Dose rate of ivermectin in dogs

Ivermectin is used in dogs for several indications, each with a different dose rate. Here's a quick overview from general knowledge:
  • Heartworm prevention: 6-12 mcg/kg orally once monthly
  • Microfilariae treatment: 50 mcg/kg orally
  • Demodicosis / mange (off-label): 300-600 mcg/kg daily orally
  • Ear mites / sarcoptic mange: 200-400 mcg/kg SC or orally, repeat in 2 weeks
Important: Collies and related breeds (MDR1/ABCB1 gene mutation) are highly sensitive - even standard doses can be toxic.
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ivermectin dose rate dogs veterinary mcg/kg indications 2024

Here is a complete, well-sourced breakdown of ivermectin dose rates in dogs:

Ivermectin Dose Rates in Dogs

1. Heartworm Prevention (Prophylaxis)

  • Dose: 6-12 mcg/kg (0.006-0.012 mg/kg) orally, once monthly
  • This is the standard approved dose used in commercial products like Heartgard®
  • FDA-approved oral doses go up to 0.024 mg/kg (24 mcg/kg)
  • Products at this dose range are safe even for MDR1-mutant breeds

2. Microfilariae Clearance

  • Dose: 50 mcg/kg orally, single dose
  • Used after adulticide therapy to eliminate circulating microfilariae

3. Sarcoptic Mange (Sarcoptes scabiei)

  • Dose: 200-400 mcg/kg SC or orally
  • Frequency: Repeat every 2 weeks for 2-4 treatments

4. Demodectic Mange (Demodex canis) - Off-label

  • Dose: 300-600 mcg/kg orally, once daily
  • Duration: Continue until 1 month after two consecutive negative skin scrapings (typically 3-6 months)
  • Important: Start low (1/3 dose for 3 days, then 2/3 dose for 3 days) and escalate gradually to check for breed sensitivity

5. Ear Mites (Otodectes cynotis)

  • Dose: 200-400 mcg/kg SC or orally
  • Frequency: 2 treatments, 2 weeks apart

6. Intestinal Parasites (off-label)

  • Dose: ~200 mcg/kg (0.2 mg/kg) orally, single dose

MDR1/ABCB1 Gene Mutation - Critical Warning

Certain breeds carry a mutation in the MDR1 (ABCB1) gene that causes ivermectin to accumulate in the CNS, leading to toxicity at much lower doses:
ParameterNormal DogsMDR1-Mutant Dogs
Toxic dose threshold~2.5 mg/kg~0.1 mg/kg (homozygous)
Neurological signs>120-150 mcg/kgMuch lower
SignsMydriasis, ataxia, tremors, comaSame but at far lower doses
Affected breeds include: Collie, Shetland Sheepdog, Old English Sheepdog, Australian Shepherd, Border Collie, Longhaired Whippet, Silken Windhound, and their crosses.
  • Dogs homozygous for MDR1 will develop toxicosis at demodicosis treatment doses
  • Dogs heterozygous react less severely but are still at risk
  • The MSD Veterinary Manual notes that critical signs appear at 120-150 mcg/kg in sensitive dogs

Summary Table

IndicationDose (mcg/kg)RouteFrequency
Heartworm prevention6-12POMonthly
Microfilariae50POSingle dose
Sarcoptic mange200-400PO/SCEvery 2 weeks x2-4
Demodectic mange300-600PODaily (3-6 months)
Ear mites200-400PO/SCEvery 2 weeks x2
Intestinal parasites~200POSingle dose
Note: Always confirm the MDR1 gene status before using higher doses. Genetic testing is available. Do not use ivermectin in puppies under 6 weeks of age.

