Dr. Caitlyn Getty, DVM, PhD, DACVIM (Nutrition), is back on the Cone of Shame to tackle a classic hot mess express: the IBD dog who now has early kidney disease. In this “How Do You Treat That?” episode, Dr. Andy Roark presents Murph, a finicky Yorkie with a sensitive gut, a history of GI explosions, and renal values on the rise. The kicker? His current food is working, and his owners are terrified to change it.
Dr. Getty breaks down how to approach cases with conflicting nutritional needs and shares her checklist for diet selection when no one food seems perfect. They dig into the new Hills Canine Multi-Organ diet, why it might be a game-changer for dogs like Murph, and when it might not be the right fit. You’ll walk away with practical tips for food transitions, client communication, and managing complex patients without causing a GI disaster. If you’ve ever had a fragile pup with overlapping conditions and nervous clients clinging to the current food bag for dear life, this one’s for you.
Check out the downloadable team training worksheet and follow along together! Empower your team to educate clients using the notes and discussion questions.
This episode is brought to you by Hill’s Pet Nutrition!
You can also listen to this episode on Apple Podcasts, Amazon Music, Spotify, YouTube or wherever you get your podcasts!
LINKS
Dr. Andy Roark Exam Room Communication Tool Box Team Training Course
Dr. Andy Roark Charming the Angry Client Team Training Course
ABOUT OUR GUEST
Caitlyn is a Board Certified Veterinary Nutritionist® and Scientific Communications Senior Specialist on the US Professional Veterinary Affairs Team at Hill’s Pet Nutrition. She spent 13 years at the University of Illinois completing her BS, DVM, and PhD in Nutritional Sciences. During veterinary school and her PhD, she became very interested in nutrition education of veterinary students and the power of nutrition in health and disease. She completed a rotating small animal medicine and surgery internship on the north side of Chicago and then moved to Raleigh, NC to complete her Small Animal Clinical Nutrition residency at North Carolina State University. She currently lives outside Indianapolis with 4 cats, 2 dogs, and her fiancé!
EPISODE TRANSCRIPT
Dr. Andy Roark: Welcome everybody to the Cone of Shame Veterinary podcast. I am your host, Dr. Andy Roark. I am here with my friend Dr. Caitlyn Getty. Caitlyn is a boarded nutritionist and she has a PhD in nutritional sciences and she is a nutrition guru. She’s one of those people who has a thing as nutrition, and she is stoked about it. And these people always get me excited when I get to talk to them about the thing that they love. So I have a question for Caitlyn today. I’m bringing her one of our, how do you treat that cases. And I’m coming with Murph. And Murph, he is an 8-year-old male neutered Yorkie that has a very, very fragile, sensitive stomach. He’s an irritable bowel dog. Not food allergy, but he is one of those. He’s very prone to pancreatitis. He’s very prone to gastroenteritis. And now guys, his kidney values are up. I’m worried that he’s an early renal dog. I do not wanna mess with his diet. His owners really are worried with “are we gonna mess with his diet and cause just an explosion of vomit and diarrhea” and “how do I maintain Murph if he’s so limited in what he can do?”
And so anyway, this is a fun case. It’s interesting to look at from a nutritional standpoint. I think Caitlyn does a great job of sort of breaking it down about what she’s looking for in a diet and in maintaining dogs like Murph for the best long-term outcome. And then we get into the Hills Canine Multi-organ Diet, and we talk about what that is, how that works, why that’s great for cases like this, what other cases it’s good for, and also when maybe we don’t wanna reach for it. So guys, that’s what we got going on. It’s a really good episode. Let’s get into it.
Kelsey Beth Carpenter: This is your show. We’re glad you’re here. We want to help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.
Dr. Andy Roark: Welcome to the podcast, Dr. Caitlyn Getty. How are you, my friend?
Dr. Caitlyn Getty: I’m doing awesome. It’s sunny, it’s gorgeous, and I’m excited to be here.
Dr. Andy Roark: Well, I am thrilled to have you here. For those who don’t know you, you’re a veterinarian, you’re a boarded nutritionist, and you also have a PhD in nutritional Sciences. Is that, I got that right? Right?
Dr. Caitlyn Getty: You did. You absolutely did.
Dr. Andy Roark: Excellent.
Dr. Caitlyn Getty: I got confused too when I was a grad student.
