Managing multiple diseases

A huge pain point for veterinarians is knowing what to recommend when you have a patient with more than one disease state. While every pet is going to have unique needs, these cases can be some of the most difficult when trying to choose what nutrients to target.

Disclaimer: I am not a veterinarian. As a Registered Veterinary Nurse I support vets in their clinical decision making. These tips are based on my experience in implementing nutritional therapies, and are designed to help guide vets choose an appropriate diet for their patients with complex needs. This post is not a substitute for a veterinary consultation or meant to replace medical advice.

When deciding what to feed a patient with multiple conditions, we must first sit down and really think about the case. What I find helpful is writing it all down – First, I list out the pet’s health conditions. Next, I take note of the nutritional factors for each condition. Finally, I note down any specific needs that patient has – do they have allergies? Do they only eat one type of food? Do we anticipate any challenges?

Note – I don’t expect this to be done within a consultation! I recommend asking if the owner will be comfortable for you to call or email them back later once you have had a moment to determine the best diet recommendation for their pet, as their case is complex and unique. Many pet owners will appreciate that you have taken extra time and care for their pet.

With all of these noted down, my next step is looking for similarities;
– Do any of the nutritional factors cross over with any of these conditions?
– Are any of these conditions triggered by any specific nutrient?
Many co-morbidities are closely linked to eachother, sometimes one triggers the other so nutritional management must take into consideration the pathophysiology of these conditions. Thinking about the ‘why’ of these conditions will help us understand how they are similar to eachother and in turn, what we can do nutritionally.

After looking at similarities, next I look at what factors conflict with eachother. Is there a nutrient that for one condition needs to be increased, but for another needs to be reduced? For example, if the patient is obese but has osteoarthritis, we would want to reduce fat content for the obesity but keep some level of fats in the form of omega oils to support the joints. It’s with these cases that I look at two points; which of the conditions is a higher priority, and which can be managed with medication. In the case of obesity and osteoarthritis, the obesity would be a higher priority as it cannot be medicated and it can be nutritionally managed which will in turn relieve some of the discomfort from the arthritis. The arthritis can also be medically managed, so the weight loss is more “important” in this case.

If you still cannot come to a consensus after looking over these points, you will need to look for a middle ground. When we look at nutritional factors, they are usually listed as a range – not a single number. This gives us some room to move when deciding on the values that are still going to be acceptable to our patient’s needs. For example, one condition may call for 20-30% protein on a dry matter basis, and another may want protein less than 20%; for this we can look at using a diet that is in the lower end of the range, around 20-25% which will likely still manage both conditions relatively safely.

My patient has developed a new condition, what do I do now?
If you’ve already implemented a nutritional plan for one or more conditions, and your patient has developed a new condition, you don’t always need to change the diet. Crazy, I know. But it’s important to once again think about the pathophysiology – did the disease or the diet cause the situation to change? More often than not when we change things in the diet, or treat a condition, it may uncover underlying issues we didn’t see coming. It doesn’t always mean you did something wrong. That being said, if you’re still stuck and not entirely sure what to do next, it might be time for referral to a Board Certified Veterinary Nutritionist, or Internal Medicine Specialist.

Still not sure? Ask me a question about managing multiple diseases down below!