Tag Archives: chemotherapy

Should I Take My Dog The Vet Appointment?

mosey-ft collins 1.9.14

Honestly, this question never occurred to me. A vet appointment without the pet? But the following article from the Dog Cancer Blog poses some interesting thoughts? What if you just need advice? What if your dog is too sick to travel? Our oncologist is a three hour drive from home so Mosey is in the car for six hours on visit days. Do the benefits outweigh the inconvenience? Read below for the reasons your vet really needs to examine your pet in person. And, as always, thank you to the folks at Dog Cancer Blog for their very valuable information:

Don’t Forget Your Dog at the Veterinarian

When booking a new consultation with me, pet Guardians often ask if it is necessary to bring their dog to the appointment. From their point of view, they are often concerned about the stress of the visit on their pet, or maybe the travel itself.

But from my point of view, a consultation without the pet is like a visit to the pediatrician without your toddler. So, yes, you should bring your dog!

In some ways I am happy that someone wants to meet me and listen to the overview of their pet’s cancer and ask questions. Educating yourself about your pet’s cancer is important. But the visit is so much more than hearing about an overview of the how the cancer presents, behaves, treatment options, and prognosis. I also review your pet’s medical record; including previous history, previous tests and the cancer cytology or biopsy report.

But a critical part of the consult is my personal evaluation of your dog.

vet-with-dogFor example, if a mast cell tumor has already been removed, but the surgical margins are narrow or incomplete, I can only discover if a second surgery is possible with a physical exam. I need to see the previous scar on your dog. I may lift the scar, and see if we can remove more tissue.  I may even show the dog to our surgeon so see what she thinks and decide if surgery is even an option. If she says no, I just saved you the time and cost of a consult with the boarded surgeon.

Or, I may feel a small mass already coming back at a scar. If the tumor is back, it changes the recommendations. I only can determine that if I examine and feel the dog in person.

Measuring Is Key

I’ve also had cases where the biopsy report lists a soft tissue sarcoma (STS) as completely removed, but the vet notes the mass was 2 cm and the scar is 3 cm. Well, we need 2 to 3 centimeter margins AROUND the tumor … so a 2 cm STS should have an 8 cm scar. I will literally measure scars to make sure that they are actually as complete as reported on lab reports. If not, it’s unlikely the margins are clean and recurrence may be likely. And if that’s true, we need to know, so we can make the best plan.

I may also need follow up tests, like an ultrasound to monitor progression of an abdominal mass or to get a baseline.

Finding Other Tumors

Just last week, I saw a dog with a mass in the bladder, most likely a tumor called transitional cell carcinoma (TCC), based on the ultrasound at the primary vet. Penelope had the classic signs of TCC – straining to urinate and blood in the urine. The vet said the mass was not in the trigone area, which is great, because then we could remove the tumor with surgery before starting chemo. (Many tumors are in the trigone where all the nerves and the urinary tubes that connect from the kidneys and out the urethra. This area is usually inoperable.)

From the ultrasound at the primary vet, it looked like Penelope was a surgery candidate.

To be safe, I recommended a repeat ultrasound. This time the boarded internist not only saw the mass in the non-trigone area but also a larger mass in the urethra, the tube through which urine flows from the bladder to the outside.

Unfortunately, that discovery meant surgery was definitely not an option. With this new info, I changed my recommendations and we discussed medical management like NSAIDs, chemotherapy, and even a stent to keep her peeing if she gets blocked.

So Penelope’s prognosis and treatment options all changed based on the exam and tests. If she hadn’t been physically present, we might have gone ahead with a surgery that would be unnecessary and not even treat the larger mass.

Finding Metastasis

I may also discover something new on the exam, like an enlarged lymph node. If we aspirate that lymph node and find the cancer has metastasized (spread), it may change the prognosis and recommended diagnostics and treatments. If a cancer has spread to the lymph node, we may need to have it removed, radiated, or it may be the reason we add chemo.

Finding Other Problems

Without the patient, we could also miss other problems, like a fever, an infection, a heart murmur, or a lameness so severe that it changes recommendations.

Just yesterday, I had an appointment with Lady, a 11-year-old Russian Blue Terrier. She came to discuss CyberKnife radiation for her recently discovered aggressive bone lesion in her humerus (shoulder), consistent with osteosarcoma.

CyberKnife is an alternative to amputation, and we typically start with a CT scan of the leg to make sure the bone is structurally strong enough to be a good candidate for it. If the tumor has already destroyed too much bone, it puts the dog at increased risk for fracture even if we kill the tumor cells with high doses of radiation.

But looking at Lady (not her X-rays), I saw that she could barely get up and walk. The family was lifting the 100 lb dog to get up and go outside to relieve herself.

I was worried that her limping and disability wasn’t just because of tumor pain. It could also be neuromuscular disease, orthopedic issues, or worse, bone metastasis. I wasn’t going to do a CT scan (very expensive) and recommend CyberKnife radiation if there was some other major underlying medical issue that prevented her from walking. We had to figure this out, first.

So, during that appointment, I consulted with my surgeon, who looked at Lady and isolated the severe pain to her knees and hips, not just the shoulder with the tumor. X-rays confirmed severe degenerative joint disease and arthritis. Unless that can be helped, removing the tumor with radiation would not help her to walk. Even amputation was out, because a dog with this severe pain wouldn’t be able to recover easily.

