Good evening everybody and welcome to tonight's webinar. My name is Bruce Stevenson and I have the honour and privilege of chairing a topic which is incredibly close to my heart, and that is, feeding strategies for senior pets. We are in for a big treat tonight with our speaker.
Before I introduce the speaker, I would just like to thank Purina, our sponsors, and we've got Gelner on, who's gonna give us a couple of words after I've introduced the speaker. Before we even get that far, a little bit of housekeeping, for those of you that haven't been on a webinar with us before. If you have any questions for our presenter, simply hover your cursor over the screen.
You will see a little control bar that pops up along the bottom. There's a Q&A box. Click on it, type in your questions.
They will come through to me and we will be holding those questions over to the end. . So that we don't disturb the rhythm and the flow of the presenter tonight.
We will get to as many of those questions as we can. We often in these cases don't get a chance to do all of them, but we will get to as many as we can. So as I promised you, we are in for a treat tonight.
Doctor Julie Churchill is a diplomat of the American College of Veterinary Nutrition. And is an associate professor and directs the nutritional services at the University of Veterinary Medical centre. She is passionate about all aspects of small animal clinical nutrition, including the role of nutrition in maintaining wellness, obesity prevention, and the treat and treatment.
The nutritional needs of geriatric patients, the nutritional management of kidney disease, as well as critical care and nutrition. She's interested in improving client communications to successfully integrate nutrition into primary patient care, which is where it should be. Julie serves on the task force, writing the AAHA guidelines for weight management and serves on the board of the Association for the Obesity Prevention and the Pet Nutrition Alliance.
She also serves on the Pet Nutrition Alliance Educational tools Committee. So as I said, she is more than qualified to give us a talk tonight. But before we hand over to Julie, a word from Gelner, our very grateful sponsors, Purina.
Gelner, over to you. Thank you. Well, dear colleagues, good morning and good evening to you.
It depends on what continent you're dialling in from. So I just wanted to welcome you to this next webinar in Purina series, and, . I have the pleasure of doing so on behalf of Purina Europe and without further ado, and with great privilege, I give the floor to the, I feel very charming, engaging and very knowledgeable speaker, Professor Julie Churchill.
So I'm very sure everyone will enjoy this lecture. Thank you. Hello Our vet and to Purina for inviting me to talk about this really honestly, my very favourite topic, feeding senior pets, both assessing and addressing comorbidities.
I have put a picture up here of my home team. Largely, it's a bittersweet, picture for me to show that I do actually feed things, both humans and senior citizens, as well as senior pets. It was, A tremendous year of loss in our family.
I lost my senior citizen mother, my hero, and one of my best friends, as well as three of our senior pets this year. Our little dachshund at 14 years old, rescued Chihuahua at, we never knew how old she was. We thought she was ancient when she came into our lives and our 15.5 year old.
Labrador. So, really the point that I'm making here is that I really do practise what I preach. My overview or what I'm hoping to cover, this evening for you and this afternoon for me, I'm in Minnesota, USA, is to, I'm a clinician, so I really, I work in a teaching hospital, but I see half of my job is seeing patients.
So, I am a clinician to the core. I wanna provide what I consider my clinical perspective in considering the challenges of nutritional management of seniors, and I think that really begins with an assessment. So I'll start by talking about the tools, hopefully to make this practical for you all, screening tools for nutritional.
Risk factors, the nutrients of concern and where it changes from an, a healthy young adult to a senior citizen, with emphasis on the common things, the things that you all see each and every day, but that are age-related conditions and the components where nutrition plays a role. And then Finish up with really where the art of veterinary medicine comes in in feeding seniors. My goal is to prolong their health span.
Not just their lifespan, but their health span. It's, my ultimate goal as both a pet parent and a veterinarian is that they thrive, not just survive. And then leave with an action plan for everyone to assess, feeding senior dogs.
Another, full disclosure is, as I mentioned, it's a, a big year of loss in our family. And so as I was preparing for this talk, I put a call out to many of my colleagues, my nutrition colleagues, and some of the folks that I have worked with in, Purina US asking them for pictures of their senior pets. And I received an onslaught of pictures.
So most of the pictures that are throughout this slide are from the personal pets of many of my nutrition colleagues and friends, and it was really a healing process for me to be able to include those as we go along. So what are the concerns about old dogs? Really, the, the big pet deal to me is that older dogs and cats are really commonly seen in primary care clinics.
It's at least the last report was it's over a third of the population now are those that see primary care clinics for care are seniors, and that percentage of the population is increasing. So dogs and cats are living longer and they're becoming a larger percentage of the, of the pets and patients that we'll see. And so from a pet owner perspective, ageing is not a disease.
It's what I'll say, progressive changes that occur after maturity. So when growth is done and you get to, the definition officially is when you enter the second half of your predicted life stage. Life span.
