By: Dr. Emily Dae Andersen
Managing chronic disease such as hepatic and renal disease warrants a multimodal approach and close owner communication and trust. Consider owner compliance and buy-in, adjunct therapies such as supplements, and overall systemic patient health for the most successful long-term outcomes.
Familiarize yourself with supplements and nutraceuticals
Supplements and nutraceuticals can provide an area of discomfort for some veterinary professionals. Yet data increasingly shows important benefits and they should not be dismissed in the treatment of many diseases. Utilizing supplements with which you are comfortable form an important adjunct to management of hepatic and renal disease. In fact, ACVIM consensus statement recommendations for treatment of chronic hepatitis include utilization of SAMe, silymarin (from milk thistle), and vitamin E for their antioxidant and anti-inflammatory properties. Benefits of omega-3 fatty acids (such as EPA and DHA) abound, including in management of renal disease. When selecting an omega-3 source for dogs and cats, inform owners that fish oil is more bioavailable and appropriate than flax seed oil.
Similarly, keep an open mind to the benefits of traditional Chinese veterinary medicine. As studies and clinical success increase, traditional Chinese herbals such as rehmannia and astragalus are becoming more commonly utilized in management of chronic renal disease. Similarly, while some may reserve acupuncture benefit to musculoskeletal or neurologic, it can be incredibly beneficial in a multitude of internal medicine diseases.
Increase owner buy-in
Supplements and nutraceuticals are commonly administered by pet parents. Many owners of pets with systemic disease are inclined to investigate a wide array of treatment options, particularly as feelings of desperation take hold. Increase owner buy-in of your medical advice and provide recommendations of trusted and data-backed supplements to your patients. Aim to gain familiarity with particular supplements, their benefits, and quality control. For these supplements, a variety of administration options such as chews and liquids are often available to facilitate patient compliance. Directing clients toward specific dosage and product recommendations will improve clinical outcome both from the physical benefit of the specific supplement and in owner likelihood to follow further treatment recommendations.
Support systemic patient health
Remember when treating any specific disease that you are first and foremost treating the entire patient. As such, the importance of systemic patient health warrants review, as the body’s interconnected workings collectively inform patient health and well-being. Inflammation from causes such as periodontal disease has been implicated in organ disease and systemic inflammation. Similarly, a correlation between tracheal collapse and liver disease has also been noted. This is likely secondary at least in part to hypoxia and hypoxic hepatic injury. Therefore, in approaching hepatic and renal diseases, remember to not overlook other systemic diseases as an important aspect of treatment of these specific organ disfunctions. The path toward greatest patient health and well-being is often not linear, even when looking at the treatment of specific diseases such as those affecting the liver and kidneys. Assessing patient health as a whole helps target systemic well-being and garners owner trust and compliance to provide the best outcomes for our beloved patients.
Dr. Emily Dae Andersen currently runs an integrative small animal house call practice and works as a high quality/high volume spay/neuter surgeon. She has also completed advanced training in traditional Chinese veterinary medicine, including acupuncture, herbal medicine, food therapy, and tui-na. Dr. Andersen is passionate about access to veterinary care, both stateside and abroad. Dr. Andersen splits her time between Connecticut and Vermont where she shares her life with a menagerie of beloved animals.