Dr. Jason Gagné, a Board-Certified Veterinary Nutritionist and Purina’s Director of Veterinary Technical Communications, is on to help Dr. Andy Roark sort out a tough case. Budrow is a 3 year-old mix breed dog with waxing-and-waning bouts of diarrhea and vomiting, and year-round allergies. His owners have tried all sorts of drugs and diets on this poor dog, and now we’re right back where we started. Let’s unpack what’s going on and get to the bottom of this!
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ABOUT OUR GUEST
Dr. Jason Gagné is a Board-Certified Veterinary Nutritionist and is Purina’s Director of Veterinary Technical Communications where he leads scientific innovation and product development for the Purina Pro Plan Veterinary Diets Brand. Jason works closely with innovation and renovation of dietary formulations, developing clinical trials, and Sales and Marketing. Prior to, and throughout his residency at Cornell, he served as an Associate Veterinarian in a small animal practice in Syracuse, New York. Jason has authored several publications in veterinary journals and textbooks, given scientific presentations at the regional and national level, taught a series of courses at Cornell, and serves as a scientific reviewer for leading journals and the American Kennel Club Canine Health Foundation.
EPISODE TRANSCRIPT
Dr. Andy Roark:
Welcome everybody to The Cone of Shame veterinary podcast. I am your host, Dr. Andy Roark. Guys, I’ve got a good one today. I have got an itchy, soft-stomached young dog. This dog has bouts of soft stools and a little bit of vomiting. Just a little bit.
Dr. Andy Roark:
He also gets ear infections and some slightly itchy skin. I’m sure you’ve never seen anything like this. Not super common at all. Guys, I want to unpack this. I want to get up-to-date. I want to give the tips, the tricks, and the pearls that I need to do a really good job with this case.
Dr. Andy Roark:
And so, I have brought in my friend, Dr. Jason Gagne. Dr. Gagne is a board certified veterinary nutritionist and he is Purina’s Director of Veterinary Technical Communications. He is a super smart guy and a pleasure to talk to.
Dr. Andy Roark:
Gang, this episode is … Man, I’m so happy. I’m so pleased. This episode is made possible ad-free by Purina Pro Plan Veterinary Diets. Let’s get into this episode.
Kelsey Beth Carpenter:
(Singing) This is your show, we’re glad you’re here, we want to you help you in your veterinary career. Welcome to the Cone of Shame with Dr. Andy Roark.
Dr. Andy Roark:
Welcome to the podcast, Dr. Jason Gagne. Thanks for being here.
Dr. Jason Gagne:
Yes. Thanks so much for the opportunity. It’s really nice to get together with you today.
Dr. Andy Roark:
Oh, man. My pleasure to have you here. You are a board certified veterinary nutritionist. You do a lot of different things. I have a case for you that I think is going to be right up your alley. I was wondering if I could run it past you?
Dr. Jason Gagne:
Yes. Let’s do it.
Dr. Andy Roark:
All right. Cool. I have Budrow. Budrow is a three-year-old … We call him a Carolina Yellow Dog. Some people call them Heinz 57. He is no kind of pure breed I’ve ever seen. He is a mixture. He is a shelter dog and he’s a super nice guy. A sweetie.
Dr. Andy Roark:
He’s probably about 35, 40 pounds. Brown, black checkerboard kind of dog. Just a happy three-year-old guy. The problem I’m having with Budrow is that he is three years old, and he has had intermittent vomiting and soft stools for a year and a half.
Dr. Andy Roark:
Just off and on. Often times, it’ll be his wellness check-up and they’ll just bring it up. Sometimes he comes in and they say, “This is getting kind of bad.”
Dr. Jason Gagne:
Yep.
Dr. Andy Roark:
It’s never awful, like an emergency. But it’s always, “Hey, doc, I don’t think this is normal.” They call it a soft-stomach. Budrow’s soft stomach is bothering him.
Dr. Jason Gagne:
Soft stomach, sensitive stomach?