And that is, gonna differ breed to breed. The little guys live longer than the great big giant dogs, so it's highly variable. But that's sort of the working definition that I use.
And when they enter that second half of their expected lifespan, there's a decreased ability to adapt to change. I like in this when I'm talking to clients is that I no longer eat like I did when I was 20. And you probably noticed from the picture, I am well beyond 20.
And so we all become more vulnerable as we age and enter the senior years to deficiencies and excesses or poor quality. So I think it's really a little bit of a decrease in our resilience. And so, what is a senior dog diet?
There are many on the market. And so a colleague of mine from Tufts, Lisa Freeman and her group did a survey of opinions about nutrient requirements of senior dogs and looked at the composition of the senior diets that were on the market. And really the bottom line is, is that the nutrient profile varies dramatically.
There, it is not a legal definition. Senior dog food or senior cat food is a marketing term. There isn't an AFO American Association of Feed Control Officials.
There's no accepted nutrient profile for seniors, so it's up to each company to determine what that is. And The other result of this study and my practise is that most owners are unaware of that difference. And so there's a big mismatch or a gap in perception of what seniors need and what those, senior diets actually are composed of.
So not all senior dogs are created equally either. So not all seniors require a diet change. So it really left a lot of questions for parents or, or senior dog and cat owners, and they, should rely on us.
So again, lots of opportunity for the veterinary healthcare team to make an impact on the nutritional plane of these dogs and cats. So I'm gonna give an overview of how to assess senior citizens risk factors, specifically related to nutrition. And I use the circle of nutrition to guide every patient interaction.
It is how I practise, and I think this is brilliant in its simplicity. Again, as a clinician, I have the, I, I walk into the exam room and I have the animal up at up at the top. The foremost is my patient.
What species are they? What age are they? What other health concerns do I have?
And then I review what diet they're currently eating, and the hands represent the feeding management factors. So how is it presented? Just because a food is delivered does not mean the animal will eat it.
And so, Again, my soapbox is that senior nutrition starts with the first year of life. How do we set these guys up for success? And so this assessment would happen every patient every visit.
Creating that culture that we're a nutrition friendly and focused practise. So, of course, we're going to be making changes as the pet ages, our needs age, their needs age, and we'll be making changes and recommended changes. So I set that, I set that expectation when they're, when I'm seeing puppies and kittens and reinforce that at each and every visit.
The circle in the middle represents if I go around this circle, I determine what they're eating, what what the composition is, whether they're eating it, and am I seeing the intended results. And if I do, then there's no need to make a change. If I don't get the expected results, I go around that circle again.
So, each and every visit, I, I tell folks when I'm king, I would have every pet be assessed at every visit. And part of that assessment is collecting a diet history. And so I've just included some references if you want to jot those down or go back and review.
The Wasava World Small Animal Association has a lovely, lovely nutrition toolkitt with many, many. Resources that you can download, print off, many of them I use in practise, many of them I give as handouts for clients. But this short diet history form I found to be very practical, and I'll just invite you to think about ways that you can collect that information.
If you wait till the time they're visiting you and ask a client what they're feeding, very often I get answers like, oh gosh, it's that purple bag, or it will be a name that's very confusing and might even be a mix of various companies. So what we have the luxury of doing, and again, I'll invite you to think of ways that would work in your practise, is that we, at the time of scheduling, Inform the client that at least for every wellness visit, the healthcare team is going to be asking information about what your pet is eating, so that we prepare them for that, they can take a picture of the bag on their cellphone and bring it in or they can collect the exact name and be prepared with that information. We actually send them an email in advance with a form that they fill out and bring with them when they arrive.
I also know as a practitioner myself, how busy your days are. And so I realise and respect every single minute that you devote, even knowing now that many of you are taking time at the end of your day to listen to this webinar. So I'm not asking you to do more.
I'm asking you to leverage what you already do and Incorporate that and frame it in the, in terms of getting this nutritional screen or risk factor assessment done by doing the things you already do. Everyone is taking a history and everyone is taking a physical exam and I've adapted this table from the Aha nutrition assessment guidelines or there is a, a, a Wasava corollary that has this exact information. I've put my initials in areas where I adapted or added on to this.
And so again, taking a history and identifying if they're eating snacks and treats and human foods that are greater than 10%, no longer is their intake going to be balanced. And again, if you're young and healthy, that might not make any difference as you lose resilience with our senior citizens. Certainly that can have an impact.
We have a rise in what I call unconventional diets. Homemade raw meat-based diets. And again, when I see these things, I sort of give a mental checklist and the more checks that I have, the more the higher risk they are at having problems and the greater the risk that nutritional intervention can be helpful.
