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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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Chemo Side Effects Help

Mosey and Zola at Substance 3

Mosey has been back on Palladia for a full month. We received really good news yesterday…at our monthly check up with the oncologist we learned that, not only has the tumor not grown, the tumor has shrunk a tiny bit! We compared x-rays from December and then had the radiologist confirm. We are ecstatic as we did not dare to hope that the tumor would cease to grow for a bit…the icing on the cake was the shrinkage. So we are staying with the Palladia as we think this is what is causing the good prognosis. That means we need to deal with the side effects. Mosey suffers from very soft stools a few times a week. We also learned that there are increased levels of protein in his urine which means yet another drug to counter this condition. The following article from The Dog Cancer Blog offers valuable tips and advice for dealing with side effects from Chemotherapy.

Chemo side effects: What should I do?

by DEMIAN DRESSLER, DVM

 

Chemotherapy does have side effects that need to be considered.  About 5% of these will require your pet to be hospitalized, on the average, and there is a 1% chance of fatal reactions overall with chemotherapy.

Although I have not seen any published data, unpublished estimates on overall risks of any side effect are roughly 25-40%.  This means that about one in three dogs will have some kind of adverse effect, but it could be a mild one.

Some of these milder side effects include loss of appetite, vomiting, and diarrhea.  Other adverse reactions include lowering of white cells (leukopenia, which causes immune system suppression), heart damage, lung damage, kidney injury, anemia, blood clotting problems, liver injury, and others.

Of course, this is a summed list for many different drugs.  A given drug will not have all of these.  You should certainly be aware of side effects with all drugs but particularly Doxorubicin (Adriamycin), cyclophoshamide, prednisolone or prednisone, Lomustine, Palladia,  vincristine, L-asparaginase, and more.

You should ask your veterinarian or oncologist about the specific effects of your dog’s treatment, and what to watch for.

For example, keeping track of body weight is quite important during cancer care.  You may need to increase the amount of calories your dog consumes.  When muscle is lost, the amino acids loss in the body hinder the immune system and the lining of the intestine.

Similarly, it is also important to monitor your dog’s rectal temperature.  The reason for this is that a low white blood cell count can often lead to infection in the body.  Most commonly, infection will produce a fever.  Most chemotherapy drugs used in cancer protocols can cause low white blood cell counts.

If your dog is drooling or smacking his or her lips, it could be a sign of nausea or too much acid in the stomach.  Usually this means we need to temporarily rest the stomach, then go on a special diet, offer antacids like cimetidine, give ginger, and consider branched chain amino acid supplements to help restore stomach or intestinal health.

Keeping an eye on the quality of the stool is vital too.  Many chemo drugs will cause diarrhea.  If this occurs, your vet should also temporarily change to a highly digestible food, and consider using something to help with the diarrhea.  Slippery elm, pepto bismol, kaopectate, or other medications and supplements can all help.

The Dog Cancer Survival Guide has more information about what you can do to help with some of the more serious side effects by giving certain supplements.  Please consult with your veterinarian and the Dog Cancer Survival Guide for proper doses for your individual dog.

Best to all,

Dr D

About the Author: Demian Dressler, DVM

Dr. Demian Dressler, DVM is known as the “dog cancer vet” and is author of Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog’s Life Quality and Longevity. Visit his blog and sign up free to get the latest information about canine cancer. Go to http://DogCancerBlog.com.

MoseyLove!

Diane and Mose

2.26.14

mosey and me

How much activity is appropriate for my cancer stricken dog?

I saw this post a few weeks ago and it was perfect timing. Mosey was just recovering from a few really bad days…so bad that we actually had made an appointment to send him over the rainbow bridge. Earlier that week, when he was happy and active, we were at the park playing his favorite game of catch/retrieve with a tennis ball. After the bad days were over, our vet said that perhaps we had overdone the exercise. Imagine my guilt…I thought playing and exercise were good things. The advice and tips below came directly from the Dog Cancer blog:

Enhancing Life Quality for You and Your Dog with Cancer: The Joy of Play

by SUSAN HARPER

play-for-dog-cancerWe love it when our dogs want to play. The repeated nudges and insistent offers of their toys are charming, aren’t they?

