Veterinary Prescriptive Nutrition by Pet Nutrition Systems

VETERINARY PRESCRIPTIVE NUTRITION

Veterinary Prescriptive Nutrition Catalog Introduction Pet Nutrition Systems has the first and only true comprehensive veterinary prescriptive nutrition service. We would like to offer you our support in your effort to provide nutrition as a tool in correcting and maintaining optimum health in all of your clients pets. Pet Nutrition Systems provide over 850 formulation/recipes to veterinary clinics, hospitals and specialty pet stores. These formulations are to be used alone &/or in conjunction with prescriptive medicine and/or eastern herbal remedies. For those of your clients who wish to have their pet’s meals premade we offer to hand make the recipes and have them shipped to their home or personal vet. clinic for pickup. Pet Nutrition System’s organic, raw and/or freshly cooked dog & cat meals are made per order and are the best option for obtaining and maintaining excellent health for your clients pets. We use organic meats, vegetables, fruits, and herbs and concentrate on how each group of nutrients work together to boost the immune system, heal illnesses and maintain optimum health We use an unprecedented “FOUR CORE STANDARDS PROCESS” that carefully consider “Form, Balance, Potency, and Freshness” in order to maximize the bio-availability of all nutrients. These custom blended formulations incorporate specific, Individualized dose of vitamins, minerals, enzymes, nutrients and symptom-oriented non drug medicines (herbal, glandular, and homeopathic).

These therapies more closely match the metabolic and nutrient requirements of an individual pet than any supplementation programs devised to date. We help you by formulating an individual diet plans that adjust and change to meet the needs of the animal you are treating. We also provide you with the best handmade whole food products that are produced to provide maximum absorption of all the critical nutrients.

Please take the time to read our VPN guidelines and contact us for an appointment.

Nutritional Factors and the Immune System An adequate nutritional state is important in managing a variety of inherited and other metabolic diseases as well as for a healthy immune system. Nutritional factors that play an important role in immune function include zinc, selenium and vitamin E, vitamin B-6 (pyridoxine), and linoleic acid. Deficiency of these compounds impairs both circulating (humoral) as well as cell-mediated immunity. The requirement for essential nutrients increases during periods of rapid growth or reproduction and also may increase in geriatric individuals, because immune function and the bioavailability of these nutrients generally wane with aging.

Assurance of proper nutritional health entails more than meeting minimal nutrient profiles defined by the AAFCO. Pet Nutrition Systemsâ&#x20AC;&#x2122; nutritional assessment considers several other important influencing factors including the status of the animal, the current diet, the feeding management and the environment. An iterative process, in which the factors affecting the animalâ&#x20AC;&#x2122;s nutritional status get assessed as often as required, provides the most thorough nutritional assessment of your pet.

• Animal-specific factors: Age, physiological status and activity of the pet. Problems related to these factors are referred to as nutrient-sensitive disorders (e.g., intolerances, allergies and organ-specific diseases). Diet choice should be restricted to those formulated to meet the diseaseassociated nutritional limitations of the specific animal. • Diet-specific factors Safety and appropriateness of the current diet. Problems related to diet factors are referred to as diet-induced disorders (e.g., nutrient imbalances, spoilage, contamination, adulteration). Feeding a diet known to be species appropriate for the animal may treat animals with these disorders. • Feeding management and environmental factors: Frequency, timing, location and method of feeding. Space and quality of the pet's surroundings. Problems related to feeding and environmental factors are referred to as feedingrelated and environment-related disorders (e.g., over- or underfeeding, excessive use of treats, poor husbandry, competitive eating in dogs, or lack of appropriate environmental stimulation). These situations require effective communications to produce the appropriate behavioral changes in the patient.

Guidelines for Evaluation: Review and summarize the history, medical record and information obtained during the screening evaluation and obtain additional data as described below.

Animal Factors • Review any changes in food intake or behavior (e.g., amount eaten, chewing, swallowing, nausea, vomiting). • Note condition of the integument. Nutrition-related abnormalities may include variable combinations of dry,

• easily plucked hair; thin, dry or scaly skin; and reduced resistance to venipuncture (due to loss of normal skin collagen density). Diagnostic work up. • Conduct minimum database/laboratory testing as appropriate. Specific testing might include a complete blood count!(checking for anemia), urinalysis, biochemistry profile!(including electrolytes, albumin), fecal culture or evaluation of other nutrient concentrations that maybe low (or high) as a result of an unbalanced diet (e.g., taurine, vitamin B12, iron). Additional workup as indicated (e.g., imaging, e ! ndoscopy). • Identify current medical conditions and medications. • Assess effects of the disease and any treatment plan on pet's nutritional status (e.g., thyroid disease). Some medications (e.g., diuretics) or procedures (e.g., significant intestinal resection, drain placement) can cause a loss or mal-absorption of essential nutrients. Diet factors • Evaluate caloric density of current pet food, particularly if pet is below or above desired BCS, or if owner has to feed unusually large or small amounts to maintain desired BCS (may have to contact PNS for this information). • Evaluate other sources of nutrients: treats, table food, supplements, food used for administering medication, chew toys (e.g., rawhide). Feeding Factors • Identify any potential influences in the following areas: - Primary feeder of pet, Feeding management (e.g., location, frequency). -Issues with multiple pets (competition for food, threats).

-Other food providers and sources, Extent of enrichment (e.g., toys, other pets, housing, food-delivery devices) -Activity of pet at home. Type (e.g., leash walks, backyard, free roaming/spontaneous).Amount (times per day/week). -Energy level and amount of activity.

Environmental Factors Environment and environmental stressors have a direct impact on nutrition. and include recent changes in the home, uncontrollable outdoor stimuli, conflict over resources such as food or access to the owner, conflict between animals. For example, both laboratory 31 and clinical 32 studies of cats with lower urinary tract syndrome show that environment plays an important role in presentation of signs regardless of the diet fed. The role of environment in other "nutrient-sensitive" disorders in cats has been reviewed, and a recent study concluded that indoor confinement and physical inactivity rather than the proportion of dry food were risk factors in the development of type 2 DM in cats. In dogs, a range of clinical situations, including competitive eating, coprophagia and obesity have been associated with environmental as well as with animal and dietary factors. Additionally, provision of food in dispensing toys may improve the welfare of indoor housed pets, 36 so changes in feeding containers also may be more important than is generally perceived.

Interpretation, Analysis and Action Upon review the nutritional assessment, interpret and analyze the information that has been gathered to devise an action plan and consider the following: Diet Factors Determine if current amount and type of food is appropriate â&#x20AC;˘ Based on life stage, lifestyle/activity, disease, body condition, concurrent medications and/or medical procedures.