So again, of course, life stage needs, we're talking about seniors and I think that we're poised at that point to do a more in-depth evaluation. Anytime then shifting to physical exam findings, any time the body condition score is abnormal. If they're too lean or if they're too heavy, those are risk factors that we should address.
I'll talk a little bit more about muscle conditioning or other comorbidities. So again, I referenced that Wasava and Aha nutritional assessment guidelines, and that's a document you can download for free. Again, if you Google Wasava nutritional assessment, it will pop right up.
And so, essentially, it's that screening process using the history and the physical exam to identify risk factors. For young adults, very often, it just means that it just means that, everything is going well. We've identified a healthy adult.
We're happy with what they're eating, and we instruct them to continue to feed that diet at that amount. But our senior citizens, if we have more of those checks, then it mandates a little bit closer evaluation. So an extended evaluation, I think is wise for all of our senior citizens.
I add in this what I call the extended screening questions because it's really what related to the things that happen very commonly in our elders. Very often, that's the time when I see abnormal body condition score. Again, either underweight or overweight.
I ask a little bit more about diet questions. Are they eating the appropriate amount? Has there been a change in their appetite?
I ask questions if they're able to chew and swallow because dental disease increases as we age or as our pets age. Mobility is another big opportunity for our senior citizens as the presence of and severity of arthritis increases. So are they able to get to their food?
Does that impair their access? Are they keeping active and again, does that impact sarcopenia or their lean muscle mass and, and so their ability to participate in a full and rich life. I'll talk a little bit more about cognitive function and assessing that and then each and every individual by what other medical conditions they might have.
So those are additional things, but again, part of your everyday exam and history of your senior pet. So, optimal nutrition is ideally what we would love to provide, but although it's a popular marketing claim, optimal nutrition to me is more of a concept. It's the goal.
I think it's the goal that, guides nutritional research. Again, how can we modify nutrition for our senior pets so that we can minimise risk of disease and maximise lifespan and quality of life. So again, I use this in terms of the concept and my goals for my patients.
So again, as they become seniors, we certainly want to prevent deficiencies and if they have lost resilience, we worry about lowering their intake or avoiding excesses because they just might not thrive if we're stressing that system. So I'll start highlighting just a couple of nutrients of concern when I'm seeing senior pets. And water, of course, is the most important nutrient of all.
And that water intake is influenced by, of course, many, many factors. Environmental conditions, how hot or how cold it is, food intake, and what type of food, if it's a dry or a moist product. Age and of course reproduction status.
But what we know about seniors, both in humans and we believe this to be true in dogs and cats too, is that age alters the ability or physiologic control of systems like thirst. And so there's decreased Their water balance is also impaired, so changed, I'm sorry, changed as they age. Total body water is lower in the elders and so when they lose water, they can sometimes have subclinical levels of renal function or renal dysfunction.
And maybe losing more water, but their ability to sense thirst, their osmoregulatory ability declines. So just as when I'm visiting my father in assisted living, I'm always reminding him to drink. So in humans, we can.
Remind them to drink. In dogs and cats, if their appetite is still robust, I often recommend just adding water, additional water to their food so that I'm taking care of some imperceptible deficiencies in water. Next, area of concern is that of energy.
And so what we know is that the maintenance energy or the energy required will, largely be related to the amount of lean body mass. Lean body mass accounts for about 96% of the animal's basal energy requirement. And what we know is that energy needs decrease with age, almost by 30% as individuals reach middle age.
I'm getting more depressed as I as I speak. We also know that some individuals, again, if they have orthopaedic disease or arthritis, can sometimes become less active and that also will contribute to lowering lean body mass. Very often, at least by middle age to early senior years, appetite doesn't change.
In fact, sometimes, if they're bored, they can even have an increased or more robust appetite. So this is a prime time as they enter their late middle age and early senior years where I will often make a Diet change and try to lower the energy density of the food, the calories per cup or can, so that I can still provide them with a reasonable food dose. Senior citizens love to eat very often if they're feeling well, and so I don't want to restrict their food volume.
There's a lovely study done by Doctor Dottie Laflamme again, looking at the energy needs of senior cats. And what we know from epidemiology studies is that weight gain increases so that overweight and ob pets is at its highest by middle age to early senior years. And so the effect of age on maintenance energy requirements in adult cats follows that same trend where it declines until those early senior years.
And for individuals then that go on, what we know is that the energy requirement actually may increase. I think again, there are several reasons this may occur. We know that in in the cats, especially sometimes digestive, the ability or function of the digestive tract declines and therefore they actually are requiring more food.
It's very common in our elder cats to see what we call, affectionately skinny old cat syndrome. So, energy is really worth evaluating on an individual basis. For healthy seniors in general, their energy is gonna decline, but their appetite remains intact.
The third area of interest for me is to pay attention to protein requirements for seniors. If I were addressing this topic 15 to 20 years ago, the the mantra or general understanding was that seniors may in fact require lower protein requirements and that that might preserve kidney health. And so, I will not bore you.
