The Fun Stuff!

It's all about quality of life, not quantity of life when it comes to pets. I'm trying to take Cody swimming as much as possible because it is something he really loves.

Cody with his swim coach

We are also spending lots of time just hanging out in the open space behind my house. My cat has taken to coming with us on walks also, so the three of us are just hanging out a lot these days.

Taking a walk with the cat

Emotional Rollercoaster

After our consultation with the oncologist, where I left with my head swimming with information about the various cancer treatments for osteosarcoma, I settled in to just trying to enjoy Christmas and time with my dog. Not a day went by though that I wasn't considering the options.

The decision making process went something like this:

I should take the most aggressive approach and help Cody beat this! We can deal with an amputation! We'll get a harness and even a doggy cart if we have to. I know good rehabilitation centers where we can get physical therapy. Cody won't miss his leg! I checked out Tripawds.com, a great web site and blog site for canine amputees. We can do this! The chemotherapy will stop the cancer in it's tracks! I gathered surgical estimates and thought about scheduling surgery for early January. His surgeon was going to be on vacation, so we would have to wait; bummer because the sooner the better. Oh wait... he has chest mets, and he is orthopedically challenged in the other 3 legs... maybe an amputation isn't a good idea.

This might be a good place to show some pictures of the hardware my dear pup is carrying around. Ya see Cody drew the short straw, so to speak. He got cancer in his "good" back leg (the left). He has no hip joint on the right because of a failed total hip replacement when he was a young dog. Since that time he has never really used his right hind leg much except to help with balance. Now with the left leg being bad, he has been forced to use the right leg, but it's not very functional

Ok, so amputation is out. That means palliative radiation and injectable chemotherapy. There! A decision. A plan. We can move forward. I scheduled appointments for chemotherapy and radiation for early January.

Throughout this process I had been talking to every veterinarian that I know about the options. Just to not leave any stones unturned I reached out to another expert. This veterinarian used to work at University of Florida doing stereotactic radiosurgery (SRS). He is now in my neighborhood and I have a good fortune of being able to refer cases to him. We discussed Cody's case and he felt that Cody might be a candidate for SRS. He would contact the head radiation oncologist at Colorado State and have her call me. Wow! I was thrilled. This procedure is as good as amputation, but it's radiation so Cody would get to keep his leg and we would kill the tumor!

At this point things got really complicated. I contacted Colorado State about a consultation. I probably used all available technologies that weekend to try to get Cody's records and radiographs to the proper people.  Fax, e-mail, text messages and phone calls! Saturday and Sunday went by.... 2 days are agonizing when you're trying to plan something like this. Monday morning (Jan. 7th) I spoke to the chief radiation oncologist. She hadn't seen Cody's radiographs yet.  She thought that SRS might give Cody about 6 months. Unfortunately they were overbooked and didn't have an opening until the 16th. Of course that is a really bad week for me to leave California because I have a work commitment that I cannot cancel. We discussed the option of driving him out and leaving him for treatment, then coming back to pick him up. Ok, I figured I could do that if this was really going to be the right thing for Cody. The price tag for SRS is approximately $5500. With that and the logistics I wanted to be super sure that this was a good treatment plan. The chief radiation oncologist called me back that evening with some bad news... she had the opportunity to look at Cody's radiographs and felt that with the metastases in the chest, Cody probably has about 2 months, and therefore didn't recommend I make the trip for SRS.

I was devastated. This meant returning to the palliative radiation + chemo plan. It felt like I was giving up. I cried for 3 days. It didn't help that Cody was sick from his first dose of chemotherapy. He stopped eating and started vomiting about 2-3 days after chemo. He bounced back and seemed really good after radiation. I decided not to continue with the injectable chemotherapy and try oral Palladia (an oral chemotherapy). However, now his neutrophil count is low, so we cannot start Palladia. When an animal is getting chemotherapy, the bone marrow is suppressed and doesn't make as many white blood cells as it normally would. The neutrophil is one of the several different types of white blood cells that fights infection. When the neutrophil count is low the animal is at risk for developing infections that can be life threatening. We have to wait until his neutrophil count comes back up before we can start Palladia.

Cody had more chest radiographs taken on Jan. 9th when he went for his first radiation treatment. Since we had been making big decisions based on his chest x-rays (not going to Colorado) we thought it might be worth checking to see what things looked like now since his last x-ray was early December. It had been a month and I again got my hopes up that if things didn't look worse that I might still consider going to Colorado. Well, unfortunately things looked worse. The nodules are bigger and easier to see and now Cody has some fluid accumulation around his lungs (pleural effusion).