If diet factors are determined to be inadequate, PNS will prepare a plan for food and treats that provides appropriate calories and nutrient intake for the animal. • Consider other food sources in total intake recommendations if necessary. PNS will help you recommend a specific feeding plan that incorporates pet food, treats, table food, feeding method, frequency and location. Feeding management and environment factors • Determine any changes in feeding management and any necessary environmental changes. Some dogs and cats can maintain good body condition when fed free choice, others require meal feeding of appropriate amounts to maintain good body conditioning. • Confirm the use of an appropriate food-measuring device (e.g., an 8-oz measuring cup), and provide food in measured amounts (whether feeding free choice or meals). • Management changes may include provision of feeding toys, and reducing conflict and competition for food. Environmental enrichment may include increased opportunities for activity (play, exercise), as well as efforts to decrease perception of threat from other animals (as well as humans) and reducing the frequency of unpredictable change in the animal's environment.

Animals with disease conditions and/or recommended nutritional changes Non-hospitalized animals for which extended nutritional evaluation was indicated may require more frequent monitoring of nutritional assessment parameters Frequent monitoring of BCS and MCS is important as many diseases are associated with suboptimal scores. Also, animals with medical conditions are more likely to receive dietary

supplements and to have medications administered with food, so specific attention to and review of these issues, with an update of the dietary plan, are important at each visit to ensure that the overall nutritional plan is optimized.

Client Education Client communication and rapport is important for achieving desired outcomes. Technicians should be involved in the nutritional service process when they have knowledge and skills in both nutritional concepts and in communication. Engage the client in decision making and defining expectations. Recommendations made by you or PNS may be modified by the client's time, lifestyle and financial limitations. Demonstrating and teaching the client to evaluate their petsâ&#x20AC;&#x2122; nutritional needs is effective in engaging the client in their pet's care. Expectations and goals should be specific, achievable and include specific follow-up to monitor progress and compliance, and to adjust recommendations. PNS will help you inform your clients about specific food choices, potential advantages, risks and concerns. Include recommendations on amount and frequency of diet fed, accounting for snacks, treats, table food, foods used for medication administration, and dietary supplements. Our goal is to assist you, your staff and your client achieve the knowledge needed to make a more informed decisions regarding their pets health thru the use of proper nutrition,

Summary Nutritional assessment is an important aspect of optimal animal care. Pet Nutrition Systems veterinary prescriptive nutrition service provides guidance for appropriate, effective assessment, evaluation, action monitoring, education and handmade meals. With little practice, this approach can be efficiently incorporated into daily practice without additional time or expense. Stay tuned for further developments and expanding knowledge. Wholesome nutrition is a key component for maintaining a healthy immune system and resistance to disease. 98% of all commercially made dog food ingested by pets are imbalanced in terms of major nutrients, minerals and vitamins, and often contain chemicals added to the final product to enhance its stability and shelf life. Nutritional deficiencies or imbalances, as well as exposures to various chemicals, drugs and toxins, present a continual immunological challenge which can suppress overall immune function, especially in those animals genetically susceptible to immune dysfunction (immune deficiency, autoimmunity, allergies). For example, Beagles are susceptible to distemper, demodectic mange, and autoimmune thyroid disease; Boxers to cancers; Doberman Pinschers and Rottweilerâ&#x20AC;&#x2122;s to parvovirus gastroenteritis with vomiting and diarrhea; and Shar Peis to IgA deficiency. However not all individuals at risk will become affected. One hypothesis to explain why some animals become affected with specific diseases while others remain normal, despite their common susceptibility, is called the "Threshold Model." In this situation, genetically susceptible individuals develop disease following the additive effects of inducing agents such as drugs, exposure to toxic or noxious substances, hormonal imbalances and dietary influences.

Genetic differences between individuals lead to quantitative variations in dietary requirements for energy, nutrients and overall health. Also genetic defects may result in inborn errors of metabolism that affect one or more pathways involving nutrients or their metabolites. Many inborn errors of metabolism are fatal, whereas others may show significant clinical improvement with nutritional management. Minimal and maximal nutrient requirements that can be important in this regard include vitamin C, vitamin E and selenium, vitamin A, copper and vitamin B-12. Similarly, a wide variation occurs in the energy needs of dogs depending on their breed, age, sex and size. Breeders quickly learn to adjust the caloric intake of their animals depending on the optimal requirements of each individual.

Nutritional Factors and the Immune System As alluded to above, an adequate nutritional state is important in managing a variety of inherited and other metabolic diseases as well as for a healthy immune system. Examples where nutritional management is important in inherited disorders include: adding ingredients to the diet to make it more alkaline for Miniature Schnauzers with calcium oxalate bladder or kidney stones; use of the vitamin A derivative, etretinate, in Cocker Spaniels and other breeds with idiopathic seborrhea of the skin; management with drugs and/or diet of diseases such as diabetes mellitus and the copper-storage disease prevalent in breeds like the Bedlington Terrier, West Highland White Terrier, and Doberman Pinscher; wheat-sensitive enteropathy in Irish Setters; and treatment of vitamin B-12 deficiency in Giant Schnauzers. Other nutritional influences include the

vitamin K dependent coagulation defect elicited in Devon Rex cats following vaccination; hip dysplasia in puppies fed excessive calories; osteochondritis dissecans (OCD) in dogs fed high levels of calcium; and hypercholesterolemia in inbred sled dogs fed high fat diets. Nutritional factors that play an important role in immune function include zinc, selenium and vitamin E, vitamin B-6 (pyridoxine), and linoleic acid. Deficiency of these compounds impairs both circulating (humoral) as well as cell-mediated immunity. The requirement for essential nutrients increases during periods of rapid growth or reproduction and also may increase in geriatric individuals, because immune function and the bioavailability of these nutrients generally wane with aging. When correcting a general physical or dietary deficiency, our handmade organic meals and healing beverages give particular attention to form, balance and potency for optimum health and measured results. Holistic veterinarians insist that the key to disease prevention is found in a diet rich from living enzymes, antioxidants, amino acids and a good source of organic protein. Pet Nutrition Systems gourmet recipes and prescriptive formulations start & end with pure restaurant quality ingredients. Pet Nutrition Systems utilizes the most advanced blood tests to diagnose and help correct your pets nutritional deficiencies, over come an illness and or improve the quality of life. We use modern science and the most advanced veterinary prescriptive nutrition programs

PNS CANCER & IMMUNE WELLNESS PROGRAM PNS CANCER WELLNESS PROGRAM A. Proper Diagnosis B. Design a Dietary Nutrition PLAN C. Supplements At Pet Nutrition Systems we encourage a proactive holistic approach to pet health care. We believe it to be the best way to protect our pets and keep them healthy. If your dog is suffering from cancer, we offer a comprehensive program to help indentify the infection and create a Veterinary prescriptive diet plan to naturally aid your pet’s body and immune system. Following the guidelines in this wellness plan can give your dog the support to stop the suffering sooner.