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mkdir -p /home/daytona/workspace/pet-diet-plan && node --version && npm list -g docx 2>/dev/null | head -5

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~/pet-diet-plan/generate.js

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const fs = require('fs');

// ---- Color palette ----
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// ======================== DOCUMENT CONTENT ========================

const children = [

  // ---- TITLE ----
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    children: [new TextRun({ text: "Complete Diet Plan for Dogs & Cats", bold: true, color: TEAL, size: 56 })]
  }),
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    children: [new TextRun({ text: "All Life Stages  |  General Healthy Pet  |  Based on AAFCO & FEDIAF 2024 Guidelines", size: 22, color: "555555", italics: true })]
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    spacing: { before: 0, after: 400 },
    children: [new TextRun({ text: "Prepared by Orris Veterinary Nutrition Guide  |  July 2026", size: 20, color: "888888" })]
  }),

  pageBreak(),

  // ======================== SECTION 1: INTRODUCTION ========================
  heading1("1. Introduction to Pet Nutrition"),
  para("Proper nutrition is the single most impactful factor in a pet's long-term health, immune function, coat quality, organ function, and longevity. Dogs are omnivores and can utilize carbohydrates efficiently, while cats are obligate carnivores with strict requirements for animal-derived nutrients like taurine, arachidonic acid, and preformed vitamin A. Diet must be tailored to life stage, body condition, and species."),
  para("This guide covers four key life stages for both dogs and cats:"),
  bullet("Puppy/Kitten (0 – 12 months for small breeds; 0 – 18–24 months for large/giant breeds)"),
  bullet("Young Adult (1 – 5 years)"),
  bullet("Mature Adult / Middle-aged (5 – 7 years)"),
  bullet("Senior / Geriatric (7+ years)"),
  spacer(),

  // ======================== SECTION 2: NUTRITIONAL BASICS ========================
  heading1("2. Core Nutritional Requirements"),

  heading2("2.1 Macronutrients"),

  heading3("Protein"),
  para("Protein provides essential amino acids for tissue growth, repair, enzyme synthesis, and immune function. Cats have a higher obligatory protein requirement than dogs because they cannot downregulate hepatic amino acid-oxidizing enzymes."),
  spacer(),
  makeTable(
    ["Nutrient", "Dogs – Adult (% DM)", "Dogs – Puppy (% DM)", "Cats – Adult (% DM)", "Cats – Kitten (% DM)"],
    [
      ["Crude Protein (min)", "18%", "22%", "26%", "30%"],
      ["Crude Fat (min)", "5%", "8%", "9%", "9%"],
      ["Linoleic Acid (min)", "1.1%", "1.1%", "0.6%", "0.6%"],
      ["Crude Fiber (max)", "≤5%", "≤5%", "≤5%", "≤5%"],
      ["Moisture (typical)", "10% (dry) / 75–80% (wet)", "10% / 75–80%", "10% / 75–80%", "10% / 75–80%"]
    ]
  ),
  spacer(),

  heading3("Key Amino Acids"),
  bullet("Taurine: Essential for cats (cannot synthesize adequately) — required for cardiac function, retinal health, bile acid conjugation. Dogs can synthesize it but benefit from dietary sources."),
  bullet("Arginine: Critical for both species — urea cycle function; deficiency causes hyperammonemia rapidly in cats."),
  bullet("Methionine & Cystine: Sulfur amino acids needed for coat, antioxidant glutathione synthesis."),
  bullet("Lysine: First limiting amino acid in many plant-based proteins — ensure adequate animal protein sources."),

  spacer(),

  heading3("Fats & Fatty Acids"),
  bullet("Omega-6 (Linoleic acid): Skin barrier, coat quality — found in chicken fat, corn/soybean oil."),
  bullet("Omega-3 (EPA/DHA): Anti-inflammatory; vital for neurological & retinal development in young animals. Best sources: fish oil, salmon."),
  bullet("Arachidonic acid (AA): Cats cannot synthesize from linoleic acid; must be provided by animal fat."),
  bullet("Cats cannot convert beta-carotene to Vitamin A — must receive preformed Vitamin A from liver/animal tissue."),

