Before discussing Cosmo's diet, let me say that he is doing well. He turned 11 in November 2019 and as of August had no more bladder stones. His hyperlipidemia seems to be under control and the soft stool problem he had for most of 2018 has also abated through the use of daily doses of Tylosin and Metamucil.

I do think that the Pet Diet Designer software has had a significant positive impact on his health. Without it, I would have been stuck with expensive prescription dog foods of dubious value and which Cosmo often refused to eat. With it, I have been able to adjust his diet easily to his specific needs and still make sure it is nutritionally complete. Cosmo has been on the following diet for about a year and still loves it.

As mentioned in the updates to previous posts regarding Cosmo's diet, the recipe for his homemade food has been evolving over the last couple of years to the following as shown in the Balance Screen of Pet Diet Designer software.

On the left side are shown the percentages of recommended allowances for various essential nutrients. Vitamins are shown on the right side. All of these nutrients, with the exception of vitamin K, are above the RA (recommended allowance), but not excessively so. PDD provides safe upper limits for total fat (597%), linoleic acid (582%), EPA+DHA (omega fatty acids, 2545%)), vitamin A (4221%) and vitamin D (588%). None of these ingredients come close to exceeding these safe upper limits. The "radial gauges" next to the RAs show the calcium to phosphate ratio is balanced as are the amounts of the various fatty acid components of the diet. Since vitamin K is produced by gut bacteria, food sources are less important.

Below is the first page of the Nutrient Report from PDD. Note that this report and the balance screen shown above include all of the food Cosmo gets each day include his "soup" and treats. 

Some of the important items to note in this report are:

1. The ratio of protein/fat/carbohydrate calories: 25%/19%/56% which is typical of a diet for dogs with hyperlipidemia in that the fat calories are below 20%. This has worked well to keep his blood lipids within the normal range. The relatively large amounts of omega fatty acids may also help control this condition. A moderate amount of protein and calcium are consistent with most dietary recommendations for dogs that tend to form calcium oxalate bladder stones.
2. Percentage of fiber: Without Metamucil, our Tucson vet thought the fiber content of this diet was too low. So now he gets about 6.5 g of unflavored Metamucil each day divided between his soup and meals. This seems to have helped his soft stool problems. And the unflavored Metamucil contains an unknown amount of citric acid which contributes to raising the pH of his urine. The manufacturers of Metamucil refused to provide information on the amount of citric acid included. Here is a reference on using Metamucil in the management of large bowel diarrhea.
3. Total moisture: Cosmo's diet, including his "soup", contains 600 ml of water. This is about 53 ml/kg/day which is close to the recommended daily water intake for a dog. He also has ad-lib water available to him during the day but rarely drinks more an ounce or two.
4. Nutrient content: The rest of the nutrient report can be found here. The nutrient amounts listed in this report are not easy to evaluate because the report does not have the RA amount. Take, for example, calcium. The report states that the recipe contains 0.67 g. The 0.67 g is the amount of calcium in the amount this recipe that Cosmo would eat each day which is 740 grams. But how does this amount compare with the RA for calcium? For that analysis one needs to look at another PDD report, the Analysis by Lifestyle report which is shown here. The RA for calcium is 1 gram per 1000 calories according to the NRC standards. Another way to define the RA is in the amount per 1000 grams of the food rather than 1000 calories. Cosmo's recipe contains 780 calories per 1000 grams or 0.78 calories per gram. So that means the RA is 0.78 g per 1000 grams of the food. That is shown in the right column. The left column shows the actual amount of calcium in his diet per 1000 g which is 0.91 grams. Dividing the two values (amount present, 0.91 g divided by amount required, 0.78 g) gives 116% of the RA which is shown in the balance report. So if you look through this report and compare the values in each column you can see if any are less than the RA and if not, how much it exceeds the RA. All of those percents are shown in the balance report above (right and left sides).

Some other changes in the diet:

1. Beef removed: Cosmo may have a food allergy to this meat which is a common food allergy in dogs. As mentioned elsewhere, Cosmo has had off and on diarrhea for several years, but it became a persistent problem in December 2017. His diarrhea seemed worse and more frequent when beef was in his diet. Removing beef from his diet helped but did not solve the stool problem completely.
2. Turkey is the main protein source: Turkey has worked well as a protein source since it is very low in fat. The ground turkey we use has about 1% fat. Using this meat made it fairly easy to reduce the fat calories in his diet to less than 20%.
3. Supplement capsules: I use several nutrient containing capsules used as supplements for humans as a source of minerals needed in his diet. These are available from Amazon and are easier to find than pure powders. I just open the correct number of capsules and pour the contents into the food mix. I use these capsules to augment the recipe with iodine, potassium, magnesium, and copper. Normally, I use the citrate salt since that anion is useful otherwise in his diet as mentioned below.
4. Citrate: One problem that dogs with oxalate stones frequently have is that their urine is quite acidic (e.g., pH5) and this can encourage the crystallization of calcium oxalate. To combat this problem many sources recommend administering 75 mg/kg of potassium citrate twice daily. The citrate is metabolized to carbon dioxide which is excreted in the urine thus raising its pH. If any citrate is excreted intact in the urine, it can compete with oxalate for calcium. The amount of citrate salts (calcium, magnesium, and potassium) used in the diet corresponds to the recommended amount of potassium citrate As mentioned above, Metamucil also contains citric acid, but I don't know how much. So he gets plenty of citrate in his diet.
5. Tylosin administered daily: This is a macrolide antibiotic that is similar to erythromycin but is only used in animals. In low doses (e.g., 5mg/kg) it has been found to be useful in treating some forms of chronic diarrhea. Since Metamucil did not completely relieve Cosmo's problem, his Tucson vet prescribed Tylosin to be given daily, probably for the rest of his life. I mix it with his breakfast food and Cosmo does not seem to mind it. Tylosin does not have a good taste, but mixing it with the Urinary SO may mask the taste. I tried not giving it to him for a month last fall, but his diarrhea returned within 30 days. So I restarted it. A reference on Tylosin can be found here. It works remarkably well.
6. Mixing the recipe: The bulk of the volume of Cosmo's diet is white rice. The grains sometimes stick together which can make uniform mixing of the other ingredients difficult. I have found that if I mix one of the oil ingredients (e.g., the canola oil) with the rice at the start, the rice grains do not stick together and mixing is much easier.
7. Corn flakes for treats: We've been using these for about a year and Cosmo loves this low fat and crunchy treat. Inexpensive too.

Well, that is the current state of Cosmo's diet. I've discussed the other ingredients in previous posts. Don't hesitate to contact me if you have any questions.