A quick reminder..

that if your veteterian has prescribed or recommended canned pumpkin for your pet, now is the best time of the year to stock up on it.

When is DM not DM?

DM is Dietetic Management Feline Formula from Purina Veterinary Diets.  We refer to canned DM as the Diabetic Management diet for cats -- it is a critical part of our management of this disease.  For more information on diabetes, please refer to this article on VeterinaryPartner.com.

How different therapeutic diets can help manage diabetic patients was one of the reminder to us that "cats are not small dogs" when it comes to disease process and treatment.  Years ago, veterinarians recommended high fiber diets for diabetic cats, as we do for dogs.  High fiber diets usually mean high carbohydrate.  We since learned that, unlike dogs, diabetic cats do better on a low carbohydrate high protein diet.  Since dry food requires some sort of flour (be it corn, rice, soy, barley, wheat, etc.) to make it crunchy and to form the kibble, it tends to be higher in carbohydrate.  So even though there is a dry DM formula, the canned DM is ideal --- until recently when Purina introduced the new DM Savory Selects "for cats who prefer meaty chunks topped with gravy."

What's wrong with introducing a new formula to add variety to a diabetic cat's diet?  The chunky Savory Selects does look more appetizing with the juicy gravy.

DM Savory Selects Dietetic Management

Have you ever made or watched someone make gravy from scratch?  Flour or cornstarch is usually added to thicken the sauce.  In DM Savory Selects, cornstarch is added to make that gravy --- and, subsequently, more than doubles the carbohydrate amount compared to the original canned DM formula. Click on image to enlarge.

DM Savory Selects: Carbohydrate 11.59% (dry matter)

"Original" canned DM: Carbohydrate 4.51% (dry matter)

11.59% carbohydrate (on a dry matter basis) is not that bad but you can find similarly low carbohydrate diets in certain over-the-counter canned food.  Some are even lower in carbohydrate than the DM Savory Selects.  

We have seen the effectiveness of the canned feline DM diet.  The diabetic cats in our care that went into remission (becomes non-diabetic) have all had DM as part of their treatment.  The cats that did not seem to respond to insulin eventually did after his family managed to convince him to eat canned DM.  We have diabetic cats that are doing well on the canned low carbohydrate over-the-counter food in the above linked chart --- but years later, they are not in remission (and unlikely to do so).  So some of the diets in the chart are alternatives for cats that will not eat canned DM (the original formula) but they cannot compare to DM.

Thus, we could not understand why Purina would make a different formula with a different nutrient profile but kept the same name.  It's fine to come up with a more appetizing formula but if it has a different nutrient profile --- twice the carbohydrate percentage of its original formula --- the diet should have a completely different name.  Or hyphenate it to something like DM-moderate (for moderate carbohydrate).  Calling it DM Savory Selects is not differentiating it enough; it sounds too much like a new flavor.

Where's the harm?
A well regulated cat on canned DM can become unregulated if fed a higher carbohydrate diet.  A previously diabetic cat that is now in remission, thanks to canned DM and his family's diligence, can come out of remission (becomes diabetic and needing insulin injections again) if his family unknowingly feeds him a higher carbohydrate diet.
And in this age of online pharmacies, that can easily happen.

Order page from an online seller

Families ordering their cat's canned DM will not know that they are putting their cat's health at risk by trying the DM Savory Selects.  Their prescriptions for the diet says "Purina Veterinary Diets DM canned" so most, if not all, online pharmacies/sellers, would sell the DM Savory Selects to these families.  The above promotion of this new formula underscores the potential harm Purina is causing with this misguided product launch.  

DM Savory Selects may be fine for cats who will not eat canned DM.  DM Savory Selects may be a good choice to transition cats onto canned DM.  But it should be made clear that  

DM Savory Selects is not canned DM.

We have relayed our concerns to our Purina representative so, hopefully, something will be done about this -- be it a change in labeling to differentiate the two formulas and/or Purina telling veterinarians about this so we can all write on our written prescriptions "NOT DM Savory Selects" when we want our patients to have the original canned DM formula.