Sometimes the decisions just get made for you in a sense. I'm resigned to the fact that my dog has osteosarcoma and it is a bad cancer and as far as I know there is nothing I can do at this point to cure my dog. Now I need to take some attitude lessons from my beloved dog. Live in the present and enjoy the little things! We are doing what we can to make Cody as pain-free as possible and doing all the fun things he loves to do!

Oncology Consultation

My happy Christmas Dog!

What's the next step after receiving the bad news that your best friend has cancer? Well after crying your eyes out, you gather your wits and schedule an appointment with an oncologist. I recommend this even if you don't think you will pursue any further treatment. Even if your general practitioner is the greatest on the planet I still think the additional information you will gain from a visit to the oncologist is invaluable. They went through 4 more years of special training to become experts in this field and are the most up to date on the latest treatments. They may also know of a study going on that your pet may be eligible for. They will also give you a prognosis in months. Which you may want to hear and it may help guide your decision making process. Personally I am not a huge fan of the "months to live" statement because all dogs are different and that can give one a false sense of hope or despair. But it does give one an idea of the effectiveness of the various treatments.

In the case of osteosarcoma the most aggressive approach to treatment is amputation of the effected limb and injectable chemotherapy. This will buy your dog 10-12 months.

If your dog is not a good candidate for amputation, you can consider a limb spare procedure depending on where the tumor is. There is a surgical procedure where they remove the tumor and replace it with a plate and/or bone graft. There is also a special type of radiation called stereotactic radiosurgery that will kill the tumor. This type of radiation is only done in a few places. Colorado State and University of Florida are two, there may be more in the USA that I am not aware of. A limb spare procedure plus injectable chemotherapy will buy your dog 10-12 months.

Just amputation without chemotherapy gains an average of 3 months.

Palliative radiation is a type of radiation that just relieves the pain, but doesn't kill the tumor. Palliative radiation plus injectable chemotherapy plus a bisphosphonate (a drug that helps build bone strength) may give your dog about 9 months.

All these projections are based on a dog WITHOUT evidence of metastases in the lungs. Unfortunately when there is gross evidence on x-rays that there are nodules in the lungs you can subtract about 3-4 months from all these estimates.

So what to do? With Christmas coming there is going to be a delay no matter what procedure we choose.  I need some time to digest the information and make a decision. Until we decide on the next step I am controlling Cody's pain with the following drugs: Tramadol (a pain killer related to morphine), Previcox (a non-steroidal anti-inflammatory), and Gabapentin (a seizure medication that is thought to help with neurologic pain). Cody has also been wearing a pain patch of Fentanyl since his biopsy procedure. Fentanyl is 100 times stronger than morphine. He seems pretty comfortable with the patch on, but I hope I can do something more to treat the pain.

Cancer Returns

It has been a while since I updated Cody's blog because, well... you know the saying "no news is good news!" He had been cruising along without problems until September, 2012. In September he started having intermittent non-weight bearing lameness of his left hind leg. It would get better with chiropractic adjustments and laser therapy and then he would stop using the leg again. I took radiographs (x-rays) of his left stifle (knee) and chest in September and didn't see anything of note on the x-rays. I even had the chest films looked at by a radiologist. I did not have the stifle film looked at, which I regret now because it turns out there was a suspicious area present, even in September. Note - if your veterinarian recommends having the radiographs reviewed by a radiologist say yes! They might catch something your general practitioner missed.
In early December I took more x-rays because the problem was becoming more frequent and not resolving with any treatment or after adding on more pain medications.
Well, bummer of all bummers, this set of radiographs showed a suspicious area on his femur AND if that weren't bad enough, his chest x-rays showed nodules that were not there in September. Knowing that those sort of patterns on radiographs usually mean osteosarcoma I dissolved into a sobbing puddle of mush and just hugged my dog like the world was ending. Of course I held out some hope that the problem would be a lesser evil like a fungal infection or less aggressive cancer.

The tumor is the area that looks "moth-eaten" at his distal femur.

Cody had a bone biopsy done on December 11, 2012. The results were chondroblastic osteosarcoma, low grade. It isn't much reassurance that the tumor is "low grade." An osteosarcoma is an aggressive bone cancer and usually by the time we (veterinarians) identify it on radiographs there already is microscopic spread to the lungs. Cody is already showing nodules (small masses) in his lungs. The thing is, in his case, we can't be sure just by the radiographs that the nodules are metastases from his osteosarcoma. They could be recurrence of his previous lung cancer or they could be metastases from his osteosarcoma. Could we biopsy them? Well, it would be difficult and require a CT scan and probably wouldn't really change anything we do at this point.