  spacer(),

  heading2("2.2 Micronutrients — Key Points"),
  makeTable(
    ["Nutrient", "Role", "Dogs", "Cats", "Notes"],
    [
      ["Calcium", "Bone/teeth", "0.5–2.5% DM", "0.6–2.0% DM", "Ca:P ratio ~1.2–1.4:1"],
      ["Phosphorus", "Bone, energy", "0.4–1.6% DM", "0.5–1.6% DM", "Restrict in renal disease"],
      ["Vitamin D", "Ca/P metabolism", "500–3000 IU/kg DM", "280–750 IU/kg DM", "Cats: max 3000 IU/100g DM"],
      ["Vitamin A", "Vision, immunity", "5000 IU/kg DM", "Preformed only", "Cats cannot use beta-carotene"],
      ["Vitamin E", "Antioxidant", "50 IU/kg DM", "40 IU/kg DM", "Increase with high PUFA diets"],
      ["Taurine", "Cardiac, retinal", "Not essential", "400 mg/kg DM", "Add in cat food always"],
      ["Zinc", "Skin, immunity", "120 mg/kg DM", "75 mg/kg DM", "Northern breeds may need more"],
      ["Iodine", "Thyroid function", "1.5 mg/kg DM", "1.9 mg/kg DM", "Excess causes hyperthyroidism (cats)"]
    ],
    TEAL, LTBLUE
  ),
  spacer(),

  heading2("2.3 Water"),
  para("Water is the most important nutrient. Cats in particular have a low thirst drive and are prone to chronic dehydration when fed exclusively dry food, which can contribute to feline lower urinary tract disease (FLUTD) and chronic kidney disease (CKD)."),
  bullet("Dogs: ~50–60 mL/kg body weight per day"),
  bullet("Cats: ~44–66 mL/kg body weight per day (wet food provides 60–80 mL/100g)"),
  bullet("Always provide fresh, clean water ad libitum — use water fountains for cats to encourage intake."),

  spacer(),

  pageBreak(),

  // ======================== SECTION 3: DOGS — BY LIFE STAGE ========================
  heading1("3. Diet Plan for Dogs — All Life Stages"),

  // --- 3.1 Puppy ---
  heading2("3.1 Puppy (0–12 months / Up to 24 months for large breeds)"),
  para("Puppies require roughly 2× the caloric density of adult dogs. Growth phase is the most nutritionally demanding and critical for skeletal, neurological, and immune development."),

  heading3("Energy Requirements"),
  bullet("Small breeds (<10 kg adult weight): ~200–250 kcal ME/kg BW^0.75 per day"),
  bullet("Medium breeds (10–25 kg): ~150–200 kcal ME/kg BW^0.75 per day"),
  bullet("Large/Giant breeds (>25 kg): ~100–150 kcal ME/kg BW^0.75 per day — avoid overfeeding to prevent developmental orthopedic disease (DOD)"),

  heading3("Key Nutritional Priorities for Puppies"),
  bullet("Protein: ≥22% DM — high-quality animal proteins (chicken, lamb, egg, fish)"),
  bullet("Fat: ≥8% DM — essential for energy, fat-soluble vitamins, brain development"),
  bullet("DHA: 0.02–0.1% DM — fish oil supplementation recommended for neural & retinal development"),
  bullet("Calcium: 1.0–1.8% DM; Phosphorus: 0.8–1.6% DM — Ca:P ratio 1.2–1.4:1 (CRITICAL — excess Ca in large breed puppies causes osteochondrosis)"),
  bullet("Never supplement calcium in large breed puppies on a complete commercial diet"),

  heading3("Sample Daily Meal Schedule — Puppy"),
  makeTable(
    ["Age", "Meals/Day", "Sample Foods", "Portion Guidance"],
    [
      ["3–6 weeks (weaning)", "4–6", "Wet puppy mousse or gruel (kibble soaked in water)", "Ad libitum with monitoring"],
      ["6–12 weeks", "4", "Puppy kibble (AAFCO growth) + occasional wet food", "Follow label; divide evenly"],
      ["3–6 months", "3", "Puppy kibble (large breed formula if applicable)", "~5–10% body weight/day (wet)"],
      ["6–12 months", "2–3", "Transition to adult large-breed food from ~12 months (giant breeds 18–24 mo)", "Monitor BCS — target score 4–5/9"]
    ]
  ),
  spacer(),

