“Trust Your Gut:” Advocating for Best Patient Gastrointestinal Health

October 7, 2022

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By: Dr. Emily Dae Andersen, DVM, CVA, CVFT

I was taught in traditional Chinese veterinary medicine to first and foremost “heal the gut” and when overwhelmed by a complicated case, to initially focus on gastrointestinal health as a starting place. This approach has been invaluable as well as relevant as we discover the nuances and importance of the GI system to systemic health. Below are a few considerations to keep in mind when approaching both preventive medicine as well as diagnosis and clinical therapies:

Food, food, food
At the core of GI health is diet. Owners want veterinary guidance on what to feed their pets, and it is our responsibility as veterinary professionals to provide medically appropriate dietary recommendations. To ensure the best compliance with our dietary recommendations, we should be cognizant of the following in our recommendations:

1) Patient food preference.

2) Owner food preference (if an owner has a strong feeling about a diet, ask them why they feel that way. This provides us with an understanding of their desires and requirements.

3) Owner financial ability.

4) Product availability (food backorders are currently abundant).

I know, these conversations and education initiatives take time away from already packed schedules. For this reason, it is important to train and empower your technicians and support staff to help with this. Much of the work obtaining good diet history and discussing diet recommendations with owners can be performed by support staff.

Monitor body condition score
Pet obesity is a significant problem affecting the overall health and quality of life of dogs and cats. As such, it is vitally important to stress good body condition score at every veterinary visit. Educate all caretakers (including children!) on how to evaluate a pet for appropriate body condition. I like to utilize my knuckles as a tool for helping owners understand how ribs on a dog or cat should and should not feel.

Recall, as well, the significance of decreased caloric needs after spaying and neutering. Emphasize and instruct owners to monitor body condition score more closely after the surgical procedure as they potentially will need to decrease the amount of food, and thus calories offered soon, rather than months down the road once the pet has already gained an inappropriate amount of weight.

Tend the microbiome
The microbiome is a “hot topic” in many areas of veterinary medicine. This is for good reason as we understand more and more about the pivotal role of viral, bacterial, and fungal microbiome plays in systemic health and well-being. The gut-brain axis stresses the impact GI health has on emotional and behavioral health. As increased data regarding these nuances emerge, more target therapies can be initiated.

With this understanding of the microbiome, fecal transplantation from apparently healthy, screened donor animals has been administered as part of supportive treatment in parvoviral infection in dogs. Small animal medicine continues to expand utilization of fecal transplantation for an increasing range of applications in GI disease to replenish a healthier microbiota. As options such as fecal transplantation capsules become more widely available, this transplantation has become a more accessible treatment option for a larger population of dogs and cats.

GI supplements abound with varying degree of quality and efficacy. Prebiotics and probiotics are frequently incorporated into supplements to optimize GI and other systemic health. They are frequently utilized to help combat intestinal dysbiosis from primary acute or chronic GI disease, and should also be considered prophylactically when administering antibiotic therapy. Probiotic brands should be carefully considered, as quality control is of particular concern—some formulas may mislabel or provide too few viable bacteria cultures to achieve the desired benefit.

Cobalamin (vitamin B12) and folate (vitamin B9) are both vitally important for GI health and are frequently depleted in chronic enteropathies and GI disease. Supplementation is widely available in both injectable and oral forms, and as they are water soluble vitamins, toxicity is exceedingly rare. Blood level testing is also widely available, to screen for clinical deficiency and help monitor treatment success.

Consider alternative and integrative treatment modalities
Many integrative modalities can be beneficial as a part of multimodal approach of GI disease. Traditional Chinese veterinary medicine (“TCVM”) includes four branches: acupuncture, herbal medicine, food therapy, and tui-na massage therapy. While the benefits of acupuncture are most commonly associated with treating musculoskeletal disease, all four branches of TCVM can be beneficial for treating GI disease.

One lesser known modality is “aquapuncture”. An example of this modification of traditional acupuncture would be to administer the vitamin B12 parenterally into the specific acupuncture points for more long-lasting benefit. Particularly for those refractory chronic cases, consider referral for a consult with a veterinarian trained in TCVM.

GI health, from good prevention to effective multimodal treatment, is incredibly important. As our understanding of the complexities of the GI system grows, owners too are increasingly more invested and interested in discussing how to best optimize their pet’s health. Leveraging the entire veterinary team to best educate owners and advocate for patient GI health is critical for successful management and optimal outcomes for everyone.

Dr. Emily Dae Andersen, DVM, CVA, CVFT 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.

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