Just like us, a dog who doesn’t feel well may go through periods of not wanting to play, or being too tired or not physically capable of regular play. Responding to surgery, chemo or radiation treatments, and just the exhaustion of the emotions and perhaps the tension of vet visits affects them, just as it does us. Even our wonderful senior animals, with or without a cancer diagnosis, may appear to be “past” the playful stage of their lives.

We can get so wrapped up in the drama of their situation that we may over-encourage rest and quiet.

“Don’t use your energy, Ziggy.”

“You’ve got to rest and heal, Oreo.”

It’s so easy to forget how important — and actually healing — play can be for us all.

Using Joy to Heal

In The Dog Cancer Survival Guide Dr. Dressler has included valuable information about dealing with our own emotional state.  Our dogs are so sensitive to our moods, the last thing we want is for them to take on our depression or worry.  We need stress relief and joy; our dogs need stress relief and joy.

Your Dog’s Job Is Joy!

In addition, our dogs want something to do. A job. A purpose. Play fulfills this need beautifully. Here are some suggestions to modify the usual games for our recovering pets, and bring back the joy for us both.

Ball Fetch: My boys and girls spent their youth flying down hills and across fields to get the prized tennis ball.  When my senior could no longer walk I discovered he still loved that ball:  I just had to change the game.

I’d sit in front of his bed and tempt him with the ball.  As the temptation grew he’d follow my magician’s hands. Where’s the ball?  I’d bounce it in front of him, closer, further away, closer again. When he started reaching for it with open jaws and bright eyes I aimed the bounces to land just in front of his nose.  He’d catch it and chew with complete joy, then spit it back at me for another go.

Involving my family in ‘keep away’ teasing added to the fun and within minutes we were laughing and my dog was thoroughly enjoying his ball again. It didn’t matter that he hadn’t chased it.  He’d caught it, and the prize was his!

Puzzle Toys:  The pet industry is full of great choices in puzzle toys these days.  Everything from balls in which you can hide treats like the Ethical Contempo Halo Food and Treat Dispense for Dogs, to Nina Ottoson’s Interactive Dog Toy and the Ethical Pet Seek-a-Treat- Shuffle Bone Dog Puzzle.  You can find these and many variations, and we’ve listed a great selection in the Dog Cancer Shop.

The secret to all of these toys, though, is that you play with your dog.  Our busy lives are such that we’re used to handing over a toy and walking away. How much better is it to play the puzzle with your dog? Add your excitement to hers as she wonders where the treat is?

Find-It Games: ”Find-it” doesn’t have to be a high-speed chase game outside.  Simply playing “which hand” adds a dose of joy to the regular “here’s your treat” action.  Showing the treat, then hiding a few in another room and taking your dog in to look together is easy and fun.  Don’t hesitate to ask for the old bargain, a ‘speak’ for a treat or a ‘paw’ for a treat. They love to be involved.

Tug and Tussle: It doesn’t need to be rough play, but this variation of keep-away gets their juices flowing and tails wagging.

Food Games: My dog loves his food, and we hand-feed because of his throat surgery. A few months ago I found myself in a routine.

1. Make good food.

2. Feed good food to dog.

3. Done.

I was just feeding spoon after spoon like a robot.  It was time for a wake-up call!  No longer did the food simply appear before his mouth. Occasionally I would present it just near enough that he’d reach for it.  Or I’d offer it higher, or lower than before, or circle it round his nose. Where would the food be next?

He became more involved and more interested because I was more involved and interested.  He got back at me, too, when he wouldn’t let go of the spoon. Who says dogs don’t have a sense of humor?