  // --- 3.2 Adult Dog ---
  heading2("3.2 Adult Dog (1–7 years)"),
  para("Adult maintenance is the longest life stage. The goal is to maintain ideal body condition score (BCS 4–5/9), support immune function, and prevent obesity."),

  heading3("Daily Energy Requirements (Resting Energy Requirement × Activity Factor)"),
  bullet("RER (kcal/day) = 70 × (body weight in kg)^0.75"),
  bullet("Neutered/inactive: RER × 1.2–1.4"),
  bullet("Intact/moderately active: RER × 1.6–2.0"),
  bullet("Highly active / working dog: RER × 2.0–5.0"),

  heading3("Macronutrient Targets — Adult Dog"),
  makeTable(
    ["Nutrient", "Minimum (% DM)", "Typical Recommended", "Notes"],
    [
      ["Protein", "18%", "25–30%", "Higher for active breeds"],
      ["Fat", "5%", "12–18%", "Adjust for weight management"],
      ["Carbohydrates", "Not required", "30–50% (dry food)", "High-quality starches (rice, oats, sweet potato)"],
      ["Fiber", "—", "2–5%", "Supports gut motility, satiety"],
      ["Omega-3 (EPA+DHA)", "—", "0.03–0.08% DM", "Fish oil 250–500 mg/day"]
    ]
  ),
  spacer(),

  heading3("Sample Daily Meal Plan — Adult Dog (10 kg, neutered, moderately active)"),
  bullet("RER = 70 × 10^0.75 = ~394 kcal/day; × 1.4 = ~550 kcal/day target"),
  spacer(),
  makeTable(
    ["Meal", "Time", "Food", "Amount"],
    [
      ["Breakfast", "7:00 AM", "High-quality dry kibble (adult maintenance, AAFCO certified)", "~130g (check label kcal)"],
      ["Evening", "6:00 PM", "Dry kibble OR 50:50 kibble + wet food", "~130g dry (or 100g dry + 80g wet)"],
      ["Treats", "Throughout", "Carrot, cucumber, plain rice cake, or commercial low-cal treat", "≤10% of daily calories"],
      ["Water", "Always", "Fresh water ad libitum", "~500–600 mL/day"]
    ]
  ),
  spacer(),

  // --- 3.3 Senior Dog ---
  heading2("3.3 Senior / Geriatric Dog (7+ years)"),
  para("Senior dogs may experience reduced metabolic rate, muscle mass loss (sarcopenia), cognitive decline, joint disease, and early renal or hepatic changes. Nutrition must address all of these proactively."),

  heading3("Key Adjustments for Senior Dogs"),
  bullet("Protein: Maintain or INCREASE to ≥25% DM (avoid protein restriction unless renal disease confirmed) — prevents sarcopenia"),
  bullet("Phosphorus: Moderate restriction (0.3–0.6% DM) if early CKD suspected"),
  bullet("Calories: May decrease 20–30% due to lower activity — prevent obesity"),
  bullet("Antioxidants: Increase Vitamin E, C, beta-carotene, selenium — reduce oxidative stress"),
  bullet("EPA/DHA: Increase to 0.5–1g/10kg body weight daily — anti-inflammatory for joints and cognition"),
  bullet("Joint support: Glucosamine (20 mg/kg/day) + Chondroitin (15 mg/kg/day) in arthritic dogs"),
  bullet("Highly digestible proteins (egg, chicken, fish) — intestinal absorptive capacity may decline"),

  heading3("Sample Daily Meal Plan — Senior Dog (10 kg)"),
  makeTable(
    ["Meal", "Time", "Food", "Amount"],
    [
      ["Breakfast", "8:00 AM", "Senior formula kibble (joint support, lower phosphorus, high protein)", "~120g"],
      ["Evening", "6:00 PM", "Wet senior food (easier to chew, higher moisture)", "~150g wet"],
      ["Supplement", "With meal", "Fish oil capsule (EPA+DHA) + glucosamine tablet", "Vet-recommended dose"],
      ["Snack", "Midday", "Soft treat or cooked chicken breast (plain)", "≤50 kcal"]
    ]
  ),
  spacer(),