That was the topic of my PhD thesis looking at protein effects on renal ageing in geriatric dogs. But what we know now is that age affects protein turnover. And so again, it, there's an increase in protein turnover and a decrease in protein synthesis or lean, lean body mass.
And that there's actually no benefit from dietary restriction. And in fact, unless there is an organ or a contraindication for protein, I actually recommend increasing protein 1.5 to 2 times the level of a of a young adult.
So my general rule of thumb for a young adult is that, and I think in pounds, or excuse me, 1 gramme of dietary protein. Per pound of body weight, or 2.5 grammes per kilogramme.
For cats, it's almost double that, 2 grammes per pound of body weight or 5 grammes per kilogramme. So then seniors are gonna be 1.5 to 2 times.
Again, unless there is a condition such as chronic kidney disease where we, where that would be contraindicated. I generally at middle age start evaluating their diet and increasing the protein. As they start to age.
And the reason for this is, again, I'm hoping that you're all doing a muscle condition scoring. It's a system and again, this is taken from the Wasava nutrition toolkit, and it is using the same skills that you do for body condition score, but looking at the areas of the Body that don't accrue fat as quickly. Looking at the temporal muscles over the scapular spine and the dorsal processes.
If those areas are starting to become more prominent, that's a sign of muscle, lean body muscle, loss of lean mass. There A condition I affectionately call overcoat syndrome where there is still excess body fat. The animals are overweight, but they have a loss in muscle mass.
And so even though they might be overweight, you can still feel these bony prominences, and that means that should be a hallmark or a warning sign that they've lost lean muscle. We know there's many conditions that can contribute to muscle wasting, but what we, what we want to be aware of is that you should take a closer look at their dietary intake because the, the more often that I do this, the more often I find that, that seniors are potentially or on the borderline of protein deficiency. Nutrients of concern again for seniors.
The next step are the sodium and phosphorus or the micronutrients. And again, I'll flash forward. I do get flashbacks.
This was the topic of my PhD thesis. Looking at whether if we limit these things or restrict these, will we in fact preserve kidney. And when a dog or cat is healthy and they, they don't have chronic kidney disease, there's no advantage to restricting these things.
So again, I take the perspective that senior citizens do best when we're meeting their needs, but avoiding excess. Or deficiencies. So my approach to seniors or for all pets is to highlight that ideally in the beginning, we're very good with preventive schedules.
So we're good with vaccines and infectious disease preventions. By the time we get to middle age, the best prevention is early detection. And so I think by the time they get to that 7 or 8 years of age for dogs and 9 or 10 for kitties, that's the time to start monitoring them even more closely.
It's, would be the same by the time they reach middle age, if they're only coming to your clinic every year or a little longer than that, would be like us. Not going to physicians for more than 5 years. So really monitoring more frequently and making an individual assessment is the best approach to preventive care for our seniors.
So we can do that health screen and that nutrition screen and identify risk factors early and intervene when it's indicated. So my approach to intervention of these senior or aging-related disease is really multimodal, looking at nutritional strategies, activity strategies, and environmental enrichment. So, as I mentioned, energy is one very important aspect of, of meeting a senior's needs and what we know again is that when they're spayed and neutered, which most of my patients are, that lowers their energy requirement by 20.
5 to 30%. And then once they reach middle age to early senior years, another 30% decline. So unhealthy weight gain is incredibly common in our senior or early senior population.
So I don't need to tell you all the importance of doing a body condition score. And so we apply the nine point scale. I'm hoping that soon becomes the universal standard for body condition.
And striving for that 5 out of 9 for dogs and cats. And so again, I know you know very well how to do that, but if I'm king, as I tell people, my hope and dream and what I think is one thing that can have the most impact on the, on the pet health across the globe is to teach our pet owners how to do a body condition score. I tell everybody that anyone can learn to do this because I, my kids were able to do this by age 5.
So by the time they went to kindergarten, they could do a body condition score. It didn't always make them popular when they had a sleepover at their friend's house and started doing a score on their, on their friends' pets, but everybody can learn to do it. And so the analogy that I use is a hand.
So I always will use my own hand or the client's hand. And so I'll, and rubbing our fingers across the flat fingers across the back of our hand as if the metacarpal bones were the rib cage. You should very easily be able to feel individual ribs without blanching your fingernails or without curling in.
If it's more like this and you can see ribs at a distance or feel them like, like your knuckles, that's too thin or if you are trying to feel ribs through the palm of your hand, then that is too heavy. And most owners that come to see me with a hand in fact leave with the very same hand, so it's something that they can learn and take home as a guide. I'm going to reference the the Purina Lifespan study, and they have kindly gifted me with these pictures where, again, many of you may have heard of this study.
