T phenomenon
- low blood pressure during a run of ventricular premature contractions
I start with a bolus 2mg/kg lidocaine IV and start a constant-rate infusion of 50ug/kg/min to 75ug/kg/min.

Anaemia

It is common to have a mild anaemia post-surgery, due to a combination of blood loss and haemodilution. In the absence of transfusion triggers – such as increased heart rate, increased respiratory rate or hyperlactataemia – it does not require treatment.

Vomiting

Anti-emetics are the first line of medication. Non-prokinetic anti-emetics, such as maropitant and ondansetron, can be used immediately; otherwise, after 12 hours, metoclopramide can also be used postoperatively. If the patient remains nauseous despite these medications, the placement of a nasogastric tube can ease nausea by removing static gastric fluid.

Excessive pain relief may also contribute to the nauseous state.

Pain relief

I mostly rely on potent-pure opioid agonists, such as fentanyl constant-rate infusions and patches. This is generally sufficient for most patients. Ketamine is occasionally used.
- Some drugs listed in this article are used under the cascade.
January 17, 2022
Breaking away from a vet’s diet of fast food

A while ago, I wrote about anorexia in vets… the stripped down, bare meaning being the clinical sign of “not eating”. As a student, I witnessed vets on placements routinely forgoing lunch or existing on a diet consisting entirely of Pot Noodles or fast food – one vet I shadowed had either a McDonalds or KFC on four of the five days.

Then, I could appreciate the lack of time and energy for cooking, but still couldn’t imagine being able to stomach so much junk food. I could not understand how you could work effectively and remain healthy while pouring so much crap into your body – and, of course, you can’t!

Isn’t it ironic that part of our job is to advise on diet and nutrition for clients’ four-legged friends, yet we don’t take our own advice?

Realisation dawns

Image © miketea88 / Adobe Stock.

As a student, there would be rare occasions I wouldn’t get lunch until 4pm or would just order a pizza through tiredness (or, more likely, from being hungover). But, on the whole, I had a pretty good diet. I exercised a lot and was organised enough to make lunch 90% of the time, so I was never stuck without food.

Yet now, as a new grad, I totally get the unhealthiness; it’s not really a matter of choice, but more a matter of pure exhaustion.

I found myself going without lunch on numerous occasions, mostly due to being stuck on farm all day TB testing, but sometimes due to being swamped with surgeries. Having not been able to stop for food all day, my first exploratory laparotomy was done after inhaling a cupcake – not the most nutritious of lunches.

24/7 shopping

There have been weeks I have consumed more takeaways or McMuffins than I am proud of, purely down to a lack of time and effort. I’m too tired to shop for food, or cook it, and I don’t want to spend all weekend meal-prepping for the week ahead, which is what my more organised, student self would have done.

It also doesn’t help that shops close early on a Sunday in England. I was definitely spoilt in Scotland, where 24-hour opening actually means 24 hours, 7 days a week.

If I cooked like I did when I was a student, my day would literally be work, cook, eat, sleep. But, to be honest, it’s not much better anyway – more like work, pick up takeaway, eat, sleep.

Maintaining a work-food balance

I do manage to get out on the bike at weekends, but not during the week, and as a former gym frequenter at uni, it gets to me sometimes that I’m becoming seriously unfit. Perhaps the answer is to get up early and go to the gym before work, but that’s not in my nature… I tried early running once, and all it did was make the day feel really long by 9am.

Mental health and well-being are constantly in the veterinary media at the moment, and, while I can empathise with my colleagues who lead the lifestyle of fast food, I’m not condoning it. This is no way to carry on. We need to try to achieve an acceptable work-life balance and, at the very least, a good work-food balance, which is something I am apparently not very good at yet.

I’m told it gets easier. Whether that means you get over being so tired all the time or just get used to it and somehow manage to power through, I’m not sure, but I hope it does – and I hope I find the energy to improve my diet.