Licking and Chewing: Dogs release tension through their jaw, and we know how much our pets love leisurely licking their paws or a nice treat. Using a Kong, or a kong-like toy is a great way to give them long periods of content.  Fill one with a little bit of healthy peanut butter, honey, or some of your own healthy, pureed food that will stick to the inside.  If your dog cannot hold it for any reason, join in and hold it for him.

You can also make tasty ice-licks. I take the chicken broth from my cooking, fill very small saucers and freeze them.  My dog loves licking the tasty, cold treat.  However, don’t leave them alone with it …  once the ice is gone he may forget that the saucer isn’t edible!  Chicken broth ice cubes are also a great treat, and frozen treats are easy to make and keep.

Laugh:  Finally, I found a wonderful and surprising resource; Laughing Dog.  The website explains how dogs vocalize when they are happy, and gives a brief demo on how to mimic their laugh.  Other resources are available along with the research that went into the development.  I regularly laugh with all my dogs, and you know what? They laugh along with me.

These are just a few suggestions to try. And here’s another: remember to bring variation into the environment too. Move your dog’s bed around with the sunshine, because the vitamin D is so important for them. If your dog is often confined inside, wrap her up and take her out.  Go for short drives. Sit on the floor together while you watch TV. Share a bowl of popcorn. Offer different bedding options. Take a nap on the floor with him.

Don’t just tell him how much you love him, tell him how happy you are that he is your dog.

Now’s the Time:

I’ve spoken to so many people who feel as I do; that this journey has actually brought me closer to my dog in ways I hadn’t considered before.  Enjoy the moments. None of us know what’s ahead, but it’s really not as important as this moment, right now.  So thank you for reading, and I hope this helps.

Now get off your computer and go play with your dog!

Happy tails!

About the Author: Susan Harper

“I’m a member of the Dog Cancer Support Team & a Dog Cancer Survivor! Two of my beloved dogs have had cancer, and with the Dog Cancer Survival Guide, Apocaps, and full spectrum help given with boundless love, Shadow lived 10 times longer than his prognosis, and Keymos triumphed, cancer-free for nearly 4 years, passing over peacefully in our arms at the age of 16. As a Member and Assistant Teacher with the Healing Animals Organization (MHAO) I’m passionate to help dogs and their people get through this journey. Early on I asked the Team how I could help, and here I am.”

Thank you Susan…This really helped.

MoseyLove!

Diane and Mose

2.16.14

mosey and me

Anti Cancer Canine Diet (part 1)

mo, maddie & di 7.2.12When Mose was first diagnosed with cancer I went into shock…grief and shock. My husband and I cried all night and every time I looked at my dog my heart broke. The next day I was angry…and determined to do whatever I could to stave off the progression of the growing tumor. I researched anti cancer treatments and asked Facebook support groups for suggestions. Food and diet were first on the list. So I immediately put Mose on an anti cancer diet.

I found the website dogcancerblog.com which provides a ton of tips, ideas, facts and programs to fight cancer. They sent me a free download with their philosophy on the proper diet for all dogs, but most especially those with cancer. The diet is an excerpt from their book The Dog Cancer Survival Guide. I have implemented many of their suggestions along with learnings from other experts. This post is the first of a series leading to the diet I have implemented for Mose.

We have always fed Mosey what I thought was a healthy diet. A high quality, organic dry food along with “treats” made from wholesome ingredients. He also always got “bites” from our meals. He loved bread dipped in extra virgin olive oil. I am a food blogger and use organic/sustainable, local ingredients in our meals so I was ok with him eating what we ate. Meat, fowl and seafood is grass-fed, organic and grain free and/or wild caught. So I felt pretty comfortable with the diet we fed him all his life. Imagine my dismay when the first thing I read regarding an anti cancer diet was to go grain free.

