Beyond Feeding

(originally published in Veterinary Forum: March, 2001)

Our problem-oriented veterinary education primes us to view anorexia as a symptom of some medical problem. When Marcia Blanchette mentions that Bubba, her basenji , hasn’t eaten for three days, we immediately begin thinking about all the different physical ailments that might cause this. If our physical examination and any work-up reveals a fever and/or other signs of infection, we feel confident we’ve discovered the source of the problem. In fact, we often place so much confidence in the eating = good health equation that we’ll use food intake as a reliable indicator of when to send hospitalized animals home. However, suppose that when all of Bubba’s test results indicate that he’s returned to good health, he still doesn’t eat much, if at all: what then?

At this point, the medical problem-oriented approach maintains that we obviously missed something when we diagnosed Bubba’s problem and we should go back and start again. However, an awareness of the role the animal’s behavior and his relationship to his owner(s) and his environment play in his health suggests other points for consideration.

In order to feel comfortable in their surroundings, animals must fulfill certain needs which form a behavioral hierarchy. First, they must establish and feel confident that they can protect their territories. Second, they must obtain food and water. If they fulfill needs one and two, they will mate and reproduce. From this we can see that, if an animal doesn’t feel secure in its physical space, it won’t experience much, if any, desire to eat or drink. This explains why some animals will go off-feed when the owners kennel them, move into a new home, or if some traumatic (to the animal) change occurs within their existing territories. It also explains why Bubba may not feel comfortable enough to eat normally when hospitalized. Not only does the hospital represent an entirely new territory, he must try to carve out a personal niche in it at a time when illness or injury could make him feel highly vulnerable.

In addition to establishing and protecting their physical spaces, animals also need to secure their mental space, too. If an animal doesn’t feel comfortable in its relationship with any human and nonhuman animal others in its household or at the veterinary clinic, this also could undermine its desire to eat and drink normally. For example, suppose Bubba is an inherently shy dog who feels very protective of his owner. When Marcia’s boyfriend and his exuberant black lab and irritable Siamese cat move in, Bubba’s world collapses. Not only must he and the lab work out the structure of their canine pack, Bubba must determine where he fits into the new human-canine pack as well as what will ensure a stable relationship with the crotchety cat. Meanwhile, his appetite plummets as does his immune response thanks to this increased territorial stress. Within the hospital setting, Bubba may need to determine his position relative to any staff members, as well as to all the other animals in his ward.

But how can we tell if behavioral rather than medical causes underlie anorexia? How the animal relates to its food serves as one indicator. Animals whose anorexia results from physical discomfort typically display no interest in their food whatsoever. However, some of those experiencing behavioral anorexia will attempt to hide the food, using articles carrying intimate owner scents, bedding, or shredded paper from the bottom of their cages. If the composition of the food permits it, others intimidated by their surroundings may take pieces of food off to some secluded nook and eat it there. Those most intimidated by their surroundings may urinate on their food to protect it from others.

When such behaviors occur in hospitalized animals, getting these animals home to a more comforting environment often solves the problem. Unfortunately, though, many working owners can’t afford to take time off to monitor a recovering pet and some feel as reluctant as the veterinarian to leave a non-eating pet home alone for 8-10 hours. Asking these owners to visit their hospitalized animals and provide familiar food in familiar containers may induce the animal to eat. Other times, asking the owner to take the animal home just to offer it food then returning it to the hospital for supervised care has merit. Particularly in pets but also in some valued food animals, owners may evolve complex feeding rituals which provide the necessary sensory input to stimulate the animal’s appetite, input these animals just don’t receive in a clinical setting. Marcia’s routine as she prepares Bubba’s meals consists of an albeit subconscious sequence of movements punctuated with comments and sweet nothings she says or sings to her dog. In the clinic, the kennel worker methodically moves through the wards with one goal in mind: to get everyone fed as efficiently as possible.

When owners can’t or won’t take an active part in the feeding process, providing hospitalized animals with as secure a space as possible may induce the behaviorally anorexic animal to eat. Reducing disruptive sensory input by keeping wards darkened when possible and using sound machines may help. Putting carriers in larger cages into which cats and smaller dogs can retreat to eat or sleep in private can help alleviate territorial stress. Upside down cardboard boxes with entrance holes cut in the side or even large paper bags will also provide a more secure territory for frightened animals; spraying these with synthetic feline facial pheromones may further soothe fearful cats. Because even the most social cat may revert to its primitive nocturnal as well as solitary roots when hospitalized, providing fresh food and water for these animals last thing at night before leaving the clinic may result in their eating more.

Veterinary philosopher Jacob Antelyes listed the rights to food and water and privacy as two of the five rights due every veterinary patient. Aside from representing an ethical standard worthy of implementation in all veterinary facilities, recognizing these needs also makes extremely good ethological and medical sense.