Dr. Andy Roark:
Yeah. At the same time, the reason that I ended up talking about his stomach is he’s in for ear infections.
Dr. Jason Gagne:
Wow.
Dr. Andy Roark:
Every three to six months he comes in for … He’s sort of shaking his head or he’s got some allergy flare ups. Again, he’s not an awful dog.
Dr. Andy Roark:
Don’t think about … He’s not a bald dog. He’s not a beet-red dog. These are just mild, nagging symptoms. And so, I wanted to ask you about this, because I’m not fixing Budrow. And it’s bothering me.
Dr. Jason Gagne:
And it’s just been occurring off and on for a year and a half?
Dr. Andy Roark:
Yes, but he’s only three. And so, it’s fairly early on. Anyways, I’ve been talking to the owners about this and going back and forth. They want me to fix the problem.
Dr. Andy Roark:
I’ve talked to them a little bit about diet and things like that. And I’ve gotten them to … They’ll try some different things. They’re doing some over the counter, limited ingredient diets. Stuff like that.
Dr. Jason Gagne:
Sure.
Dr. Andy Roark:
Mostly, they’re like, “No, no. I think he needs an allergy medicine,” or things like that. I’m having a hard time just unpacking this. There seems to be a lot going on. I know I just sort of gave you a hot mess. Help me break this case up.
Dr. Jason Gagne:
Sounds like a great case. I may have heard this story once or twice.
Dr. Andy Roark:
There’s a lot going on with Budrow.
Dr. Jason Gagne:
It sure sounds …
Dr. Andy Roark:
Help me to break this apart into bite-sized pieces. How do I work this case up, first of all? And then, how do I get these people on-board with where we need to go?
Dr. Jason Gagne:
Yes. Have you done any treatments in the past with him before? Antibiotics or antihistamines? Something like that?
Dr. Andy Roark:
You mean for … Treating ear infections, he’ll scratch around his neck and everything. Get a skin infection. He’ll end up on some Cefpoderm and things like that.
Dr. Jason Gagne:
Okay.
Dr. Andy Roark:
And then, just basic … Cycling onto bland diets. Cycling onto high-fiber diets. I thought maybe increasing fiber earlier on might be helpful. He cycles onto short-term therapeutic diets and then back off again, to get back onto whatever his owners are excited about.
Dr. Jason Gagne:
Well, I think you raised a really good point there in the beginning … When you were telling me about how long this has been going on and taking your history of this dog.
Dr. Jason Gagne:
A three-year-old dog, a year and a half? It’s a pretty significant amount of time. And the itch [crosstalk 00:05:22].
Dr. Andy Roark:
It’s always one of those things where he comes in and they’re like, “This time, it’s his skin. It’s not his ears. It’s different.”
Dr. Andy Roark:
And I go, “I feel like these things are all tied together.” At some point, we keep having general skin and general stomach problems.
Dr. Jason Gagne:
Well, obviously, it could occur separately or it’s occurring together. The GI and the skins signs as well as the ears. Well, it’s called derm happening there.
Dr. Andy Roark:
Yep.
Dr. Jason Gagne:
You said they tried other diets? Limited ingredients, over the counter things?
Dr. Andy Roark:
Just over the counter stuff. Not therapeutic diets necessarily.
Dr. Jason Gagne:
Okay.
Dr. Andy Roark:
They get excited, like many pet owners do. There was some grain-free stuff they were really excited about. There was a bison diet that they found, that was very affordable that they liked. Again, stuff that they find a Tractor Supply, Costco, things like that.
Dr. Andy Roark:
Not any specific place, but they sort of light on things and they get these recommendations. They get excited about them. I haven’t been able to guide them away from that.
Dr. Jason Gagne:
Right. Right. No. First of all, I think one of the most important points to bring up is that in your history-taking of this dog … Just sitting back, listening to the owner, and the observation that this has been going on for a year and a half.
Dr. Jason Gagne:
The fact that some medications have been tried. The fact that what’s called limited ingredient, over the counter foods have been tried to no avail. I think there’s a little bit to unpack there, because of something like a non-seasonal pruritus … The off and on GI signs with a loose stool. Maybe a little vomiting.