STEP A: Proper Diagnosis Determining exactly what the illness is and its cause in your dog is not always easy and may require some patience. PNS has found that the quickest and easiest route to determining the problem is to consult with one of our board certified specialist. Once we have consulted with your or our specialist a blood tests will be recommended to determine what physiological and dietary deficiencies are present in the pet’s body. Armed with this information we will be able to design a holistic organic rotation diet plan that with correct the deficiencies, bolster the immune system and avoid any ingredients that maybe working against the body’s quest for optimum health.

STEP B: Assist With Nutritional Diet Plan The best option for a dog with cancer is a homemade diet. This allows you to eliminate simple carbohydrates like white rice, potatoes and processed grains. The homemade diet should consist of 75% meats and 25% vegetables - mainly green ones like sprouts, broccoli, spinach, celery, etc. Fruits and sweet vegetables like peas, sweet potatoes and beets should be avoided. Evidence also suggests that cancer is inhibited by a high fat diet. You can add more fat to your dog's diet by adding more fish oil, which has additional benefits. Reducing risk factors for cancer, eating a properly balanced diet (free of

pesticides and preservatives), drinking pure water, providing appropriate antioxidants, vitamins and minerals, and exercising regularly can help prevent cancer. Once cancer has been found, additional supportive measures are needed. Cancer cells utilize carbohydrates for fuel and compete for the body for amino acids. However, these cancer cells do not metabolize fats. Some data suggests that high fat diets can help the patient overcome the effects of cancer and even reduce cancer expansion. Cancer causes metabolic changes in your dog's body, which require a modification in diet. Unfortunately most commercial diets are inappropriate for dogs with cancer. This is due to the following: * Most commercial diets contain meat by-products, which are higher in hormones that can stimulate cancer growth. ! * The ratio of proteins, fats and carbohydrates is inappropriate for cancer support. ! * Preservatives like BHT and BHA have been linked to various health problems in pets and should be avoided. Once we have obtained your blood test back from the lab and receive your PNS Veterinary Prescriptive Nutrition form our animal nutritionists will select the proper recipes for your petâ&#x20AC;&#x2122;s diet plan. You will receive these recipes to make for yourself or have our commercial kitchen make and ship to you.

PNS DIGESTIVE DISORDER WELLNESS PROGRAM PNS DIGESTIVE WELLNESS PROGRAM A. Proper Diagnosis B. Design a Dietary Nutrition PLAN

At Pet Nutrition Systems we encourage a proactive holistic approach to pet health care. We believe it to be the best way to protect our pets and keep them healthy. If your dog is suffering from digestive disorder problems, we offer a comprehensive program to help identify the infection and create a Veterinary prescriptive diet plan to naturally aid your pet’s body and immune system heal. Following the guidelines in this wellness plan can give your dog the support to stop the suffering sooner.

STEP B: Assist With Nutritional Diet Plan Once we have obtained your blood test back from the lab and receive your PNS Veterinary Prescriptive Nutrition form our animal nutritionists will select the proper recipes for your petâ&#x20AC;&#x2122;s diet plan. You will receive these recipes to make for yourself or have our commercial kitchen make and ship to you. One of the hallmarks of Inflammatory Bowel Disease (IBD) is an inflamed intestinal lining. This inflammation and the mucus it secretes reduce nutrient absorption. Addressing this problem is to reduce the inflammation with herbs and essential oils and make the food more easy to break down for ease of digestion. Boiled long grain rice and ground meat is preferred for sensitive digestion. Most commercial dog foods, especially the dry varieties are very difficult for the digestive tract to break down. It is important to note that ingredients like wheat, corn and soy (present in large amounts in dry dog food) tend to increase inflammation and irritation. If a raw or home-prepared diet is impractical, look for high quality commercial brands that list meat as the first ingredient, do not contain animal-byproducts and do not contain artificial colorings or preservatives. Some lean ground beef, lamb, chicken or turkey (cooked or raw) added to a high quality commercial diet is a worthy compromise. In addition, try adding some finely chopped or pulverized fruits and vegetables. Spinach, broccoli and blueberries all have anti-inflammatory properties to help with skin issues. Serving the fruits and vegetables raw with their nutrients and enzymes in tact is the best for skin health.

PNS IRRITABLE BOWEL WELLNESS PROGRAM PNS DIGESTIVE WELLNESS PROGRAM A. Proper Diagnosis B. Design a Dietary Nutrition PLAN

At Pet Nutrition Systems we encourage a proactive holistic approach to pet health care. We believe it to be the best way to protect our pets and keep them healthy. If your dog is suffering from irritable bowel syndrome, we offer a comprehensive program to help identify the infection and create a Veterinary prescriptive diet plan to naturally aid your pet’s body and immune system heal. Following the guidelines in this wellness plan can give your dog the support to stop the suffering sooner.

STEP B: Assist With Nutritional Diet Plan Inflammatory Bowel Disease IBD, Irritable Bowel Syndrome and ulcerative colitis, are an inflammation of the intestines. These diseases cause the intestines to form ulcers and become inflamed, scarred and easy to bleed. The most common symptoms are diarrhea, acute abdominal pain, cramping, fever and fatigue. Diet and nutrition is very important in IBD management to prevent malnutrition and extreme weight loss. Once we have obtained your blood test back from the lab and receive your PNS Veterinary Prescriptive Nutrition form our animal nutritionists will select the proper recipes for your petâ&#x20AC;&#x2122;s diet plan. You will receive these recipes to make for yourself or have our commercial kitchen make and ship to you. Feed a high fiber diet when IBD is under control and a low residue diet during flare ups to give the bowel a rest and minimize symptoms. It is very important to continue nourishing your body even during a flare-up. Try small frequent ground meat meals. Eating a high protein diet with lean meats, fish and eggs, may help relieve symptoms of IBD. A low fat diet will also help to decrease

contractions

the

intestines. Your

PNS

consultant

may

recommend liquid vitamins to give your pet's bowel a rest and replenish lost nutrients so that their body can repair itself .Some of our patients find peppermint helpful. Peppermint is a natural anti-spasmodic that relaxes smooth muscles in the intestines. Some lean ground beef, lamb, chicken or turkey (cooked or raw) added to a high quality commercial diet is a worthy compromise. In addition, try adding some finely chopped or pulverized fruits and vegetables. Spinach, and blueberries all have anti-inflammatory properties to help with skin issues. Serving the fruits and vegetables raw with their nutrients and enzymes in tact is the best for skin health.

