This is interesting, because in human medicine it is widespread.

It would seem that fear of life quality loss, expense, side effects, and lack of cure in true malignancy are the main deterrents.

However, there are some reasons why some do opt for chemo in treating their four legged family members.

Some cancers actually respond pretty well.  By response, I mean that the signs of the cancers go away and the dog, for all intents, is normal again.

Although this is temporary, in some cases the remission can be very long, even years in the best cases. Granted, these long remissions usually arise when dog guardians combine the chemo with other steps in full spectrum care.

One of the cancers that really responds well is lymphosarcoma.  Over 80% of lympho cases will get what is called a first remission, meaning the cancer signs and symptoms disappears for a period before needing a second round.

Many dogs handle the chemo well.  The number of dogs that are able to deal with the toxic effects of these drugs does indeed go up if certain steps are taken.  These are discussed at length in The Dog Cancer Survival Guide.

The best way to cure a true malignancy is to remove it with surgery.  However, not all cancers can be removed.

We call these cancers “non-resectable”.  A non-resectable cancer takes several forms. Most of these occur in masses (tumors) that require injuring  vital structures to be removed successfully.

Other times, a cancer cannot be removed because it is found in the circulation (cancer cells flowing around the body).  Lymphosarcoma or leukemias occur here.  Also, cancers that have spread into the circulation from a growth fit in this class.

There are some tumors that spread into the surrounding areas in the neighborhood of the tumor. One cannot see the spread with the naked eye. However, when the surgery takes place, cancer cells are left in the surrounding neighborhood.  Many of these cannot be removed and chemotherapy is one option.

Cancers that spread into the surrounding neighborhood of a growth are called “locally invasive“.  Some include fibrosarcomas, squamous cell carcinomas, some hemangiosarcomas, and more.

Finally, if a tumor arises in one location and then shows up on another location (metastasis), chemotherapy is often considered.

The most important thing to remember is to arm yourself with the facts.  Find out the success rates of the chemo, how many respond, for how long, what is involved, the cost, rough incidences of side effects, and what you can do to decrease toxicities.

All my best,

Dr D

In dogs with true malignant cancer, we all agree life quality is the most important factor to consider.

How can we tell? Ascertaining life quality is done by weighing the positive against the negatives.

Some positives include enjoyment of food, drink, athletic outlets, normal bodily functions, mental stimulation, social interaction with people or other animals, and a good mental state.

Negatives arise when these are lost.  When the positives start to be outweighed by the negatives, the life quality scale tips to the negative.

If one looks at the positives, they can be boosted to increase life quality. There are many ways to boost these in dogs that are normal.

However, in dogs with cancer, in particular those who can’t get around as well with a fading appetite and lethargy,  intentional life quality boosting can be tough.

An extensive look at intentional life quality boosting can be found in The Dog Cancer Survival Guide.

One way to do this is by self esteem building. Life enjoyment goes up with self esteem increases.  When you feel good about accomplishments, your life quality goes up.

When we were kids, we felt better by overcoming manageable challenges. Learning to walk, tying your shoes, and riding a bike are manageable challenges. They are stimulating and fun and give a sense of satisfaction.

Dogs need the similar things to feel good. The reward they get is praise and attention.

Praise and attention are central! A celebration occurs after the task is completed!

Some examples of manageable challenges are:

• going out on a walk in a new area
• going up stairs or an incline
• responding to a cue by rolling over for a long belly rub
• learning to shake

Remember, the life quality boost comes with the celebration received upon making progress towards the goal. We are not going to successful completion as our goal in this.

Coming up with new ways to increase stimulation and praise can really help restore vitality and a better life.

All my best,

Dr D

Osteosarcoma occurs in both dogs and humans, but is much more common in dogs. It is the number one bone cancer in the canine.

A recent study found that eight widespread brands of dog food contained high levels of fluoride.

It was found that there was a link between fluoride in drinking water and bone cancer in boys.  The areas with high fluoridation in the drinking water had higher levels of osteosarcoma. Here is the link.

In 2006, there was an interesting scandal surrounding the study involving suppression of this data and a dissenting researcher at Harvard.

Osteosarcoma does not have a single cause. There is no doubt there is a genetic basis due to the breed predilection (giant breeds), but genes are not the whole story.

This fluoride issue is discussed in The Dog Cancer Survival Guide in the osteosarcoma section on causes not addressed by conventional veterinary dogma.

The fluoride content found in these eight brands were found to be from 1.6 to 2.5 times higher, on a body weight basis, than the EPA’s legal maximum for fluoride intake in water for people.