Dr. Jason Gagne:
I think we have to start to rearrange our differentials there. I think we need to start thinking about adverse food reactions, actually. And I think it’s really interesting for me as a nutritionist to look at that problem.
Dr. Jason Gagne:
It’s where food could be your friend, but it could also be your enemy at the same time. And then, it could be the solution to the problem. Let me ask you this. Is the dog in a good body condition score? Good muscle condition? Good appetite?
Dr. Andy Roark:
Yeah. Exactly. He seems to be … It’s one of the confounding parts of the case. He seems to be a pretty much super happy guy. I think if he was less happy, his owners would be more motivated to weight into this. He seems to hold his weight well. He seems to be energetic, playful. A playful, goofy guy.
Dr. Jason Gagne:
Really, a good place to start would be maybe an elimination diet trial. Having that conversation with the owner that, again, food may be something where … It doesn’t seem natural, but sometimes the immune system starts to recognize certain ingredients, certain foods as an enemy.
Dr. Jason Gagne:
How do we work with that dog and understand that nutrition can be a therapy rather than hopping around from medication to medication? At the same time, doing good profession of antibiotic stewardship too.
Dr. Andy Roark:
No, I agree with that. And that makes sense. Let me get into the nuts and bolts of what I need your insight on.
Dr. Jason Gagne:
Sure.
Dr. Andy Roark:
I’ve got this dog. I’ve got Budrow and he’s having this upset stomach. He’s having some soft stool and he’s having intermittent vomiting. Everything. That’s what they were in for most recently.
Dr. Andy Roark:
I’m 100% on-board with the diet trial and I think that I can make this case of, “Hey. It’s been a year and a half. It’s time to do this.” How do I actually implement and carry out the food trial while treating the condition that he has?
Dr. Andy Roark:
Do I want to get him stabilized and then start this food trial? Am I changing his diet while he’s having this soft stool and GI general upset? Help me figure out how to … What does this look like to implement that food trial, while I have a dog that is symptomatic and itchy?
Dr. Jason Gagne:
In my experience, communication is of utmost importance with these owners. It truly is. Because you have to get them to buy into it, in order to do good by the dog like you want to.
Dr. Andy Roark:
Right.
Dr. Jason Gagne:
What we need to do here is inform the owners and discuss with them what an adverse food reaction is. The immune system may be recognizing food as a foe. At that point, we need to take a complete dietary history.
Dr. Jason Gagne:
We need to see what this dog’s been eating. You mentioned that the dog has been eating some of the limited ingredient, over the counter foods. Right?
Dr. Andy Roark:
Yeah.
Dr. Jason Gagne:
Explain to them that, while they are good foods, complete and balanced, et cetera … They may not be taking into account, “limited ingredients.” That’s what they are.
Dr. Jason Gagne:
There may be a little bit of cross-contamination of proteins within the manufacturing environment. We need to move away from those over the counter foods. The reason I bring up the protein is, as we know, it’s an intact protein that is usually the cause of the adverse food reaction.
Dr. Andy Roark:
Let’s unpack that a little bit. Spell that out for me a little bit more. When they say, “Hey. I’ve got this diet. It says it’s limited ingredient.”
Dr. Andy Roark:
You say there may be cross-contamination and things like that … Lay out what you mean when you say that. Help me understand how to explain that to clients.
Dr. Jason Gagne:
There are many companies out there that sell foods over the counter.
Dr. Andy Roark:
Sure.
Dr. Jason Gagne:
They may want to make a bison food or a venison food. And that’s wonderful, as they should … That may be something that a dog has not consumed before and is on the side. We may think, “Hey. You know what? Go to the pet store. Get that bison food. Try that out.”
Dr. Jason Gagne:
However, in that manufacturing environment of that manufacturer, it’s possible that they have run their chicken and rice food, let’s say, first. And then, they run their bison and rice food. Or bison and potato food. Whatever that may be.