PNS LIVER SUPPORT WELLNESS PROGRAM PNS LIVER WELLNESS PROGRAM A. Proper Diagnosis B. Design a Dietary Nutrition Plan C. Detoxify the Liver

At Pet Nutrition Systems we encourage a proactive holistic approach to pet health care. We believe it to be the best way to protect our pets and keep them healthy. If your dog is suffering from liver failure, we offer a comprehensive program to help identify the allergens and create a Veterinary prescriptive diet plan to naturally aid your pet’s body and immune system heal. Following the guidelines in this wellness plan can give your dog the support to stop the suffering sooner.

The first step in combating liver disease is to get a correct diagnosis. Knowing the exact type of liver disease may allow you to eliminate the underlying problem, as in the case of bacteriological infection. At a minimum, a correct diagnosis will give you a prognosis and the best method of treatment. !There are numerous blood and urine tests that will give clues to the cause of the problem, but a liver biopsy may be the best or only option to knowing the specific type and cause. The biopsy can be performed either with a needle guided by ultrasound through the body wall or with a full surgical procedure where the surgeon actually looks at the liver and removes a small piece.!

STEP B: Assist With Nutritional Diet Plan Once we have obtained your blood test back from the lab and receive your PNS Veterinary Prescriptive Nutrition form our animal nutritionists will select the proper recipes for your pet’s diet plan. You will receive these recipes to make for yourself or have our commercial kitchen make and ship to you. The pet’s food should ideally contain a good source of protein along with fat and fiber. Since pets suffering from liver disease easily digest high fat foods, the meal should contain 40 percent of calories from fats. These meals must consist of the best quality ingredients like organic ground chicken, organic ground beef, tofu, and wheat bran. You could also add small amounts of rice to the diet. Fat is a good source of energy, particularly for dog’s that are severely debilitated. The pet’s diet may have to be modified once the dog shows signs of recovery. It’s therefore important to conduct follow up vet checks to determine the pet’s response to dietary modification and medication. Along with fats, the pet’s meal should contain soluble and insoluble fiber. It promotes digestion and eliminates bile acids from the body. A fresh, homemade diet is the very best option for a dog with liver problems. A liver condition requires specific dietary requirements that are difficult, if not impossible to find in commercial diets. A beneficial liver diet should: * Be free of chemicals and preservatives that over tax the liver. ! Include sources of protein that do not produce high levels of ammonia during digestion. Examples are cottage cheese and tofu. Meat produces the highest levels of ammonia. !

* Have fresh, unaltered nutrients from raw vegetables that support liver function. Examples are cabbage, Brussels sprouts and carrots. If raw vegetables are not tolerated, then lightly steam or boil them. ! * Contain soluble and insoluble fiber to help absorb ammonia in the digestive tract. ! * Dogs with copper storage disease need to be placed on a special diet low in copper. PNS recommends a one to two day break-in period, feeding small light meals. The meals should include tofu, cottage cheese or a small amount of lean meat along with fresh vegetables that support liver function like broccoli, cabbage, cauliflower, etc.

Step C: Proper

Detox Program

Liver detoxification is beneficial for most types of liver disease, especially in the early acute stage or when fever is present. Fasting greatly reduces the liver's usual elimination load and allows the body to break down and expel older wastes that have accumulated in the liver and fatty tissue. Fasting is not appropriate for all types of liver disorders, so be sure to check with your veterinarian prior to starting any fast. !The highly respected veterinarian and author Dr. Richard Pitcairn, !The break in period should be followed by a liquid fast that consists of plenty of fresh spring or filtered water, fresh pressed vegetable juices (not canned or bottled) or vegetable broth made from vegetables that support the liver. !After the fast you should feed your dog simple, light meals like those used for the break in period, for about two or three days. Then start to slowly introduce a natural liver support diet When your dog is dealing with liver disease, it is important to make sure their environment supports the healing process. With the help of your ministrations, your dog's liver will be detoxifying and trying to regenerate, so it is important to keep the liver's load as light as possible. Opt for natural solutions whenever possible. A good replacement for many household cleaners is white vinegar. It makes a good all purpose cleaner that can be used to mop floors or clean glass and other surfaces. Read the ingredients on shampoos and other products that will come into contact with your dog's body and choose products that are truly natural. Your dog will appreciate your efforts.

PNS URINARY TRACT INFECTION WELLNESS PROGRAM A. Proper Diagnosis B. Design a Dietary Nutrition Plan C. Proper Hydration

At Pet Nutrition Systems we encourage a proactive holistic approach to pet health care. We believe it to be the best way to protect our pets and keep them healthy. If your dog is suffering from unrinary tract infection, we offer a comprehensive program to help identify the allergens and create a Veterinary prescriptive diet plan to naturally aid your pet’s body and immune system heal. Following the guidelines in this wellness plan can give your dog the support to stop the suffering sooner.

STEP A: Proper Diagnosis Determining exactly what the illness is and its' cause in your dog will not always be easy and may require some patience. PNS has found that the quickest and easiest route to determining the problem is to consult with one of our board certified specialist. Once we have consulted with your or our specialist, a blood tests will be recommended to determine what physiological and dietary deficiencies are present in the pet’s body. Armed with this information we will be able to design a holistic organic rotation diet plan that with correct the deficiencies, bolster the immune system and avoid any ingredients that maybe working against the body’s quest for optimum health. UTI. If your dog starts to exhibit symptoms like increase marking, blood in the urine or increased drinking, odds are, your dog has a urinary tract infection. There are numerous blood and urine tests that will give clues to the cause of the problem, but a liver biopsy may be the best or only option to knowing the

specific type and cause. The biopsy can be performed either with a needle guided by ultrasound through the body wall or with a full surgical procedure where the surgeon actually looks at the liver and removes a small piece.!

Citrus Juice Citrus juices boost the acid level of your dog's urine, making your dog's urinary tract an inhospitable environment for the bacteria that causes a urinary tract infection. Orange juice and cranberry juice work wonders.

Apple Cider Vinegar Apple cider vinegar is a great home remedy for all sorts of dog maladies. It can alleviate the symptoms of allergies and arthritis, and helps to correct your dog's pH balance. Dilute the vinegar in your dog's drinking water in order to ensure that your dog drinks it.

