Video Transcript: Perianal & Anal Sac Tumors- What You Need to Know About Your Dog’s Cancer
James Jacobson: One of the types of cancers that you addressed in The Dog Cancer Survival Guide are Perianal, Anal Sac Cancers, cancers of the rear end. I guess I’ll throw this to you first Dr. Dressler, what are the signs and symptoms that you might be looking at if your dog has one of these cancers?
Dr. Demian Dressler: These cancers are similar to some other cancers like such as cancers that occur in the mouth and the oral cavity and that many times they’re not noticed right off the bath and this is for I think obvious reasons and not too many guardians spend a lot of time inspecting their dog’s rear ends. So most of the times the tumors are either cut later after they’ve been there for a while and they’ve gotten pretty big or the veterinarian will noticed it during the course of routine physical and these tumors their growths and they’re right around the rear end and some of them are benign and some of them are malignant and it brings up a really important point which is the veterinarians really need to be doing rectal exams on elderly dogs both male dogs and also female dogs because not all of these tumors are going to be occurring where you can see them with the naked eyes, sometimes they occur deeper and they could be felt with the fingertips as supposed to relying on visual inspection alone.
James Jacobson: Dr. Ettinger, what are your thoughts on Perianal and Anal Sac tumors?
Dr. Susan Ettinger: Yeah, it’s an umbrella term for a couple of different types of tumors Dr. Dressler pointed out and so there are the benign adenomas, which you know regardless of what are types of benign cancers, malignant cancers early detection is so key cause even these benign tumors can be very challenging if they are not detected early and they require a big surgery some of those are actually associated with testosterone levels and so in some of those big tumors you can, if the dog is still intact you can castrate them and the tumors may resolved completely on their own or at least be smaller and more surgical. Then there’s the malignant category, there’s the Anal Sac adnocarcinoma, the sebaceous gland adnocarcinoma they vary on how aggressive they are in their metastatic pattern but it’s definitely one where you want to try to find early and then primary treatments gonna be surgery and some of these cases you may be looking at chemotherapy. Some cases radiation may be required as well. So, it can be a mixed pad of treatment option there’s also some exciting evident that palladia has some anti-cancer properties for these tumors as well, some new options out there as well that could be useful for your pet.
James Jacobson: Dr. Dressler, what options do you commonly used and recommend for perianal and anal sac tumors?
Dr. Demian Dressler: Let me bounced back I forget to mention something which is kind of interesting on the more malignant types of these cancers are secreting chemicals signals on the body which can alleviate the blood calcium and this is another fetch for doing early detection testing specially in dogs that are starting usually over the age of seven maybe eight something like that give or take and you can see a high blood calcium level and that can be a flag in some cases only used to have for these types of cancers for your vet to go on a search and many times still felt turned up in a rear end but back to your question Jim which had to do with what do we do? So, for the benign one such really important or at least the most common benign one to get your dog neutered later in life because that would help to limit the regrowth of adenomas benign forms the most common benign forms and then in addition to what Dr. Ettinger had pointed out we want to change to a cancer fighting diet, we want to bring in a plant supplements phytochemicals which are called apoptogens those are certain substances that can help turn on cancer cell suicide very beneficial in my experience, immune support. Some of these cases will require stool softeners as a part of the therapy because sometimes there can be some difficulty evacuating solid waste and pooping and we have to pay attention to brain chemistry, we have to pay attention to life quality by deliberately taking steps to decrease stress and improve the life quality of our patients, so we can have a really good long life together.
James Jacobson: Tremendous amount of information in the book on these types of cancers tumors if you have that I invite you to check out in The Dog Cancer Survival Guide. I wanna thank both of you veterinarians for joining us today, Dr. Ettinger in New York, Dr. Dressler in Hawaii, thank you.
Transcript of Melanoma- What You Need to Know About Your Dog’s Cancer
James Jacobson: One of the cancers that you talk about in The Dog Cancer Survival Guide are Melanomas, Dr. Dressler, I throw out this question to you first, if you have a dog with a melanoma, what are likely signs and symptoms that you are facing?
