Many have concerns their dog may be in pain. And rightfully so, since pain is a definite negative. Pain control is a massive topic all by itself, and it is by no means strait forward.
There are different kinds of pain. Sometimes dull, throbbing pain happens in cancers like osteosarcoma (bone cancer). Severe pain in the abdomen can occur with bleeding hemangiosarcomas (spleen tumors). Mast cell tumors likely produce burning pain in the skin or in other locations. Pressure-associated pain can happen with nasal tumors like fibrosarcomas. Bladder tumors like transitional cell carcinomas cause burning and irritation leading to urgency to urinate.
There are different kinds of pain, and they respond to different treatments. We have tablets, capsules, liquids, injections, infusions, transdermal patches, cold, heat, acupuncture, physical therapy, mental techniques, and more.
The best approaches to pain management are always multimodal, which means we attack the problem from different angles to achieve a better result. This is true for the drugs your veterinarian prescribes too. Many times lower doses of multiple drugs are a lot better than higher doses of single drugs.
The perception of pain not only involves the tumor or cancer itself, but also what the brain and spinal cord do with those signals. In some cases, pain can actually be amplified above and beyond what is expected by what is happening in the central nervous system (previous pain, anxiety, fear, depression, and others). These areas can be focused on too as part of a total pain control plan.
By combining approaches from different angles, you get a better result. Less pain, better life quality! Ask you vet about combining different approaches.
Let’s look at more life quality topics in the next post.
Best to all,
Dr Dressler
August 20th, 2008 at 1:32 pm
As you describe the different types of pains associated with different types of cancers - HOW can YOU know if it is “burning” or “throbbing” or “pressure associated” or “sharp”, etc. when an animal can’t talk? These are very specific pains but an animal cannot tell you if it is sharp or burning, etc. As a human with a severe disability doctors and nurses have always asked me to rate and describe my pain and it is difficult enough for me let alone an animal that cannot explain pain. I would have to say that the only REAL way to know if there is any pain at all (let alone the type) is by any different behaviors in the animal as you go on to describe. But I am still curious as to your second paragraph.
August 20th, 2008 at 5:16 pm
You make a great point. How can we really be sure? I cannot say if another PERSON feels the same pain as I do, or see the same color of blue as I do. We have to do our best to extrapolate and make assumptions based on the information we have at hand. So, from an abstract standpoint, forgetting about dogs for a moment: when you use the label (word) in discussing the color blue, I make an assumption that I EXPERIENCE the same blue that you do. We can certainly agree that something is blue based on our mutual communication, but the actual experience…who knows?
(Another point is that not all cancers cause pain, I was referring to those that do.)
Okay, so more directly, when a skilled vet makes a read on what an animal is experiencing, we use labels other than words to gather information, since the dogs don’t speak. The labels are clusters of observations that are grouped in our heads that refer to our own experiences projected onto the dog. Again, the ability of persons differ in their sensitivity to detect these observations. The hemaniogsarcoma pain that I have seen in some cases of this cancer in the spleen happen around the time the tumor is rupturing. I gather it is deep (because I have to press deeply to elicit a pain response), and dull (because they tense their abdomen and look at me when I palpate instead of pulling away, biting, or jerking as if it were sharp). I then reflect on myself and use what my reactions would be when experiencing a certain type of pain. So the experience that is described is an assumption, just like you experiencing the color blue as I do is an assumption.
When mast cell tumors cause pain, they release histamine, cause substance P release and other chemical signals, which is what your body releases when you get stung by a bee. These dogs lick, chew, and rub the mast cell tumors that cause discomfort. Bladder cell tumors cause bladder inflammation, just like a bladder infection. When bladder tumors cause pain, these dogs strain to urinate, urinate small amounts frequently, and posture for long periods with no urine being produced as they have emptied their bladder long ago. These are classic signs of bladder irritation, which humans describe as burning and increased urgency to urinate.
So we take information from lots of sources to formulate the specifics on what a dog feels. We also rely on intuition and empathy.
