Nutrition- Final- 4

wilsbach's version from 2016-04-18 00:15

Annie, the diabetic cat.

Question Answer
fat cat is what kinda diabetes?type 2-- dec sensitivity to insulin
Pros and cons of hospitalized vs outpatient for inappetant DM cat?These cats have dec sensitivity to insulin, so their BG is high and they feel like crap. So you want to lower their BG. You can hospitalize for insulin as needed. But can try to send home with long acting insulin too. But at a hospital you can monitor their response, which you can't do at home.
So if the problem with a type 2 diabetic is that they are resistant to insulin but still producing insulin....why are we giving them insulin?shes not producing enough to overcome the resistance. so give her a high dose of insulin to overcome it.
what do you want carbs, protein, and fat levels to be like with DM?LOW carbs. HIGH protein. moderate fat.
So this cat is fat and diabetic. A diabetic diet has low carbs, high protein, and moderate fat. But you need them to lose weight- and a weight loss diet is high fiber, moderate carbs, low fat, high what do you do?well...Hills is the only diabetic diet which can be used to tx both DM and help with weight loss. If not choosing hills, you will need to get less food bc of the moderate fat content, so give WET FOOD so has satiating effect.
is there another benefit to the diabetic diet, aside from helping control BG? When do you want to start diabetic diet?want to start as soon as newly diagnosed, bc diabetic diet can actually help get cats off insulin/start remission IF STARTED EARLY.
4 main nutritional goals of feeding the diabetic cat1) primary goal is nutritional consistency. (want same level of protein, fat, etc every meal every day). that is most important. Let their body predict what it's getting. (2) control clinical signs (PUPD, keep animal alive. lots of ppl dont like giving injections) (3) improve peripheral insulin sensitivity (make them lose weight) (4) stabilize insulin dose (if have to keep them on insulin).
WHEN do you want to introduce the new diabetic diet to annie?WHEN SHE IS HOME AND FEELING BETTER so she doesn't develop aversion to it. In the meanwhile, feed her what she will eat.
what should you use to judge if you're doing a good job with annies BG?base it on CSs- if shes in hospital, the BG curve wont be too helpful bc shes super stressed which raises BG.
for an animal on insulin, when do you feed and when do you give insulin?ALWAYS FEED FIRST AND THEN GIVE INSULIN!!! if you give insulin and then they don't eat, they're gonna bottom out.

Chastity....overweight dog (weight loss diet)