Step C: Proper Hydration Making sure your dog has access to clean drinking water is especially important for dogs that have recurrent UTIs. !Water source must be pure For all pets, filtered or spring water is recommended. Never give your dog water that has gone through a water softener that uses salt pellets, as the sodium levels are too high. !Water must be kept clean - Dogs are messy drinkers and the very act of drinking quickly contaminates static sources. Unmoving water is an ideal breeding ground for harmful bacteria, so water bowls should be cleaned daily and the water replenished.

PNS KIDNEY DISEASE WELLNESS PROGRAM PNS KIDNEY WELLNESS PROGRAM A. Proper Diagnosis B. Design a Dietary Nutrition Plan C. Proper Hydration At Pet Nutrition Systems we encourage a proactive holistic approach to pet health care. We believe it to be the best way to protect our pets and keep them healthy. If your dog is suffering from allergies, we offer a comprehensive program to help identify the allergens and create a Veterinary prescriptive diet plan to naturally aid your pet’s body and immune system heal. Following the guidelines in this wellness plan can give your dog the support to stop the suffering sooner.

Canine kidney disease can be caused by chronic bacterial infections or blockages in the urinary tract, antifreeze poisoning or abdominal injury. Many commercial dog foods, over-processed and filled with preservatives, fillers and allergens, do not support the overall health of your dog. Choosing a suitable diet-whether it's a high quality commercial formula, a prescription diet, a raw or homemade diet or a combination-will improve your dog's health, support the kidneys and other vital organs and provide high quality nutritional for your dog. Canine kidney failure can be sudden or progressive. Sudden onset kidney failure is usually due to an infectious disease or poisoning. Chronic kidney failure is the result of an ongoing disease. The kidneys can function with as much as twenty-five percent tissue damage, so often, symptoms do not appear until there is extensive loss. Symptoms of kidney disease include increased thirst and urine output. As the kidneys deteriorate, toxins will begin to build up in the blood. Vomiting, diarrhea, lethargy and poor appetite will occur.

STEP B: Assist With Nutritional Diet Plan Pet Nutrition Systems Kidney failure/disease formulations help dogs deal with strengthening the digestive system and build up the immune system. For years the standard diet for dogs with renal insufficiency was one of restricted protein. New evidence has shown that high protein diets do not make renal failure worse and that the amount of protein may be secondary to the quality of the protein source. For dogs with early stage kidney failure, many veterinarians do not recommend low protein diets due to evidence that protein restriction could inhibit the body's ability to repair itself. However, restricting protein in late stages of CKD may be helpful because it reduces nitrogenous wastes, making it easier for the kidney to do its job. The experts do agree that phosphorous should be limited. Foods that are high in phosphorus include egg yolks, bones of any kind, organ meats and dairy products. If your dog's kidneys are compromised, these foods should make up a very limited part of their diet. Plenty of fish rich in omega 3 is the best base for kidney disease. Our use of organic and natural human grade whole food promotes the

growth of friendly bacteria in your dog's digestive tract. Processed kibble should be eliminated all together. It will dehydrate the body and is very hard for dogs with kidney disease or most digestive issues to break down and process. * There are special prescription canine renal diets available. They are low protein foods that do not stress the kidneys. Several commercial brands are available. * Avoid poor-quality commercial foods that contain chemical preservatives and an abundance of grains such as corn, wheat or soy. * For homemade meals, combine 8.5 ounces cooked white rice, 2.75 ounces cooked ground beef, one large boiled egg, 1.5 ounce white bread along with 1 teaspoon vegetable oil and 2 teaspoons calcium carbonate. * Other acceptable ingredients include parsley, potatoes, ground chicken, chicken fat, parsnips, cooked kidney beans and cottage cheese. Do not use liver or other organ meats. Once we have obtained your blood test back from the lab and receive your PNS Veterinary Prescriptive Nutrition form our animal nutritionists will select the proper recipes for your petâ&#x20AC;&#x2122;s diet plan. You will receive these recipes to make for yourself or have our commercial kitchen make and ship to you.

Step C: Proper Hydration Dogs with reduced kidney function lack the ability to concentrate their urine, resulting in more frequent urination. Their water intake must be increased in order to flush waste products from the kidneys. If their water consumption is not adequate they risk dehydration and a build up of toxicity. In the later stages of kidney failure subcutaneous fluids (fluids given under the skin) are often prescribed to supplement the water the dog drinks in order to avoid dehydration. The procedure usually needs to be done several times a week and most dogs learn to tolerate it. !In providing your dog with adequate hydration, the following considerations are important: !Water source must be pure - spring water is considered the best. It is naturally free of additives like chlorine and fluoride that can tax the kidneys. Never let your dog drink from puddles or other standing water. If you must give your dog tap water, make sure it has been filtered. !Water must be kept clean - Dogs are messy drinkers! Pet food, hair and other waste can quickly contaminate their water bowls. Bowls of standing water are an ideal breeding ground for harmful bacteria, so water bowls should be cleaned daily and the water replenished. !

PNS INFLAMMATORY BOWEL WELLNESS PROGRAM PNS DIGESTIVE WELLNESS PROGRAM A. Proper Diagnosis B. Design a Dietary Nutrition PLAN C. Supplements At Pet Nutrition Systems we encourage a proactive holistic approach to pet health care. We believe it to be the best way to protect our pets and keep them healthy. If your dog is suffering from inflammatory bowel disorder, we offer a comprehensive program to help identify the infection and create a Veterinary prescriptive diet plan to naturally aid your pet’s body and immune system heal. Following the guidelines in this wellness plan can give your dog the support to stop the suffering sooner.

STEP B: Assist With Nutritional Diet Plan Once we have obtained your blood test back from the lab and receive your PNS Veterinary Prescriptive Nutrition form our animal nutritionists will select the proper recipes for your petâ&#x20AC;&#x2122;s diet plan. You will receive these recipes to make for yourself or have our commercial kitchen make and ship to you. One of the hallmarks of Inflammatory Bowel Disease (IBD) is an inflamed intestinal lining. This inflammation and the mucus it secretes reduce nutrient absorption. Addressing this problem is to reduce the inflammation with herbs and essential oils and make the food more easy to break down for ease of digestion. Boiled long grain rice and ground meat is preferred for sensitive digestion. Most commercial dog foods, especially the dry varieties are very difficult for the digestive tract to break down. It is important to note that ingredients like wheat, corn and soy (present in large amounts in dry dog food) tend to increase inflammation and irritation. Food allergies and food intolerance can cause gastric upset. Food allergies are thought to play a role in causing IBD. If a food allergy is present in dogs, some form of skin distress usually accompanies it. If a raw, home-prepared diet or our catered VPN meals are impractical, look for high quality commercial brands that list meat as the first ingredient, do not contain animal-by-products and do not contain artificial colorings or preservatives. Clean raw or slightly cooked whole food and plenty of filter water is preferred when fight IBD. Some lean ground beef, lamb, chicken or turkey (cooked or raw) added to a high quality commercial diet is a worthy compromise. In addition, try adding some finely chopped or pulverized fruits and vegetables. Spinach, broccoli and blueberries all have anti-inflammatory properties to help with skin issues. Serving the fruits and vegetables raw with their nutrients and enzymes in tact is the best for skin health.