This information was really helpful, because now we knew a few things:

  1. We can add pain meds, specifically non-steroidal anti-inflammatory drugs (NSAIDs) to her treatment to help bring her some relief.
  2. Her underlying arthritis is too severe for an amputation.
  3. By treating her arthritis we can improve her comfort and mobility.

Once she is feeling better, THEN we can do a CT scan to see if she is a CyberKnife candidate. She may still be!

Bottom Line: Bring Your Dog

So … will I occasionally do a consult without the dog? Yes I do make exceptions, but it really limits what I can do for the pet and the family if the pet is not there to be evaluated.

Live longer, live well,

Dr. Sue

About the Author: Susan Ettinger, DVM, Dip. ACVIM (Oncology)

Susan Ettinger, DVM. Dip. ACVIM (Oncology) is a veterinarian oncologist at Animal Specialty Center in New York and the co-author of Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog’s Life Quality and Longevity. She blogs about dog cancer at http://DogCancerBlog.com.

MoseyLove!

Diane and Mose

4.6.14

mosey and me

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Lymphoma

mosey marist college habitat build 3.20.14 instagram

Mosey at the Habitat for Humanity Taos College Spring Break build

One of the objectives of this blog is to help educate and inform pet parents fighting cancer in their furbabies. Sadly, Mosey’s cancer is very rare and he is not a candidate for surgery or radiation (except a palliative version). I reached out to the canine cancer community to see if anyone would be willing to share their stories of fighting more common forms of cancer. I was very happy to receive the following facebook post:

Hi Diane! I’m actually a veterinarian and run a FB page for my pup that is going through chemo for lymphoma. That way there is info from both the doc and mommy point of view. Erin Houser Kelly
I confirmed that she was giving me permission to share her story and am so pleased to say she agreed. Her dog, Wrigley, is in remission from lymphoma. Here is their story from both Erin’s and Wrigley’s point of view:

On Monday, October 14th Wrigley was diagnosed with lymphoma. This is his page– dedicated to him and what is important to him (hint: it includes food, his 4 legged sister and the 2 little girls that share his residence– as well as his adopted parents

A humans guide to canine chemo: My lymphoma journey, by Wrigley
wrigley

Wrigley!

Welcome to my site old and new friends… Whether you have met me in person or are just an animal lover in general, I have deemed myself an ambassador for canine chemo. Why? Because it’s something a lot of pet owners ask themselves about– “would I put my own pet through it”? I hope to take away some of the scary thoughts about the process. By no means am I an expert– I mean, I’m just a dog (although I am pretty smart) and I’m not going to load this down with a lot of medical jargon. This is just my side of the story and I hope to be able to help some pet-parents along the way.Lets face it– cancer is a scary word for anyone. And chemo conjures up visions of hair loss and violent sickness– which is all very common in human treatments. However, in the animal world chemo doesn’t have the same side effects. The goal is to keep me happy and comfortable and my mom keeps using the term “quality of life.”

The sad reality is that I was diagnosed with a terminal cancer (Stage IIIa, B-cell lymphoma) and without treatment my life expectancy would have been 4-6 weeks. There is a good chance I would be gone by now or nearing the end of my life if my parents chose not to go forward with chemotherapy. The day I was diagnosed I didn’t look or act sick, mom just noticed my lymph nodes were a little big. However, it’s a rapidly progressive disease that would have caused me to go downhill very quickly. And my family wasn’t ready to say good-bye just yet.

A few days later my mom had me seen by a veterinarian oncologist (Dr. Back actually graduated vet school with my mom back in 2007– but she went back to become a specialist– she’s obviously SUPER smart!). They started chemotherapy that day and a week later I was determined to already be in remission. The Dr is doing something called the “CHOP protocol”which is an acronym for the different types of meds they use to treat me. It’s a 6 month protocol and after that point I am just monitored for return. Unfortunately, it’s not a matter of IF it comes back, it’s a matter of WHEN. However, with chemo my life expectancy went from 6 weeks to up to 12-18 months (maybe 2 depending on how well my body does). That’s a big difference– especially when you calculate that into “dog years.”

The biggest question people ask my mom is “how sick does the chemo make him?” And she can easily say that there have been very, very few side effects. The biggest problem I had was with a steroid that was used at the beginning of treatment that makes me drink a lot of water and so I have to urinate a lot too– so started having accidents in the house. Plus the steroid makes me very hungry so I’m not above breaking into cabinets, purses and the trash can to steal food. The good news is that the steroid dose has tapered and I’m done with it next week– and I’m no longer having accidents in the house. Overall, no one can tell I’m sick… The chemo hasn’t made me throw up and I still have all my hair– I will have about a 6 hour window once a week where I’m sleepy but that’s the extent of the effects so far. Overall, my quality of life is amazing– I’m still romping around the house with my sister, love to take walks and lay on my back in the grass under the sun.

If this blog can help someone else along the way then I think I’ve done a good job. Lymphoma is a tough diagnosis (and my mom cried for 2 days straight when she found out)– but chemotherapy is giving me a chance to spend an extra year (hopefully more) with my family.

If you feel this note has helped you, or may be beneficial to friends/family that may have a pet in this position, please feel free to share this note or my page. And I’m always open to questions. Both my parents work full time so I have plenty of time to blog during the day while they are gone 😉

Yours in Remission,

Wrigley

I so appreciate hearing this success story…remission is something we all hope and pray for. If your pet has been diagnosed with Lymphoma and you have specific questions for Erin or Wrigley please ask them in the comments section of this post. I will continue to provide updates as to Wrigley’s prognosis.

MoseyLove!

Diane and Mose

3.29.14

mosey and me

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