Question Answer
one big thing you can ask owner to do in order to know where calories are coming from?food journal. Sometimes they wont believe all the things they put in their mouth!
Weight loss is more than about the animal- it's also about the person. Explain the "readiness assessment" of the clientThey can be in diff stages of readiness. You can sell them a weight loss program, but how ready they are determines if they will stick with it: (1) "pre- contemplation" stage- just found out, prolly surprised. Do Open ended questions, see where they are mentally. (2) contemplation is next stage. "Do you think my dog is fat"? Then ask questions (3) decision making stage- thinking about it. you told me,i thought about it. now theyre back and saying "what does this involve/ how much does this cost". (4) "Action phase" <--willing to do sthing. Make lifelong changes for their dog. which means they have to change their lifestyle to change the dogs lifestyle. When do all this, need to talk to person who is doing all the feeding. At action phase need to develop a plan. if family involved, everyone has to buy into it.
what should carbs, protein, fat, and fiber be like in weight loss diet?CARBS: moderate- majority should be from FIBER. protein: highish protein (don't want them to lose lean mass). fat: low fat. fiber: high fiber-- filling and low in calories. LIMIT TREATS.
when exercising, its all about...duration and intensity. at least 30min 2x a day and intensity depends on pt (if turn blue while walking, need to be careful).
The sensitive topic of treats- what should you consider? How much of the diet should be treats?Knee jerk reflex is to say none but no client will stop givign treat- so need exact treats, size, what they are, and number. Need to assign calories. needs to be . Have to assign calories! Has to be decided by everyone in family.
what suppliment can help be a fat burner while supporting lean mass?L-carnitine (amino acid derivative and nutrient involved in lipid metabolism in mammals and other eukaryotes). Also good for helping recovery from hepatic lipidosis
what plays a role in if you are "naturally" skinny or fat?your microflora
what are some things you can do to help keep the pet and client on track?rechecks (weight ins) with pictures, Change the bowl size (smaller bowl= looks like more food), food toys (move to get food), owner education, food journal, contests/awards, apps (but check these out before you recc them).
what is the problem with just feeding them less of their regular food?Might not meet their mineral and AA requirements. and hills doesn't have excess minerals in them. Can have micromineral deficiencies.
how should you calc your food dose for an obese patient?IDEAL WEIGHT at "obese prone" factor
So you calculate the amount of Kcals they need from their food a day...but wait, what about treats?need to subtract 10% kcal for treats! So *have to subtract treat calories before calculating food dose.
how often should you feed your weight loss pt?at least 2x a day.... Grazing meal theory in humans- thermic effect of food. Eat smaller amounts more often- use more metabolism to burn separately. small amount of evidence dog has same thermic effect of food. Cats do have some with carbs. Might help if do more meals per day but up to client
how often should you recheck your patient on their new weight loss diet?start with once every 2 weeks. every 2 weeks till start losing weight- then 4 week rechecks. If 6 weeks, client doesnt come back, they forget. be very up about congratulating him, reward them. if you can take pics thats great.
what is a safe amount of weight loss?1-2% of obese body weight loss per week. and to get that is hard- so hes not too worried. This is the max tho.
so say they reach their ideal weight- what now?Only one thing you can change- Amount you can feed her. Need to find isocaloric intake (taking in what they are burning). If switch to maintainance food- volume might be much less. can go from weight loss to lower calorie maintainance foods. but food dose will still be smaller. What about treat? Dont change em.
how do you find isocaloric intake?jump food dose up, once at ideal bw. jump up from 5-10% until stop losing weight.

Charlie dog, straining (stones)