There is a great article with some nice graphics to review by clicking here.

So what do we do with this information?  Well, owners of dogs afflicted with osteosarcoma or at risk for it (large or giant breeds, especially neutered or spayed) may want to limit the fluoride intake of their canine friends.

It is suspected that the high fluoride content of the foods was found in the added bone meal. Take home message?

Check your dog food ingredients. Avoid bone meal in these dogs and consider unfluoridated water sources. Calcium carbonate is an alternate calcium source for home made diet recipes. Specific recipes are in The Dog Cancer Survial Guide.

All my best,

Dr. D

Like any weighty decision, sometimes the emotions involved can paralyze our ability to choose.

During these times it is so important to gain some clarity by seeking support in counselors, support groups, spiritual leaders, old friends and the like.

For more on gaining some clarity during these difficult times, see The Dog Cancer Coping Guide.

If a decision is made to try to make your dear friend comfortable during the departure stage (as opposed to letting him or her go), I would like to go over a few items.

a. Diet: at this point we forget about the standard dog cancer diets. Most dogs in this state don’t want to eat much and appetite stimulants (B complex, prednisolone, anabolic steroids, cyproheptadine) don’t do much to help. Go ahead and tempt your dog with the good (tasty) stuff.

b. Pain control: essential. Try Tramadol, amantadine, NSAIDs like Metacam or Deramaxx, gabapentin, fentanyl patch, and long-acting morphine.  Combinations must be used, and these drugs require veterinary supervision.

c. Hydration: you want to give your dog about 1 ounce per pound in a 24 hour period. So a 12 lb dog gets 12 oz over 24 hours. Try flavoring with a little low sodium broth or bullion. Have your vet teach you how to give subcutaneous fluids if you can’t hand-hydrate.

d. Prevent bed-sores: decubital ulcers (bed sores) happen in large dogs who don’t move much laying on hard surfaces. Roll your dog over, by rotating the legs under the belly/chest to flip, at least every 8-12 hours. Pad the surface well.

e. Prevent urine scald and fecal soiling: sponge bath at least two times daily if your dog cannot make it outside.

f.  Improve life quality: bring your dog outside, go for a drive, massage, brush, stroke, talk to, sing to, tell your dog his or her life story from start to finish, and play with toys if possible.  Apologize for anything and everything you could have done better. Touch therapies and acupuncture are options too.

This is a very tough time. However, if you are able to take the time to do things the right way, your dog’s goodbye can seem more like a farewell for now, my friend.

All my best,

Dr. D

BPA is Bishenol A.  It is found in many different types of plastic. The most common is the clear, hard plastic called polycarbonate.

BPA is also found in plastic food and beverage containers, “carbonless” receipt paper, canned food lining, white dental fillings and more.

It is also likely found in some of the plastics in the dish that your dog may be eating and drinking out of. It may be in the lining of the canned food you are feeding your dog.

It has been shown that BPA leaks out of the plastic, into the food or water over time.  If your dog is chewing plastic objects, my guess is this accelerates the process.  Old plastic is the worst.

The story with BPA, at least as far as we are concerned, is that the chemical may increase the proliferation of some mammary cancers and hemangiosarcoma.

How is this possible?

BPA has been shown to have effects in the body like the natural hormone estrogen.
If excessive estrogen effects are seen in the body, it stimulates certain cells to divide.

The cells that are stimulated to divide have little receptors in the outside of the cell.  A receptor is like a lock for a key.  Here, the key is estrogen.

When an estrogen molecule floats along, it can attach to the estrogen receptor. This binding tells those cells that have the estrogen key in the  receptor lock to start multiplying.

Some mammary tumors and hemangiosarcomas have been shown to have estrogen receptors.

Therefore, if BPA can attach to the receptor just like estrogen can, it may stimulate the growth of these cancers.

The pundit gallery will argue that the levels of BPA allowed by the Environmental Protection Agency and the FDA are safe.

Sadly, there are now many, many publications by independent scientists showing lower levels than those allowed by the EPA and FDA have estrogenic effects.

Here is just one example for you to check out for yourself.

Legislators hear testimony from associations such as the Polycarbonate Business Unit of the American Plastics Council along with those of independent scientists.

Since our elected officials have no way of judging the science on either side, legislation is stymied.

For the time being, I feel it is time to stop using plastic bowls, dishes and toys for our dogs, especially those afflicted with hemangiosarcoma or mammary tumors.

Canned food is in question as well. If you are not feeding your dog a canned cancer diet like ND or others, I would consider switching to home-made stews.  There are recipes and tips in The Dog Cancer Survival Guide.