  pageBreak(),

  // ======================== SECTION 4: CATS ========================
  heading1("4. Diet Plan for Cats — All Life Stages"),
  para("Cats are obligate carnivores. Their metabolism is fundamentally different from dogs: they have irreversible hepatic enzyme activity for amino acid catabolism, cannot convert beta-carotene to Vitamin A, cannot synthesize taurine adequately, and have a diminished thirst drive. Dry-food-only diets in cats are associated with FLUTD, obesity, and CKD."),

  // --- 4.1 Kitten ---
  heading2("4.1 Kitten (0–12 months)"),

  heading3("Energy & Protein Requirements"),
  bullet("Energy need: ~200–250 kcal ME/kg BW per day (approximately 2× adult requirement)"),
  bullet("Protein: ≥30% DM — from animal sources only (chicken, turkey, fish, egg)"),
  bullet("Fat: ≥9% DM — arachidonic acid essential; provided by animal fat"),
  bullet("Taurine: ≥400 mg/kg DM (wet) or ≥1000 mg/kg DM (dry) — absolutely essential"),
  bullet("DHA: Critical for retinal and neurological development — supplement with fish oil if not in food"),
  bullet("Feed kitten-specific AAFCO-certified food until 12 months"),

  heading3("Sample Daily Meal Schedule — Kitten"),
  makeTable(
    ["Age", "Meals/Day", "Food Type", "Portion"],
    [
      ["3–6 weeks", "4–6", "Queen's milk / kitten milk replacer / wet mousse", "Ad libitum"],
      ["6–10 weeks", "4", "Wet kitten food (pâté) + soaked kibble", "~25–30g wet × 4"],
      ["3–6 months", "3", "Wet kitten food (primary) + dry kitten food", "~40–60g wet/day + 15g dry"],
      ["6–12 months", "2–3", "Kitten wet + limited dry; maintain taurine", "~60–80g wet/day"]
    ]
  ),
  spacer(),

  // --- 4.2 Adult Cat ---
  heading2("4.2 Adult Cat (1–7 years)"),
  para("Adult cats should ideally receive 60–80% of their diet from wet/canned food to support urinary tract health. A high-protein, low-carbohydrate diet that mimics their natural prey diet is ideal."),

  heading3("Daily Energy Requirements"),
  bullet("Neutered adult cat (4 kg): RER = 70 × 4^0.75 ≈ 236 kcal/day × 1.2 = ~283 kcal/day"),
  bullet("Intact adult cat: × 1.4 factor"),
  bullet("Indoor cat (low activity): × 1.0–1.2 factor"),

  heading3("Macronutrient Targets — Adult Cat"),
  makeTable(
    ["Nutrient", "Minimum (% DM)", "Ideal Range", "Notes"],
    [
      ["Protein", "26%", "35–45%", "Animal-source only — no plant protein exclusivity"],
      ["Fat", "9%", "15–25%", "Include arachidonic acid (animal fat)"],
      ["Carbohydrates", "Not required", "<10% ideal", "Cats lack salivary amylase; excess carbs → obesity"],
      ["Taurine", "0.04% (wet) / 0.1% (dry)", "0.05–0.15%", "Must supplement in all commercial cat foods"],
      ["Fiber", "—", "1–3%", "Hairball formulas: up to 8–10%"],
      ["Moisture", "75–80% (wet)", "Wet food preferred", "Promotes urinary dilution"]
    ]
  ),
  spacer(),

  heading3("Sample Daily Meal Plan — Adult Cat (4 kg, neutered, indoor)"),
  bullet("Target: ~280 kcal/day"),
  spacer(),
  makeTable(
    ["Meal", "Time", "Food", "Amount"],
    [
      ["Breakfast", "7:00 AM", "Wet pâté or chunks (chicken/fish, grain-free preferred)", "~85g (1 small can)"],
      ["Afternoon", "1:00 PM", "Small portion of dry kibble (high-protein, limited carb)", "~15–20g"],
      ["Evening", "7:00 PM", "Wet food (different protein source for variety)", "~85g"],
      ["Water", "Always", "Running water fountain preferred", "~150–200 mL/day total"]
    ]
  ),
  spacer(),