December 1, 2017
Eating disorders and the veterinary profession

The general public associates the word “anorexia” with the eating disorder characterised by refusing to eat to lose weight, which, in human medicine, has the more specific name of “anorexia nervosa”. As vets, we use the word the term “anorexic” in the slightly different sense of being a clinical sign our patients exhibit – defined as “a lack or loss of appetite”.

Is the veterinary profession practising what it preaches when it comes to nutrition?

When referring to vets themselves, however, these definitions blur together a little, but I believe many vets frequently exhibit clinical signs that may or may not be part of an eating disorder.

While there is a lack of hard evidence or figures for eating disorders within the veterinary profession, it is estimated 10% of UK veterinary students suffer from eating disorders (not limited to anorexia nervosa), which is higher than the figure for the general UK population, which sits at 6.4%. (vetlife.org.uk).

Another branch

We are all made very aware of the mental health statistics and suicide risk of vets, and eating disorders are another branch of that tree.

Despite the lack of evidence to back up the theory, based on anecdotes alone, I’m willing to bet eating disorders, or even intermittent “anorexia” (the clinical sign), are more prevalent in qualified vets than the general population.

I’ve lost count of the number of times I’ve been on EMS and spent the entire day in the car with the same vet, going from call to call and not seeing them eat once.

I’m probably on the other end of the scale; I tend to get indigestion and heartburn from excess stomach acid production if I don’t eat regularly enough, so I tend to stress about the next time I’m going to eat (which turns into a vicious cycle because those symptoms also develop as a result of that stress). Therefore, I always try to ensure I have a packed lunch so I never get caught out.

On the road

Veterinary professionals on the road can often find themselves picking up fast food, which will be of long-term detriment to their health.

The number of ambulatory equine or farm vets who don’t appear to carry food in their cars is astounding.

They often rely on getting time to stop for food – which, inevitably, results in them not eating for the whole working day or picking up unhealthy fast food or snacks, which isn’t really much better.

When discussing my observations with fellow students, many of them have similar tales, and the problem is not limited to ambulatory practice.

While many vets and nurses in small animal practice will have a slightly more routine structure to their working lives, there’s always the odd mad day, week or month when they just can’t seem to grab a minute to supply their digestive system between consults, surgeries and emergencies.

Despite my own claim of always being prepared to avert such situations, sometimes they’re unavoidable.

I’ve found myself a few select times during rotations when I’ve been so rushed off my feet, trying to get everything done or see clients, that I haven’t eaten lunch until well after 4pm. Then, it’s likely I’ve got to that stage of being “past hungry”, but, as it is at that point I normally get headachey and feel a bit weak, I force something down despite not really wanting it any more.

Can’t or won’t?

Now, there’s a subtle difference between anorexia (a “lack of appetite”) and physically not having a chance to eat despite the grumbling in your stomach and the agonising knowledge there’s a pretty decent lunch waiting in the fridge in the next room – but it’s a fine line.

If a client has been waiting 20 minutes for you already, surely another two won’t hurt while you inhale a sandwich? Are vet staff just too busy to eat sometimes or are they not finding the time themselves? No matter how stressed and busy you are, you should still be able to satisfy the basic human right of being able to eat.

I believe the problem of the profession not eating properly is a combination of possible eating disorders, stress related anorexia and the working environment.

Take responsibility

Finding time to eat is crucial, says Jordan, for the health of both the profession and its patients.

I have previously expressed my opinion of the poor work-life balance within the UK veterinary profession, and ignoring rest breaks that are a legal requirement in almost any other field – while not entirely to blame – certainly doesn’t make it easy for vets to look after themselves.

On the other hand, vets need to take personal responsibility for their own health and find time to eat during the working day – if you don’t look after number one, you won’t be providing optimal care to your patients.

As much as skipping one meal might seem like a short-term solution to helping a patient that little bit sooner, it will be at the detriment of your clinical ability in the long term.

Evidently, this is not a clear cut problem and, as such, there’s no fix-all solution.

However, I think vocalising these issues is a good starting point if we wish to become a more healthy, sustainable profession in the future.

November 2, 2016