The plastics recognized as being prime BPA-leakers have the numbers 03 and 07 in the small triangle stamp on the bottom.

Best to all,

Dr D

Most of the readers of this blog are searching for information.

Once a true malignancy has developed, the realities can feel utterly unacceptable.

This leads to information gathering.  Whenever we are faced with situations that appear unsolvable, many will search for solutions.  And here you are.

The problem is that there is too much data out there, and you might lack a road map.

This was the motivation behind the Dog Cancer Survival Guide: sift through all the data, pick only the best, and provide a framework yielding improved outcomes.

I thought it would be useful to provide you with an outline here that you can start filling in with your data, if you do not have the Guide.

Fist: put on your oxygen mask.  This means that you need to deal with whatever emotions come up for you so you can think clearly to help your dog.  The Dog Cancer Coping Guide is one option. Others include counselors, support groups, old friends and so on.

Next, if appropriate, perform a Life Quality Analysis.  This involves widening back, considering how much risk and side effects you are willing to risk given your dog’s expected lifespan. Then the expected positives are weighed against the negatives.

A part of Life Quality Analysis is to define what your personal ideas are about treatment and take a stand. At this point it is critical to have the courage to be your dog’s primary health care advocate.

Now choose what you will utilize in conventional veterinary care for your dog. Options are surgery, chemotherapy, and radiation.  Clinical trials may be available in your area.

Consider also more rarely used but promising options like IV Vitamin C and neoplasine, which require your vet’s involvement.

Discuss with your vet and oncologist the pros and cons, side effects and expected outcomes.  Take notes.

After noting side effects, consider what you will use to lessen them.  Many are discussed in the Guide and in this blog.

Minimize pain, nausea, vomiting, diarrhea, bone marrow suppression, heart damage, kidney injury, liver harm and other toxicities related to treatments.

Get your dog on a cancer diet.  One blanket recommendation is carbohydrate restriction. Sugars and starches turned into sugars are cancer food, so avoid if possible. There are recipes in the Guide as well.

Do what you can to stimulate your dog’s immune system. I discussed many approaches like cancer vaccines, medicinal mushrooms, astralagus, Beres Drops, Avemar, AHCC and others. Many are in this blog.

Rotation between supplements helps get an average. Some may help and some may not, but if you rotate you will likely get some wins.

Choose among the supplements that have solid in vivo (in living bodies) evidence for shrinking tumors, slowing growth, and decreasing metastasis.

Some of these include Artemisinin, curcumin, luteolin, EGCG, flax lignans, melatonin, and more.  Rotation details are in the Guide.

Do what you can to maximize life quality and happiness by boosting your dog’s self esteem, social activity, stimulation, exercise if possible, and minimizing stress.

This is a basic framework you can use like an outline.   I use it to organize my thoughts when starting on a treatment plan for Full Spectrum Cancer care.

Best to all,

Dr D

In Edinburgh, a 9 year old Rottweiler was found abandoned by it’s owner.  He was quite ill, very thin, painful and weak.  This Rott had been tied with a leash and left.

As if this were not enough, the dog had end-stage cancer.  The cancer was found in a lung, which had collapsed. His paws were also riddled with tumors.

He was taken to a vet, who proclaimed it was the worst case of animal neglect he had seen.

To make matters even more difficult to comprehend, no-cost veterinary care is available in the United Kingdom.  There is a charitable organization, the PDSA, that sees tens of thousands of sick animals in each of its several locations.

These are hospitals are quite nice, as the PDSA is one of the most well-funded charities in the UK.

Then again, perhaps the owner of the dog would not have qualified for PDSA care, due to a healthy income. On the leash was the word “Harrah’s”.  Harrah’s is a casino.

This particular constellation of events is mind-numbing when seen from a compassionate viewpoint.

My first reaction was to pray that the person who did this suffers an immediate and painful death.

My second reaction was to pray that he or she gets cancer and then is abandoned to starve and dehydrate in the street.

Some time passed.  I recalled Martin Luther King, Jr. saying, “An eye for an eye leaves everyone blind.”  I cooled down.

I started thinking about the way we treat animals after I could  think again.

How could this utterly incomprehensible event have ever happened? None of us would ever do something like that. Ever.

Right?

I wondered….would some practices I accept as normal elicit the rage in another like this dog’s treatment did in me?

One of my regular readers is Anu, one of my clients. Hello Anu. Anu is from India.

Most of us have heard of the cows that roam the streets in India, and the belief that the cow is sacred. Pretty different, pretty weird.