  // --- 4.3 Senior Cat ---
  heading2("4.3 Senior / Geriatric Cat (7+ years; super-senior 12+ years)"),
  para("Senior cats are prone to hyperthyroidism, CKD, dental disease, weight loss (cachexia), hypertension, and cognitive dysfunction syndrome. Nutritional management is critical from age 7 onward."),

  heading3("Key Adjustments for Senior Cats"),
  bullet("Protein: INCREASE to ≥35–40% DM — sarcopenia is common; restrict only if confirmed advanced CKD"),
  bullet("Phosphorus: Restrict to <0.5% DM if CKD present — phosphate binders may be needed"),
  bullet("Calories: Increase in underweight seniors (BCS <3/9); decrease for overweight"),
  bullet("Moisture: Maximize wet food — CKD management depends on hydration"),
  bullet("Antioxidants: Vitamin E, C, beta-carotene, EPA/DHA — reduce inflammation and cognitive decline"),
  bullet("Iodine: Avoid high iodine foods if hyperthyroidism confirmed; restricted iodine diets available (Hill's y/d)"),
  bullet("Highly palatable soft foods — dental pain and reduced olfactory sense decrease appetite"),
  bullet("Omega-3 (EPA+DHA): 30–40 mg/kg/day — renal-protective and anti-inflammatory"),

  heading3("Sample Daily Meal Plan — Senior Cat (4 kg)"),
  makeTable(
    ["Meal", "Time", "Food", "Amount / Notes"],
    [
      ["Breakfast", "8:00 AM", "Wet senior formula (high protein, low phosphorus)", "~85–100g"],
      ["Lunch", "12:00 PM", "Small wet meal or soft treat", "~30–40g"],
      ["Evening", "7:00 PM", "Wet food (rotate proteins — chicken, turkey, white fish)", "~85–100g"],
      ["Supplement", "With meals", "Fish oil (EPA+DHA) + vet-prescribed phosphorus binder if CKD", "As directed"],
      ["Water", "Always", "Water fountain + add water to wet food if needed", "~150–200 mL/day"]
    ]
  ),
  spacer(),

  pageBreak(),

  // ======================== SECTION 5: FEEDING FREQUENCY & BCS ========================
  heading1("5. Feeding Frequency Summary"),
  makeTable(
    ["Life Stage", "Species", "Meals per Day", "Notes"],
    [
      ["Puppy (<3 months)", "Dog", "4–6", "Small frequent meals prevent hypoglycemia"],
      ["Puppy (3–6 months)", "Dog", "3–4", "Transition to 3 meals"],
      ["Puppy (6–12 months)", "Dog", "2–3", "Large breeds stay on 3 until maturity"],
      ["Adult", "Dog", "2", "Twice daily preferred over once — reduces bloat risk"],
      ["Senior", "Dog", "2–3", "Smaller portions; easier to digest"],
      ["Kitten (<3 months)", "Cat", "4–6", "Ad lib or frequent small meals"],
      ["Kitten (3–12 months)", "Cat", "3–4", "Scheduled feeding preferred"],
      ["Adult", "Cat", "2–3", "Puzzle feeders reduce boredom/obesity"],
      ["Senior", "Cat", "3–4", "More frequent; smaller meals for easy digestion"]
    ]
  ),
  spacer(),