Dr. Demian Dressler: Well, melanomas are growths that most commonly come out of cells which produce pigment and so they are usually dark, most commonly and they are found in areas also that are dark, usually the surface of the skin and their broken into a few different categories, some of them will turn up in the mouth, somewhere within oral cavity, and then some of them will turn up down on the toe, toe area and that’s another category and then some of them will pop up somewhere usually in the torso the chunk area of the dog and we break these into different categories because of the fact that they behave very differently depending on where they show up and the interesting thing about melanomas are malignant melanomas in dogs different from people. In humans many times fair skin people will get these as a consequence of sunlight exposure, the ultraviolet radiation, but we do not see these in dogs other tumor types yes, but not melanomas so that’s the big difference that everybody should realize.
James Jacobson: Dr. Ettinger, what are your thoughts on melanomas?
Dr. Susan Ettinger: Yeah, most people know about melanoma, just as Dr. Dressler pointed out from people and interestingly the skin melanomas in dogs in general tend to be benign, but once in the oral cavity in the mouth and the digit are malignant and more similar to the skin melanomas in people, it’s a little bit different, but the ones in the mouth and the digit are gonna be one of these cancers that are locally aggressive so very invasive into the tissue and surgery radiation is gonna be very important in the primary area that the cancer is growing and then there’s an exciting new treatment option that you can do to help turn on the body’s immune system to attack the cancer cells that are very metastatic that have a high spread rate. What we’ve learned which is really interesting about the melanoma vaccine is that it works fast for this stomach disease you really still need that surgery and or radiation for the primary cancer. Another question that I get is “can I use the melanoma vaccine to prevent my dog from getting this cancer?” unfortunately that’s not the way that the vaccine works, so it’s really a treatment option and not a preventative option.
James Jacobson: Why did they call a vaccine?
Dr. Susan Ettinger: It’s a vaccine because it turns on the body’s immune system by with the simulations something called tyrosine which is part of the melanoma cell but you’re actually turning on the immune system to go and attack those cancer cells and that’s similar to how a vaccine works and that it’s an immune system military mechanism.
James Jacobson: I get it… Dr. Dressler your thoughts on options on treating melanomas.
Dr. Demian Dressler: Melanomas are cancers that really need the full spectrum approach. We need to be sure that we’re not blind-sided by our own biases, for example if we’re more holistic people, we can’t rely only on the use of say, supplements diet, herbs these type of thing because of the fact that these cancer if it shows up in the mouth, and if it shows up on the digits, it’s not, it’s a serious disease and we have much higher efficacy with the use of surgery and chemotherapy and radiation and if we only rely on the non-conventional approaches now having said that, we need to take advantage of the new information, Dr. Ettinger mentioned on melanoma vaccine it’s an important feature of full spectrum treatment and this is addition to cancer fighting diet, the use of plant derive compounds, phytochemicals, which help turn on cancer cells suicide that is called the apoptogens, fatty acids can help, certain types of fibers can help, and we always need to remember to restore good brain chemistry to anti-cancer state, a cancer fighting state and these can be done by deliberately increasing our joys in life and our life quality efforts so we can have the longest, happiest life possible.
James Jacobson: Dr. Ettinger, Dr. Dressler, thank you so much. There’s a lot more information on melanomas in The Dog Cancer Survival Guide. We thank you both for joining us today.
Transcript of Brain Tumors: What You Need to Know About Your Dog’s Cancer
James Jacobson: One of the types of cancers that you talk about in The Dog Cancer Survival Guide are brain tumors. Dr. Dressler I start with you first, if you have a dog who has a brain tumor, what are the likely signs and symptoms that you’re looking at?
Dr. Demian Dressler: Brain tumors most commonly will happen in elderly dogs not everytime. In my experience in the most common signs of brain tumor would be seizure disorders and seizure we all know what a seizure looks like but a rapid muscle contractions and many times if it’s bad enough, those can involve all of the muscles in the body in a grand mal seizure. Now there can be more subtle signs of a brain tumor though and none all of these can be picked up at home for example something called anisocoria which are pupils that are not dilated, not as big on one side, one eye compared to the other eye sometime there’s a little drooping of the face kind of a palsy they called that. Other times we can have odd behavior at home things like head pressing which should be pushing of your dog’s head into the corner of the room or walking in circles and sometimes even a behavioural changes where we’ve got a more vocal measles all of a sudden a big change in anxiety, increase in anxiety or this types of things. There are a lot of different neurologic signs that can all point to the brain.
James Jacobson: Dr. Ettinger, what are your thoughts on brain tumors?
