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How long will my dog live?

Thank you to the Dog Cancer blog for this post

What’s my dog’s prognosis?

Dog Cancer Prognosis

Once you have been told the horrible news that your dog has been diagnosed with cancer, so many thoughts start racing around your head. One of the common questions I get is, “How long will my dog live, Doc?”

Despite all my training and experience as an oncologist, this is so hard to answer.

During my residency training I had to learn lots of numbers and statistics related to a cancer. I’ve discussed some of the common terms in a previous post, The Oncologist’s Perspective on Statistics: Part Three. In that post I discuss median survival times, response rates, metastasis rates. These are important facts to learn about for your dog’s cancer.

How does treatment impact how long your dog will live — and how likely is he to respond to that treatment?

How high is the metastasis rate?

These are very complicated questions for an oncologist to answer. For example, for a low or intermediate grade soft tissue sarcoma (STS), incomplete surgical margins (aka “dirty”), make recurrence (the tumor regrowing in that same area) 10X more likely, and so additional surgery or post-op radiation is recommended if there is a recurrence. BUT … with low or intermediate STS, the metastasis rate (how often that tumor spreads to other areas of the body) is 10-15%, so chemotherapy, which treats the entire body, is not typically recommended. In contrast, let’s look at a high grade STS. For these tumors, the metastasis rate climbs up to 40% — so chemo may be recommended to delay metastasis.

That’s a lot of numbers to juggle, and if you’re a little confused, it’s because it’s confusing. And then there is this:

Numbers Are Just Numbers — Not Your Dog!

I’ve blogged before about how stats are helpful, but don’t predict the way individual cases turn out in that series on statistics, but I bring it up again because my cases this week drove this home, both good and bad.

Case: Osteosarcoma in Blackie’s Wrist

Blackie is a mixed breed dog with osteosarcoma (OSA) of his left metacarpal bone. This is one of the bones in the paw just below the wrist (carpus).

I met Blackie after his front leg amputation, and we reviewed all the stats for OSA.  Osteosarcoma is the most common bone tumor — 85% of dogs with cancer in the bone will be diagnosed with osteosarcoma.

Statistics tell us that three-quarters of these tumors develop in the limbs, with the front legs twice as likely develop this tumor.  The most common locations are towards the knee and away from the elbow – the top of the shoulder, the wrist, and the knee (bottom of femur or top of tibia). The metacarpal location is less common but it is reported.

Here are those numbers, or stats: survival times for OSA cases with amputation and no other treatment is about four to five months, with 90-100% dying by one year, and only 2% still alive at two years. In contrast, the median survival times for OSA cases with amputation and chemotherapy increase to ten to twelve months, with 20-25% of dogs are still alive at two years.

We also discussed that chemotherapy is well tolerated. 80% of dogs that receive chemo have no side effects. About 15-20% have side effects and most are mild and self-limiting — they recover on their own with little intervention – maybe some nausea and/or diarrhea, which is treated at home with meds or antibiotics. 5% or less are severe and may lead to hospitalization.

So back to Blackie. He had 3 doses of chemo, with very little side effects, but when he came in for his 4th treatment, he was not doing well. His legs were swollen and he was reluctant to walk. His right front leg was most significantly swollen, and considering he only has 3 legs, I was very concerned.

My training made me suspicious he had developed lung mets (metastasis) and a very uncommon condition related to that called HO, or hypertrophic osteopathy, which is when new bone develops along the shafts of long bones. HO is most commonly seen with metastatic disease to the lungs, especially OSA. Blackie’s chest X-rays confirmed the metastasis. Plus he had a skin met near his thigh and another met deeper under his skin by his right humerus.

This was only 3 months after his amputation! I took a few deep breaths before I went in the room to tell his dad that the statistics I gave him at the initial appointment had not predicted poor Blackie at all. His tumor has turned out to be way more aggressive than the statistics would have led us to believe. This week, we need to shift gears to make him more comfortable and see if we can slow the progression of the mets with a new therapy.

Case: Daisy Mae’s Splenic Osteosarcoma

The other case I saw this week where the stats were less than helpful was Daisy Mae. You can see her picture on my Dr. Sue Facebook page – she’s pretty darn cute!)

Daisy Mae was diagnosed with OSA of her spleen, called extraskeletal OSA (because it is outside the skeleton). It’s an uncommon tumor in the spleen (hemangiosarcoma and benign hemangiomas are more common). There’s limited data in the literature. In one report, the median survival time with surgery alone was 1 month, and 5 months with surgery plus chemotherapy.

