Taking Action With the AAHA September 23, 2010 By Katherine Knutson, DVM & Susan Thorson, DVM The AAHA for Dogs and Cats were sponsored by a generous educational grant from Hill s Pet Nutrition. Educational events are presented in collaboration with Hill s Pet Nutrition. AAHA for Dogs and Cats Kimberly Baldwin, CVT, VTS, ECC Joe Bartges, DVM, PhD, DACVIM, DACVN Tony Buffington, DVM, PhD, DACVN, Chair Lisa M. Freeman, DVM, PhD, DACVN Mary Grabow, DVM Julie Legred, CVT Donald Ostwald, Jr., DVM, DABVP (Canine & Feline) Extended Evaluation The Circle of Nutrition Animal factors Diet factors Feeding factors Environmental factors Interactions Used with permission of the American College of Veterinary Nutrition, www.acvn.org 1
Body Condition Score Muscle Condition Score Basic Assessment Nutritional Screening Risk Factor History Altered gastrointestinal function (e.g., vomiting, diarrhea, nausea, flatulence, constipation) Previous or ongoing medical conditions / disease Currently receiving medications and/or dietary supplements Unconventional diet (e.g., raw, homemade, vegetarian, unfamiliar) Snacks, treats, table food > 10% of total calories Inadequate information about or inappropriate feeding management Inadequate or inappropriate housing Check () if present Physical Examination Body condition score 5-pt scale: any score other than a 3 9-pt scale: any score less than 4 or greater than 5 Muscle condition score: Mild, moderate, or marked muscle wasting Unintended weight loss of > 10% Dental abnormalities or disease Poor skin or hair coat New medical conditions / disease 2
Extended Evaluation Screening Animal Diet Feeding Environment History Food intolerance Barren or chaotic Altered GI Function Overeating, gorging Spoiled food environment medical conditions/disease Effect on FI? Correct diet for disease? Effect on FI? Effect on access or compet. for food? Meds ± diet suppl. Affecting diet adequacy? Effect on FI? Total calorie intake? Who is doing this? Are others affected? Unconventional diet Is the diet satisfactory? Other unconventional? features Snacks, treats, table food > 10% Inadequate or inappropriate housing How is the pet affected? Effect on diet adequacy? Effect on FI? Other features affected? Barren or chaotic; competition Physical Examination BCS MCS Many diseases BW > 10% dental dz or disorder Effect on appetite or Poor skin or hair coat food intake? Quality, suitability for the situation identified Amount, frequency Effect on access or compet. for food? Others with similar problems? New disease Establish Individual Patient Action Plan Implementing a nutrition service within your hospital Between the different patient life stages Between different disease states Creating the same message between staff Gaining compliance with your clients Goals Today Understand that nutrition is medicine Evaluate your hospital s approach on nutrition Create ways to implement nutrition as a service Design new protocols Develop nutrition roles for each team member 3
Traits of a Practice where Nutrition Is An Integral Component of Excellent Medicine Passionate and committed leadership to the importance of nutrition Belief and culture that nutrition is an important component of medicine Consistent Communication is the cornerstone of any successful program Written protocols that establish your practice s medical recommendations Evaluation process for compliance and function Nutritional medicine is dynamic Continuous training of the entire veterinary healthcare team Nutrition is Medicine 4
Evaluate your hospital s approach on nutrition Where to begin? Jump Start? Blow Up? Implementation Action Item #1 All Hospital Staff Needs to Read AAHA for Dogs and Cats Kimberly Baldwin, CVT, VTS, ECC Joe Bartges, DVM, PhD, DACVIM, DACVN Tony Buffington, DVM, PhD, DACVN, Chair Lisa M. Freeman, DVM, PhD, DACVN Mary Grabow, DVM Julie Legred, CVT Donald Ostwald, Jr., DVM, DABVP (Canine & Feline) Nutritional Assessment Quick Reference Guide. The resource guide is available in the links box and on the web page for this event. 5
Welcome Finally Friday Meeting Who What When Where Why How When doing strategic implementation always be able to answer the following: Today s Agenda General Update 8-8:45 Review of AAHA for dogs and cats 8:45-9:45 What are we doing? 9:45-9:55 What are we not doing? 9:55-10:15 Rank items to be implemented 10:15-10:45 Determine who will implement 10:45-11:30 Who is in charge of follow up?11:30-12:00 6
Welcome Finally Friday Meeting Part Two: Nutritional Guidelines Today s Agenda Discussion of healthy non-therapeutic dietary recommendations along with therapeutic recommendations using evidence based medicine We need to give consideration to our patient s nutritional status in both wellness and sick exams 7
Healthy non-therapeutic dietary recommendations Based on Life stages: Kitten / puppy Breed specific Young adult Adult Mature Distinguished 8
Therapeutic Guidelines Obesity Arthritis Kidney Disease Liver Disease Heart Disease Breed specific requirements FLUTD Diabetes Cancer Critical Care Starvation Post surgery Dental Senility 9
Design new protocols Protocol name: Obesity/weight reduction Basic Idea: Successfully establish a protocol for patients that need weight reduction Rationale: Obesity and morbid obesity carries significant health risks which reduce both the quality and longevity of our patients lives. How it will work: All staff members will promote a healthy BCS at all times. Each will have a script that respectfully allows them to discuss weight. Who needs to do what: Client service- BCS, MCS, weight tracking, calorie requirements, send out congrats cards, be versed on health risks CVT CS plus dietary recommendations CVTA s same as CVT s Volunteers BCS, MCS, support for dietary recommendations Management - same as CS Doctors all of above along with recent evidence based medicine on obesity Body condition score 9/9 Needs weight loss of 5 pounds Can eat ½ cup of r/d daily Environmental stimulation Weigh every two weeks Nutrition is Medicine Your clients know that NUTRITION for their pets is very important They are going to follow someone s advice- let it be a medical recommendation Make certain that your hospital knows more than the pet store clerk Educate your clients so they make the right nutritional choices for their pets 10
