For many it is out of the question.  No nearby cancer referral center, no veterinary university, no money.  But for those that live fairly close to a facility that offers this modality, it is an option.

Why do people opt for radiation for their dogs? What is the point?

Radiation is to help dogs that have cancers that are hard to cure. These cancers either never go away, or go away with treatment only temporarily.  So people consider it as another way to increase their dog’s life expectancy or to hopefully improve life quality.

Radiation is used to decrease the tumor cell burden (kills certain types of cancer cells), in very few cancers can cure them.  More and more frequently, it is used to help with tumor pain. If a tumor cannot be removed with surgery (inoperable), radiation can be an option as well.

What cancers are very sensitive to radiation (where radiation can kill a lot of the cancer cells)? Lymphosarcoma is a biggie, perianal adenoma/adenocarcinoma, neuroblastoma, plasmacytoma, and transmissable venereal tumor.    Some other cancers that are moderately sensitive (radiation helps a bit) are nerve sheath tumors (hemangiopericytomas), fibrosarcomas, and histiocytomas.

Radiation can help control pain with osteosarcomas in dogs.

So that’s a bit of the good.  Let’s look at the bad in the next blog post.

Best to all,

Dr Dressler

I am not talking about racial or sexual discrimination of course.  Rather, something I realized that we all carry within us, and I include myself in this, is the presence of viewpoints that condemn before investigation. 

Condemnation before investigation is a concept that was put forth by William Haley, a British philosopher and theologian in the 1700’s, and later attributed to Herbert Spencer. The idea is that something is immediately criticized before actually checking it out first to see if there is merit.

The danger in this process is that limits the options we have in treating dog cancer.  Branches of medicine tend to be divided between conventional (allopathic, Western, etc.) which is your chemo/radiation/surgery,  and alternative, which tends to lean towards deficiency correction, nutrition, mind/body, homeopathy, Chinese medicine, and is a general catch-all for what is “not” Western.

Here’s the problem: one finds that members of one group, more often than not, poo-poo the other group. Without really checking it out first. Condemnation before investigation. 

How many times have a heard an “alternative” dog owner tell me that antibiotics are “bad”? How many times have I heard a colleague blow off the idea that the pet food a dog eats can affect his long-term health?  That herbs are silly? How about that surgery is just a bad idea? No real evidence that acupuncture does anything? 

These viewpoints are rooted in the same mental process that produces racial prejudice and bigotry against women.  They are belief systems arising from indoctrination, reflexive responses, peer pressure, fear of criticism, and attachment to the ego.

There is only condemnation of the other perspective or person.  No investigation. No allowing of a “what if…”

When medical people do this, options that could be used to help save a dog with cancer are never explored, the mind is never really allowed to do its job, and we are faced with resulting survival statistics that are garbage.

The key is investigation and avoiding our attachment to certain viewpoints.  Only in this way can we create new ideas and evolve at a decent pace.

I am hard at work on a manuscript that attempts to avoid this partisan approach to medicine, and uses a Full-Spectrum approach to create a comprehensive plan for dogs with cancer. 

Cancer, whether in canines or people, can be snuffed out.  The key is really considering the possibilities…allowing that cure and non-toxic remissions to exist as real possibilities…and avoiding condemnation before investigation.

Best to all,

Dr D

This info applies to any big surgery involving cancer in dogs though.  I thought that a few bits of vet-only knowledge would be nice for dog owners.  That way you can discuss the important topic of pain control at the time of a major cancer surgery.

Before the procedure, you might want touch base with the vet about pain control. Pain is a major negative in life quality.

Different vets will have different ideas on pain control.  Those those a bit more on the ball will most definitely be giving pain control a priority.  

More modern vets will use a CRI, which is a Constant Rate Infusion of pain controlling drugs. This is a nice thing to do. It means the drugs are constantly flowing into the body through the IV.

Some will give an epidural, which is an injection of pain controlling drugs into the fluid around the spinal cord. Another nice technique to use in combo with other drugs.

Many use a Fentanyl patch, which is a fairly good way to control pain.  You have the patch applied to the dog a day or so before the surgery and it releases fentanyl through the skin. I like to combine it with some other agents for pain control.

My opinion is that one or more of these be used for major cancer surgeries, along with injections of other drugs as needed after the surgery.

Good options for take-home meds are sustained-release morphine and tramadol.  These should be combined with some anti inflammatory like metacam or possibly deramaxx or rimadyl.