Dr. Susan Ettinger: Yeah, these can be hard to find the earlier I think because it’s really hard to pick up on several neurologic changes in our pets just as Dr. Dressler was talking about. We know from people sometimes they have headaches, sometimes they have headaches in the morning that were often. Those are things that we might not pick up in our pets ‘cause they don’t tell us that their head hurts they’re pretty tolerant you know, four legged creatures, so they can be hard to pick up early. Typically the best way to figure out where it is once your pet, there’s a suspicion that there’s a brain tumor is usually there’s gonna be some sort of advance imaging on the head, the best one in my opinion is an MRI, CT Scans may also be done depending on your location but that’s gonna give us an idea of where in the brain the tumor is, and what treatment options are, some are gonna be surgical and some radiations gonna be the main form of treatment and at our hospital we’re very lucky to have us unique type of radiation called the “cyberknife” which is a type of radio surgery where they don’t need surgery but the radiation does the job of surgery in one to three treatments. So, and in some patients chemotherapy can be used as well if surgery and radiation are not an option. So, there’s a lot of different options out there, once the diagnosis is made…
James Jacobson: And if you are looking at the cyberknife as an option there’s a whole video in this series specifically on that unique procedure. Dr. Dressler, what are your thoughts about treating brain tumors?
Dr. Demian Dressler: Brain tumors are tough even perhaps more so than other cancer, they don’t rear their head, so to speak until they’re more fairly advanced. With these, this is one of the few cancers where in human letter through we actually has some benefit to the use of homeopathy. There’s a paper published which you can read about the Dog cancer blog and sometimes homeopathic management can have some benefit at least with gliomas. Nutritional you know, attention is very important we need to always try to give a healthy diet, and it’s a diet that’s different it’s specifically for dogs that have cancer and the other types of supplemental support that we talk about immune supports as well as maintaining as much as possible overall life quality and focusing on pain and making sure that our love pets aren’t experiencing any pain all these are important features of full spectrum care.
James Jacobson: There’s a lot more information on brain tumors and what you can do if your dog has a brain tumor in The Dog Cancer Survival Guide. I wanna thank both of you for joining us today, Dr. Ettinger in New York, Dressler in Hawaii, thank you.
Transcript of Soft Tissue Sarcomas- What You Need to Know About Your Dog’s Cancer
James Jacobson: One of the cancers that you talk about in The Dog Cancer Survival Guide are soft tissue sarcomas. Dr. Dressler, I’ll throw this question out to you first if your dog has soft tissue sarcoma, what do you likely looking at? What are the signs and symptoms?
Dr. Demian Dressler: Well, soft tissue sarcoma as the name suggests, grows out of soft tissue or connective tissue. Now, that’s about the only unifying thing that we can say about these tumors. And the reason is because they can show up all over the place. They can show up practically in any organ that has soft tissue around it or connective tissue around it. They are firm, that is a pretty unifying a, a feature of them and there, they do expand into the neighbouring area, so if one were to see a soft tissue tumor, soft tissue sarcoma on the outside of the dogs by a where visible to the naked eye. It would look like a bump and in general a quite firm bump. And if you’re to move it around with your fingertips you would notice that it’s pretty well embedded in the surrounding neighbouring tissue. It’s not going to be one that’s gonna have a little stuck underneath or can be moved around quite easily. There are most always planting down roots into the neighbouring tissue.
James Jacobson: And Dr. Ettinger, your thoughts on this type of cancer.
Dr. Susan Ettinger: When I think about the soft tissue sarcomas of the skin and the subcutaneous tissues, the one unifying theme that I think about is that, in general there are locally aggressive or extensive but they have a low metastatic rate which is a good thing. So, in general about only ten to fifteen percent of below and intermediate grade sarcomas will spread internally in the body which really means your local surgery is gonna be your best chance for good control of these cancers. Some dogs depending on the location may need radiation after surgery but if the one thing that you remember is that you wanna know what this mass is before your Veterinarian goes in cuts it out. So, planning planning planning. It’s really good to have either pre-surgical aspirate which what you know it’s sarcoma or pre-surgical biopsy, so that surgeon will go in into as wide a surgery the first time ’cause your best chance are good long term control for these cancers is if your first surgery is wide and aggressive and you don’t need to go back in into a scar revision. So, planning, planning, and planning. Make sure your Veterinarian finds out what it is before the first surgery.
James Jacobson: Dr. Dressler, your thoughts about treatment options for this type of sarcomas.
