VETERINARY

N U T R I T I O N

CARE

Effective December 2019: Veterinary Nutrition Care will be closed to new patients. Please see the directory at www.acvn.org for a listing of other available services.

Helping people give pets their best®

Please feel free to use this fee structure to your advantage


Take the time to thoroughly and accurately complete the Nutritional History Questionnaire


You may find yourself thinking: ​"But, why are so many questions necessary? You're asking for information that can't possibly be relevant to my pet!" While this is a completely reasonable reaction to being asked many questions about your pet, each question serves a purpose. Keep in mind, your veterinary nutritionist didn't set out to make pet owners do inordinate amounts of paperwork, she set out to collect all of the information that would make the a pet's nutritional assessment and plan formulation go as efficiently as possible.
                    
Here's an example of a nutrition visit, though it applies equally for Vet Consults, let’s say- for Jack, your overweight dog with a history of skin problems. You decide to schedule a nutrition visit and complete a Nutritional History Questionnaire at your leisure. You take this opportunity to look up the name of the diet you used to feed Jack, and measure the amounts of each ingredient in the home-prepared recipe you are currently feeding. You list supplement names and dosages and provide a lot of other information, even though you’re not sure why the nutritionist has asked for things like the name of a diet you fed Jack several years ago. You make sure to email the completed questionnaire back to Veterinary Nutrition Care 7 days before your appointment. 

When you and Jack arrive for your nutrition visit, and your veterinary nutritionist is familiar with his medical history, as well as all of the information you provided. She explains the role that diet may be playing in Jack’s skin problem, and that one of the concerns is that his immune system is not responding normally to certain diet ingredients that he has been fed previously. One way to approach this is an elimination diet trial, which means that Jack would be fed a diet made entirely of ingredients that he’s never been fed before. That explains why she needed to know so much about Jack's previous diets! Since you provided all of his previous diet information, the nutritionist was able to research the ingredients of those diets- she knows exactly what ingredients he has and has not been fed before. With this information, she is able to propose a few different options for potential diets. Given some of the other details about your family preferences that you mentioned in the questionnaire, one of these stands out as a best option. 

Another important piece of information that you provided is exactly how much of each diet ingredient Jack eats per day; with this, your nutritionist was able to determine how many calories Jack consumes per day, which you both know is too much, since Jack is overweight. 
Using this, your veterinary nutritionist proposes a plan to feed the skin-specific diet in an amount that will allow Jack to gradually return to a healthy weight. From your questionnaire, your veterinary nutritionist also knows that “treat time” is an important part of Jack’s day, and that it would be hard (or impossible) to change that part of your routine. To accommodate this, she calculates a daily allowance of a certain item that works with his elimination diet trial. 

All of this makes you and Jack happy. You make a plan to follow up with a phone call about Jack’s progress with the diet change and his current weight in two weeks.

At your two-week check in, it's too early to tell about the skin problem, but it looks like you may be on the right track. The good news though, is that Jack is starting to lose a bit of weight. Since your veterinary nutritionist had accurate information about how much Jack was eating before, she was able to tailor Jack's feeding plan to allow him to lose weight right away. You can't wait to see his progress at his next visit in a month.

Your veterinary nutritionist bills at an hourly rate, and since you followed the recommendations to make the process efficient, your bill is as expected, Jack is making progress, you knew what to expect, and things went according to plan. You are happy with the experience.   


You can also help your veterinary nutritionist be more efficient (and cost effective) with follow-up


Whether follow-up communication is done by phone or email, and whether your question is following a visit or a Vet Consult, if you state concerns clearly, and questions in a way that makes them answer-able, it will take less time to respond. For phone calls, think through the points you would like to make and write down a list of your questions before calling. For emails, read over what you have written before sending. Ask yourself if the communication is clear and makes sense, and if all of the relevant information is included. Please include links to articles or products referenced in email, or correct and specific product names by phone. You can also refer to your visit or Vet Consult summary, which will include what information your veterinary nutritionist wants to know about your pet at follow-up.

For example, Bob and his cat Muffy had a visit with Veterinary Nutrition Care yesterday. Muffy has a combination of medical conditions that makes selecting a diet tricky, and Bob prefers not to home-cook for her. A suitable commercial diet option was found and recommended. Muffy is also underweight, so the plan is to feed her a certain amount, and recheck her weight in a week to make sure she is gaining weight appropriately on the new diet. All went well with the visit, but that evening, Bob came across one of many websites that makes claims about commercial pet food ingredients being unhealthful for pets. This prompted him to question the recommendation made by Veterinary Nutrition Care. He also found three other products that appeal to him just in case the claims are true and his veterinary nutritionist changes her recommendation.