Hope this answers your question
Best,
Dr Dressler
August 21st, 2008 at 4:06 pm
I am glad that you brought up mast cell tumors/cancers because my husband and I have a beautiful 9 1/2 yr-old female Golden Retriever who is both an early retired service dog as well as a full-fledged family member and only daughter to my husband and I. To our surprise and absolute horror — she was diagnosed on Aug 7th with Mast Cell Carcinoma - Grade 3. The only sign was a growth on her tummy that went unnoticed for numerous reasons. There were no outward signs like her licking the area, etc.. It was pride pickling invisible to the naked eye and pretty much had to be felt for diagnosis. She had just been to the same doctor exactly 5 months prior for her shots and he always spends a great deal of time feeling around her underside. And he felt nothing then.
As soon as WE noticed this flat, somewhat scaly growth on her underbelly we called our veterinarian for an appointment right away. We took her in on July 30 and our veteran Veterinarian (25-30 yrs) shaved the entire area for a better look and then came to us saying that, from the looks of it, it was most likely nothing “bad” but certainly something that should be removed. He is not one to hold back information to make one feel good so that was not the case. He did surgery on the same day and when we came to pick her up — he told us that he had to go a little deeper than he thought he would “to get it all” but that was all. There were about 25 or 30 stitches to be removed 10 days - 2 weeks later. Our girl was not even phased by their presence either.
He wanted to have a biopsy done either way but, just prior to going to get her, my husband and I did not think we wanted to go ahead with the biopsy because if it WAS cancer we would not allow any further surgeries (any more openings to ANY species including humans) make it “Oh happy day” for cells to metastasize much quicker than leaving well enough alone. In addition to the money factors of further surgery and her age. And if it was NOT cancer — waste of a biopsy.
But our veterinarian made many good points as to why we should go ahead and do it anyway. And now, if she gets sicker sooner or later, at least we will know what it is from. Our vet was super surprised at the pathology report and said that it may not have even been there a month ago with as rapidly as these tumors spread.
Anyway, as you know, Goldens are very stoic and we have no idea whether she is in pain or not. I think I had heard once that if a dog pants alot — that may indicate pain or discomfort. Well, she always pants alot here in Tucson, AZ summers so we do not know if this is a sign or not. I remember noticing that she was panting more just before summer began (and since) but I have no idea whether if it is related or not and I can beat myself up until I am blue about wondering “back then” if I should have been more attentive.
Other than that there are no outward telltale signs. She has slowed down significantly over the last 10 months because she has hip dysplasia AND she began exhibiting signs of shoulder or elbow dysplasia or arthritis by limping — favoring her front right leg. Ever since her diagnosis of hip dysplasia almost 5 years ago she has been on Piroxicam every other day which has helped her greatly up until about 10 months ago. Five months ago when we were at the vet I asked him if there was anything “more” besides the glucosamine/condroitin supplements which seemed to be doing nothing for her “new” front leg joint pain.
Ironically he said he had been having an ongoing debate with his colleague in the same office as to whether glucosamine/condroitin was more effective IN DOGS or Omega-3s were. My veterinarian was in favor of the latter so we started her on those. They did not do anything.
I remembered he had also mentioned COSEQUIN but only in passing. I told my husband about this and he did some research finding that it was basically glucosamine/condroitin so there was no sense in trying it.
Well, I could not stand to see her limping so I ordered three bottles of it online. Within 30 days she was no longer limping! So we have kept her on that.
Like humans, I think it all comes down to what works for the individual. But now that I know that she has mast cell grade 3 carcinoma — we have no idea how many weeks or months or years she has left. The veterinarian said he removed everything that was there but did not sugarcoat or hide the fact from us that it was an infamously rapidly spreading form of cancer. Which will lead me to another post regarding the thread on omega-3 fatty acids.
Thank you for reading this long post!
Lori Michaelson
August 21st, 2008 at 10:57 pm
Lori, see the next blog post (8/21/08). I hope it helps you and your dear Golden friend!!
Warm Regards,
Dr D
August 22nd, 2008 at 4:18 pm
Can’t find the one you are refrerring to with that date (8/21/08) — same day as your above post to “se the next blog post….”.
Did you mean the one really dated 8/22/08 covering chemos, intralesional triamcinolone, etc?
Lori
August 22nd, 2008 at 5:53 pm
Yes, it posted on the 22nd even though i clicked “post” on the 21st, sorry..D