Dr. Andy Roark: At some point, I don’t know if you remember all the letters behind your own name. There’s just so many of them. So anyway, I am super thrilled that you’re here. I wanna run a case by you today and do a little, how do you treat that? Does that sound okay?
Dr. Caitlyn Getty: That sounds perfect.
Dr. Andy Roark: Good, good, good. I have an 8-year-old male neutered Yorkie named Murphy. And he goes by Murph, AKA, The Murphster. So Murph is a special child. He has a chronically soft stomach. This is a dog that likes to steal food.
He loves to sample treats. He begs for food all the time. And if you give him anything, he erupts into diarrhea and vomiting. Like, that’s his party trick. Yeah, that’s his party trick. And so I got Murph pretty well ironed out. He’s been on i/d for some time now. It works really well for him.
He’s not a food allergy guy. He’s just an irritable bowel disease kind of, you know, very sensitive, reactive GI sort of guy. And in response to his tendency to steal food and explode in diarrhea and vomit, his owners have become really protective of his food. Like they got something that works. He’s well regulated.
They are like white knuckling, holding on to i/d, and they’re like, this is our jam. This is our thing. And as long as we do this and we don’t deviate, everything is fine, but Murph has got some renal insufficiency and I don’t like the trend lines of his renal insufficiency. So his BUN is creeping up. His creatinine is creeping up. His urine specific gravity is creeping down a bit.
We’re getting to a place where I feel like we need to start trying to show those kidneys some love. And so I’m looking at that and you sort of, my go-to around kidney disease is, generally sort of nutrition and nutritional, you know, choices to help support those patients. I want The Murphster to have the longest life possible.
His owners want that too, but again, they’re really worried about tinkering with the diet that he’s got. And so I wanna talk to you about how do I approach this? How do I treat this? And then once I kinda have a plan with you, how do you approach the messaging of this back to the clients to sort of help them get on board with any changes or modifications we wanna make?
And so let me stop talking there and just sort of say, that’s Murph, that’s what I’m looking at. I’m gonna slide him across the table to you and say Caitlyn, how do you treat that?
Dr. Caitlyn Getty: Awesome. And these are my favorite, thes complicated, you know, you’ve had them well maintained for a long time and now you have something new. What are we gonna do about it? And so as you slide The Murphster across the table and he’s feeling he’s spicy. He seems real spicy.
Dr. Andy Roark: Yes. Oh, he, yeah. He’ll bite ya. Just be careful.
Dr. Caitlyn Getty: but I also feel like his record is about this thick.
Dr. Andy Roark: Yeah.
Dr. Caitlyn Getty: These owners seem like they’ve been in to see you, you know, two to three times a year for what’s going on. We’ve got some really great trend lines
Dr. Andy Roark: Oh, every time he steals something and eats something, he comes to see me every time and it’s a lot.
Dr. Caitlyn Getty: So this is a dog where we actually have a great dietary history and we can see kind of how he’ll react. And we look back, we see, know, maybe he got a piece of roast beef and that might be a little fattier than he can handle. Or he got some, you know, whole bag of dog treats and that’s more than he can deal with. So it sounds like we wanna keep him, so for his GI issues, we wanna try to keep him in that highly digestible camp. Like, the i/d like the GI diet category. Try to keep the fat. So the fat and i/d is kind of what we consider moderate.
Dr. Andy Roark: Okay.
Dr. Caitlyn Getty: If you’re looking at the, like a product guide, for example, say like three to five grams of fat per hundred would be moderate, i/d sits kind of right in the middle of that. So we wanna keep it there or lower. But then we look at the renal disease and that is, his second issue that we need to focus on while also maintaining his GI health. And you look at how renal foods are formulated, and of course they’re gonna be low in phosphorus to help reduce that work on the kidneys.
They’re low in sodium, to help again, reduce work on the kidneys, reduce possible blood pressure issues. They tend to be lower in protein which may be in early stages. We don’t need super low in protein, but it kind of depends. We’d have to look at his trends and how he’s doing. and then they have a handful of other things in there.
Things like Omega-3 fatty acids to help with blood pressure and renal hypertension and inflammation. But also because a lot of these kidney patients aren’t eating well. So like in our later stages, those stage three, four dogs, especially things like a Yorkie that might get super, super picky if they’re not feeling well, these foods are very calorie dense and they tend to be pretty high in fat. Which also happens to make them taste good. And so if you think about a dog like Murph who’s really sensitive about dietary change, going from what we would consider a moderate fat diet to a more of a higher fat diet makes me a little bit nervous.