PNS ALLERGIES WELLNESS PROGRAM PNS ALLERGY WELLNESS PROGRAM A. Identify the Allergen (s) B. Design a Dietary Nutrition Plan C. Supplements At Pet Nutrition Systems we encourage a proactive holistic approach to pet health care. We believe it to be the best way to protect our pets and keep them healthy. If your dog is suffering from allergies, we offer a comprehensive program to help indentify the allergens and create a Veterinary prescriptive diet plan to naturally aid your pet’s body and immune system heal. Following the guidelines in this wellness plan can give your dog the support to stop the suffering sooner.

STEP A: Identify the Allergen(s) Determining exactly what is causing the allergic reaction in your dog is not always easy and may require some patience. PNS has found that the quickest and easiest route to determining the problem is to do an allergy blood test. Spectrum is the most common but there are others that will identify the allergens and tell us what are the safe ingredients to form your diet plan around. There are other blood tests that we recommend to determine what physiological and dietary deficiencies are present in the pet’s body. Armed with this information we will be able to design a holistic organic rotation diet plan that with correct the deficiencies, bolster the immune system and avoid any ingredients that maybe working against the body’s quest for optimum health.

An allergy is an overreaction of the immune system when it feels threatened by a protein of a food, a bee sting, a drug (like penicillin), or an airborne mold or pollen. If the body views this environmental input as an invader it releases an overload of histamines in response. This can create symptoms as simple as a runny nose, itchy eyes, hives and general swelling to more severe reactions such as vomiting, diarrhea, quickened heart rate and trouble breathing and even possibly a loss of consciousness due to a drop in the patientâ&#x20AC;&#x2122;s blood pressure. This is called anaphylaxis shock. Flea Dermatitis The most common allergen is flea dermatitis, which is an allergy to flea saliva. It only takes one flea to make a dog with a flea allergy miserable. Flea dermatitis is difficult to discern from other skin conditions since the intense itching results in excessive licking, biting and chewing - resulting in skin eruptions and hot spots. Eliminating the fleas and keeping them away from your dog could be an easy solution to your dog's skin problem. PNS prescribe the best products for you to use to manage any parasite issues. Our all-natural flea, tick and insect repellent is the best daily alternative to flea colors, and toxic sprays. Inhalant and contact allergies Your dogs could be allergic to the same types of inhalant stimuli that we are, such as molds, dust mites, household chemicals, house dust, feathers, pollen, etc. Identifying an inhalant or contact allergen is easily done with our blood test. Then making the simple changes to your living environment with help alleviate the problem. Food allergies It is estimated that up to 45% of pet allergies are the result of food ingredients. It is very important to select the right allergy test when it comes to identifying food allergies and the alternative elimination diet take a long time and is rarely correctly administered. If you choose to do an elimination diet rather than the simple blood test be mindful that it is a very lengthy process requiring planning, consistent follow through and no missteps or mistakes or you will have to restart the program from the beginning.

An elimination diet starts be restricting the dogâ&#x20AC;&#x2122;s diet to two items (one meat and one carbohydrate) that are not a part of their normal diet. Examples are venison and potato, duck and sweet potato, rabbit and rice, etc. The diet should contain only the same two items for 12- 14 weeks. If symptoms improve you place the dog back on their original diet. If symptoms return you know you are dealing with a food allergy. Once a food allergy is determined, you will begin the lengthy process of returning to the two-item diet until symptoms show up allowing you to identify the ingredients causing the reaction.

STEP B: Assist With Nutritional Diet Plan Pet Nutrition Systems Allergy formulations help dogs deal with unresolved allergies by fighting inflammation and strengthening the digestive system. These particular formulations have added additional amounts of long chain fatty acids, found in the highest concentrations in fish oil, for a variety of health reasons. Fish oil not only helps reduces inflammation, reduces itching and has the added benefit of supporting kidney function, the cardiovascular system, the digestive system and helps maintain a healthy coat and skin. We use 100% wild salmon, not farmed sources, organic chicken and pure protein sources. Wild salmon has higher levels of beneficial omega-3 and lower levels of saturated fats. In addition, farmed salmon have been found to contain significantly higher concentrations of PCBs, dioxin and other cancer causing contaminants. Our use of organic and natural human grade whole food promotes the growth of friendly bacteria in your dog's digestive tract. Unlike processed food products like canned food or kibble which need the addition of digestive enzymes, which are necessary to properly breakdown food and absorb nutrients. Once we have obtained your blood test back from the lab and receive your PNS Veterinary Prescriptive Nutrition form our animal nutritionists will select the proper recipes for your petâ&#x20AC;&#x2122;s diet plan. You will receive these recipes to make for yourself or have our commercial kitchen make and ship to you.

PNS CHRONIC EAR INFECTION WELLNESS PROGRAM PNS EAR INECTION WELLNESS PROGRAM A. Proper Diagnosis B. Design a Dietary Nutrition PLAN C. Supplements D. Proper Ear Hygiene At Pet Nutrition Systems we encourage a proactive holistic approach to pet health care. We believe it to be the best way to protect our pets and keep them healthy. If your dog is suffering from chronic ear infection, we offer a comprehensive program to help indentify the infection and create a Veterinary prescriptive diet plan to naturally aid your pet’s body and immune system. Following the guidelines in this wellness plan can give your dog the support to stop the suffering sooner.

underlying cause for recurring ear infections is allergies. For best results in managing your dog's ear infections you will need to determine the source of the allergy. If your dog is diabetic or has an immune suppressing disease, there may not be an allergy involved.

pesticides and preservatives), drinking pure water, providing appropriate antioxidants, vitamins and minerals, and exercising regularly can help prevent infections. The first step in helping your pet eliminate toxins from the body is to examine lifestyle factors like diet and exercise. Most of us are so used to feeding our pets commercially produced food that the thought of doing anything else seems very strange. But just as we need to eat a range of foods to ensure we remain healthy, so do our pets and the more natural and unprocessed the better. I would suggest that you detoxify your pet. Raw food contains many essential nutrients and minerals that may be destroyed by cooking and processing. Commercially produced food typically contains many chemical substances which not only have no nutritional benefit but can actually seriously affect your petâ&#x20AC;&#x2122;s health â&#x20AC;&#x201C; especially in the long-term.