It was going on when I was in my resident years. And so I knew that they had a colony of 48 Labrador retrievers that they matched by gender and size from the age of weaning and followed them through their entire life span. They had a control group that initially was ad lib fed, and the dog that they were matched, so the matched set, was able to receive a 25% restriction.
Again, the goal was, could controlling calories or calorie restriction impact lifespan and life quality and other health risks. So I'm just taking a snapshot in time here from this study, and I talk about this study so much, people think that I actually did it. again, I had no, no role in this.
I just think it was life changing for the way that I practise. Again, here's a snapshot in time at age 6, the pair, and here's a snapshot in time at age 10. And so what you can see is the difference in the lean fed group.
Their average body condition was just a little over 4.5 on that 9 point scale compared to 6.7 out of 9 on that scale.
And so to my eye, there isn't a very big difference. And so when I'm extrapolating that to the patients that I see, think back to the last patient that you evaluated that was a 6.5 on the 9 point scale.
When I ask my colleagues. I asked, what do you, what did you think about that 6.15 patient?
And they'll tell me, not too bad. Didn't seem, you know, not very heavy. But here's really the results of this study.
Again, looking at a snapshot of this, this, life span study at 8 years of age. Osteoarthritis in the lean fed group compared to the control fed group, more than two joints, arthritis in the hip and shoulder, . Or more than 2 joints.
77% of the control group had osteoarthritis in more than 2 joints at age 8 compared to only 10% of osteoarthritis in the lean-fed group. So again, going back to that picture, not a very big difference in body condition score. A huge difference in orthopaedic healthy age 8.
So as a pet owner who certainly wants my pet to live well beyond 8 and not needing pain medication for arthritis. That's a really big quality of life difference. So again, just displaying this data in a slightly different way, looking the restricted group is the green line and the control fed group is the blue line.
And what you can see here again looking at a score of arthritis was that the osteoarthritis. The onset was earlier and the progression more rapid in the control fed group. So what we learned or what I take my take home point from this is that maintaining a lean body condition lowers the prevalence and lessens the severity or slows the progression of arthritis.
So we talk a lot about obesity because it's an easy word to say. But I'd really like this to be a call to action to stop thinking about the problem as obesity and start thinking about, I made up this word overweightedness. Because again, that lifespan study shows me that you, we start to see negative health consequences when as little as 15% above their optimal health.
Again, I, in my introduction, the disclosure was I serve on the board of this, pet obesity prevention, and this is data from the last 2017 survey where in our, in the US 50 6% of the dogs and over 60% of the cats are overweight or obese. And again, you know full well the negative impact on lives. They're not thriving when they have all these other comorbidities largely associated with unhealthy weight gain.
I put this picture in here just to take a breath, not a before and after picture, but to show you what a normal body condition of a dachshund looks like cause it's so refreshing. This was an actual patient seen by a colleague of mine at our at our clinic and this overweightedness or obesity led to the demise of that poor individual. There's a lovely study done in 2016 by a French group, Hui and Pochelan again looking at an index or an assessment of frailty in aged dogs.
And so that's taken as modelled after geriatric. Humans where there is a frailty index score because what we know is that seniors start to age, losing muscle mass and strength, that they are much more likely to become frail, and that is directly related with morbidity and mortality. So they looked at a group of service dogs, again, that were followed and their healthcare was very well documented to try to apply this to senior dogs.
But the frailty-related phenotype or the aspects of that are things like chronic malnutrition or undernutrition. Exhaustion. Again, when sleep, wake cycles are disrupted, individuals get more tired, lower physical activity, osteoarthritis, and other things can impair mobility, and lead to weakness.
And so I think this study is a Really good pilot, in my opinion, in thinking about these things and factors that contribute to frailty, which can be linked to morbidity and mortality and thinking about what can we do to prevent the, the onset of these things. Sarcopenia or loss of lean muscle mass is a really prevalent problem both in humans and in aged dogs and cats. So the loss of muscle again is consistent and I would encourage everyone to do muscle condition scoring on every individual so you can start to get a feel for that if you're not already doing that because it's associated loss of muscles associated with mortality.
It's an avid area of research, again, both in human medicine and gerontology because multiple, it's complex and multiple things are at play. It's not just inadequate intake, . Or decreased activity, there's an increase in cytokines and a reduction in growth hormones and androgens and insulin resistance, as well as decreased protein synthesis or that increased turnover that I talked about all contributing to comorbidities.
So, recognising early, I'm always doing muscle condition scoring so that I can determine is this patient losing muscle more than I would expect and what things can I do to preserve muscle mass. So assessing every patient at each visit should include body weight, body condition, muscle condition, and a diet history. I'm striving always for stability, for maintaining ideal health.