Dr. Jason Gagne:
There could be a little cross-contamination of that chicken in the bison food. And then, if the dog has an adverse reaction to the chicken, they are still consuming some amount of chicken within their bison food.
Dr. Andy Roark:
Right.
Dr. Jason Gagne:
That’s what I’m saying. That’s why I err to the side of therapeutic food. Because you have those … What should we call them? Best practices.
Dr. Jason Gagne:
The standard operating procedures in the manufacturing environment. Cleaning those lines. Cleaning those conveyors, so that you don’t have that confounding factor, potentially. Does that make sense?
Dr. Andy Roark:
It definitely makes sense. Give me the basics just real fast of a food trial. What notes do I want to make sure that I hit when I do this? I know we’re going to get serious about it.
Dr. Andy Roark:
I’m going to have to get utmost compliance from the client. I want to do it right the first time. What notes do I need to make sure I hit to run a good food trial?
Dr. Jason Gagne:
I think you need to be upfront that therapeutic diets are more costly. I do think that, at the same time, you need to mention that the alternative here is some medications, which … Depending on the severity of the GI signs or the derm signs, you may have to get some medications at first.
Dr. Jason Gagne:
But you could err away from medications. You could err away from those side effects subsequently. And that food could actually be the solve here. The important thing here is that, in that dietary history, you’re saying, “Hey. What supplements are you taking? What treats are you feeding? Any table scraps?”
Dr. Jason Gagne:
That really starts to come out in that conversation. You’d be surprised how many obesity cases I’ve solved with just asking those questions. The wife looks at the husband or the husband looks at the wife and says, “You’re feeding the dog in the morning too?” And then, they wonder why they were overweight.
Dr. Jason Gagne:
But getting back to this case here. We need to really tell them, “Okay. I understand you’re feeding them this. You’re supplementing that.” We need to get away from anything flavored. We need to be pulling away those table scraps. We need to be pulling away those excess treats. So on and so forth.
Dr. Jason Gagne:
So that the only thing the dog is consuming for this elimination diet trial is the food. That therapeutic food that you’re recommending.
Dr. Andy Roark:
Sure.
Dr. Jason Gagne:
If it’s derm signs, it’s typically eight to twelve weeks in time. If it’s GI signs only, usually you see a fix within two to four weeks.
Dr. Andy Roark:
Okay. That makes sense.
Dr. Jason Gagne:
Some of them. Because so many dogs have GI and derm signs together. It’s going to be the eight to twelve weeks, because the derm is going to trump the GI there.
Dr. Andy Roark:
Right. Got you. That totally makes sense. What are the keys in selecting my therapeutic diet?
Dr. Jason Gagne:
Well, again, taking that dietary history. Asking the foods that the dog has been on previously. It really helps there choosing. If you want to go to a novel protein diet, that is a therapeutic diet.
Dr. Jason Gagne:
I do find that has been a little less efficacious over time. That really is what gave rise to the hydrolyzed diets back in the late 90s, early 2000s. Hydrolyzed diets have been great. They still continue to be great.
Dr. Jason Gagne:
But if you’re not familiar with that concept, it’s basically … You take a parent protein and you break it into smaller pieces, so that the immune system doesn’t recognize the small pieces. It’s highly digestible as well. Oddly enough, some dogs do fail a hydrolyzed diet.
Dr. Andy Roark:
I’ve seen that. And so, I wanted to ask you a little bit about that. I have seen some breakthroughs and failures on hydrolyzed diets. They actually tend to do better on a novel protein diet. Something like that. I’ve found those cases.
Dr. Jason Gagne:
It does happen occasionally and you scratch your head at it … In theory, if this does happen, it’s possible that you break the parent protein into a smaller piece, and then that smaller piece refolds. And it can act as an epitope. The immune system flares anyway is the gist.
Dr. Andy Roark:
I always question adherence at home. Even if they’re like, “No, doctor. I don’t give them anything else.” I always struggle. I may have been unfair to those people.
Dr. Jason Gagne:
No.