Here’s one email that Bob could compose. He’s not very specific about any of his concerns, or what he wants to do about them.

Dear Dr. Farcas,
I Googled the commercial diet option you recommended for Muffy, and read online that kibble isn’t good for cats since it is full of bad stuff and fillers. I don’t want to be feeding anything bad, but don’t really have time to home-cook for her, so what else can I feed Muffy? They are only out to make a profit and don’t care about pets. Vets who recommend this stuff should be ashamed. I found some other products online. How about products x, y, and z? How much should I feed?
Thanks
-Bob

Response from Veterinary Nutrition Care:

Dear Bob,
Thank you for your email. I’m not sure exactly what “bad stuff” to which you refer. There are many claims about pet food ingredients floating around the internet:
Some are just wrong, such as stating that certain ingredients are “filler” and have no nutritional value. Some of which are mis-stated, such as all pet foods containing grain are bad for pets- this requires more interpretation, and depends on the specific pet and the specific diet. Some of which are misunderstanding, such as stating that unrecognizable ingredient names are things that shouldn’t be fed to pets. Pet food labeling is regulated differently than human food items, and the ingredient names don’t always conjure up a representative picture of what the item actually is, so an ingredient that sounds like something you would never want to eat can actually provide your pet with excellent nutrition (under the correct circumstances). Other “unrecognizable” ingredient names are actually the proper names of vitamins, minerals, and other important nutrients included for a good reason- to make the diet complete and balanced. Based on our previous discussions, I’d still recommend the diet we discussed. It uses safe ingredients that create an overall nutritional profile that is appropriate for Muffy. Further, it comes from a manufacturer with good quality control processes. If you would like another option, I can investigate further, but would need to know what specific criteria you are looking for in a commercial diet.    
I hope you know that I care about Muffy’s health very much (it’s part of the reason I do what I do). Veterinary Nutrition Care also makes no profit from commercial diet recommendations.
I’m not exactly sure what you want to know about products x, y, and z. Given Muffy’s medical conditions, x and y aren’t good options. I don’t have any experience with z, and the product’s website doesn’t provide much nutritional information- mainly marketing. I’d be happy to make a phone call for more information if you want to proceed with another option besides the commercial product I recommended. If product z turns out to be a good option for Muffy, I can determine how much she should be fed.
I'd still recommend proceeding with the plan we made yesterday.
I hope this helps. Please let me know:

1) If you have further concerns about pet food ingredients, and if so, what are the specific concerns

2) If you want to proceed with investigating other commercial diet options, and if so, what are the criteria you have for selecting one. Perhaps this would be easier to discuss by phone.
3) If you would like me to look further into product z.
Also, please give me a call or email in a week with Muffy’s current weight.
Thank you,
-Amy

It took over 30 minutes for the veterinary nutritionist to investigate the products Bob mentioned and compose this response, which means that additional follow-up communication (which is needed, given Muffy’s conditions) will now be billed separately. This email also requires both Bob and his veterinary nutritionist to take even more time to reply, since there are still unanswered questions.

Here is another way Bob could state the same questions and concerns.

Dear Dr Farcas,
I read online (link to site) that some ingredients in commercial pet food are fillers, and aren’t good for dogs.  Does this change your recommendation? If it does, I’ve also found some other products (links to products x, y, and z) that sound good to me, since I’d prefer to use a commercial diet instead of home-cooking for Muffy. If the recommendation does change, would any of these work for Muffy? Please let me know how much of each that I would feed.
Thank you,
-Bob

Response from Veterinary Nutrition Care:


Dear Bob,
Thanks for your email. The website you found isn’t a reliable source of evidence-based information, meaning that the content is largely opinion and rumor. Based on this, I wouldn’t change the recommendation. Products x and y aren’t appropriate for Muffy’s medical condition, and product z’s website doesn’t provide enough information to decide. I’d recommend proceeding as we discussed yesterday. Please let me know if you have any other questions or concerns- I'd be happy to discuss your question further, probably by phone would be easiest. If not, I’ll plan to hear from you in a week with Muffy’s updated weight.
Thank you,
-Amy    


In this case, it took only 8 minutes for Bob's veterinary nutritionist to review the website and products to which Bob referred and to compose a reply, however it still answers the same basic questions as the longer response above. Muffy’s additional follow up would then still be included in the amount billed for the initial visit.

Of course, no one here is going to tell you what to say or how to say it.

Veterinary Nutrition Care will always respond to your questions and concerns to the best of your nutritionist’s ability. If you prefer to take a different approach, Veterinary Nutrition Care will support you and keep you up-to-date with amounts billed for follow-up communications.