You can make out small round densities (lighter areas) that are the nodules.

One Year Post-Op

I have really good news to share. Cody is more than 1 year out from his diagnosis of lung cancer. Yay!

We have done radiographs and blood work at 4-6 months intervals and so far everything appears to be clear and cancer free. He still has trouble with his arthritis, but you wouldn't know it when you pull out the ball! He still chases it with gusto! The dog door gives him a little trouble these days too.

Diet and supplement update:
I started him on a commercial frozen raw diet mixed with a high quality dry food. The raw diet I am using is either Nature's Variety Instinct or Stella and Chewy's. I mix in just a bit of Wellness Core, Reduced Fat. I also steam veggies and add them when I have time. I found this diet to be easy for me to fit into our busy lifestyle and he seems to be thriving on it. His poops are very small - I'm taking that as a good sign that most of what is going in is being digested and utilized.

Current supplements & medications: Adequan injections, Royal Coat (fish oil & borage oil, by Ark Naturals), Lubrisyn (hyaluronic acid), Veterinary Immune Tabs (Ramaekers Nutrition), Vitalzym (enzymes), probiotics, Apocaps, Pain Plus (Resources), Dasuquin, Previcox, Heartgard Plus and Comfortis. Oh and occasionally Gas X!

6 Month Check Up

Wahoo! Last month we took chest x-rays and did blood work to see how Cody is doing. No obvious evidence of any cancer. Yay!
The anti-cancer regimen has morphed and changed over time. I am now cooking for Cody sporadically as time allows and I tend to keep it really simple. I'll boil chicken and steam veggies. Now and then I will throw a bunch of green stuff (parsley, kale, brussels sprouts, etc.) into the food processor and sprinkle it on the food. The consistent base of his diet is Wellness 95% canned meat, and Wellness Core, Reduced Fat kibble. I usually will mix some kibble in with the homemade diet, just to keep his tummy from getting upset. Because I travel a lot and sometimes he comes with me or sometimes I have someone else taking care of him I've opted to keep an easy feeding option like kibble and canned food on hand.

I've also recently changed his supplements. I've gone back to giving him the Veterinary Immune Tabs from Ramaekers Nutrition. In a previous post I mentioned that there was some concern over the anti-oxidant super oxide dismutase. I think that the amount is not very much, so I'm not going to worry about it. For the last few months I've been buying Transfer Factor and K9 Immunity separately. The Veterinary Immune Tabs contain both of these plus vitamins, minerals, amino acids, probiotics, some essential fatty acids, joint supplements, and tumeric. This supplement is costing me about $174 a bottle and it lasts Cody about 1 month (the recommended dose is 1 tablet per 20 lbs). That is my cost plus shipping. If you purchase this product through a veterinarian it will probably be about $200+ a bottle. You can also contact Ramaekers directly and order it directly from them which may save you a little money.
I am still adding in the Apocaps - Dr. Dressler's product. I've weaned Cody off of some of the other pain and joint supplements to see how he does. I've stopped the Dasuquin and Pain Plus, but have continued to give him Lubrisyn (an oral high molecular weight hyaluronic acid). He still gets Previcox, a NSAID, every other day. I make sure he is getting digestive enzymes and probiotics to help with digestion and keep his gut healthy. So far we haven't had any bad bouts of diarrhea in a while (probably because I haven't gone crazy with home cooking!).
Tonight he got a treat. I decided that buying a whole Rocky organic chicken would be the least expensive option for chicken. I roasted the chicken with broccoli and zucchini. The easy part is cooking it, now the fun will be deboning it all!!
Instructions: Pre-heat over to 400 degrees. Wash the chicken, pat dry. Put chicken in roasting pan, spread veggies (in this case broccoli and zucchini) around the edges and stuffed inside. I also kept the livers and neck and placed them in the roasting pan along with the vegetables. Add approximately 1/2 cup water. Cover and roast for approximately 1 & 1/2 hours or until the internal temperature of the chicken is 170 degrees. Remove skin and debone. Serve! Cody says thanks! Yummy!

Home Cooking - You Can Do It!

Oh good grief... the home cooked diet is the best option I know, I know...but honestly folks getting it down to a routine takes time. If you are struggling, don't worry I sympathize. I think there needs to be a support group for owners who make home cooked dog food (there probably is I just haven't done the internet search yet!).