Here in the US, many of us happily recall, “Beef…it is what’s for dinner.”  Yes, of course beef cattle are for food.

However, citizens of an entire country would be horrified to consume an animal that they consider sacred. They would never, ever eat a cow.  It would be horrific.

But many of us have no problem with it.

Perhaps the “guardian” of that poor Rottweiler, the person who I still feel should be shot for walking away, also had no problem with it.

Maybe that’s how that incomprehensible, gut-wrenching event in Scotland transpired.

Let us, and I include myself in this, be careful in our anger.

Sending each of you my best,

Dr D

This fear is a rational one.

The reason that the bad effects of chemotherapy are seen is a bit complex, but stems from what I believe are two main areas.

First, the usual strategy in using chemotherapy drugs has been to give the MTD, or the Maximum Tolerated Dose.  This translates into the idea that you give as much drug as you can up to, but not reaching, the point where it could cause heavy-duty side effects.

So when we give MTD’s, due to the fact that not all patients are the same, a fraction of them will experience the serious and sometimes even life-threatening consequences. These are the sensitive ones.

We should screen for the sensitivity.  We can take advantage of the test for the MDR mutation to assess for chemo sensitivity (see previous post and my e-book), before the chemo is started.

The second reason contributing to chemotherapy toxicity is because very little effort has been given, in particular in veterinary medicine, to actively decreasing side effects during chemo.

In human medicine there have been some pharmaceutical advances, but very few veterinary oncologists are actively promoting things like coenzyme Q, carnitine, cordyceps, IP3, glutamine, or ginger during chemo.

I have am trying to make these more mainstream with this blog and The Dog Cancer Survival Guide, hoping that more veterinarians will promote decreasing chemotherapy toxicity.

Toxicity management is so important because we could use higher doses of our drugs (higher MTD’s) and improve our outcomes with less side effects.

In response to this need, a new facet has emerged from conventional medicine called metronomic chemotherapy.

Metronomic chemotherapy involves a very frequent, but low, dose of chemotherapy, especially with the use of the drug cyclophosphamide.

Metronomic chemo is different from traditional MTD chemo.  In traditional chemo we use high doses for short periods, and the time off between treatments lets the body rebound.

In metronomic chemo, the lower doses lessen the toxicity risks.

The guess behind the way metronomic chemo works is that it may prevent the new blood vessel cells that feed the tumor from working properly.  The cells lining the blood vessels may be dying off.

Metronomic chemo is being looked at for use in children, and the veterinary community has recently started getting interested too.

Does it work? It is really too early to say, as even the human trial data is sparse. But there is some promise and it could be worth a try.

I think the best candidates would be for those dogs with low grade (but real), or slowly growing cancers that are difficult to cure with surgery.

If the cancers are growing too rapidly, the slower effects of metronomic chemo would not be practical.

This is another option that should be considered for dogs.

Best to all,

Dr Dressler

There are a number of different items that can be used.  Some have interactions with other meds, or possibly side effects that would not be desirable. I told her about one that you might want to know about too.

I would like to share with y0u one of the old time options that can help significantly-

slippery elm.

This is one of those that I have learned from experience, as opposed to scientific literature.  There is very little “scientific” literature on safety and efficacy of slippery elm used for dogs with cancer (Pubmed does discuss its use in cats with digestive issues, however).

So, for those who are interested in knowledge passed down from empirical evidence and the old days, read on.  Since data can be obtained from various sources in full-spectrum veterinary care, I am offering this to you here.

Slippery elm is actually a tree, and the active ingredient is harvested from the inner surface of the bark.

Slippery elm contains mucilage, some fiber, a little glucose, some tannins, and may contain antioxidants.  The one we are most interested in is mucilage.

Mucilage is a substance that adheres to irritated spots on the lining of the stomach or the intestine.  It binds together, forming a coat or a patch.

In clinical medicine, we use a drugs like Pepto Bismol or Carafate for similar purposes.

The coat or patch has the effect of sealing the defect in the stomach or intestinal lining, which lessens the fluid accumulation within the stool. It also promotes more rapid healing of these structures.

Herbologists will also use slippery elm for cough due to an irritated windpipe ( like tracheobronchitis), or for conditions causing irritation of the bladder lining (for example, urinary infections).

Since both diarrhea as well as hemorrhagic cystitis (with bladder lining irritation)  are conditions frequently seen in patients receiving chemotherapy, slippery elm is a nice option.

It is recognized as very safe by those who use the herb frequently.