Some vets really into new stuff will start the dog on Gabapentin before surgery, or possibly amitriptyline. You can start these days before surgery and they can help with pain control in combination with other drugs.

Drugs I don’t like for real pain in major dog cancer surgery? Buprenex (buprenorphine), only a moderately strong drug, not a big enough gun in my opinion.   Torbugesic (torbutrol) in dogs for take-home pain control is too wimpy and too short-acting.

So, the take home message? First, control that pain!  Multimodal analgesia, or using different ways to accomplish pain control is where it is at.

So be your dog’s health advocate and make sure pain is under control.

Best, 

Dr Dressler

Often the first question that arises is, “But will my dog be able to have a normal life on 3 legs?” Everyone, the answer is almost always yes. 

There are two big things to factor.  First, are you available to assist your dog in walking during the recovery period? The remaining limbs need to strengthen to support the extra weight.  This can take just a few days in a lean, young dog, or it may take a few weeks in an older or overweight one.

The second things to factor in is other problems that could affect the weight bearing, like arthritis, hip dysplasia, old ligament tears, back or neck problems, and so on.  The presence of other orthopedic issues can slow or complicate things a little and should be discussed with your vet.

Usually, most dogs are up and hopping around whenever or wherever they want to within 1-3 weeks.  They really do just fine once their strength builds.  It can be hard to watch but many times when people are depressed about it, they start to look at the dog and realize, “Wow..my dog actually seems pretty happy!”

They just seem to move on with life and live in the moment, which is a good lesson for all of us to learn from our dogs.

During recovery, you will need to help your dog learn to walk on three legs.  This is really pretty simple. you just need to help them support their weight during walking.  This can be done with a commercial sling you can purchase, or with a towel looped under the belly or the chest.  You just lift some of the weight and they will hop right along.

Remember in males that you will need to position the towel away from the sheath for urination or you will have a wet sling and a unhappy boy!

You will want to provide a surface that is not slippery to walk on.  Ramps can help get up in some cases too.

You should work on keeping your dog lean.  Being overweight has a whole collection of bad effects in dogs with cancer, and bone cancer is no exception.  Additionally, the extra load makes it harder to move around.  Another issue to remember is that being overweight increases the risk of injury in the remaining limbs due to increased wear and tear (arthritis, cruciate ruptures, and more).

Activities that required four legs can always be modified.  Dogs will learn to live how they can and they adjust, just like we do.  If you watch them, they will derive as much pleasure in their new life as they did before. The limits of what they can do change, not the limits of how happy they can be.

Let’s look at the surgery itself and preserving as much life quality as possible with pain control in the next post.

Best to all,

Dr Dressler

Osteosarcoma is a common cancer in the dog.  Most of the time it occurs on the long bones of the legs in large breed dogs.  And most of the time a veterinarian or veterinary oncologist will recommend amputation of the affected leg.

You will likely have some strong feelings about it, as one who loves a living, breathing being facing the removal of a limb.

This is a heavy duty question.  Since it has a lot of emotional charge for those interested in preventing pain and suffering, it can be a hard choice.  The choice warrants careful contemplation to make sure you are able to cope with the situation.

At least two factors should be  considered. The first is life quantity, which is also life expectancy.  The second is life quality, which of course is how good  life is.

Let’s look at life quantity first, or life expectancy.

First, get an idea of the average life expectancy of your dog.  Be careful with this.  These numbers are just averages, just like they are for people.  There is an excellent review of dog life expectancy  here.

Once you have ascertained what a dog’s potential life expectancy is, you need to weigh how much more time are we looking at for your dog.  Your vet can help with this by discussing the impact of your pet’s individual health problems.

We want to see whether, at the time of diagnosis, your dog has already reached the expected life length for most dogs like yours.

If your dog is close to what one would expect for average life length, the motivation or payoff for the surgery should be considered carefully. If your dog is not yet there, one might consider going ahead with the surgery.

It should be noted that most dogs with this kind of cancer do not survive beyond a year, with amputation alone (read more here).

However, this does not mean that your dog will pass away within a year, as you have access to continued treatment from your vet, oncologist, and the information contained here.  There will be more in upcoming publications being edited right now.

One last intangible is your particular dog’s personality.  Some dogs just have this will to live, and sometimes one can perceive this pretty clearly.  They just want to keep going.  They are driven.  This will to live, a tenacity, boosts lifespans.   Remember to consider this factor too.