Dr. Demian Dressler: Well, in the best case scenario, the wide excision that Dr. Ettinger was talking’ about may you’ll the cure and that’s really what we’re going to be hoping for. Now, it may not always happen that we may not be able to achieve a cure in to those cases then we have to switch to overall strategies to address the physiology in our dog’s bodies. And that’s accomplished by paying attention to the different areas of cancer care. In addition to the dietary changes which can help a dog with cancer in addition to immune stimulants, in addition to those supplements that turn on cancer cells suicide which are called apoptogens those are derive from plants and of course we always wanna make sure that we have our dog’s pain control and that we’re taking steps deliberately improve life quality so that we can maintain a nice good quality of life for as long as possible.
James Jacobson: Lots of information in the book if your dog has a soft tissue sarcoma.
Dr. Susan Ettinger: Can I add one more thing?
James Jacobson: Please do Dr. Ettinger.
Dr. Susan Ettinger: Because I, in kind of thinking about what I just said I think it’s important to realize that some of these tumors are not, your Veterinarians not gonna be able to get wide margins because of the location. They’re gonna be down on the legs and no matter how fabulous your Veterinarian is, there is an just enough skin and tissue around it. So I don’t want you to be frustrated if you get back, that biopsy reported says the margins were not clean. There are lots of good options that you can do after surgery even if it’s on a part of the body whether you’re not able to get a scar revision done. Radiation can prevent reoccurrence low dose oral chemotherapy; metronomic chemotherapy has been recently shown to delay reoccurrence. So, there’s a lot of good options again so don’t get you frustrated, you know, again if it’s in the location of the body where you can’t get clean wide margins. They’re still very treatable cancers.
James Jacobson: Alright, I like the word that you guys that Dr. Dressler’s said, he said the word cure as a possibility and you don’t often talk about that when it comes to dog cancers, so that’s a, that’s reassuring a lot more information in the book. Dr. Dressler in Hawaii, Dr. Ettinger in New York, thank you so much for joining us today.
Transcript of Nasal Tumors- What You Need to Know About Your Dog’s Cancer
James Jacobson: One of the cancers that you talk about in The Dog Cancer Survival Guide is nasal cancers. Dr. Dressler, I’ll throw this question out to you first, if your dog has cancer of the nose, what are the likely signs and symptoms that you might be looking’ at?
Dr. Demian Dressler: Nasal cancers are tricky, and the reason why they are tricky is because the fact that they grow within the nasal sinuses. And we can’t see into the nasal sinuses with our naked eyes as guardians or as Veterinarians for that matter. And so, many times we have to rely on things progressing to the extent that we see signs from the outside of the dog’s body, or the dog’s doing something different that, with normally be witnessed. Some examples should be a discharge that is some material green, yellow, or occasionally bloody or mucousy coming out of, one of the nostrils. Sometimes, we’ll see a bit of a swelling in the area of the muscle either a strange or sometimes it’s even a cavities so a depression in the area of the muscle. And very, very rarely I have seen nasal cancers show as dogs are having a some gagging or some swallowing, or some peculiar coughing noises, or something like that, and these are most commonly occurring when the nasal tumors are farther back in the nasal sinus.
Dr. Susan Ettinger: This is a, in some ways similar to bladder cancer in dogs and not a lot of patients have a secondary infection on top of the cancer which is a little bit confusing for the guardian and sometimes Veterinarian because they start the many antibiotics and the symptoms to discharge improves and so you think it’s just an infection but in general there’s a possibility that there is an underlying cancer in the nasal and the sinus cavities so that can be a little bit confusing and so I think it’s one of those, that’s going on with your dog. You wanna, really consider pursuing advanced diagnostics and often you’ll need a nasal biopsy and in best case scenario the better way to diagnosis is with a CT scan and Rhynoscopy which is a scoping procedure where they’re gonna get a biopsy, but that’s really gonna give you the complete picture about the extent of the disease on the type of nasal cancer that your dog has.
James Jacobson: Dr. Dressler, your thoughts on treatment options for nasal cancer.
Dr. Demian Dressler: Well, treating options we, as usual have a lot of different things to choose from. A nasal cancer can be a little bit frustrating in some cases. It’s difficult to achieve a cure. Radiation is one of the central ways that nasal cancers are treated and radiation therapy many times does a lot of good with respect to improving life quality and also longevity. Surgery in some cases can be tough because the surgery that’s needed many times would be so extensive, in other times many, many time so extensive that is just not possible. We’ve also got to remember that changing the diet can be an important additional help to fighting cancer for a K9 patient. The additional supplements can be very usual including those that turn on cells suicide in cancer cells, those were called apoptogens. And of course life quality enrichment with deliberately improving things that are the joys in life for our patients and we of course can’t forget that pain control when appropriate.