YOUR NUTRITION EDUCATION AAHA Nutritional Guidelines - lists many excellent websites as references Veterinary Conferences Veterinary Journals Ask the pet food representative for your clinic for abstracts and journal articles relating to nutrition in pets, along with any courses they offer Learn about levels of research Evidence Based Medicine Team Education Nutritional CE at staff meetings Provide information on the science of nutrition & the tools to communicate it to your clients. Remove the translational barriers Present this in everyday language as opposed to the language of medicine Make these talks short and concise Address the client perspective Needs to be ongoing conversations Add a bit of humor and have FUN!!! 11
Mini CE Subjects The role of nutrition in puppy and kitten growth. What s the big deal about large breed puppy formulations? How important is salt or omega fatty acids in diets for cats with urinary tract disease? How can a food help a cat with chronic kidney disease? Why on earth does this food cost so much? Is table food OK to combine with an allergy diet? How is JD different from glucosamine supplements? How to take the weird out of explaining Brain Diet. Nutritionists and Nutrition/Food companies representatives often will visit your staff meetings to provide education. This brings a fresh perspective and new means of presentation along with up to date research information. There are many web based nutrition curriculum opportunities available for staff. These are motivational with milestones and prizes. Interactive Learning Techniques See one, Do One, Teach One Interactional Learning Transmission Type Education 12
Interactive Learning Activities Role playing Nutritional jeopardy Body Condition Scoring lab Exam Room Implementation Goals efficient, convenient, part of the rest of the process, effective & interactive communication with your client Include prompts & resource materials in the exam room Report Cards / SOAPS Examination Record These must have a space to record the following: Life stage or age equivalent Weight and Previous Weight BCS & MWS Current Diet & Snacks & Supplements Your nutritional recommendations Picture of the BCS you utilize and circle what the patient is at that exam Writing down this information validates it in your clients eyes 13
Involving your Client Have a Body Condition Scoring Diagram accessible Have client friendly anatomic models & diagrams available Have Caloric Requirement Charts available You now have your client involved and engaged in an interactive conversation about their pet s health. 14
You have become your client s GUIDE to their pet s nutritional health They have been shown pertinent aspects of their pets nutrition during the physical examination. They have seen and felt their pets body & muscle condition score. They will receive an individualized nutritional plan based on the nutritional assessment and the physical examination. Interactive conversations are far more effective in gaining client acceptance and support of your medical recommendation plan. The pet has a greater potential for receiving the care and support they need. The client is happier. You are happier with this method of medical relationship. Pet Nutrition Events Local Events AmeriCanine Idol Paws In The Park Grand Opening of the Dog Park Community Events Duck Race Kids Safe at the Local Hospital Fall a- Palooza fun run event Pet Health and Fitness Fair Summary You will assess the nutritional status of your practice with the traits of a practice that embraces nutrition as an important component of excellent medicine, and with the AAHA Nutritional Assessment Quick Guide. You can access a number of resources for learning about nutrition. You will work with your team to develop your nutritional protocols. The exam form &/or report card will be structured with the prompts for pertinent information. Body Condition and Muscle Condition Scoring will be used in the exam process to draw in client participation. Nutrition will be included with the other components of excellent medical care such as diagnostics, procedures, and pharmaceuticals. Education of your team will become an ongoing process. The subjects will be presented in client language. The points to be remembered will be few & concise. You will make the learning interactive and bring in an element of fun. 15
Questions? 1. To complete the evaluation, please go to the following website: http://www.keysurvey.com/survey/329075/d818/ 2. After completing the evaluation, you will automatically be linked to the Continuing Education Certificate. The CE certificate can only be accessed after the evaluation is completed. 3. Download the CE Certificate (in pdf format) to your computer and print enough copies for those persons viewing the web conference with you. Your input is very important! We take feedback seriously in order to provide you with the highest quality experience possible. If you have any questions about completing the evaluation or accessing your CE certificate, please email us atwebconference@aahanet.org or call 800/252-2242. Questions to the Speaker Please email your questions to webconference@aahanet.org by Thursday, September 30, 2010. Dr. Knutson and Dr. Thorson will provide written responses to all of the questions and they will be posted on AAHA s website by Tuesday, October 12, 2010. The AAHA for Dogs and Cats were sponsored by a generous educational grant from Hill s Pet Nutrition. Educational events are presented in collaboration with Hill s Pet Nutrition. 16
Tough Talk: Communicating Nutrition With Difficult and Not-So- Difficult Clients webcast, October 4 17, 2010. Nutrifluent: Speak the Clients Language workshops, beginning October 2010. Please visit www.aahanet.org/nutrition The AAHA for Dogs and Cats were sponsored by a generous educational grant from Hill s Pet Nutrition. Educational events are presented in collaboration with Hill s Pet Nutrition. 17