Dr. Andy Roark:
I didn’t say anything, but …
Dr. Jason Gagne:
No, no, no. That brings back to my earlier comment about really clear communication of saying, “I’ve taken this dietary history. I know what your dog has consumed. Now, this is all we’re going to consume for eight to twelve weeks.”
Dr. Jason Gagne:
On this therapeutic diet only. Because, I too, have made this mistake in the past, where I’ve had people fail an elimination diet trial. As I scratch my head and wonder why at times … I come back and say, “All right. What are we feeding? Tell me what’s going on here.”
Dr. Jason Gagne:
I have had the owner who goes through the Wendy’s drive-thru and get a Frosty. Not really conducive to the trial at that point.
Dr. Andy Roark:
Right.
Dr. Jason Gagne:
I blame myself there and I’ve really learned to hone my communication skills with these owners. Something else that’s also truly important is that … As we tell these owners to transition their dogs over the course of a week onto that diet, we follow-up with them at the end of the week.
Dr. Jason Gagne:
Someone should call them and ask them how it’s going. “How did that transition go?” And then, continue to encourage them to move along for the remainder of the trial.
Dr. Andy Roark:
Well, what am I looking for at Week One when I say, “How did it go?” What type of …
Dr. Jason Gagne:
A successful transition, Andy.
Dr. Andy Roark:
What is that? What is a successful transition?
Dr. Jason Gagne:
They’re feeding some diet, as they come into you. You want to tell them to wean down on that diet over the course of a week. And then, what would be the term there? Waning?
Dr. Andy Roark:
Waxing? Waxing.
Dr. Jason Gagne:
Waxing and waning here. We’re going to wane down on the old food, we’re going to wax onto the new food. Over that course of a week, you’re slowly decreasing the old and slowly increasing the new.
Dr. Andy Roark:
Success is just doing the thing?
Dr. Jason Gagne:
Yes. Success is just [crosstalk 00:17:30].
Dr. Andy Roark:
Okay. Just giving it to them.
Dr. Jason Gagne:
But it’s that waxing and waning.
Dr. Andy Roark:
I got you. I wanted to know if there was a clinical sign that you’re looking for, Week One, if we’re talking about a six-day … Or I think you said … How many days was it for GI signs to resolve? Six to eight weeks?
Dr. Jason Gagne:
Usually, two to four. Two weeks or four.
Dr. Andy Roark:
Two to four weeks. Okay. Even then, we’re not there yet. That’s why I was pushing back on that.
Dr. Jason Gagne:
No. Success at the end of Week One is that you have transitioned.
Dr. Andy Roark:
Got it.
Dr. Jason Gagne:
If you see improvement at the end of Week One, that’s great. But don’t necessarily expect it.
Dr. Andy Roark:
Right. That makes sense. Set that expectation so that they’re not like, “I’ve been doing this for a week and I don’t see any difference.”
Dr. Jason Gagne:
Absolutely. Absolutely.
Dr. Andy Roark:
Given what we have in modern therapeutic diets, is there a time that you’re going to not reach for a hydrolyzed diet to do this diet trial?
Dr. Jason Gagne:
I would say that what I really like to do at this point is … Considering some of the novel protein diets are not as relevant anymore, unfortunately. And that’s not because of them. That’s just because many of those over the counter foods have started using those proteins.
Dr. Andy Roark:
Sure. It’s gotten bougie … Bison sells. People go, “Oh. I want that.” You see it everywhere.
Dr. Jason Gagne:
It’s novel to owners, but not really novel to your dog per se. I’ve moved away from those. I still do go for hydrolyzed diets as well. But now, there are elemental. There’s an elemental diet out there as well, which is basically an amino acid based diet.
Dr. Andy Roark:
Talk to me a little bit about that. How that differentiates from your hydrolyzed diets.
Dr. Jason Gagne:
Instead of a hydrolyzed protein diet, where you’re talking about a parent protein being broken down into smaller pieces, and then that really odd potential to refold and still stimulate the immune system … In an elemental diet, you’re dealing with amino acids only.