If there's weight fluxes up and down yearly to we have seasonal flux like weight gain and loss and gain and loss, and that impacts metabolic rate. So ideally we're striving for stability to maintain health. I have to give a slight disclaimer that there are some early studies that looked at the association of body condition with chronic kidney disease patients and patients in congestive heart failure, and there was a slight a hypothesis or proposed advantage to animals that were 5 to 6 out of 9.
I think we still need to do more work in this area, so I, I have a little debate with my colleagues that are saying they would rather see their patients maintain a heavier body condition so that they have some to spare for when they get ill, but that is again work, it's an association and not everyone succumbs to chronic kidney disease and congestive heart failure when we know there are so many other negative health impacts from overconditioning or overweightedness. So more work to be done in that area. I still am going to recommend striving for healthy weight and stable body weight and body condition.
It also, management of seniors and sarcopenia is multimodal. We want to make sure for certain that we're meeting protein needs that, there are pharmacologic agents again, potentially new strategies like ghrelin agonists and cytokine agonists and myostatin antagonists. So I think stay tuned.
That's an area for future work. And the other feature that I think there's great opportunity and we sometimes forget is the environmental factors. So, in our area, rehabilitation or physical therapy is another big aspect combining that with nutritional management to see how we can keep these animals fit, conditioned, and do whatever we can to preserve lean body mass.
Cognitive dysfunction is another area of great opportunity in our senior dogs and cats. Again, as are the percentage of our population of aged animals is increasing, I think this is another area where we can increase our awareness and potential for intervention. It's hard to get prevalence data on this because again, it's it's, it's under-recognized, but the last report I read was that estimated 20 to 30% of middle aged dogs were showed signs of cognitive dysfunction, but by age 14 in in dogs, at least 60% had some degree of behavioural changes or cognitive dysfunction.
Again, early detection is our best prevention, but this is tricky because there are so many confounders. It's worth thinking about as they enter their early senior years, to get an owner survey or a behavioural. Of course, we want to rule out all the things that can be confounding like endocrine disease, pain, urinary tract disease, sensory losses like decreased vision and hearing.
And so really we are aiming toward a diagnosis of exclusion. But there are some great tools that we can use and again in our land, there are these great little handouts to give owners that's based on a behavioural assessment or an assessment of cognitive dysfunction syndrome. Diha is the, cronym for looking at signs of disorientation where the dog will get their spatial orientation gets goes awry, altered social interactions or changes S for their sleep wake cycle, alterations in memory and learning, so they might have house soiling.
Again, you want to rule out any medical cause for that. Altered levels of anxiety and activity. And I understand that Purina has developed, well, doctors Breckman, Tika, and Ama have developed and Nestle Purina has produced a little scoring sheet that can be given to Owners and so if you haven't seen these, I'd encourage you to check them out.
It's helpful to prompt give these prompt questions for owners. I usually try to administer these early senior years, so in that 7 to 8 range, and then do it annually so we can start to pick up any problems early. Because we now have some intervention methods.
And so I, I called the last several years, the year of the coconut cuckoo for coconuts because all of my clients were asking about the benefits of coconut oil. And I have to dismiss my immediate action and rejection of nutritional trends because in this area, there's some studies supporting the use of diets enriched in medium chain triglycerides. So there are intervention tools now, nutritional interventions, as well as others for canine cognitive dysfunction.
It's been shown that medium chain triglycerides can actually provide the brain with an alternate fuel source of Of ketones. And so, brain energy is related, so an energy supply is definitely promotes improved cognitive function. And so this was shown to have a benefit at at a beginning dose of 1.3 grammes for every 100 calories of energy.
Many of these diets, marketed or studied to promote improvement in canine cognitive dysfunction, it is another group of broad-spectrum antioxidants to reduce oxidative stress and mitochondrial cofactors. But the studies that have been done in this area have mostly shown that we really need a multimodal approach. So we want to do not just nutritional intervention, but environmental enrichment and exercise.
And then usually, I resort to pharmacological support after I have those other parts in place. So in the perfect world, every decision I would make and every recommendation to a client, asking them to do one more thing or buy something special would be evidence-based. But the best evidence-based medicine is the integration both of research evidence, clinical expertise, and client or owner preference.
We can't only operate in the research world because if we produce a diet or or a nutrient and the That the client won't buy it or the patient won't eat it, it will be useless. So we have to incorporate all of those components when we're applying it to our patients. So the biggest challenge for me as a clinician is what I call the conundrum of comorbidities.
And this is where the art of vetMed comes in because The science is lacking. There isn't evidence or clinical trials of patients with multiple comorbidities. And so here's the tier or the decision-making tree for me as a clinician.
I consider the patient at hand and what their medical problem list is and what part of their problems are an acute onset that might potentially be reversible versus chronic disease that my goal is to keep it stable. Which one of these conditions is impacting the clinical signs or the quality of life and to what degree? It might not be the most serious disease, but the one that's impairing the joy of every day that, that increases in priority for the client and for me.