James Jacobson: There’s a lot of information if your dog has…
Dr. Susan Ettinger: I’d like to.. Can I add some please?
James Jacobson: Please! Please!
Dr. Susan Ettinger: So, I think in terms of conventional treatment options as Dr. Dressler mentioned, surgery itself is not doesn’t really achieve white clean margins. It’s very hard to remove the entire tumor from the nasal cavity and radiation is really the main conventional treatment. Most nasal cancers tend to stay local in the nasal and sinus cavities so they have a low spread rate. And there’s a, two main types of radiation out there. One is conventional radiation and then there are a few places in the country including the hospital that I worked at in New York that has a type of radiation called radiosurgery and nasal cancers are the second most common cancer that we treat with radiosurgery with our cyberknife unit. And it allows the nasal cancer to be treated instead of fifteen to twenty treatments and three treatments were just less trips to the hospital, less anaesthesias for your pets and actually less side effects with very comfortable treatment efficacy. So, again this is an evolving field, there are some newer treatment options out there and definitely, some new things to learn about.
James Jacobson: Well, and if you’re looking at cyberknife, we have a video in this series specifically about that procedure. A very interesting one and lots of information in the book both about that and all the options are available to you if your dog has tumors in the nasal region. More information in the book but for now I wanna thank you both for joining us, Dr. Ettinger in New York, Dr. Dressler in Hawaii, thank you.
Transcript of Oral Cancers- What You Need to Know About Your Dog’s Cancer
James Jacobson: One of the cancers that you talk about in The Dog Cancer Survival Guide is oral cancers, cancers of the mouth. Dr. Dressler, if you’re looking at a dog who has oral cancer, what are the signs and symptoms that you might be seeing?
Dr. Demian Dressler: I’ll be honest, these tumors are most commonly at least in my experience found by Veterinarians during a physical exam. And the reason for this is that, it’s only in the later stages where we see signs at home. Many times these tumors are just silently growing somewhere in the mouth, usually along the gum line or occasionally back in the tonsil area, in the roof of the mouth, the palate, occasionally under the tongue, and unless a guardian is really involved either in home dental care or just very, very tuned in to looking for things that are abnormal on the mouth, they usually won’t actually find that. Now, in the late stages it’s true that there may be signs that are visible at home that a guardian could pick up and these would include things like difficult to eating or drooling, or possibly bleeding or sometimes even really bad breath as the top of the tumor starts to get a little bit broken down and starts to smell a little bit bad.
James Jacobson: Dr. Ettinger, your thoughts on oral cancers.
Dr. Susan Ettinger: Yeah! It’s one of those such frustrating for the guardian because they are often found late because to be honest she sticks her fingers in their dog’s mouth all the time so, it can be frustrating, there’s a couple common malignant cancers that we see. In general excluding oral melanoma most of the oral cancers tend to be what we call a local disease so they tend to stay in the head and neck area and have lower spread rate, so most of the treatment options were gonna be focussed on the cancer in the oral cavity, and whether that surgery or radiation. Those are the two main conventional treatment options that will think about for the main oral cancers excluding oral melanoma.
James Jacobson: Dr. Dressler, what are some of the options that you look out when you’re dealing with oral cancers?
Dr. Demian Dressler: In addition to the ones that you, Dr. Ettinger brought up, we should also consider specially with the melanoma is a, not only the chemotherapy but additionally the melanoma vaccine which is available through oncologist, we can really, really help with survival time. And we’ve also got to make our dietary changes to a cancer fighting diet. It’s important to focus on supplementation with proper supplements like the use of apoptogens, which are plant derived compounds that help to turn on cancer cells suicide. Immune support are very, very important as well on the supplement front and life quality enrichment as usual is such an important piece of cancer management so that we can really get good life quality and take advantage of some altered brain chemistry that may be beneficial in helping a K9 cancer patients are also considerably.
James Jacobson: Dr. Dressler in Hawaii, Dr. Ettinger in New York, thank you so much for joining us today.