Until then, please pass this information along to your veterinarians or families with diabetic cats -- especially cats who are currently on canned DM or other low carbohydrate canned diets.

Purina Feline DM is a diet that is deserving of the term therapeutic or prescription diet.  It plays an important role in the management of diabetic cats.  It would be a shame if any lack of success with DM Savory Selects mars the reputation of the original DM or worse, makes people doubt that diet does make a difference in the life of a diabetic cat.

Little and Often

Or little and not often if we are referring to my blogging.

Are you a planner?  One of those people who has to plan everything from the big picture or goal down to the basic steps or "next actions"?  You research everything there is to know about a project before even thinking of starting it (is that even possible?)?  When it comes to pet care and training, have you read all the blog posts, scoured the pet fora, and consulted with Dr. Google but have yet to actually do anything about it?  Well, don't feel bad.  I am probably more guilty of that than any of you out there.

Elaine: Modeling the fluffy covered harness

Our storage area was cluttered with my "project support" materials -- some related to the clinic and my plans for the practice, most were my own pet projects (literally as well as figuratively).  As I tackled the piles of ideas-that-went-nowhere, I realized that those ideas went nowhere because I spent all my time planning and researching, and not actually doing any of it.

Well, that's not true.  Covering the harness with a re-purposed fluffy blanket for extra padding was probably an idea that thankfully went nowhere (you have Elaine to thank for not having to view a video on that one!).

I digress.

It can be difficult for some planners to take those final steps to become doers.  Procrastination, anyone?  It does not help that one of the tip to overcome procrastination is to break projects down into small doable next actions.  That just mean more planning time for me.  So, even though being diligent and doing my research have served me (and our patients) well, it had also kept me from sharing ideas and information with you.  I spend way too much time thinking of what to write instead of just doing it.  I need to learn that I do not have to discuss the A-Z of dog training philosophy to share a video on operant conditioning or shaping behavior.  Besides, is that not the beauty of blogging?  That I can follow-up later with more information if needed or requested?  Well, this will be a work in progress.  We will see if I can keep up with more timely published blog posts instead of having a backlog of drafts.

Do you have a pet related project that has been sitting in your Someday/Maybe List because you think you just do not have the time to start?  Is "Take Elaine jogging Thursday evenings" still stuck in my (uh, your) Waiting For List because I (you) just have not found that perfect running harness for her?

If I can blog off-the-cuff (and believe me, this was not easy for me), you can make a dent in whatever project that has been in a holding pattern, pet-related or not.

• Nail Trim: Don't worry about getting the Qwik-Stop Powder when your baby is not even letting you touch his paws yet.  Just start the counterconditioning exercise. Touch his paws while someone is giving him treats.  See this video from Dr. Sophia Yin for details.  Again, don't worry about getting a nail trimmer or anything yet, just use the exercise to get him to let you touch and handle his paws.  You can get the nail trimmer (and research that all you want!) after you are able to safely hold his paws and manipulate his toes.  Disclaimer: I tried the technique in the video and was nowhere as successful as Dr. Yin and definitely not in 4 minutes.  You may have better outcomes though.
• Home Dental Care:  Start touching your pet's mouth and lifting her lips to get her used to the handling before worrying about what types of toothbrushes and pastes to get her.  If she is aggressive, you may have to ask your family vet or trainer for advice and/or do some research first (I know, research --- that's what I wrote to stop doing just seconds ago) but that's not the case for most of us.  Most of us have not started brushing our pet's teeth because we imagine it to be some epic project when it can really be just developing a habit or routine.
• Running with Your Dog:  It's all fine to research how to avoid causing neck injury to your dog before taking her out for that first run.  But if you are not even currently taking her out for long walks, don't let the lack of a good harness keep you from starting her training with walks and refreshing her heeling skills.

The "little and often" approach is effective in many situation, including pet care and training.
So now, that I have managed to finish a post, without outlining and mindmapping it ad nauseam, and share a couple training videos (the shaping video still amazes me) that had been languishing on my lists, I am off to take Elaine out for that evening walk.