That’s life quantity.

This is the first step. Next we look at life quality on three legs.  We will look a little at the surgery itself, some issues that affect life quality on three legs, and more.

I will post more on this issue in the next entry.

Regards,

Dr Dressler

As I had indicated, it turns out that if one were to take vitamin C, at huge doses by mouth, the blood levels you get are puny. When you, or your dog, takes a pill, some gets absorbed into the body, but some passes out in the waste.

People who took 18 grams of the stuff (which equals gagging down 9-18 of those “horse pill” tablets) per day, only ended up with 220 micromol/L in their blood. That means a huge amount Vitamin C ends up literally going down the toilet.  

Those studies showing that cancer cells die when exposed to vitamin C  needed more than 1,000 micromol/L.  Since 220 is much less than 1000, the cancer cells were not dying.  

This is probably why the two clinical trials where people had to down 10 grams of vitamin C daily showed no benefit in surviving their cancers.

So the message seems clear…don’t bother with strait oral vitamin C (ascorbic acid) when you are trying to help your dog kill cancer cells.  In my opinion, bases on the evidence, you can’t get the levels you want for cancer cell death.

But there are other ways to get the stuff in the body.  What about injections?? Does that help?

Well, I could not find solid reports on the effects of intravenous vitamin C given to canine cancer patients.  Recall I want good, solid, science-based information…however, I did find some in the human literature.

A paper came out in 2006 that showed 3 human patients with tumors that would have been expected to have led to their demise opted for IV vitamin C at whopping doses.  Read the abstract here.

One had a form of lymphoma (lymphosarcoma), one a kidney tumor, and other was transitional cell cancer of the bladder.  All had signs of either local spread (into the surrounding areas) or distant spread (metastasis). Bad, bad stuff.   

The amazing thing is that in each of these three, the tumors went away.  Gone.  Nada. Zippo.  And that, my friends, is pretty astounding.  Granted, the lady with the kidney tumor (a chronic smoker) developed lung cancer 4 years later…but the information is pretty impressive regardless.

Does this mean everyone with a dog should go out and schedule IV vitamin C injections for their dogs? No. Especially not dogs with urinary stones like calcium oxalates, which likely can be worsened or theoretically even caused by the injections.  

But, it does mean that in certain circumstances, it should be considered.  Vitamin C IV injections appear fairly safe overall, and people are starting to pay attention to Vitamin C IV injections in cancer therapy…check it out.  For the vets out there, the protocols are here too.

Note that it is, at this point, probably unwise to give these doses of IV vitamin C in conjunction with chemotherapy until the issue of whether it helps or hinders chemo is clarified.  I would also avoid IV vit C at these doses if your dog is receiving radiation therapy.

Best to all,

Dr Dressler

Lots of people became pretty excited, and decided to see if Vitamin C did anything to cancer cells in the lab.  In test tube studies, they found it sure did, see for yourself.  Melanoma cells, leukemia cells, neuroblastoma cells, carcinoma cells, fibrosarcoma cells…you get the idea.  Sure enough, it seemed Linus was on to something.

And Vitamin C did not kill these nasties by being an antioxidant.  No.  It actually had pro-oxidant effects, and increased the free radicals within the cancer cells to make them die.  See the blog on ozone for more about oxidation.

Anyway, among Mr. Pauling’s ideas was to take massive oral doses to get high blood levels so the vitamin C would do what it did in a test tube. Unfortunately for Linus, there was a flaw in his thinking.

You don’t get good blood levels of Vitamin C when you take it by mouth, and neither does your dog.  Turns out the body keeps the Vitamin C in a low range when given as a tablet.  And the range is too low.

Two published clinical trials found that vitamin C did not do anything for cancer patients. Things did not look good for Linus.

But it turns out that there is hope.  There are ways to use the cancer-killing effect of vitamin C for dogs with cancer.  And it turns out that these ways might really work.  Stay tuned for more!!

Best to all,

Dr Dressler

First of all, what is ozone anyway? Ozone is a gas that can be administered after it is dissolved in liquid, most commonly either IV or as an enema.  It is a powerful oxidant.

In cancer, at least two points about oxidation are important.  First, oxidation is the process that creates harmful free radicals (reactive oxygen and nitrogen) when the cell cannot eliminate them.  Excess free radicals hurts cells (damages the DNA, lipid, protein and more).