Transcript of Transitional Cell Carcinoma- What You Need to Know About Your Dog’s Cancer
James Jacobson: One of the cancers that you both talk about in the Dog Cancer Survival Guide is transitional cell carcinoma. I wanna first of all throw this to you Dr. Dressler, if you’re looking at transitional cell carcinoma, what likely are the signs and symptoms that a dog guardian is facing?
Dr. Demian Dressler: Well, this tumor is most common cancer of the urinary tract that you see more in dogs or in certain breeds like Scottish and also dogs that are more overweight or obese. And the strange thing about transitional cell carcinoma is that it’s a growth that’s coming out from the inside of the bladder wall, growing internally into the bladder, and it can really look like a urinary tract infection to a Veterinarian because the signs are almost identical at least first thought, and those signs reflect inflammation of the bladder with this means to the dog is they’ll feel uncomfortable and so many times they’ll have blood in the urine, many time will be straining to urinate, many times looking at the genital and often urinating small amounts frequently. And one of the tricky things for the Veterinarian and also in aspect that all guardian should be aware is that often a urinalysis will look just like a urinary infection and so we always need to have this type of cancer in mind when we’re dealing with an apparent diagnoses of a urinary tract infection, especially if you have scotty or an obese dog or an elderly dog.
James Jacobson: Dr. Ettinger, what are your thoughts on transitional cell carcinoma?
Dr. Susan Ettinger: Yeah! It’s one of those that guardians look back and wonder if it’s should have been cut sooner because and actually was interesting as a lot of dogs with transitional cell carcinoma have a secondary bacterial infection, or secondary urinary tract infection, and that’s why they temporarily respond to the antibiotics and then they complete the course of antibiotics and the symptoms recur. So, it’s a little bit frustrating and quite some tends to be 20/20, but it’s a cancer with a lot of treatable option, some dogs depending on the location in the bladder will recommend surgery, but it is a cancer that even if it’s non-surgical they can respond very well to chemotherapy. There are a lot of different options and some new chemotherapy options out there for transitional cell carcinoma. And so, it’s definitely one that you wanna find out if the cancers spread, if it’s surgical and then you know just consider all the different options for it.
James Jacobson: Dr. Dressler, what are your thoughts on treatment options for transitional cell carcinoma?
Dr. Demian Dressler: Yeah! The surgical options there are usually or most commonly a palliative that means that we’re trying to improve life quality not always necessarily life expectancy as Dr. Ettinger point it out to chemotherapeutic options which do the same thing we’ve also got to remember to make changes to the diet, we wanna use a cancer fighting diet, we wanna use supplements including supplements that turn on cells suicide in cancer cells, that is called apoptogens, immune support are very, very important for these cancers and of course deliberates steps to do life quality enrichment so we can make sure that we’ve deliberately taken the energy and the time to maximize our dogs enjoyment in life and the happiness in life.
James Jacobson: There is a…
Dr. Susan Ettinger: I do wanna add one thing, there is some evidence that surgery if it is in an resectable area will allow chemotherapy deviate a little bit more effective, so it can be considered palliative but there is some reason evidence for just still being look at that perhaps if you do surgery first and then add chemotherapy, it’s better than just going straight to chemotherapy. So, it really varies case by case.
James Jacobson: Very good. Thank you so much. There’s a lot of information on transitional cell carcinoma in The Dog Cancer Survival Guide, and I wanna thank you both for joining us today. Dr. Ettinger in New York, Dr. Dressler in Hawaii, thank you.
Transcript of Hemangiosarcoma- What You Need to Know About Your Dog’s Cancer
James Jacobson: One the types of cancer that is discuss in the Dog Cancer Survival Guide is Hemangiosarcomas. Dr. Dressler, I’ll throw this question out to you first. If you have a dog with Hemangiosarcomas, what do you likely looking out in terms of signs and symptoms?
Dr. Demian Dressler: Well, Hemangiosarcomas is tricky because it can occur in a variety of different areas in the body. It can occur in the skin and just right on the surface of the skin and those were not too bad. There’s a little kind of purplish lumps and it bleeds sometimes when they’re pressed or scratched. Those are usually not too bad, but if it invades deeper and there is a growth on the skin that is going down deeper underneath the skin, those are usually more malignant. Now the strange thing about Hemangiosarcomas is, it is characterized as a growth or a swelling that spreading off of the blood vessel and that can be connected to the signs on the dog and I’ll explaine why. Some of these dogs will have Hemangiosarcomas most commonly as a matter of fact in the spleen, the internal organ the spleen. Because of the fact that these tumors are connected to blood vessels, many times that bleed within the tumor itself or sometimes into the abdomen and these dogs can the first to show signs very very suddenly with all the said having decrease in energy level and weakness in the back legs to the extent that sometimes they’ll actually collapse and grow very very pale because one of these tumors is bleeding internally. There is a third or not a third but there is yet another form where it can sometimes affect the heart and those dogs will show signs of heart disease, and those, these dogs will have many times coughing, many times it’s going to be lethargy, sometimes abdominal swelling, sometimes laboured breathing, and also collapse. So, there’s a variety of different signs that you can see with Hemangiosarcomas all depending on where it pops up in the body.