Remember, little and often.
Let's hope I can remember that too when it comes to blogging!

Microchips

Friday May 11th provided a good reminder to us why microchips are a simple yet powerful tool that we  recommend for all of our patients. In the morning one our clients contacted us to let us know they found a stray dog. They scheduled an appointment and brought the friendly cocker spaniel for a microchip scan. The scan confirmed that a chip was present, and after a few phone calls our clients were able to reunite the wayward dog with his grateful owner.

Sadly, only about an hour later we received a call from Long Beach Animal Care services that they had found a cat recently deceased (probably hit by a car) with a microchip that may had been implanted by us. Even though we had implanted the chip 14 years ago, we were able to provide Long Beach Animal Care with the appropriate owner information so that they, in turn, could provide the owner with some closure. Pet microchips can save lives and reunite companions. There are several major microchip manufacturers and several registration options, so make sure to ask your veterinarian about microchipping options for your companions.

Book Review: Pet Food Politics: The Chihuahua in the Coal Mine by Marion Nestle

"Pet Food Politics: The Chihuahua in the Coal Mine" by Marion Nestle (no relation to the food company) examines the causes, details, and fall-out from the pet food recall of 2007. What were the causes that led to the recall? What lessons were learned? Finally, what measures, if any, were taken to prevent future similar episodes?

Many pet owners remember that beginning in March 2007, many major pet food manufacturers began recalling popular lines of pet diets. Iams, Eukanuba, and Blue Buffalo were among the many popular brands of dog and cat food that were pulled from the shelves of grocery stores, pet stores, and veterinary offices. Anger and confusion set in among many pet owners, as foods that had been promoted as safe and healthy for our companions were removed and considered possibly dangerous. Understandably, many pet owners felt betrayed and lost trust in pet food manufacturers. Worst of all, many dogs and cats lost their lives from eating contaminated product.

Pet Food Politics begins by tracing the roots and causes of the recall. Many pet food companies, as it turns out, outsource the manufacturing of their pet foods to a pet food manufacturer. The manufacturer produces the foods in accordance with the companies'  manufacturing specifications (the "recipes," so to speak). By producing many companies' pet foods, a manufacturer (such as Menu Foods) can take advantage of economies of scale to purchase ingredients for less and consolidate production to usually produce the foods at a cheaper cost than the pet food companies could do on their own. (Thus, at least up until the recall, many  of the "high end" foods including varieties of Science Diet, Royal Canin, and Natural Balance were made by the same manufacturer that made low-cost competitors such as Walmart's Old Roy.)

Like many other products, many pet food ingredients such as wheat gluten are often available for less overseas. Menu Foods purchased its wheat gluten from Chinese companies. Oftentimes, food manufacturers find it easier to deal with a "go-between" or broker, that specializes in obtaining the low-cost overseas products for them rather than dealing with the ingredients' producers themselves. One of these companies, ChemNutra, provided Menu Foods with wheat flour that had melamine added to make it appear as the much more expensive wheat gluten.

Shortly after the food recall was first announced, Cornell researchers discovered that elevated melamine was common to the foods in the ill and dying patients. They remained perplexed however, as the only research available on melamine (all old, out of date studies), showed that it was dangerous only at much higher levels. It took a few more weeks for veterinarians at UC Davis to discover that, when mixed with the compound cyanuric acid, melamine was dangerous even at much lower doses.

As alarming as the background behind the recalls is, Nestle also details corporations quick to claim innocence and denial. All of the major players denied responsibility and tried to shift blame to others. Consider that at one point or another:

-Menu Foods blamed ChemNutra for the laced wheat "gluten" it used.
-ChemNutra claimed innocence, and stated they were only "brokers" and were never owners of the product themselves.
-Xuzhou Anying ("owners" of the product that ChemNutra provided Menu Foods), stated that they too, didn't actually manufacture product, only purchased it themselves from 25 manufacturers throughout China. Even worse, Xuzhou Anying officials were at one point quoted as stating "The poisoning of American pets has nothing to do with China."

Sadly, neither Nestle nor the FDA were able to find the actual manufacturers of the laced product, and, given the complexities of our food supply, are unlikely to ever do so.