So then we’ve kind of got a conflicting nutritional need for this dog and what do we look at to try to find the correct food for him.
Dr. Andy Roark: Right.
Dr. Caitlyn Getty: So when I was a resident, and when I’m looking at cases like this, I like to make a list of all of the nutrients I’m considering. So I’m looking at phosphorus, I’m looking at fat, I’m looking at digestibility, not a nutrient, but I still consider it kind of a nutritional factor and something that I’m considering.
Dr. Andy Roark: Okay. I like that.
Dr. Caitlyn Getty: And I make a list and what do diets look like and how, where do they all rank? What I find when I make a list like that is that there’s no one diet that’s gonna be the most perfect for kind of every combination of conditions, but there are diets out there that might be pretty close to what we’re looking for each condition.
So we can try to get something that’s gonna be highly digestible, keep it moderate fat, then also gonna be kidney friendly for those earlier stage renal patients. And so when I’m thinking of something like that, I’m thinking of the new canine multiorgan because it’s going to be that kind of combination and Like conflicting nutritional needs. It kind of, tries to go and address the different kind of more middle of the road. How are we gonna treat these kinds of patients? It’s not the lowest protein, but you know, this Murph dog probably doesn’t need a super protein restriction.
It’s, you know, right at the beginning levels of phosphorus restrictions for a kidney dog. It’s got a lower fat, it’s highly digestible. And so that might be the kind of food that I’m gonna reach for because it’s suited. Specifically for those conflicting needs, maybe it’s not as kidney diet and not as GI diet, but it’s kind of situated right in the middle.
Dr. Andy Roark: This makes sense to me. I need to keep Murph on the straight and narrow as far as his, GI upset. But like I said, he’s not a severe renal dog. I’m just seeing progression and I want to, I wanna make sure that we’re managing it. That makes sense to me.
Talk to me about how you sort of introduce these diets. Something like this. So, I’ve got this dog and, they’re sort of fragile. Mom and dad like to hold on to the sort of diet that they have. When you start to transition like this, if you’re gonna say, I’m gonna try, you know, the multi-organ diet yeah.
How do you start to introduce that? I can imagine. I don’t know. Are there extra considerations given lemme pause here for a second and be honest about Murph. He’s fragile. He’s fragile. And again, I know that sounds silly and I should just be like, just we’re switching and we’re gonna do this quick transition. But is there any, is there any way I’m going to mess this up? Is there any way that I can smooth this transition? Because if I switch him, Caitlyn, and he explodes in diarrhea and vomit, I’m gonna have a lot of cleanup to do in a metaphorical client customer service sense. And so help me with that. Are there any best practices in making the transition here?
Dr. Caitlyn Getty: Absolutely, and I think, you know, he might be fragile, but a lot of dogs and cats, I would consider every dog and cat fragile if we’re worried about, you know, them having some kind of health condition, wanting to make any kind of treatment change. And then the clients, right, of course, are worried about their pets.
They want the best for them. They wanna avoid any kind of issue. And so I think the slow transition is gonna be the best bet. So not the, we ran out of a bag that we’re feeding now and we have this new bag of this new food. So we’re just gonna start switching to that new food right away. That seems like Murph might have a little bit of an issue, probably a blow up. And usually when we’re doing a transition, I would think over maybe a week, you know, you start doing 25% of the new diet, 75% of the old diet gradually switch over until you’re at a hundred percent of the new diet. With the dog this sensitive, I’d probably try to do that over two to three weeks to try to slow down. You know, those changes in the nutrient profile they’re gonna have different ingredient sources.
Dr. Andy Roark: Okay.
Dr. Caitlyn Getty: You know, digestibility and things like that. But any kind of change can make a sensitive dog have an issue. So trying to go slowly work the new diet in.
Dr. Andy Roark: Okay.
Dr. Caitlyn Getty: If you notice an issue, maybe back off, let ’em resolve and then you can keep going. slowly it’s gonna be our way forward here, especially ’cause he’s so new in his, likely renal disease. I don’t think we have to rush into a new food. I think taking our time really benefits Murph here.
