Page 3 - Appetite_Stimulation_In_Dogs_Complete

In the presence of disease, if patients are
Patients might have a very
treatable disease but the
medications make them feel
bad, so the owners stop
treatment because they lose
faith that we can get a positive
outcome.
—Dr. Cook
2 clinician’s forum February 2018
not eating, it is much harder for them to
heal, and much harder for us to treat the
disease process.
—Dr. Burney
Veterinary Cooperative Oncology Group Dr. Freeman: In heart failure, hyporexia
(VCOG) has published a grading system for and dysrexia are huge problems. I hear
appetite. But there are at least 3 other this all the time from owners who spend
grading schemes that I have found. So half their day trying to get their dog or
pinpointing the incidence of inappetence cat with heart failure to eat.
is challenging. In the literature, it ranges
from 20% to 80% in oncology, depending Dr. Johannes: Many of my patients
on the chemotherapy used, and 20% to starting chemotherapy are suffering from
50% in general. In cancer, when chemo- hyporexia or dysrexia. Gastrointestinal
2
therapy is quite effective, we are killing off lymphoma is probably the worst because
a lot of tumor, which releases cytokines, I don’t know if they’re not eating because
further exacerbating the inappetence. of the chemotherapy, because of the
disease, or both. Depending on the type
Dr. Burney: The ultimate consequence of chemotherapy, probably between
of continuous inappetence is death. 15% and 50% experience some level of
However, the prevalence of inappetence inappetence. We expect to see it with
is difficult to determine. In my practice doxorubicin, but depending on the
probably about 30% of patients have patient, it’s even seen with vincristine
some form of hyporexia or dysrexia, but and cyclophosphamide. We need to
the percentage is definitely not that high emphasize to our clients what they may
for anorexia. I can’t tell you how many see and the importance of reporting
times a client tells me, “Oh, Dr. Burney, what they’re experiencing at home.
my dog is not eating anything at all.” On
questioning, I learn that just yesterday Dr. Cook: Dogs with chronic pancreatitis
he ate a Vienna sausage, a pig’s ear, and diabetes frustrate me the most.
and several cat treats––more than his You’re dealing with not only inappetence
caloric requirements, but low-quality or but also with its complications and the
inappropriate foods. In such cases, the stressor of giving insulin. Clients quit
consequences can be severe nevertheless. giving the insulin, and then the patient
Then, in the presence of disease, if becomes ketotic. Or the patient will eat
patients are not eating, it is much harder something inappropriate and the
for them to heal, and much harder for us pancreatitis flares up. Other patients
to treat the disease process. If they need might have a very treatable disease but
any medications or surgical procedure the medications make them feel bad, so
that might impact their appetite and they the owners stop treatment because they
already are not eating, it just makes it that lose faith that we can get a positive
much harder to help a patient get better. outcome.
Dr. Freeman: In one study we did with Dr. Larson: Does your approach
dogs with heart failure, appetite changes change if faced with an acute
were an important reason that owners versus chronic condition associated
ended up euthanizing their dogs. So not with inappetence? And what’s the
only is it bad in terms of the disease, but impact when you do not yet have a
it may be the reason owners give up. diagnosis?
Dr. Larson: Can you tell us more Dr. Burney: Nutritional support is
about inappetence in heart disease incredibly important in all patients
and other common conditions? regardless of whether they have an acute