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Vine Post: Measuring Your Pet's (Dry) Food Intake

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Case Report Short: Elaine Tran

Today we begin a new occasional blog series called "Case Report Shorts." As their name implies, "Case Report Shorts" will be short summaries of cases that we come across. In order to make these "Short Reports" possible, brevity and clarity will be emphasized. Our aim of these reports, as with our blog in general, will be to both to enlighten and inform others of the complexities involved in companion animal health care. Our first Case Report Short is Elaine Tran.

Elaine and Dr. Tran in July

Elaine Tran is Dr. Tran's own 11 year old pit bull mix. Even though Elaine seemed fine (she had been acting fine, eating fine, etc.) in September Elaine had a blood test administered as part of a routine senior and pre-dentistry check-up. Some of the results were somewhat abnormal but since Elaine was otherwise fine, Dr. Tran decided to postpone the dentistry and re-retest her a few months later.

In January Dr. Tran proceeded with the follow-up diagnostic tests. Unfortunately, the follow-up blood test was much worse. It was now obvious that Elaine, still acting "fine on the outside," was having some type of serious medical problem. As a result of that follow-up test, Elaine had an xray, then an ultrasound a few days later. The xray seemed to show some sort of round mass in her abdomen; the ultrasound confirmed the mass to be a "splenic mass." Even though the splenic mass did not appear to be at risk of rupturing, Dr. Tran elected to have it removed as urgently as possible.  Elaine's liver also appeared abnormal on the ultrasound (which was not surprising considering the abnormal liver values on her blood test); so the initial plan was to biopsy (to get some samples for testing) her liver during surgery.

Lateral (side) view of Elaine's abdomen. Red arrows outline the round mass on her spleen.

Less than a week after the ultrasound, Elaine was admitted to Animal Emergency and Medical Center in Torrance for her splenectomy (surgery to remove her spleen).  Surprisingly, her pre-surgical blood test showed an anemia that was not there a week ago.  The reason was revealed when the surgeon entered Elaine's abdomen.  The splenic mass had developed a small crack and had started to bleed.  The surgeon was met with another surprise when he checked the liver --- a large mass occupied one of Elaine's liver lobes.  In addition to removing the spleen, the surgeon had to remove 2 of her liver lobes to completely remove the mass.

A 4 -inch mass in Elaine's liver

A 3-inch mass on Elaine's spleen

Indeed, even though Elaine was "acting fine" on the outside, it is conceivable that had she not had that surgery, she would, at the minimum, have developed a hemoabdomen (blood in her abdomen) as her splenic mass had started to bleed. Or she would have developed more complications from the liver mass.
The surgery proved complicated and long, but was successful. Still, her recovery was somewhat difficult. She wouldn't eat or drink and she remained very weak. When she finally had an appetite, she would vomit anything she ate the first couple of days.  It's been 2 weeks since her surgery and Elaine is finally showing glimpses of her normal self.

The growths themselves were tested.  The growth on Elaine's spleen was a benign mass -- surgical removal was curative.  The growth on her liver was a well differentiated hepatocellular carcinoma. Although we have to monitor her other liver lobes (via ultrasound) for recurrence, the overall prognosis is good for Elaine. We could not have wished for a better outcome.

Today (February 14th) is Elaine's 12th Birthday. Thanks to the help from AEMC, we hope to have Elaine with us for many more to come.

Elaine just a couple of weeks after her surgery, February 2013

The Westminster Kennel Club Dog Show and Application Review

We always enjoy watching the annual Westminster Kennel Club Dog Show. The show is not only a celebration of our closest friends, it's impressive seeing how well they are kept and trained. This year's edition, No. 137, is scheduled to start this Monday February 11th.

In conjunction with the 137th Westminster Kennel Club Dog Show, the WKC has released a smartphone application for Android and iOS devices that, we believe, is well worth the download. The application is clear and well designed. We particularly like its focus on education, both about the show itself and its participants.

After launching the application, you're presented with several options, including Dog Show maps, directories, schedules, even a live feed once the show starts. Westminster 101 will help you learn what judges look for when they decide Best in Show. It has everything from judging criteria to a glossary of frequently used terms.

Perhaps our favorite section of the application is the Breeds section. Here, the application lists the entirety of breeds to be judged at the show. In addition to the judging schedule for all breeds, selecting a particular breed will provide you with a treasure trove of useful breed information. You can see the breed's formal name, group, typical photo, and useful education facts and characteristics.


The Westminster Kennel Club's free Dog Show application will not only help you better enjoy the upcoming Dog Show, it's a great educational tool to aid you in learning basic facts about dog breeds. It's obvious that the WKC spent a lot of time and effort into this well made application. Best of all, the application is free. (Click here to visit the download page.) So download it, and cheer your favorites on to Best in Show!

Some brief thoughts on the New Year...

As the year past us begins to fade, the beginning of  a new year presents us with opportunities to both assess the past and establish goals for the future. 2012 was particularly difficult for us; we had to say final goodbyes to many companions. To all who left us last year, we loved you and we cried for you and we will miss you dearly. You will be in our hearts forever. But we're optimists at heart. The past year also brought us many new friends, and we know 2013 will bring us even more.  We look forward to coming up with new ways to improve on the care and comfort that we provide.  We hope and wish for you and your family  a healthy and happy 2013.

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.