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.

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.

Which is why 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.

Did You Know.... Puppy Vaccine Series are Age-Dependent?

One of the more frequent comment we hear from clients with new puppies:
She only needs one more puppy vaccine.  The breeder already gave her three 4-in-1 shots.

Even assuming those three 4-in-1 shots or DA2PP (DHPP) vaccines --- as the combination vaccine for distemper, adenovirus-2 (infectious hepatitis), parainfluenza, and parvovirus is commonly known --- were given every 3 weeks, the above comment is true only if the puppy is currently at least 14-16 weeks old.  If the breeder gave the vaccine at 6 weeks old then again at 8 weeks and 10 weeks (we usually recommend and follow a 3-4 weeks interval but it is not uncommon to see puppies coming in with 2 weeks intervals), that puppy would still need at least 2 more vaccines to complete the puppy series.  In this example, we would have postponed the vaccine until 3 weeks after the last one (puppy would be 13 weeks old then) and give the last of series 3 to 4 weeks after that (puppy would be 16-17 weeks old).  If there is a question about the puppy's immune status, we sometimes would give another one so that the puppy's last of series vaccine would be at 5 months of age.  Why?  Because even though we know that maternal antibodies are gone from most puppies immune system by 4 months of age, some puppies may take up to 5 months of age.

Maternal antibodies protect puppies (and kittens) from diseases that their immature immune system are not able to handle.  However, the presence of maternal antibodies also prevent puppies from producing their own antibodies.  Maternal antibodies neutralize or inactivate the vaccines (virus) before the puppy's immune system has a chance to "see" the virus to produce his own antibodies.  If we stop the vaccine series when maternal antibodies are still present and the puppy is later exposed to the virus (most commonly parvovirus) after maternal antibodies are gone, the puppy, not having adequate appropriate antibodies of his own, will succumb to the infection.  It is no surprise then that parvo infection is often seen in unvaccinated (or incompletely vaccinated) puppies around 14 to 24 weeks old.

An 8-weeks old puppy that will receive three DA2PP (DHPP) vaccines, one given every 3-4 weeks (ending at 15-16 weeks old), will likely have adequate protection.  So would a 15-weeks old puppy with two DA2PP (DHPP) vaccines, one given every 3-4 weeks (ending at 18-19 weeks of age).  However, not that we recommend this, a 6-weeks old puppy that will receive four DA2PP (DHPP) vaccines, one given every 2 weeks (ending at 12 weeks old) may not have adequate protection. 

Bottom line, it does not matter if the puppy received two, three, or even four DA2PP vaccines already.  What matters is the time interval and when that last one was given.

For more information on vaccines, please visit Vaccine FAQ and General Information and 2006 AAHA Canine Vaccines Guidelines, Revised.

Timing of vaccines is only one aspect of the vaccine protocol.  Add to that, the different vaccines, the pet's lifestyle, health status and risk exposure and you can see why the best vaccine protocol is one that is tailored to your pet's needs.

Spring Into Summer

Easter and Spring Break signal the coming of warmer weather and summer fun. Some things you can do to prepare your canine and feline companions for fun in the sun.

If your pets have long hair or thick coats that you had let go "au naturale" through the winter, it may be time for them to visit a good groomer.  Depending on the breeds and lifestyles, an appropriate trim will keep your pets comfortable and safe as they mingle at the local dog parks or beaches.

click on image to enlarge
Parasite Control
Although we recommend year round parasite control in Southern California, some people do stop using preventatives over the cooler winter months.  Restart flea control and be prepare for the warmer summer days.  Even if your companions spend most of their time indoors, they bound to pick up fleas on their walks -- and bring them back to your home to multiply.  Fleas can give your pets more than just itchiness.  Products such as Sentinel also takes care of heartworm and intestinal parasites, e.g. whipworms and roundworms.

This 2008 chart has a good summary of the different flea control products available.  Some recent notable changes to that chart include: Advantage II replacing Advantage; upcoming discontinuation of Promeris; and introduction of generic fipronil products. The wide array of flea control products can be confusing.  Advantage, Frontline Plus, Sentinel/Program and/or Comfortis are often used for our patients --- it all depends on the pet's lifestyle and client's preference. If you are not familiar with the flea control products, please consult your family veterinarian.

General Physical Exam
You do not have to wait for your pets to be sick before taking them in for a physical exam and consultation with your family veterinarian.  A wellness visit, especially if one has not been done within a year (or 6 months for seniors and pets with chronic medical conditions), is a great time to go over preventative health care and general concerns.
This is also the perfect opportunity to discuss any noise and fireworks phobias with your veterinarian.  July 4th is not that far away. Starting early on behavior modification may help us avoid drugs (i.e. tranquilizers) during the festivities.
Vaccinations for boarding requirements are usually best done at least 2 weeks before checking your pets into pet lodges.  If you have travel plans for the summer, discuss vaccine requirements with your veterinarian to ensure a safe boarding experience for your pets.

Spring Blooms and Summer Heat
Warm weather dangers deserve a separate article.  Briefly, though, as we enjoy Spring and get ready for Summer, please remember:

* Heat Risks: Limit dog exercise to cooler times of the day. Do not leave unattended pets in parked cars.
* Gardening Risks: Check with the ASPCA's Animal Poison Control Center to be sure your plants are pet-safe.

Certain diseases are more prevalent in some regions than others, i.e. heartworm and Lyme disease.  Please consult your family veterinarian for specifics in your area.