James Jacobson: Dr. Ettinger, your thoughts of Hemangiosarcomas.
Dr. Susan Ettinger: Yeah, the most common form that I see of the different types of Hemangiosarcomas which is again a cancer of the blood vessels is the one of the spleen. That is a really frustrating cancer for both Oncologist and for the guardian it is an aggressive cancer, it fills with blood that as Dr. Dressler points out can cause internal bleeding and can really make a dog very sick very suddenly. But it’s also a very metastatic cancer and so we think about surgery that remove the spleen as the main treatment option, but again this is a cancer that is probably metastasize over yet at that time, and chemotherapy is typically used afterwards. But again it’s a frustrating cancer. It’s not one of the cancers where the survival times are as long as some of the other cancers and it’s a hard cancer for everyone involved.
James Jacobson: Dr. Dressler, any final thoughts on treatment options for Hemangio?
Dr. Demian Dressler: Yeah, many times surgery is something that will get the dog out of the immediate crisis that is remove the source of blood loses if it is from a bleeding internal tumor which is one of the most common presentations. We have to also remember that in addition to chemotherapy, a diet, diet change, healthy cancer diet is very important and we want to give supplements, there are certain natural compounds found in plants called apoptogens are better able to turn on cells suicide in cancer cells but this has been shown in petri dishes and in test tubes, and those are important to supplement as well, and of course we cannot forget life quality enrichment which is an important part for over all well-being and immune support and the different areas really a full spectrum care and helps these dogs with hemangiosarcomas.
James Jacobson: There’s a tremendous amount of information of hemangiosarcomas in the Dog Cancer Survival Guide. I want to thank both of you for joining us today. Dr. Ettinger in New York, Dr. Dressler in Hawaii, thank you.
Transcript of: Mast Cell Tumors- What You Need to Know About Your Dog’s Cancer
James Jacobson: One of the common types of cancer that you guys both talk about in the dog cancers survival is mast cell tumors. I wanna first start off with you Dr. Dressler. What might a dog guardian see if their dog has been diagnosed with mast cell?
Dr. Demian Dressler: That’s a tough question. The reason why it’s a tough question is because mast cell tumors are characterized by having a variable appearance. That means that they can look very very different. As a consequence of this, they can be called the great impersonators at, or sometimes great imitators. They can look very very different. Now, classically when you think of a mast cell tumor as a clonation you think of a red rays inflamed growth. That’s probably the most common presentation meaning that’s probably the most common way that it shows up on a dog in the most common location for mast cell tumors of the skin. However, mast cell tumors can occur anywhere in the body and they can look like anything. One of the hallmarks of mass cell tumors though are that they secrete a certain chemicals which create inflammation and many times that will account for the redness and the swelling and sometimes the discomfort that you can see around the mast cell tumor and some of the internal organ signs as well.
James Jacobson: Dr. Ettinger, your thoughts on mast cell tumors.
Dr. Susan Ettinger: Mast cell tumors are a very complicated cancer and that the outcome in one dog will be very variable from another dog. One of the most important tools about the oncologist or a Veterinarian will use in to try to predict is the grade which is determined by the biopsy once the tumor is removed. And there are classically three grades and these can help the clonation try to predict how was gonna be, but some dogs with the mast cell tumor we gonna be cured with the relatively simple surgery and some dogs may need surgery radiation in to where chemotherapy from the conventional tool box. So, it’s a really variable tumor and really wanna, you’re gonna wanna get a specialist involved to help you navigate through the complicated world of mast cell tumors in dogs.
James Jacobson: Dr. Dressler, what are your thoughts in terms of treatment options for mast cell?