  heading1("6. Body Condition Score (BCS) — Target Ranges"),
  para("BCS is assessed on a 9-point scale. The ideal BCS for both dogs and cats is 4–5/9 (ribs easily felt without excess fat, visible waist from above, abdominal tuck visible from side)."),
  makeTable(
    ["BCS Score", "Condition", "Action"],
    [
      ["1–2 / 9", "Emaciated / Very thin", "Immediate veterinary assessment; increase calories 30–50%"],
      ["3 / 9", "Thin", "Increase food by 15–20%; high-protein diet; recheck in 2 weeks"],
      ["4–5 / 9", "Ideal", "Maintain current diet; continue regular weigh-ins"],
      ["6 / 9", "Overweight", "Reduce calories by 10–15%; increase wet food; more exercise"],
      ["7–8 / 9", "Obese", "Weight management diet (L/D or Metabolic formula); vet guidance"],
      ["9 / 9", "Severely obese", "Veterinary-supervised weight loss; caloric restriction 30% below RER"]
    ]
  ),
  spacer(),

  pageBreak(),

  // ======================== SECTION 7: FOODS TO AVOID ========================
  heading1("7. Foods to Avoid — Toxic & Harmful Items"),
  para("The following foods are toxic or potentially harmful and must never be fed to dogs or cats:"),
  makeTable(
    ["Food", "Toxic to", "Effect"],
    [
      ["Chocolate / Cocoa", "Dogs & Cats", "Theobromine toxicity — tremors, seizures, cardiac arrhythmia, death"],
      ["Grapes & Raisins", "Dogs (cats too)", "Acute renal failure — even small amounts can be fatal"],
      ["Onions, Garlic, Leeks", "Dogs & Cats", "Hemolytic anemia (Heinz body anemia) — cats more sensitive"],
      ["Xylitol (artificial sweetener)", "Dogs", "Severe hypoglycemia, liver failure"],
      ["Alcohol", "Dogs & Cats", "CNS depression, metabolic acidosis, death"],
      ["Macadamia Nuts", "Dogs", "Hyperthermia, weakness, vomiting, tremors"],
      ["Raw Dough / Yeast", "Dogs & Cats", "Bloat from CO2 production; ethanol toxicity"],
      ["Avocado", "Dogs & Cats", "Persin causes vomiting, diarrhea, cardiac damage"],
      ["Caffeine", "Dogs & Cats", "Tachycardia, seizures, death"],
      ["Cooked Bones", "Dogs & Cats", "Splintering — GI perforation, obstruction"],
      ["Raw fish (excessive)", "Cats", "Thiaminase destroys Vitamin B1 — neurological signs"],
      ["Liver (excessive)", "Dogs & Cats", "Vitamin A toxicosis — bone deformities, anorexia"]
    ]
  ),
  spacer(),

  pageBreak(),

  // ======================== SECTION 8: SAMPLE WEEKLY MEAL PLANS ========================
  heading1("8. Sample Weekly Meal Plans"),

  heading2("8.1 Adult Dog — Weekly Rotation (10 kg, neutered)"),
  makeTable(
    ["Day", "Breakfast", "Dinner", "Treat"],
    [
      ["Monday", "Chicken & rice kibble (130g)", "Beef wet food (150g)", "Carrot stick"],
      ["Tuesday", "Salmon kibble (130g)", "Chicken kibble (130g)", "Plain rice cake"],
      ["Wednesday", "Turkey & sweet potato kibble (130g)", "Turkey wet food (150g)", "1 tbsp plain yogurt"],
      ["Thursday", "Lamb kibble (130g)", "Sardines in water + rice (100g + 40g)", "Cucumber slices"],
      ["Friday", "Chicken kibble (130g)", "Beef & vegetable wet food (150g)", "Boiled egg (½)"],
      ["Saturday", "Salmon & potato kibble (130g)", "Chicken wet food (150g)", "Blueberries (few)"],
      ["Sunday", "Turkey kibble (130g)", "Home-cooked chicken breast + steamed veg (150g total)", "Apple slice (no seeds)"]
    ]
  ),
  spacer(),