I strongly recommend Pet Food Politics. It's part mystery, part drama, and part tragedy. It tells of a mystery illness that seemingly came out of nowhere to claim hundreds, maybe thousands, of lives. It details the drama of veterinarians, universities, pet food companies, and an understaffed FDA racing to find a cause. The tragedy is not without its villains (you'll have to read it to see who were the most egregious offenders) and its heroes: Nestle singles out the pet food maker Castor and Polluck's, the San Francisco based pet store Pet Express, and Internet journalists for being open and proactive during at the height of the crisis. (The FDA, severely underfunded and under tremendous pressure from the public, journalists, and pet food companies, also comes across fairly well.) Finally, it's a cautionary tale: Nestle details the major reforms that are needed in the way we deal with food production, both for pets and humans, if we're to avoid future episodes. And, given the interconnections of our food supply, one that can't simply be solved by avoiding pet foods altogether.

Lesson Learned and Office Closing Wed 3/28/12

Let's start with what may be inconvenient news to our clients - - -
Our Office is Closed Tomorrow, Wed 3/28/12

Elias will check phone messages and emails throughout the day.  He will help you as much as he is able but most messages may have to wait until I get back in the office Thursday.

I am scheduled for an ear surgery tomorrow morning.  I understood it was an outpatient procedure.  A couple hours to recover from anesthesia then I should be fine to go home.

Those of you who had surgery, or experienced it with family members, can probably already see the mistake(s) I made.

I have done countless surgeries on our patients but have never been on the receiving end myself.  Unbeknownst to me, in human medicine, outpatient surgery just mean I would not be admitted in hospital - - -  not that it would be a quick procedure under sedation or "light anesthesia."  I had thought I'll miss tomorrow morning but will be back in the office in the afternoon to at least answer emails and calls.  Fortunately, I called the nurse to confirm the surgery details yesterday.  She could not answer my questions so the surgeon called me today.  To be honest, the nurses were probably getting annoyed by all my questions - - -  it was my third call in as many weeks.
The bottom line is I cannot work at all tomorrow so the office will be closed. 

The nurses were nice and tried to answer my questions the times I called in preparation for the surgery.  They just were not clear on my concerns and I just did not know enough to ask the right questions.

The experience made me realize the same thing can happen to our clients and patients.  Most of our procedures are routine and familiar to clients with previous pets.  But there are clients who may be going through the procedures for the first time with their pets.  And just as with my (in)experience, they may not know what to ask to prepare for their pets before and after a procedure, especially a surgery.

We always end our instructions to our clients with "Let us know if you have any questions or concerns."  But this experience reminds me to continue to make an effort to understand the pet's home environment to help anticipate potential issues.

I am sure I'll have more learning moments in the days ahead....

Another Saturday at The Family Vet (Part 2)

Another Saturday at The Family Vet (Continued from part 1...)

 The pit puppy had a large bone stuck in the back of his mouth! Suddenly, as if aggravated by Dr. Tran's exam, he  struggled vigorously against Elisabeth's restraint in an effort to paw at his mouth again and again. He was clearly in discomfort and the situation, while not a medical emergency per se, nevertheless demanded immediate action. Dr. Tran administered a combination drug to sedate the thrashing panicked pit bull.

 Mindful that a sedated patient can still chomp down on her fingers, Dr. Tran carefully extracted the marrow bone that was wedged around the upper molar.  Even though the bone had punctured the gingiva and caused an open wound, the tooth itself appeared undamaged.  The wound was flushed and antibiotic and pain medication were administered.  A much more comfortable pit puppy soon recovered from the sedation and was once again wagging his happy tail. Throughout the procedure we remained in awe of the pit's happy attitude.

Hoover

The next day we received a welcome update from Hoover's owner; he was much more himself and was continuing to improve. The owner kept lamenting that she had given Hoover a carrot; we recommended, as we generally do, that it's a good idea to check with your veterinarian before altering your pet's diet, and that if you do, it's best to monitor him or her for at least the first few times to make sure they're tolerating the change.  Most dogs would not have any problems with some carrots.  Hoover just happened to be sensitive to it, or his hyperactivity prior to eating chunks of carrots upset his stomach. Regardless, she had the right instinct in calling us and bringing him in (even though it was "just one vomit"), thereby preventing a possibly serious situation from occurring.