I was at the store today asking the butcher about the meats they carry. Well you should have seen the look on his face when I told him the organic/natural, antibiotic free, chemical free, etc. etc. meat I wanted wasn't for me. For my dog please....and can you order some chicken necks too please? After I explained that my dog has cancer he stopped looking at me like I was totally crazy.  Turns out he had a Boxer a while back.

Today's batch was a master piece if I must say-so myself.  I did buy some shiitake mushrooms to add, but after Cody spit out the uncooked sample I gave him, I decided that at $12.99 a pound the shiitake mushrooms will be eaten by me, thank you very much.

The Dog Cancer Survival Guide is a good read folks

It has been three months since Cody's surgery. You would think that in three months I would have my act together and have Cody on an established anti-cancer regimen, but no....I'm still working the kinks out. And I don't even have all that personal family stuff like kids and a husband to deal with!! Personal life aside, it is hard to find enough time in the day to accomplish everything on one's to-do list.

I did have a phone consultation with Dr. Demian Dressler, the author of the Dog Cancer Survival Guide. I will share my notes with you from our conversation. First I would like to mention that one of the first comments Dr. Dressler made to me after he asked me if I had his book was "you've probably skimmed through some of it, but haven't actually read it yet, right?" Bingo! How does he know me so well? Then over the next hour and a half he basically proceded to give me the abridged version of the book. Well geesh, I could have just saved myself $300 bucks by reading the book! Not really. It was very worthwhile being able to speak directly with Dr. Dressler and ask him questions that related specifically to Cody. I would still recommend reading the book before setting up a consultation!

The gist of the conversation:
Get Cody on a home-made cooked cancer diet.
Minimize the amount of anti-oxidant supplements.
Supplement with omega 3 fatty acids only, do not add omega 6 fatty acids (they already get enough in the food).
Give Apocaps.
Give K-9 Immunity.
Give transfer factors.
Give probiotics and digestive enzymes.
Optional: give a trace mineral supplement (he recommended Beres Drops) and give modified citrus pectin.

The nitty-gritty: Diet
The Dog Cancer Survival Guide provides guide lines and a recipe for a home-cooked diet. There is a link to the diet on Dr. Dressler's blog: http://www.dogcancerblog.com/

The nitty-gritty: Anti-oxidants
You may have heard that taking antioxidants is good for you and your dog, right? Why? Well the theory is that antioxidants bind with free radicals preventing them from doing damage to cells in your body, thus causing cancer, heart disease, and general overall deterioration of the tissues of the body. All healthy people and pets should be taking antioxidants and enjoying the protective effects. People and dogs who are getting chemotherapy should not, in theory, take antioxidants. This is because when we give chemotherapeutic drugs we are creating free radicals in an effort to attack the cancer cells and kill them. Antioxidants theoretically block the action of the chemotherapy. Dr. Dressler has a good discussion on his blog (http://www.dogcancerblog.com/anti-oxidants-versus-pro-oxidants/) about antioxidants and pro-oxidants.  In summary he says: " Thus, before true clinical cancer actually develops, you want antioxidant effects, not pro-oxidant ones, in general. In contrast, after cancer clinically develops, one could choose pro-oxidants as the anti-cancer weapon. " There is a lot of debate over this subject so Dr. Dressler's approach is to at least try to separate supplements that are pro-oxidant, such as Apocaps, from supplements that have an antioxidant effect (K-9 Immunity). Hopefully we can get the best of both worlds with this approach? I don't think we really know yet.

I had Cody on a very good quality supplement called Veterinary Immune Tabs by Ramaekers Nutrition (http://ramaekersnutrition.com/vitpro.html). Dr. Dressler was concerned about the oxidant, superoxide dismutase (SOD) and recommended I discontinue the supplement.  For now I've stopped giving it, but I'm thinking the amount of SOD in this supplement is not very much and I may consider giving to Cody again. Especially if it works out economically.

To be continued with the nitty-gritty on Apocaps, K-9 Immunity, transfer factors, and omega 3s.

Support Groups

Cancer...the big 'C'... it conjures up all kinds of emotions and seems these days we are all touched by this scary disease in some way. A family member, a friend, your dog, your friend's mom....I'm willing to bet the degrees of separation between you and cancer is 1 or 2, certainly not 6.

There are people working on the question of why. There are people working on the question of when. There are people working on the questions of what. There are people working on the question of how. How do you deal with the diagnosis, the treatment, the emotional fall out? Well, there are resources and with the good 'ol internet most are just a few clicks away.