Dr. Jason Gagne:
You’re working from that foundation up, rather than top-down. The immune system isn’t going to recognize amino acids. You look to amino acid base diets in the past. Really great success with pediatric Crohn’s patients for decades on these.
Dr. Jason Gagne:
They’re highly digestible and obviously they really hit the mark for novel as well. Very successful there and have been to shown to be excellent at malnutrition and GI disease. I will back up for one second.
Dr. Jason Gagne:
We talked about a dog here that’s in good body condition, good muscle condition, great appetite. Those dogs, at least in a textbook … I’m not saying this happens, because it doesn’t happen for me very often.
Dr. Jason Gagne:
But when you’re done with that eight to twelve week trial, if you’ve got derm and/or GI and derm? Theoretically, you’re supposed to ask the owner to re-feed the old food.
Dr. Andy Roark:
The re-test.
Dr. Jason Gagne:
Yeah. I may be a specialist, but I’m not sure I have any better luck than you, Andy, at getting people to do this. They may look at you like you’ve got three heads.
Dr. Jason Gagne:
I ask the question. I communicate this with them if we want a definitive diagnosis, because it does help our profession to advance as vets. But that owner has every right to say, “I’m not doing that.” And that’s fair at that point.
Dr. Andy Roark:
I’ve had those conversations. It’s very much in my category of, “Look, it’s my job to tell you this.”
Dr. Jason Gagne:
Occasionally, you get that curious owner and they want to do it. What’s really cool though is that, sometimes they flare, and then you go back onto the food you were feeding and it works. That’s the therapeutic food. And then, they stay on that for life. That’s great.
Dr. Andy Roark:
Sure.
Dr. Jason Gagne:
Occasionally, they re-challenge. And the dog actually can go back to their old food.
Dr. Andy Roark:
Why is that?
Dr. Jason Gagne:
Now, I may not have said that. But it speaks to nutrition probably giving a rest to the epithelium or the mucosal epithelium.
Dr. Andy Roark:
Interesting.
Dr. Jason Gagne:
Nutrition being the cure in that case.
Dr. Andy Roark:
That’s fascinating.
Dr. Jason Gagne:
It’s weird. I know.
Dr. Andy Roark:
But it validates some of the things that we’ve seen. Where you say, a lot of times if I can get this calmed down, sometimes I can get at least a long break from …
Dr. Jason Gagne:
It’s almost like a reset button.
Dr. Andy Roark:
Exactly. Right. That’s a great way to put it.
Dr. Jason Gagne:
For those owners that, there may be a little bit of sticker shock at the therapeutic diet. Saying, “This is a lot of money.” Maybe they actually do want to do that re-challenge and go back to the old food and see what happens?
Dr. Andy Roark:
That makes sense.
Dr. Jason Gagne:
The only time you would not deviate from it and say, “No, you’re on this food for life,” is when you have the severe GI disease. The protein-losing enteropathies, the lymphangiectasias, et cetera. Because you know that you have to stay therapeutic for that.
Dr. Andy Roark:
And that does make sense. That’s super helpful. And then, also I’ve talked to clients and I’ve said, “Hey. Look, this is the diet that we need to use.” They look at me and they’re like, “We can’t afford this. This is a three-year-old dog, but we hope Budrow’s going to be around for another 10 years.”
Dr. Andy Roark:
And I go, “This is 10 years of an expense.” It’s nice to at least say, “Well, let’s try this and let’s get him straightened out. See if we can hit the reset button at least, and see what we’ve got.”
Dr. Andy Roark:
Sometimes, they do. They hit the reset button and they re-challenge. And then, he starts to itch again or he starts to have soft stools. But they’re a believer in the diet. They say, “Okay, well, we’ve seen this work.”
Dr. Jason Gagne:
Absolutely.
Dr. Andy Roark:
A lot of times, people are looking at it and they go, “I don’t know if this is going to work. I don’t even know if this is really a problem that can be addressed with nutrition.