From the Dog Cancer Diet:

“You’ll see very few grains in the ingredient list. There are also no added sugars. Most grains and sugars are absent because they are not part of a dog’s natural diet. Perhaps more important, most grains can feed cancer. Let me explain. Grains and sugars are packed with starches and simple carbohydrates, otherwise known as simple sugars. Cancer cells love simple sugars. They feast on simple sugars. They grow stronger and faster on a diet of simple sugars. In other words, cancer is a junk food junkie.
Very few dog lovers actually feed their dog pure sugar, but many feed their dog simple carbohydrates without realizing it.
Most forms of corn and wheat break down very easily into simple sugars. If you look at the ingredient list on most commercial dog foods, corn and/or wheat are often first on the list.

Cancer is a junk food junkie. Cancer thrives on a diet full of sugar. Cutting out any foods that are sugary – or that break down easily into simple sugars – is very important. Most forms of corn and wheat break down into simple sugars, and these are often major ingredients in some commercial pet foods and treats.

Even dog lovers who feed their dog homemade food often include carbohydrate-rich potatoes, peas, corn and carrots in their meals. The body breaks these vegetables down very quickly into simple sugars.Because simple sugars feed cancer, I advise you to avoid carbohydrates and sugars in your dog’s diet. Complex carbohydrates, on the other hand, can be a good source of energy for your dog’s body while she fights cancer. Oatmeal and brown rice are both good sources of energy. There is even some evidence that the polysaccharides in their bran are cancer-fighters!”

taste of the wildSo we have eliminated all grains from Mosey’s diet. I shudder to think that I used to make him homemade treats from organic white, wheat and corn flour sweetened with honey. I thought because I used organic ingredients I was doing a good thing. I am trying so hard to stop feeling guilty. The excuse of “I just didn’t know” rings hollow. I now feed him a mix of dry and canned food from a very high quality grain free brand called  Taste of the Wild. Their philosophy is to create meal blends delivering the proper mix of protein, fruits & vegetables and natural antioxidants similar to what canines would eat in the wild. Mosey needs a combination of dry and canned food because an all soft diet causes very loose stools. (his whole life…not a result from the cancer) This mixture is supplemented with poached chicken or fish, steamed cruciferous vegetables like broccoli, cauliflower, kale or swiss chard (I will discuss reasons why in a separate post) and flax-seed oil stirred into a 1/4 cup cottage cheese.

The cottage cheese and flax-seed oil blend comes from another source…The Budwig Diet officially known as the

Dr Johanna Budwig Anti-Tumor Diet

The philosophy for this diet comes from Dr Budwig’s belief that mixing cottage cheese with flaxseed oil (called quark) can stop or reverse cancer.

“One of the keys in the Budwig diet is consuming foods that offer nutrients that help cells absorb oxygen. Dr. Otto Warburg received the Nobel Prize in 1931 for discovering that when cells can no longer absorb oxygen, cancer can develop. Dr. Budwig built on that knowledge and was the first to develop a diet and protocol that restores cells to 
normal functioning.

At the heart of the Budwig diet is organic, cold pressed, liquid flax-seed oil blended with cottage cheese or “quark.” Dr. Budwig discovered that when these two foods are blended together, the sulfurated protein components in the cheese, such as cysteine, bond with the oil, making it more water-soluble and easier to digest and metabolize. 
Consequently, more of the essential fatty acids and electrons in the highly unsaturated flax-seed oil reach the cells and have a healing effect on the cell membrane where carcinogens attach themselves. The membrane of each cell is made up of lipids. Flax seed oil can improve this important outer cell lining that is crucial to cell function and division.”  (from canine cancer.com)

The good news is he absolutely loves this diet. Is it doing any good? I hope and pray that it is. There is so much more to an anti cancer diet. Future posts will discuss raw foods, protein, supplements, properly cooking meat and vegetables, proper weight for pets with cancer, ideas for dogs who won’t eat and holistic options. Please note, I am not a Dr or in any way an expert. I review any changes I want to implement to Mose’s diet with our local vet and our oncologist. In many cases we are learning together. Please discuss any changes you want to make to your dog’s diet with your vet prior to making the changes. Different drugs will react differently with food and supplements so be careful!

MoseyLove!

Diane and Mose

2.09.14

mosey and me

 

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MoseyLove!

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