Question Answer
things you should do if dog is strainingrectal to check prostate, Abdominal palpation.US abd- kidneys, bladder (can scatter sound waves if stones- will know sthing in there). Palpate urethra carefully. radiographs/urethral contrast study. MAKE SURE GET WHOLE URETHRA ON LATERAL RAD. Fecal- esp look for whips (bc large bowel- and whips in the large).
how can you guesstimate what stone types they have- and how do you go about testing thislook at urine pH!!! but urine strips aren't accurate- use a pH meter.
Alkaline urine (pH above 6.5) which stones will form?Mg, ammonium, phosphate, struvite.
Acidic urine (less than 7 pH) which stones will form?Urates, cystine, calcium oxalate
so basically, all the stones we've heard a lot about form in acidic urine, EXCEPT for _________ which forms in alkaline urinestruvite.
When should you be looking at urine sediment?while it is still warm from body! if cool, things can precipitate which wouldn't normally be there physiologically.
what should you know about seeing crystals on sediment?not necessarily type of the stone. Can be diff.
What should you keep in mind if you see bact on U/A?stain can have bact in it- culture most definitive.
infection or stone first?could be either way
which stone is usually 2* to infection? why?STRUVITE- because infection with urease-producing organisms splits urea into ammonia, which drives the pH up, which causes alkaline pH which struvites like to form in.
what is Urohydropropulsion, what is it good for?retrograde flush stones back into bladder. good way to get samples/remove stones
What age and gender tends to get STRUVITES?YOUNG, FEMALE (<2yr) (bc 2* to UTIs and females more likely to get UTIs)
stones more likely to occur in young animals (<2 yrs)Struvite, urates, cystine, CaOx
most to least radiodense stones? how big must stones be to see on rads?CaOx > struvite > urate and cystine. need to be >3mm to see on rads, but US can even pick up sand
what if blood urea nitrogen (BUN) low, on rads look like applejacks,and pH is 6.4-- what stones, and why?liver dz--> URATES.
what two things on chem might hint you what stone you have?BUN is low? might be urates (liver problems). Ca high? Might have CaOxs.
what are cystine stones made of? What can you do with diet to help?cystine stones are (cys= CystiEne) cys-cys= cystine is an amino acid. want LOWER PROTEIN DIET. and cystine is a type of AA might might a difference too. Since sulfur-AAs come from animal proteins, might want to dec protein and have the protein you do have come from more animal sources (REMEMBER CATS NEED S-AAs THO. CAREFUL).
So if cystine stones, change diet...lower protein, specifically sulfur containing amino acids (animal protein).
So if CaOx stones, change diet...lower Ca
So if Struvite stones, change diet...lower Mg (and treat that UTI probably)
So if urate stones, change diet...uric acid comes from protein, and there is non-protein nitrogen. nucleic acids. purines and pyrimidines. purines are source of uric acid. So lower nucleic acids... so lower in cells. What protein is low in cells though?? EGGS-- ONLY ONE CELL
*what is the drug you can give to help prevent urate stones? How does it work? what is the big precaution with this one?allopurinol, a xanthine oxidase inhibitor. but if you give those and then don't change nucleic acid level in diet, you get xanthine stones!!! SO MUST ALTER DIET-- EGGS are great bc only have one cell (very low nucleic acid content) soy flour and wheat gluten also work
What can you add to diet to acidify the urine (which stone is this useful for)(good for struvites bc they form in alkaline urine. cats like to make these). add sulfur containing amino acids (3-AA) (because sulfur-->sulfuric acid) can add D,L methionine (a type of sulfuric acid). Can add phosphoric acid also... Can do that for a dog too, if they happen to have struvites.
what can you add to diet to alkalize the urine? (which stones is this useful for)(basically stones that aren't struvites- so cystine, urates, CaOx, etc) give bicarb (HCO3), KHCO3, K-citrate (can binds to some stone constituents). Or NaHCO3 (sodium bicarb).
stone patient-- want wet or dry food?WET-- want lots of hydration to keep urine dilute (less concentrated=less chance of precipitation) (some companies add salt to try to inc water intake-- jury is out on if this is a good idea)
what does glucosamine have to do with stones?no evidence it works, but with glycosaamino glycans, there is lining of these GAGS on bladder, might play a role. prolly doesnt hurt. not sure if it helps tho.
drug with dogs for cystine stones?thiola- cysteines are more common in EU than US tho
you will need your stone dog back, for...serial UAs, culture urine
Dalmatians get what stone?Urates-- dalmatians dump uric acid out of kidneys and into urine (genetic thing). So will you have to do this lifelong? half way through life might be able to start feeling them anything (and stop thiola) and can not form more stones. but this is just dogs not cats.
naturally occurring inhibitors of stones?Tam's horse fall protein- this is a naturally occurring inhibitor found in urine. if they lack this, they tend to form stones more. Might explain why not all pets get these
naturally occurring promoters of stones?STRUVITE: classic precipitate formation. classic supersaturation with a nidus. CAOX: this is more like nanoparticles. Subset of human population which have genetic predisposition. Schnausers tend to get these.nano particules are tiny and they are initiation for the CaOx stones. So nanoparticles are a promoters for CaOxs.
Cats like to form which stones? (2)struvites and CaOx.
Cats like to form Struvites and CaOx...but how does signalment differ between the two?Struvites: young (<5yr). CaOx: Male, neutered, >5-7yr
how well do cat urinary diets help prevent the 2 kinds of stones they get?there is no data. There was one study- and showed no difference. for CAOx in cats. and they followed the stuff we talked about but didn't do anything about the nanoparticles (which is a big deal with CaOx).
if a cat comes in and is a stone former, what is the most important thing to start with?get them on WET FOOD to help dec concentration of urine
which breed of dog likes to form CaOx AND struvite?schnauzers
If an animal is forming CaOx AND struvite-- these have pretty diff ways to avoid. which should you treat??CaOx can only be removed bu sx-- so focus on CaOx diet. Can dissolve struvite. So put on CaOx diet, if form struvite, can dissolve them.
If you see urate stones....what should you look at?(1) is liver working (2) is it a dalmatian (3) look for genetic change in kidney