After surgery, we decided to give Daisy Mae conventional IV chemo followed by anti-angiogenic oral chemo. This week she is 18 months out and tumor free at her checkup! I always say I love when I am “wrong”, and my patients outlive the stats.

Bottom Line: Use the Stats, Don’t Live By Them

So should you ignore statistics and published studies? Of course not! They can help you to make treatment decisions.

But you must realize that stats will never predict the individual. I personally hope your pet outlives the stats, but my advice — after all my training and years of clinical experience — is this:

Learn the facts, and then be hopeful.

Live longer, live well,

Dr Sue

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Are You a Dog Lover, or a Dog Guardian?

From the Dog Cancer Blog: Are You a Dog Lover, or a Dog Guardian?

dog-cancer-guardianYour role as a Guardian is the first thing Dr. Demian Dressler, author of The Dog Cancer Survival Guide, talks about in his book, and for good reason.

When we’re facing cancer, we need to be fierce warriors and protectors. This is sometimes a stretch for those of us new to the diagnosis. As Dr. D says:

“Disbelief is a normal reaction; as a fellow dog lover, I truly sympathize. But disbelief doesn’t help your dog. Changing your thoughts from ‘I can’t believe this’ into ‘I can deal with this’ is your first priority.”

Your first step takes you from being a Dog Lover to becoming a Dog Guardian.

We’re all dog lovers, of course. We adore our dogs – and many of us think of them as our family members. But we must, when it comes to cancer, become Guardians first and foremost.

What’s a Guardian?

A Guardian protects. A Guardian stays calm in a crisis and makes choices based on logic and reality, not wishful thinking.

And a Guardian is in charge. You know your dog better than any veterinarian, oncologist, healer, friend, or your dog itself. And so you must take the leadership role in your dog’s care.

Think of it this way: whoever gets paid to take care of your dog is your employee.

You can look at their opinions and expert advice as just that: expert advice.

But ultimately, you are the expert on your own dog, on your relationship to your dog, and on your life.

So: You’re in charge.

You’re the Guardian.

The role of Veterinarians and Oncologists

Your veterinarian employees – or team members, if you prefer — have great expertise that you probably don’t have.

For some guardians, that means those experts make the decisions about cancer treatments. And if that’s what you want to do, that’s fine – as long as you, the Guardian, have decided it is what is right for you.

If it’s not, however, you get to call the shots. Dr. Susan Ettinger, coauthor of The Dog Cancer Survival Guide, is a veterinary oncologist, and she assures us that she does not think of herself as “in charge” of any of her clients.

“The owner is in charge, and I help them with my expertise. My responsibility is to use everything I know and everything I’ve experienced to bring clear, calm, reasoned protocols to the table. I have to take everything into consideration, including budget, preference, tolerance to the therapy, and of course, any other health issues the dog may have. I have to work closely with the primary care vet. I have to explain my thinking and recommendations in detail, and be honest about what I think my suggestions will offer to clients. But ultimately, all decisions are made by the owners.”

Emotional Management

Whether we like it or not (and many of us here at Dog Cancer Vet have not liked making the transition from dog lover to dog guardian) we Guardians are in charge.

And so we have to deal with our emotions, so we can think clearly and make good choices on behalf of our dogs.

When you get your copy of The Dog Cancer Survival Guide, you might be surprised to see how many pages are dedicated right up front to managing emotions. But Dr. Dressler included the exercises and explanations for a good reason: we humans get dumb when we’re emotional.

Make sure you don’t skip over chapters 1, 2, and 3. And definitely read chapter 4, which reminds us of the dog’s super abilities.

Once your emotions are managed, you’ll be able to tackle the details in the rest of the book.

Because it has soooo many resources, we highly recommend The Dog Cancer Survival Guide for anyone dealing with dog cancer. It’s available everywhere books are sold, including Amazon.com, and also, of course, on our store.

Best Wishes & Doggy Kisses from Our Homes to Yours,

Dog Cancer Vet Team

(The Team of Dog Lovers Who Understand What It Means to Have a Dog with Cancer)

About the Author: Dog Cancer Vet Team

There is a whole team of dog lovers behind Dog Cancer Vet and DogCancerBlog.com, and we’re here to help, because we understand what it’s like to deal with dog cancer. We work for Maui Media, the book publisher which includes paperback and digital copies of the best-selling animal health book Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog’s Life Quality and Longevity. This must-read book is available everywhere books are sold in paperback, and digital formats (iPad, Kindle, Nook). It is authored by our veterinarian bloggers Dr. Demian Dressler, and Dr. Susan Ettinger, DVM, ACVIM (Oncology).

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