Second, the body has ways of combating free radicals naturally (dietary antioxidants, enzymes, pH buffers and more). When the body takes in an oxidant like ozone, the body will crank up it’s natural defenses against the damage caused by the oxidant.

Cancer cells have a tendency to produce lots of free radicals normally.  That’s actually a common theme in different  cancer types. Their defenses against free radical accumulation are low.  Thus, they are running on high gear, producing a lot of free radicals, but are living dangerously since they can barely neutralize their own free radical production.

This is where ozone comes in.  There is some evidence that it kills cancer cells in the test tube (see article), which is nice, but lots of things do that. Ozone increases the free radical production in the cancer cells, and these free radicals are toxic to the cancer cell.

The problem is this:  often something will kill a cancer cell in the lab but not in the body.  A cancer in a petri dish in not a cancer in a dog.

Unfortunately, there was no survival advantage when ozone was actually studied in cancer patients, as you can see. But it did seem to help with side effects from chemo and made the patients feel a bit better.  The reason why this occurred seems to be that the ozone therapy boosted the body’s natural antioxidant defense systems.  This is kind of like an immunization…a little of the bad stuff in the body boosts its defense.

A kind of neat fact is that ozone, dissolved as a liquid, does kill germs very effectively when applied directly to them.  Inhaled ozone is toxic to the surface of the lungs.

What’s the take home message? Basically,  I’m not excited about it for dogs with cancer.  The pro-oxidant effects do not seem to kill tumors in the body, and these effects initially may not be all that healthy for the body (prior to when the body recovers with it’s  own antioxidant surge).  Plus, there’s cost and availability issues.

Best to all,

Dr Dressler

Removal of all the cancer cells from the body during surgery is pretty important.  How can we tell?

The most important thing to do is get that biopsy report.  Some don’t want the extra cost.  “Just get it out” is a line I have heard from time to time. However, the report from the path lab can be absolutely critical.

Why does it matter?  Well, there are a couple of reasons.  First, the pathologist can evaluate the borders of the tissue I, or your vet/oncologist, submit after removal.  This is called comprehensive margin evaluation.

This evaluation tells us if there are cancer cells still left in the dog or not, around the surgery site anyway.  If there are cancer cells at the border of what gets turned in to the lab, there are probably some left in the dog.

So, if you get the path report back and there are cancer cells at the edge of the submitted specimen, it would be wise to go back in and remove more tissue. Yes, I am talking about a second surgery.

Some cancer types spread out around where the lump actually is resting.  So the dog will have cancer cells around the tumor that you can’t see with the naked eye. Some examples are osteosarcoma, some mast cell tumors, squamous cell carcinoma, fibrosarcoma, hemangiopericytoma (nerve sheath tumor), some mammary cancers (inflammatory carcinomas especially), hemangiosarcoma, malignant melanoma, and more.

In these cases, sometimes a wide excision (removing more than what “looks like” the cancer at the time of surgery is the way to go.  A fine needle aspirate or small biopsy before surgery can actually save cost in the end, by ascertaining whether a wide excision is needed before surgical removal.

Best to all,

Dr Dressler

Sometimes these are tough to answer, and the reason is micrometastasis.

Micrometastsis occurs when a cancer spreads from a site, but the spread is not detectable by the usual means available.  Only a few cells take off, traveling perhaps in the circulation to set up shop elsewhere in the dog’s body. So few cells spread, that they are undetectable.

So you have someone like me take the tumor out, for example, and the borders are examined by a pathologist to see if the margins are “clean” (no cancer cells at the edge, they are all located near the center of the removed piece, suggesting complete removal).  Your path report says “complete excision” (complete removal).

Say though, that you are faced with the diagnosis of a malignant melanoma, a Grade 3 mast cell tumor, an osteosarcoma, an advanced squamous cell carcinoma,  a large hemangiosarcoma, or some other kind of canine cancer with a known tendency to spread.

Suppose your vet or oncologist was very thorough and did all that could be done to see whether there was evidence of spread, and all the tests were negative.  But your vet or oncologist is still pessimistic.  Why?

Micrometastasis.  The cancer did spread, but only a few cells.  These can sneak up on us later, turning up as cancers that were not there at the time we checked, but were there later.

This is why we are sometimes talking about steps beyond surgery when there is no evidence the cancer has spread. We want to make sure we are addressing the known tendency of these cancers to take off, even when the tests looking for spread are negative.

Best to all,

Dr D