Dr. Andy Roark: I think a two to three week transition is well beyond what I had in mind, which makes me feel good. Like that actually is like two to three weeks is a long transition. And but again, I, that’s, I, like that and I like if I set that expectation and say this is gonna be a three week transition, you know, like, this is how we’re going to do it and, sort of map it out for the clients in, in, in percentages.
That makes sense to me. Talk to me some more about sort of canine multiorgan in general. So, you know, we’re looking at Murph and, he’s a renal dog, a, gi upset dog. This diet can’t be a panacea. It can’t be, it’s multi-organ. Just this is the only diet you ever need because everything is an organ. Like talk to me about when, do I reach, when, do I reach for this?
Dr. Caitlyn Getty: So this diet I don’t know who’s familiar with g/d out there. So g/d is kind of the predecessor diet, which was a similar, you know, low fat, highly digestible kind of renal diet. This is g/d’s new fancy cousin.
Dr. Andy Roark: Okay.
Dr. Caitlyn Getty: This is the upgraded version of g/d and so one of the big facelifts of this food is that we actually added Omega-3 fatty acids, which is super important for our kidney patients.
It helps reduce that inflammation like I mentioned before, but also is gonna help with any kind of systemic inflammation. We mentioned GI diseases and it’s also good for fat sensitivities in dogs. It’s not a low ultra low fat, but it is in the low fat category. So,
Dr. Andy Roark: Okay.
Dr. Caitlyn Getty: super sensitive. It might not, like you’re that you need super fat restriction. Maybe not, but like ones that you’re like, I need to go lower fat. I have something else going on. It’s a really nice diet for that. The other things about this food, so I mentioned before that it’s gonna be lower in sodium.
It has those Omega-3 fatty acids. It also has carnitine in there, which, back to biochemistry. If we think about lipid metabolism and the heart and how muscles get their energy, they need carnitine to get those lipids into the inter mitochondrial membrane and all that. So it’s a heart healthy type diet as well and then, If you’re familiar with the Hills line of products and the, S plus OX shield or the SOX shield as I like to call it.
Dr. Andy Roark: Okay.
Dr. Caitlyn Getty: This food also has that, which means it helps reduce the occurrence of strite and calcium oxalate crystals. So a lot of these little guys prone to issues like that. oh, and then as well, so it’s a moderate protein diet.
Dr. Andy Roark: Yep.
Dr. Caitlyn Getty: It’s low in sodium. does have some soluble fiber in there as part of its kidney bundle, so that active biome kidney defense. But that also makes it really attractive as a liver diet. And it’s got a moderate protein level, so it’s in the fives and moderate five to seven.
When we think about a chronic liver patient, we’re reaching for something that’s labeled for liver disease, like an L/D or something like that. But those dogs don’t always need that protein restriction. A lot of times they actually need more of a moderate protein to help support the liver, health, any kind of healing that needs to go on.
And so this diet actually fits right. Like nicely in there where it’s a moderate protein diet, it is lower in sodium in case we have any kind of portal hypertension going on. But it has a really nice profile for that as well.
Dr. Andy Roark: Yeah, that makes sense.
Dr. Caitlyn Getty: All those things together.
Dr. Andy Roark: Where do you see veterinarians reaching for this doing well? So I guess what I’m saying is: When you think about the vets out there who have multi-organ on their shelves in their practice, who’s doing it right? Who’s using it well and what are they doing?
Like are there cases that are getting where this is really benefiting and you seeing some doctors reaching for it, whereas other doctors might, not like that might stand out in their mind as far as this is a great case for multi-organ. Are there any sort of tips and hacks like that, that you’re seeing?
I said, Iknow. So we’ve got multi-organ on the shelf, for example, and I look at it and sometimes I’m like, I wonder which cases, I’m not thinking about this, where I think it could be valuable. And yeah. Are there any best practices that you’re seeing?
Dr. Caitlyn Getty: Sure. It’s kind of, if you think about your hot mess express cases that have a lot of things going on and you kind of need it to be a moderate lot of nutrients kind of diet, right? You need like a low moderate fat, you need a moderate protein, you need the minerals to be moderate levels. need it to be highly digestible ’cause they’re having GI issues. Maybe they’re also having diarrhea. This is the diet that I would be reaching for. I used to use this, not multiorgan, but GD all the time in the ICU when I was a resident because it really fit those. I have a dog with four problems.
