VN June 2023

Vetnews | Junie 2023 39 With all the advancements in Veterinary Medicine today, one of the most frustrating aspects, all around, is the pruritic dog. Convincing the owner to proceed with a food elimination diet trial is just the start; their compliance is entirely dependent on your detailed (and clear) explanation of the trial and your managing their expectations! Without taking the time to be clear in your guidelines to your client, you are setting yourself up for failure and the client for frustration and “vet- hopping”. By sending a client home to do a food elimination trial, you are sending them home to run a diagnostic test, without supervision, for 8 – 12 weeks. A take-home reminder of what you discussed is key to compliance- scan the QR code to download some assets for both you and your clients! Recent studies have shown the prevalence of true adverse food reactions to be much higher than initially believed: as many as 15-20% of all dogs and cats with chronic pruritis ( https://doi. org/10.1186/s12917-017-0973-z) . This increase shows how crucial food elimination trials have become! STEP 1: SELECTING AN APPROPRIATE DIET It is often difficult to know which diet to choose. The choice ultimately lies with the client, but your expertise is crucial in guiding their decision- making. For a food elimination trial, a hydrolysed diet is preferred vs a novel protein diet. In the Royal Canin range, two hydrolysed options exist, each with its own merits: Royal Canin Anallergenic: With the lowest molecular weight proteins currently on the market, Royal Canin Anallergenic is the Gold Standard in food elimination trials, comprised exclusively of free amino acids and very lowmolecular weight oligopeptides, and formulated with purified starch. A diagnostic tool for AFR! Royal Canin Hypoallergenic (Feline and Canine): composed of a highly digestible hydrolysed soy protein isolate. STEP 2: ATTENTION TO DETAIL Every aspect of allergen exposure needs to be accounted for, and clients are made aware of how they can inadvertently negate a negative result from a feeding trial. • Plastic: Food bowls, measuring cups, buckets: Plastic is porous! It will retain trace amounts of DNA from previously fed foods, continuously exposing your patient to the exact allergen you are trying to avoid. Remember to advise your clients to use a stainless steel bowl (that has been washed thoroughly with soapy water), or if they prefer plastic- to get a new one! Similarly- provide your client with a new measuring cup! Clients also often dispense their food into their plastic buckets at home- contaminating their new diet. Advise them to keep the food in its original packaging within the bucket. • Flavoured chews and medications: Flavoured chronic medications and over-the-counter products contain DNA- discuss alternatives for the duration of the food trial. Remember- clients will fall back into old habits (pilling with something tasty)- rather, advise pilling with a small amount of banana (known to have the smallest risk of inducing an allergenic response). STEP 3: THE ITCH SCORE Keep the client aware of progress and focused on the end goal, and simultaneously gain invaluable insight that lets you know if you are on the right track! STEP 4: MANAGING EXPECTATIONS While 1 in 5 pruritic patients will show a positive response to a feeding trial- 4 will not! Give the client the statistics- informed clients are much more compliant! A negative result still gives answers, and the client will then be on a chronic pruritis management journey with you. Should they get a positive result, it could make all the difference in the quality of life of their pet! If the client is well informed of the possibilities and realistic expectations are explained to them, their overall satisfaction and compliance will be far greater than that of a client that believes in a “one shoe fits all” approach. STEP 5: FOLLOW-UPS The two main objectives: 1. Check-in on owner compliance and concerns 2. Keeping the patient comfortable without compromising the trial There is no one way to manage dermatological issues in the chronically pruritic patient, but a properly conducted feeding trial is the first step on the journey. Make sure you give yourself (and your client!) the time needed during that initial consult to make a success of the trial truly, and to better the lives of your pruritic patients. v Starting from scratch: feeding trial guidelines (Dr Tilana Botha)