It may reduce the absorption of certain drugs taken by mouth, so it should not be given within 6 hours of critical oral medications.

I do not recommend its use for more than about 3-5 days at a time in dog cancer patients due to the glucose content (sugar is bad for cancer patients). Similarly, depending on the chemo drug being used, there may be a (slight) theoretical concern of lowered chemo efficacy due to the possible antioxidants in slipppery elm.

So don’t use in on an ongoing basis, but it usually is fine for short term use as needed, in my opinion.

The dose for dogs is about 1 teaspoon full per 60 lbs body weight, given 1 to 2 times daily, for 3-5 days in cancer patients.

This dose can be mixed in food, or dissolved in warm water with some low sodium broth added for flavor.  This liquid can be administered with a turkey baster or using a plastic oral dosing syringe from your veterinarian.

Discuss the use of slippery elm with your veterinarian before using in your dog.

All my best

Dr D

We seem to have forgotten about relative risks.

A relative risk is simply the risk of something in comparison to something else.  Take the risk of cancer versus the risk of heartworm in a dog on heartworm preventative.

Now, I am a practicing veterinarian and I do annual heartworm tests on my patients.  Granted, I live in an area that has one of the highest heartworm rates in the country. However, guess how many heartworm positive dogs I diagnose in patients receiving their heartworm preventative?

Almost zero. I think I had one case in my career, maybe two.  I have over 5000 canine patients registered at my hospital. That’s pretty low odds.

Okay, let’s switch it up.  How about how many patients do I see with cancer?  A lot.  Cancer is the number one pathological killer of dogs today, with mortality higher than trauma, diabetes, kidney disease and any other disease state.

Depending on who you believe, somewhere between one in four to one in six dogs will die of cancer.

Clearly there is something wrong with this picture.  Why is the public accepting of annual heartworm tests and unaware of cancer as a threat?  Why are dog lovers not demanding that every lump and bump be checked?

What about blood work,  urinalysis, X-ray and ultrasound for the internal cancers?

One argument is cost.  A heartworm test is $40-60 dollars.  The screens I mentioned for internal cancers are crude and costly. But, they are what we have.

So, how would one test for internal cancer, in a way that make sense?  Well, it is tough to test for each internal cancer, since there are many types.

There is a specific cancer test for lymphosarcoma made by Pet-Screen, which is in England.  Your vet can contact them and arrange for sample processing, although it is not cheap. So that’s one, and they are working on a hemangiosarcoma test next.

And the fact is that our cure rate for truly malignant cancers is quite low these days, so it would seem that we need a slightly different approach. When we diagnose cancer currently, we are late in the game.

Carcinogens, family traits, free radical excess, viruses, and more alter healthy genes, turning them into cancer-causing genes.

Testing for these altered genes that set up cancer is going to be quite complex and costly.  There are many of them and they are not clarified yet.  Sure, we are aware of gene sites of mutations leading to cancers like ras, erk, trk, myc, the b proteins, and the huge family of the protein kinases, among others.

The problem is that the number of these genes quite high, so I believe it makes less sense to test for the mutations leading to cancer.

There are other factors, aside from damaged genes, that are responsible for cancer development.  These include metabolic abnormalities, many involving sugar.

In addition to abnormal metabolism setting the stage, we have factors creating immune system suppression.

And a major one, I believe perhaps the biggy, is inflammation in the body, and the chemical signals that are tied to it.

Ongoing chemical signals in inflammation increase free radicals (which promote mutations), suppress the immune system, and are tied to metabolism problems that promote cancer growth.

One of the central genes involved in inflammation is called NF-kB.

If this gene is being turned on over abnormally long periods, you have lots of inflammation. This is not healthy at all.

Why not test for excessive, prolonged NF-kb signaling?  This could help screen for increased risks for cancer development.  Many cancers make a lot of NF-kb. There are other health risks seen when this gene is turned on excessively that a dog’s guardian would want to know about.

On top of that, we could be proactive much earlier, perhaps even before detectable cancer development.  One could be more vigilant, begin antioxidants, cut the carbs, begin anti inflammatory supplements, eliminate body fat, and then reassess.

We could also start our cancer hunt earlier and more aggressively in these dogs.

Yes, this is just one idea and requires a lot of work. Yet it is a candidate for a cost-effective way to take action when it really counts,  possibly before cancer starts. You heard it here first, folks.

Take home message?

Focus on catching cancer early. For the time being you will have to settle for blood testing, X-ray, ultrasound, urine testing, and checking every growth on your dog. And don’t forget the Pet Screen lymphosarcoma test.

Best,

Dr D