Once we have obtained your blood test back from the lab and receive your PNS Veterinary Prescriptive Nutrition form our animal nutritionists will select the proper recipes for your petâ&#x20AC;&#x2122;s diet plan. You will receive these recipes to make for yourself or have our commercial kitchen make and ship to you.

PNS BLADDER INFECTION WELLNESS PROGRAM PNS BLADDER WELLNESS PROGRAM A. Proper Diagnosis B. Design a Dietary Nutrition PLAN C. Adequate Hydration D. Supplements At Pet Nutrition Systems we encourage a proactive holistic approach to pet health care. We believe it to be the best way to protect our pets and keep them healthy. If your dog is suffering from Bladder Infections, we offer a comprehensive program to help indentify the infection and create a Veterinary prescriptive diet plan to naturally aid your pet’s body and immune system heal. Following the guidelines in this wellness plan can give your dog the support to stop the suffering sooner.

STEP B: Assist With Nutritional Diet Plan Calcium oxalate crystals are often a genetic problem caused by a lack of an enzyme to process oxalates. Diet change is needed to help prevent these. PNS has developed a guideline for recipes and supplements that will help you. Purine crystals are another genetic problem. Again, a diet change is needed with recipes low in purines. This would mean a diet about 50% of vegetables, and avoiding red meat, wild game, organ meat and oily seafood (canned fish and shellfish). Safer animal proteins include chicken, eggs, pork, dairy (yogurt and cottage cheese), rabbit and duck. If purine crystal amounts remain high, protein may need to be reduced to a third of the diet. Once we have obtained your blood test back from the lab and receive your PNS Veterinary Prescriptive Nutrition form our animal nutritionists will select the proper recipes for your petâ&#x20AC;&#x2122;s diet plan. You will receive these recipes to make for yourself or have our commercial kitchen make and ship to you.

Step C: Adequate

Hydration

Making sure your dog has access to clean drinking water is especially important for dogs that have recurrent UTIs. Water source must be pure - PNS recommends the use of filtered or spring water. Never give your dog water that has gone through a water softener the sodium levels are too high. PNS has a line of filtered health infused water for you purchase on our Health and Wellness page. Water must be abundant - A normal dog will drink 1.5 cups of water per 10 pounds of body weight per day. During hot weather or after exercise these needs increase. Dogs experiencing urinary tract or kidney problems may drink even more. Water must be kept clean - Unmoving water is an ideal breeding ground for harmful bacteria, so water bowls should be cleaned daily and the water replenished. Remember; never allow your dog to drink from puddles or other freestanding water. It could contain toxins from road run-off, lawn chemicals, etc.

VPN Prescriptive Pet Formulation Form Pet Information Pet Name (first, last):_________________________________________________ __ Species: cat / dog Age:__________yr / mo Breed:________________________________________________ ________________ Weight:___________lb / kg Sex: M / MC / F / FS Client Information Name:________________________________________________ _______

Mailing address:______________________________________________ ________

Phone Number:______________________________________________ _______

Email Address:______________________________________________ ___________________________

BCS (Body Condition Score 1 – 10)

________

MCS (Muscle Condition Score 1 – 10) _________ Body Weight ________________

Daily Calories Calories will be calculated based on signalment and weight unless a custom amount is entered here:____________Cal/day Check up to 3 Conditions or Approaches* __Healthy Pet ____Food Allergy,__ IBD,__ Adverse Reactions to FoodGI __Highly Digestible (acute GI-itis, constipation, post GI surgery) __High Fiber (diabetes mellitus, colitis, constipation) __Low Carbohydrate (diabetes mellitus) __ mod. fat restriction Pancreatitis, Hyperlipid., Lymphangiectasia __ severe fat restriction Pancreatitis, Hyperlipid., Lymphangiectasia __Early Renal Disease __Advanced Renal Disease and/or Protein-losing Nephropathy Hepatic Disease __ normal protein level (no encephalopathy) Hepatic Disease __ protein restricted (encephalopathy) __Urolithiasis (calcium oxalate) __Urolithiasis (struvite not for dissolution, FLUTD, for cats only) __Urolithiasis (urate or cystine) __Other _____________________________________________________ ________

Human Foods to Avoid (ex.chicken):___________________________________________ ______________________________________________ Desired Protein Source, if available Example (Pork)________________________________________________ ____________

To submit email to Daryll@petnutritionsystems.com or call 570.262.9914 or 562.295.6391

* NOTE: certain combinations and/or foods may not be available/appropriate. See petnutritionsystems.com or call 1-570-262-9914 for an up-todate listing of available recipe options.

References International Renal Interest Society Guidelines. http://www.iriskidney.com/guidelines/en/treatment_recommendations.sh tml Elliott J. Rawlings J Markwell PJ, et al. Survival of cats with naturally occurring chronic renal failure: effect of dietary management. J Small Anim Pract 2000;41(6):235-242 Ross RJ, Osborne CA, Kirk CA, et al. Clinical evaluation of dietary modification for treatment of spontaneous chronic kidney disease in cats. J Am Vet Med Assoc 2006;229:949â&#x20AC;&#x201C;957. Subcommittee on Dog and Cat Nutrition, Committee on Animal Nutrition, National Research Council. Nutrient Requirements of Dogs and Cats 2006. Available online at http://www.nap.edu/catalog.php?record_id=10668#toc Accessed 12/19/09. Association of American Feed Control Officials. Official publication. Oxford, Ind: Association of Feed Control Officials 2010. Availableâ&#x20AC;¨online at http://www.aafco.org Thatcher CD, Hand MS, Remillard RL. Small animal clinical nutrition: an iterative process. In: Hand MS, Thatcher CD, Remillard RL, et al. Small Animal Clinical Nutrition 5th Ed. Marceline, Missouri: Walsworth Publishing Co 2010;3-21. Bauer JE, Olson WG. Development of a modular curriculum for education in nutrition. J Am Vet Med Assoc 1994;205(5):681-684. Bauer JE, Buffington CA, Olson WG. ACVN highlights common principles of nutrition. Vet Forum 1995;(12):55-58. Michel KE. Using a diet history to improve adherence to dietary recommendations. Compendium of Continuing Education For Veterinarians 2009;31(1):22-26. University of California Davis Nutrition Support Services Diet History Form. Available online at http://www.vetmed.ucdavis.edu/vmth/small_animal/nutrition/ newsletters.cfm