Dr. Andy Roark: Yes.
Dr. Caitlyn Getty: They’re all conflicting each other, and this none of them are in conflict with each other, with this kind of nutrient profile.
Dr. Andy Roark: So the dental disease, liver mass, bladder stones, irritable bowel disease dog with not great kidneys. This is this. That would be the one. Okay, great. Good. Alright, good.
Dr. Caitlyn Getty: That would be perfect. Yes.
Dr. Andy Roark: I have those patients and that’s what I was looking for is whenever I see the hot mess express, that’s when the bells need to go off in my head of like, Hey, we should start thinking about what this patient needs in, in its diet and then let’s start to match up.
But that’s super helpful for me. Are there any pitfalls that you see vets falling into either by reaching for the diet too soon or by not reaching for the diet, things like that? We talked sort of best practices. Are there mistakes you see people making the transition thing earlier was a great example, like that slow transition.
If you’ve got a fragile patient that’s a pitfall that might have gotten me and I’m, sorry, with glad we talked about that. So are there other pitfalls or things that you see people sort of falling into as they start to make a diet switch or, to reach for multi-organ?
Dr. Caitlyn Getty: I think the transition’s gonna be the, biggest one. You have to kind of look at. Which issue is gonna be the most pressing for the patient? And for example, in this dog, Murph dog, if his IBD had been a raging PLE for example,
Dr. Andy Roark: Yeah.
Dr. Caitlyn Getty: or like lymphangiectasia that needed serious, fat restriction and he was, you know, on a diet that was a lot lower. That might be the case where this diet’s not for that dog and maybe we need to compromise in other places. But that’s probably the biggest, potential issue that I might think of is, those very, very, very fat sensitive dogs.
Dr. Andy Roark: That’s super helpful.
Dr. Caitlyn Getty: Otherwise, it’s a very applicable kind of diet.
Dr. Andy Roark: That’s fantastic. That’s exactly what I was looking for is, there’s always something where I say that’s the big mistake that I want to make sure that I don’t make. And so that’s really, really helpful. Alright, so Caitlyn, this is super helpful.
Are there any last minute words of advice or anything you have for me with The Murphster far as sort of transitioning over to him? We talked to I think the slow transition is gonna help me talking to his owners quite a bit. Are there any other points that you would like to make or anything else that I’m missing?
Dr. Caitlyn Getty: I don’t think it’s anything we’re missing. I think we talked about it at the beginning, but maybe when we’re re-discussing Murph’s kind of digestive issues with his owner’s education on his treats and what he might have access to throughout the day. Maybe if there’s kids or if there’s guests over.
Dr. Andy Roark: Yeah.
Dr. Caitlyn Getty: What are some acceptable options for this dog? What has he responded well to in the past? You know what’s not gonna upset his renal disease. And you know, maybe even something as simple as setting aside some of his regular food so that if you have guests they can give it to him and it’s not gonna upset. But I think treats are one of those things that get overlooked, but are a huge part of the conversation.
Dr. Andy Roark: Yeah, that’s outstanding. Well, Caitlyn, thank you so much. If people are all fired up about canine multiorgan and they’re like, I wanna learn more, help me get my head around this. Where do you send them to get this insight?
Dr. Caitlyn Getty: So I like to send them to our HillsVet.com page, and from there you can go on our Hills Veterinary Academy and learn all about multi-organ, but also a lot of the rest of the diets. and even if you’re not on HVA, if you’re looking at the other parts of the website, things like the product guide are there as well, so you can look up all the nutritional information about multiorgan and make your best feeding recommendation.
Dr. Andy Roark: That’s super helpful. I’ll put links to that in the show notes so everybody can check it out. Caitlyn, thanks for being here guys. Thanks for tuning in and listening. Everybody take care of yourselves.
Dr. Caitlyn Getty: Thank you.
Dr. Andy Roark: And that’s what we got guys. Thanks for being here. Thanks to Caitlyn for being here. Thanks to Hill’s Pet Nutrition for making this episode possible. Gang I linked up everything in this show notes. If you wanna learn more about canine multi-organ diet. If you wanna learn more about Hill’s Canine Multiorgan, I got you covered links in the show notes, as I said. Gang, take care of yourselves, everybody. I’ll talk to you later.