I ask for each disease what's the prognosis or the progressive nature which may ultimately impact lifespan or quality of life. And then I put all those into the equation when I'm considering the nutrients of concern and the nutrient evidence. I wanna build a nutrient profile.
I wanna meet the minimum needs for species, so for a senior dog or senior cat. Then I think about the, what are the needs for each disease. Are there any contraindications or intolerance to when I'm meeting sort of the needs of a healthy senior where do any of those diseases cause an intolerance or contraindication, and then I find that balance or priority when I'm sort of making a decision.
I put this here so that you can refer back to it. And all I did was collate sort of where the minimum requirements are, but then what a diet that would be considered high in protein or low in protein or high in fat and low in fat. Again, so when you're reviewing or comparing diets and you're looking for something that's low, this could be a guideline for what that range of nutrients might be.
So really just there for your information. So we're nearing the end of time and I wanted to just give briefly a case example on where the art of managing these comorbidities comes into play. And here is Peach, a 15 year old domestic short hair who presented to cardiology and respiratory distress, open mouth breathing, really pretty serious condition.
But as you can see, Peach was Incredibly obese, 12.8 kgs or 28 pounds, well off the scale of 9 on the nine scale. We did a body fat index and Peach was, had 72% body fat compared to what a healthy range would be 20.
And no significant levels of lean muscle loss, but certainly, orthopaedic disease with hyperextension and breakdown of those joints. The primary prevailing condition was respiratory disease and stage C hypertrophic cardiomyopathy. Again, elevated renal and kidney values, normal thyroid status, and I was called in to develop a weight loss plan.
Now, we really have to take a step back, and that is not the time to initially implement a weight loss plan. Certainly, the adiposity was compounding his respiratory distress, but he, of course, needed to be stabilised with all of his great heart meds, and I wanted him to be feeling better before I implement a diet that he may reject. If he's anorectic.
Cause again, when you can't breathe, you can't eat. So he was stabilised even with the assistance of mirtazapine. When we took a diet history, this little fellow was only eating just a little over 220 calories.
So that told me again that his caloric requirements were quite low, much lower than anticipated and expected. So our nutritional plan ultimately, after stabilising his heart disease was to pay attention, very strict attention to meeting his protein needs in the con in the context of his lower calorie requirement, to assure intake, and I definitely wanted to choose a lower sodium, diet cause I didn't want to exacerbate his heart disease when he's already requiring, Diuretics. So after he was improved, we, they added in inhalation or ventilation therapy and we were able to reduce his diuretic dose and then we were able to implement a weight loss plan.
So we picked a product again not to endorse any particular product, but we compared all the therapeutic weight loss products. And look to find the highest protein, lowest calorie, lowest sodium product. And we wanted to put him on a plan of a calorie restriction but very, very close monitoring so that we wanted him not to exceed 1 to 2% per week.
Ultimately, when he was stabilised, we added in omega 3 fatty acids. I'm going to very briefly talk about this case and then finish up. And so again, this is a senior, senior citizen that came to me with chronic kidney disease after, after acute kidney disease, infectious leptospirosis, hypertension, proteinuria, and this stinker had a foreign body two times this last summer because he ate his owner's underwear.
He had severe orthopaedic disease, degenerative joint disease, and severe sarcopenia. He was sent to me to see could we increase his protein at all because we wanted to reduce, we wanted to try to minimise that sarcopenia. And I will again give the very brief overview, but his kidney disease was aggressively managed with subcutaneous fluid therapy.
His hypertension was managed. He was on Epogen and he had been given a renal therapeutic diet, but he wasn't eating very well. And so, I certainly, with the onset of protonuria, I didn't want to increase his protein with the worry that I would exacerbate his kidney disease.
So what we opted to do first was to enrol him in a rehab plan and get better control of pain, so he had acupuncture and we modified his pain medications. And once we were able to do that, I actually didn't need to change his diet because once his pain was controlled, he much more readily ate his renal therapeutic diets. So I'm frequently asked, do I add supplements or do I pick a food that has that supplementation already enriched.
So if I have a joint diet that has omega 3 fatty acids in it, do I add it to a food or do I pick a food with that supplement in? And so what we wanna do when we're making that decision to feed a therapeutic food that has the supplement incorporated, or do I add a supplement on top, I wanna make sure that the base diet is meeting the patient needs. So if you use this, this study that looked at over 200 dogs and they were measuring the what we expected their metabolic rate to be or their energy requirement to be and what their actual metabolic rate was or their energy requirements.
And so when you do a calculation, you're really getting sort of what the average is. There is a bell curve so that what we know is there's just dramatic variation. Between individuals.