Dr. Andy Roark:
They may not have totally bought into that, “Budrow’s ears comes from his diet,” idea. And so, if I can just get them past that and get them to see some results. A lot of times, I have a lot more credibility with them.
Dr. Jason Gagne:
You know what? When you talk about the derm aspect of adverse food reactions and that true food allergy … Otitis externa. Those ear infections may be the only derm sign.
Dr. Andy Roark:
I believe that.
Dr. Jason Gagne:
It’s actually quite common. That is the number one sign for derm in food allergies, is the otitis externa. In addition to really stressing to owners and saying, “This is the only food to feed.”
Dr. Jason Gagne:
Taking that dietary history first and really actively listening to how long this has been going on, the signs, the off and on. I think what’s a really, really important point is to stress that the alternative here is continued medications.
Dr. Andy Roark:
Right.
Dr. Jason Gagne:
You’ve already been doing that. And it doesn’t seem to be working. The problems keep recurring. You think about it as we brought up the antibiotics. Those antibiotics are really disturbing that GI microbiome.
Dr. Jason Gagne:
What does that mean in the long run? What happens there? The Prednisone. The dampening of the immune system at the same time, systemically. What are the side effects long-term of that? Probably, not good. Probably, worth an eight to twelve week trial for the food.
Dr. Andy Roark:
That makes sense. I did a presentation in Orlando at the VMX conference, and I was talking about the psychology of making recommendations. There’s this idea of reframing. And it’s how we present concepts to pet owners.
Dr. Andy Roark:
If I take them to the therapeutic diet, and I put it down and I talk to them about the price … If they compare that price to over the counter dog food that they get at the grocery store, it looks really expensive.
Dr. Andy Roark:
If I compare it to the drugs and the medications and the examinations and the re-checks and the pain of dealing with infected ears … It looks like a much more reasonable cost. But it really is, how do you frame it?
Dr. Andy Roark:
Are you comparing the therapeutic diet to the thing that they buy at the grocery store? Or are you comparing it to the repeated visits to the veterinarian? The medications. The drug refills. Things like that.
Dr. Jason Gagne:
It absolutely is. It’s a whole slew of other things. And then, lastly, the long term side effects of the meds too.
Dr. Andy Roark:
That’s a really good point. Jason, do you have any final pearls, words of advice for me? Or pitfalls that I should look out for when I go and have this conversation?
Dr. Jason Gagne:
I’m just going to … I think we’ve done quite a bit of talking here about it and the importance of the communication. Just following up with these owners. Particularly, after that first week to make sure that they’re continuing to be compliant.
Dr. Jason Gagne:
And then, maybe some re-checks along the way there during that elimination diet trial. Touching base with them after two to four weeks to make sure about the GI. And then, definitely as we get out to the eight to twelve week period too.
Dr. Andy Roark:
This is fantastic. Thank you so much for your time. Thanks for helping me with this. Where can people get more information if they want to learn more about therapeutic diets? You mentioned the new elemental diet. Where can people learn more about this?
Dr. Jason Gagne:
Well, if you’re interested in that elemental diet that I was talking about earlier on, I’d say a great website to look up there would be purinaproplanvets.com. Or, of course, like any company, reach out to your sales representative.
Dr. Andy Roark:
Good. Sounds great to me. I’ll put a link down in the show notes for people to get that. Thanks a lot for being here. I appreciate your time.
Dr. Jason Gagne:
It’s been excellent. I appreciate the conversation. Good luck with Budrow.
Dr. Andy Roark:
Thanks, buddy. I’ll need it bye. That is our episode. That’s what I got for you. Guys, I hope you enjoyed it. I hope you got something out of this. Some tips, some tricks, some pearls. Some new ways of thinking or just a refresher on how to handle these uber common cases.
Dr. Andy Roark:
Gang, take care of yourselves. Be well. Enjoy your practice. Enjoy doing good things. Enjoy helping people and vets. And I will see you next time.
Editor: Dustin Bays
www.baysbrass.com
@Bays4Bays Twitter/Instagram