Recently a blogger reached out to me and asked me to post something about cancer support groups. Here is his post:

Support Groups Take Away the Loneliness

When you are facing difficult times, it helps to talk with people who understand what you are going through. Cancer, in particular, is a lonely road to travel that not everyone can relate to. Whether you are recently diagnosed or a survivor who has marked the 5-year milestone, support groups can help you travel this path and take away the feelings of isolation.

Tell someone you have cancer and they are sympathetic. They will tell you they’re sorry, they’ll say they’re praying for you. But they really don’t want to hear about how your bowel movements have been affected and how every stray hair now leaves you’re worried about the ones that remain.

Talk to another cancer patient, however, and you have someone who can relate and truly understand. They’ll share their experiences, assure you that what you’re going through is normal and help you find effective coping strategies. More than sympathy and prayers, you’ll get information that you can really use, and a friend who might even help you find some laughter in this difficult time.

The support groups can meet in person or they can be online. The method will depend on what works for you. Whether you are diagnosed with a common cancer such as breast cancer and chat online or going through a rare cancer like mesothelioma and meet in person, the therapeutic effect is the same: You won’t feel as alone anymore.

Support groups can also provide each other with valuable resources, referrals for doctors or tips on how to handle the debilitating exhaustion that sets in after treatments. Because these other people know exactly what you’re going through, they have a good idea of what you are looking for and can help you find it. They know which doctors have the best bedside manner and will share that information with you. They also know which clinics are using the most ground-breaking procedures for treatments and will guide you to that information, as well.

There is hope for anyone struggling with cancer. You don’t have to travel this road alone and you don’t have to isolate yourself to get away from the sympathetic glances that start to hurt as much as the diagnosis. As a survivor who lives in constant fear of a relapse, you can find comfort and relief in support groups. People in all stages of the process can find healing and help by sharing their stories and offering help to others. Find a support group today and get involved so you can say good-bye to the suffocating isolation.

By: David Haas

To Chemo or Not to Chemo

It has been about a month since Cody's surgery. He is doing well. The incision is healed and his hair is almost totally grown back in. No more evidence of grey in the muzzle! I'm not sure what I saw before.

I've slowly been gathering information about what types of things I can do to help prevent this cancer from coming back. I'm speaking to 3 veterinary oncologists and you might be able to guess how that is going! Three opinions!! Well not that differing actually. They all recommend metronomic chemotherapy. This web site has a very good explanation of the process and the theory behind metronomic therapy http://www.veterinarycancer.com/metronomic_chemotherapy.html

Basically it is low doses of chemotherapy given over an extended period of time. This therapy is thought to reduce the toxicity of the chemotherapeutic drug and also to inhibit angiogenesis. What the heck is angiogenesis??? Just like it sounds folks, production of new blood vessels. Cancer needs blood to grow. Shut down that pathway - no cancer. There's a great talk by William Li on angiogenesis: http://www.ted.com/talks/william_li.html. Check it out.

The recommended protocol for metronomic therapy is typically a non-steroidal anti-inflammatory (NSAID) plus a chemotherapeutic agent. Two of the three oncologists I've spoken to have recommended I keep Cody on Previcox (that is the NSAID I'm giving him for his arthritis) and add in Cytoxan (also known as cyclophosphamide). If a dog is not already on a NSAID the drug of choice is piroxicam which has been studied extensively for its benefits in treating transitional cell carcinomas in dogs. I am assuming (I haven't asked the oncologist yet) that they have found that all NSAIDs seem to have similar effects on cancer and that is why it doesn't make a difference which NSAID you use.

Now Cytoxan can be a little scary. The drug can cause a hemorrhagic sterile cystitis and/or bone marrow suppression. To prevent the cystitis you basically need to get your dog to drink a lot of water and urinate a lot. Not usually an issue with Labradors, thank goodness! To monitor for bone marrow suppression it is wise to have a CBC (complete blood count) performed every 1-2 weeks. Humans taking this drug are likely to lose their hair. This can happen in dogs, especially those that have continuous hair growth (Poodles).

I'm going to dig around a bit more and I'll let you know what I decide. I guess my biggest fear as a pet owner is that if I don't do the metronomic chemotherapy and the cancer comes back will I be kicking myself and wishing I'd done it. If the cancer doesn't come back well then I'll be singing the praises of all the holistic therapies I've chosen. If the cancer comes back even with doing all of the above well then I guess at that point you just have to let nature take its course.