And so if I use my 15 year old Labrador as the example, and I wanted to feed her a therapeutic joint diet, and the diets are formulated to be where this would be the predicted food dose. This is a dog again that has an average expected intake, and I use the example of 14 magic crystals is the therapeutic dose for arthritis. But my Labrador was 15 years old and arthritic and not very active and had a lower metabolic rate.
So this was her food dose to maintain her lean body mass. So again, if I chose the therapeutic diet for her, I wouldn't be achieving the right dose of that nutraceutical. So I make decisions basically on what does that animal need in calories and then will my therapeutic dose meet.
The dose that I'm trying to achieve. So really the bottom line is that senior care is really individualised and it requires frequent monitoring and seeing if we make an adjustment, are we achieving that quality of life that we want? Are we achieving the therapeutic value that we want?
And remembering that multimodal approach that we want to have a nutritional strategy. We want to incorporate as much activity, keeping them vibrant and alive so they thrive, not just survive. Cause senior pets will continue to be an increasing part of our population.
We need to do a proactive assessment and monitoring is key, so that we tailor our recommendations to the individual. Nutritional gerontology is increasingly important so that we can maintain their health span, not just their lifespan, and manage those comorbidities. It really includes partnering with the clients and parents, so and involving everyone on the healthcare team so that we're addressing everybody's needs.
And with that, I'm just going to thank everybody, including all of my colleagues who donated the pictures of their lovely senior pets, which are such an important part of our life. Julie, that was absolutely fantastic. Thank you so much for sharing your knowledge with us, and giving us time tonight to, to listen to you and to take all of that in.
I, I personally could sit here and listen to you for hours. Purina, thank you to Purina for sponsoring. We really do appreciate sponsorship, especially when the webinars are of such high quality.
It really is fabulous. Julie, I'm sure you're not not the first time that somebody's gonna make a comment like I'm going to do now about throwing a spanner in the works or putting the cat amongst the pigeons with the senior protein diet levels. Sure.
Most of our questions are going back to relating to that. Sorts of questions we're getting is, how do we go about increasing protein levels in a senior diet if we're not gonna change the diet? Do we need to be concerned about raising phosphorus levels if we're pushing protein levels up?
I think let's start with those. Yeah, those are excellent questions and near and dear to to my area of interest. I do not generally add supplements when I'm not meeting their protein needs, I look for a different diet.
So remember that diets are formulated to be complete and balanced. And when we start adding a lot of protein, you're actually adding a lot of phosphorus as well and not balancing that with cal. So very often the, the genre that is serving me well are the diets that are aimed at weight management or even some of the therapeutic weight loss diets.
For example, this 15 year old Labrador ended up being on a prescription or therapeutic weight loss diet so that she could have a very high protein intake but not many calories and it is still balanced. When it's balanced like that and when kidneys are normal, and that I can assure you when most of the time, the great, the great good news is for senior dogs, most of the time their kid their kidneys outlive. The dog.
So, renal ageing is not a very significant phenomenon in the canine species and so I avoid excess, but I don't worry when it's in the appropriate balance, it's not harmful. Excellent. Going back to what you were just saying about your old old child that you had there on the, the weight diet and that, would you then supplement omega oils to get the benefits for the joints?
Yes, she did. I did for her. She did have significant amount of arthritis and the therapeutic joint diets, which are excellent.
But her individual metabolic rate was too low. Even if I used a therapeutic joint diet, I would have had to supplement to get that dose effect. Right, right.
Yeah, there's loads of questions coming through here. I'm trying to paraphrase, that's absolutely fine. But there's a lot of them that are very, very similar.
One of the ones that's a striking theme coming through is, is the, well, they made a comment to say surely the quality of the protein is as important as the quantity of the protein. Oh, of course it is. And that's why when you're choosing great companies, the quality, we have so many great choices.
That's the good news as well. And when we're choosing great companies, and I'll refer everyone to the Wasava criteria or guidelines for selecting a great company and then quality of protein is rarely an issue. Excellent, excellent.
There are loads of comments coming through and about how fabulous the presentation has been and how excellent it's been. Anthony always likes to say, if we were in an auditorium, you would be hearing thunderous applause at this stage. So yeah, that's really good.
. Folks, there are lots of questions here. We don't have time unfortunately, to go into specific cases for individual people asking questions. But, Julie, I really thank you for this and I know personally I am going to be putting a push into the webinar vet to get you back again.
Oh, I would love it. Thank you so much. Thank you everyone for giving your time, your precious PTO or personal time for, for listening to me.
And it's also to Purina, thank you for sponsoring tonight's webinar. We do appreciate it. And of course, to all of you that have sat through and listened to this webinar and hopefully enjoyed it half as much as I have.
Thank you for logging in and we'll see you again on the next webinar. Good night everybody.