When she finally picked up the pit (now named "Harry"), his new owner was surprised to see him so clean. Dr. Tran and Jon had taken the time to give Harry a much needed sponge bath. The swelling on the right side of his face, and the redness in his eye, were both already nearly gone. Now much cleaner, well-fed, and having that bone taken out (and gotten lots of hugs, love and affection throughout) Harry's experience was a reminder to all: NEVER give your pet bones --- unless you are willing to accept the consequences which may include intestinal perforation, obstruction, fractured teeth, gastroenteritis, and, as in Harry's case, a bone wedged around your tooth.

Harry

Sadly, two-and-a-half weeks after we found her abandoned in an empty tissue box in the parking lot, the orphan puppy died this past Saturday morning. Her's, Harry's, and Hoover's experiences reminds us of the frailty of life, and of the responsibility and commitment that comes with accepting a companion into our lives.

Another Saturday at The Family Vet

Saturday February 18th had already been shaping up to be a busy day, as we had a solidly booked schedule. Additionally Dr. Tran already had her hands full - for the past two weeks she has been living in 4 hour shifts, nursing a tiny puppy only a few days old. If you've ever cared for day-old orphan puppies you're familiar with the procedure: stop whatever you're doing every 4 hours and make sure the puppies are sufficiently fed, stimulated for defecation and urination and finally get cleaned up and re-situated in clean, warm and comfortable bedding. So, when you're asleep in the middle of the night and the four hours are up, you get up; when you go to a restaurant for a Saturday night dinner and the four hours are up, you stop your meal, and take the puppy out so she can have hers first. It's an exhausting, demanding responsibility.

Compounding this, late morning we received a call from a client: her puppy (a cute 3-month old Mini-Schnauzer mix named "Hoover") had vomited and was now lethargic, just laying around and not moving. Wisely, the owner followed our instructions and brought the Hoover in for us to observe him.

Just a few minutes after that, (and still in the middle of our full schedule) another client came in with a pit bull puppy she had just found roaming the streets. The puppy was in terrible shape: he had a gash in his ear, and was soiled in urine and feces. Most concerning of all he had some discharge and redness from his right eye and the right side of his face was swollen. Despite the mess he was in and the obvious lack of care he had received the puppy was happy and in good spirits, wagging his tail and eagerly seeking out my hand for a few strokes of affection. It was a reassuring yet heart breaking scene all at once. In addition, the puppy had already caught a lucky break, as the client had decided to keep him. Because we were already so over-capacity and because she had decided to adopt him,  I offered, and the client agreed, to let us keep the "Pit" overnight, so that we could address his health issues the next day.

When Hoover came in I immediately commended the client for bringing him in. Although he had only vomited once, he was clearly in bad shape: he was alert but very lethargic. Small breed puppies that are weakened can be slow to eat and become even dangerously weaker still, potentially developing a condition called hypoglycemia that can lead to seizures.  The client offered her hypothesis of what could've gone wrong: this morning she had given him 2 small pieces of carrot for the first time. Dr. Tran treated Hoover for hypoglycemia and gastroenteritis, and throughout the afternoon he made slow but steady improvement.

Pit

By now, late in the day and long after our closing hours, (and right after the orphan puppy's third feeding), we had a chance to speak with Pit's new "owner." Although we hadn't noticed it while he was here, she casually mentioned to us that he was scratching at his right eye; she thought that's what had caused his eye to be red. Dr. Tran decided to examine him after-hours instead of waiting for the next day. She wanted to make sure the apparent eye discomfort was not due to something in his eye.  If we didn't find a foreign body, (in simpler terms, "something stuck in his eye"), we would, at least, place an e-collar on him to keep him from doing further damage to his eye.  What she found shocked her and the weary staff.... (to be continued....)