German AJ, Holden S, Moxham GL, et al, Simple, reliable tool for owners to assess the body condition of their dog or cat. The WALTHAM International Laflamme, D. Development and validation of a body condition score system for dogs. Canine Practice 1997;22:10-15. Laflamme, D. Development and validation of a body condition score system for cats: a clinical tool. Feline Practice 1997;25:13-18. Lund EM, Armstrong PJ, Kirk CA, et al. Prevalence and risk factors for obesity in adult dogs from private US veterinary practices. Intern J Appl Res Vet Med 2005;4(2):177-186. Lund EM, Armstrong PJ, Kirk CA, et al. Prevalence and risk factors for obesity in adult cats from private US veterinary practices. Intern J Appl Res Vet Med 2005;3(2):88-96. Kealy RD, Olsson SE, Monti KL, et al. Effects of limited food consumption on the incidence of hip dysplasia in growing dogs. J Am Vet Med Assoc 1992;201:857–863 Scarlett JM, Donoghue S. Associations between body condition and disease in cats. J Am Vet Med Assoc 1998;212:1725-1731. Kealy RD, Olsson SE, Monti KL, et al. Effects of limited food consumption on the incidence of hip dysplasia in growing dogs. J Am Vet Med Assoc 1992;201:857–863. Gulsvik AK, Thelle DS, Mowe M, et al. Increased mortality in the slim elderly: a 42 year follow-up study in a general population. Eur J Epid 2009;24(11):683-690. Anker SD, Ponikowski P, Varney S, et al. Wasting as independent risk factor for mortality in chronic heart failure. Lancet 1997;349:1050-1053. Freeman L, Roubenoff R. Nutrition implications of cardiac cachexia. Nutr Rev 1994;52:340-347. Michel KE, Anderson W, Cupp C, et al. Validation of a subjective muscle mass scoring system for cats. J Anim Physiol Anim Nutr 2009;93:806. Stenske K, Smith J, Newman S, et al. Aflatoxicosis in dogs and dealing with suspected contaminated commercial foods. J Am Vet Med Assoc 2006;228(11)1686-1691. Available online at www.avmajournals.avma.org Bren L. Pet food: the lowdown on labels. FDA Veterinarian Newsletter July/August 2001;XVI(IV). Available online at http://www.fda.gov/animalveterinary/newsevents/fdaveterinariannewslet ter/ ucm130726.htm Accessed 4/26/10. Finley R, Ribble C, Aramini J, et al. The risk of salmonellae shedding by dogs fed salmonella-contaminated commercial raw food diets. Can Vet J 2007;48:69-75. Weese JS, Rousseau J. Survival of salmonella copenhagen in food bowls following contamination with experimentally inoculated raw meat: effects of time, cleaning, and disinfection. Can Vet J 2006; 47: 887–889.

Finley R, Reid-Smith R, Ribble C, et al. The occurrence and antimicrobial susceptibility of salmonellae isolated from commercially available canine raw food diets in three Canadian cities. Zoonoses Public Health 2008;55:462-469. Wojciechowska JI, Hewson CJ, Stryhn H, et al. Development of a discriminative questionnaire to assess nonphysical aspects of quality of life of dogs. Am J Vet Res 2005;66(8):1453-1460. Buffington CA. External and internal influences on disease risk in cats. J Am Vet Med Assoc. 2002;220 (7):994-1002. Yeates J, Main D. Assessment of companion animal quality of life in veterinary practice and research. J Small Anim Pract 2009;50(6):274281. Stella JL, Lord LK, Buffington CAT. Sickness behaviors in domestic cats. J Am Vet Med Assoc, In Press, 2010. Buffington CAT, Westropp JL, Chew DJ, et al. Clinical evaluation of multimodal environmental modification in the management of cats with lower urinary tract signs. J Feline Med Surg 2006; 8:261. Slingerland LI, Fazilova VV, Plantinga EA, et al. Indoor confinement and physical inactivity rather than the proportion of dry food are risk factors in the development of feline type 2 diabetes mellitus. Vet J 2009;179: 247. Landsberg GM, Hunthausen W, Ackerman L. Handbook of Behavior Problems of The Dog And Cat. Philadelphia: Elsevier 2003;554. Overall, K. Clinical Behavioral Medicine for Small Animals. St. Louis: Mosby 1997;160-194. Http://Www.Petfoodindustry-Digital.Com/Petfoodindustry/201002/#Pg36 Taylor J. Puzzling Petfood. Pet Food Industry Magazine 010;52(2):3439. Subcommittee on Dog and Cat Nutrition, Committee On Animal Nutrition, National Research Council. Nutrient requirements of dogs and cats, 2006. Available online Http://Www.Nap.Edu/Catalog.Php?Record_Id=10668#Toc Milgram NW, Siwak-Tapp CT, Araujo J, et al. Neuroprotective effects of cognitive enrichment. Ageing Res Rev 2006;5(3):354-369. Overall KL, Dyer D. Enrichment strategies for laboratory animals from the viewpoint of clinical veterinary behavioral medicine: emphasis on cats and dogs. ILAR J. 2005;46(2):202-215. Available at Http://Dels.Nas.Edu/Ilar_N/Ilarjournal/46_2/Pdfs/V4602overall.Pdf Chan D, Freeman LM. Nutrition in critical illness. Vet Clin North Am Small Anim Pract 2006;36: 1225. Eirmann L, Michel KE. Enteral nutrition. In Silverstein DC, Hopper K. editors: Small Animal Critical Care Medicine, St Louis, Saunders Elsevier: 53-62.

Frankel RM. Pets, vets, and frets: what relationship-centered care research has to offer veterinary medicine. J Vet Med Educ 2006;33:20-27. Cornell K, Brandt JC, Bonvicini K. Effective Communication In Veterinary Practice. Vet Clin North Am Small Anim Pract 2007;37(1). The Bayer Animal Health Communication Project Http://Www.Healthcarecomm.Org/Bahcp/Homepage.Php Vogt AH, Rodan I, Brown M, et al. AAFP-AAHA feline life stage guidelines. J Feline Med Surg 2010;12:43–54. Epstein M, KuehnN, Landsberg G. AAHA senior care guidelines for dogs and cats. J Am Anim Hosp Assoc 2005;Mar/Apr(41). Association of American Feed Control Officials. Official publication. Oxford, Ind: Association of Feed Control Officials 2010. Available online at http://www.aafco.org