  heading2("8.2 Adult Cat — Weekly Rotation (4 kg, neutered, indoor)"),
  makeTable(
    ["Day", "Morning", "Afternoon", "Evening"],
    [
      ["Monday", "Chicken pâté wet (85g)", "Dry kibble (15g)", "Tuna wet food (85g)"],
      ["Tuesday", "Turkey & giblets wet (85g)", "Dry kibble (15g)", "Salmon wet food (85g)"],
      ["Wednesday", "Chicken & pumpkin wet (85g)", "Soft treat (5g)", "Duck wet food (85g)"],
      ["Thursday", "Whitefish pâté wet (85g)", "Dry kibble (15g)", "Chicken mousse wet (85g)"],
      ["Friday", "Rabbit wet food (85g)", "Soft treat (5g)", "Ocean fish wet (85g)"],
      ["Saturday", "Turkey wet (85g)", "Dry kibble (15g)", "Mackerel wet (85g)"],
      ["Sunday", "Chicken & shrimp wet (85g)", "Dry kibble (15g)", "Beef pâté wet (85g)"]
    ]
  ),
  spacer(),

  pageBreak(),

  // ======================== SECTION 9: SUPPLEMENTATION ========================
  heading1("9. Recommended Supplements"),
  makeTable(
    ["Supplement", "Indication", "Dose", "Species"],
    [
      ["Fish oil (EPA/DHA)", "Coat, joints, cognition, kidney", "50–100 mg EPA+DHA/kg BW daily", "Dogs & Cats"],
      ["Probiotics", "GI health, microbiome support", "1–5 billion CFU/day", "Dogs & Cats"],
      ["Glucosamine", "Osteoarthritis, joint support", "20 mg/kg/day", "Dogs (mainly)"],
      ["Chondroitin", "Joint cartilage support", "15 mg/kg/day (with glucosamine)", "Dogs"],
      ["Taurine", "Cardiac, retinal health", "250–500 mg/day", "Cats (always), some dogs"],
      ["Vitamin E", "Antioxidant (especially seniors)", "1–2 IU/kg BW/day", "Dogs & Cats"],
      ["B vitamins", "Anorexia, CKD, neurological signs", "Vet-prescribed B complex", "Cats with CKD"],
      ["Potassium", "Hypokalemia (CKD cats)", "2–6 mEq/cat/day (vet guidance)", "Cats with CKD"],
      ["L-carnitine", "Weight management, DCM", "50–100 mg/kg/day", "Obese dogs"]
    ]
  ),
  spacer(),

  // ======================== SECTION 10: GENERAL TIPS ========================
  heading1("10. General Feeding Tips & Best Practices"),
  bullet("Always transition to new food gradually over 7–10 days (25% new / 75% old → 50/50 → 75/25 → 100% new) to prevent GI upset."),
  bullet("Feed at scheduled times in a quiet location — reduces food guarding and stress eating."),
  bullet("Use stainless steel or ceramic bowls — plastic harbors bacteria and can cause chin acne in cats."),
  bullet("Measure food with a kitchen scale rather than cup scoops for accuracy."),
  bullet("Monitor BCS monthly and adjust portions accordingly."),
  bullet("Dental health: Provide VOHC-approved dental chews or brush teeth 3–5× per week."),
  bullet("Avoid free-feeding dry food in cats — promotes obesity and reduces urinary dilution."),
  bullet("Multiple small water stations around the home increase feline water intake."),
  bullet("Regular veterinary nutritional assessments every 6–12 months."),
  bullet("Look for AAFCO statement on packaging: 'complete and balanced for [life stage]' and feeding trials preferred."),

  spacer(),
  spacer(),

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    children: [new TextRun({ text: "⚠  Disclaimer", bold: true, color: "CC0000", size: 24 })]
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    spacing: { before: 80, after: 200 },
    children: [new TextRun({ text: "This diet plan is a general guide based on AAFCO and FEDIAF 2024 nutritional guidelines for healthy pets. It does not replace veterinary advice. Pets with medical conditions (renal disease, diabetes, heart disease, food allergies, etc.) require individually tailored therapeutic diets under veterinary supervision.", size: 20, italics: true, color: "666666" })]
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