Dr. Demian Dressler: Well, one of the most important is always surgery or we, mast cell tumors at least once it’s not yet spread need to be remove with a wide excision. And then there is a variety of different chemotherapy tools so that it can be used for mast cell tumors if it’s appropriate, and when it’s appropriate, and then of course don’t forget we have diet supplements, life quality enrichment, brain chemistry modification, and all of the different “alternative pieces” that we can use traditiously, intelligently so that we can have maximum good quality life for dogs with mast cell tumors.
James Jacobson: There is a tremendous amount of information on mast cell tumors in The Dog Cancers Survival Guide from all approaches using a full spectrum approach, and I wanna thank you both for joining us today Dr. Ettinger in New York and Dr. Dressler in Hawaii, thank you.
Transcript of: Lymphoma- What You Need to Know About Your Dog’s Cancer
James Jacobson: One of the types of cancers that you talk about in the dog cancer survival guide is lymphoma. First of all, I will start with you Dr. Dressler. What are the signs and symptoms that a dog guardian might see if the dog has lymphoma?
Dr. Demian Dressler: Lymphoma is a strange cancer and that lymphoma is starts as a spread cancer. Usually doesn’t form a single bump. Lymphoma many times is discovered by veterinarian during a physical exam or they feel the lymph nodes which, or can be located underneath a jaw or in front of the shoulders or on a legs or on the groin are swollen and those feel like bumps. This is sometimes a guardian will notice this too, they’ll come in to the vets and they’ll say to me, “Well, Dr. D. what are all these bumps underneath my dog’s chin or I feel this bumps in the back legs or these types of things. These bumps can swell many times without the dog actually showing signs of illness that would be things like decreased appetite or vomiting or diarrhea or thirst changes and these types of signs. So, typically with lymphoma you’ll see one or the other or both. In other words, swollen lymph nodes or some changing behavior that would let you know that your dog is not feeling well.
James Jacobson: Dr. Ettinger?
Dr. Susan Ettinger: Yeah, I think lymphoma is as Dr. Dressler said a unique cancer and that it’s systemic that it spreads throughout the body. It is one of those cancers were once your veterinarian has made the diagnoses, I encourage you to get in into specialist as quickly as possible, ’cause it’s really, it’s a little scary in a sense of it. It is a pretty rapidly progressing cancer and without treatment, most dogs only live on average a month. On the flip side, in my opinion, it’s one of the more treatable cancers and that treatment, the basis of treatment is chemotherapy. Dogs live well and they live longer with treatment in on average will live well over a year, 13 or 14 months. So, it’s a rapidly progressive cancer but in my opinion a very treatable cancer, but it’s one that you wanna make a rapid decision and you wanna get in and see a specialist sooner rather than later.
James Jacobson: Dr. Dressler, any final thoughts on lymphoma.
Dr. Demian Dressler: Lymphoma like other cancers should be treated by looking at the whole tool box, the entire array of treatments. Lymphoma is not one where we use surgery often because the cancer cells are spread throughout the body. They start in the lymphatics and they are moving around the body, so we don’t really have a mast to remove. We also sometimes will use radiation from time to time, chemotherapy is the foundation of conventional treatment for lymphosarcoma and we must include to really get maximum survival advance, your maximum life quality also diet, and apoptogens which is substances that turn on cell suicide in cancer cells, and the other full spectrum approaches which can really help us and which are outlined in The Dog Cancer Survival Guide.
James Jacobson: A lot of information on lymphoma if your dog has lymphoma in The Dog Cancer Survival Guide. Dr. Ettinger in New York and Dr. Dressler in Hawaii, thank you both for being with us.
Dr. Demian Dressler & Dr. Susan Ettinger: Thank you.
Transcript of: All Natural, Homeopathic & Holistic Approaches to Dog Cancer Care
James Jacobson: When you find out your dog has cancer, you may think I’m not gonna go the traditional route I am gonna go the total homeopathic route for my dog’s cancer. I want it to ask both of you veterinarians what your thoughts are about going the homeopathic route.
Dr. Demian Dressler: It’s interesting when we look at the different treatments that we have available. We should also differentiate between homeopathic vs. holistic or alternative. This homeopathic has to do with using very minute amounts of substances in the body to try to create a certain effect and alternative or holistic usually refers a branch of medicine that is non-conventional in the area of cancer. The conventional stuff is surgery, chemotherapy and radiation. In the holistic compartment we have diets, supplements, acupuncture mind, body, and the touch therapies thing of this nature. When we look at homeopathies specifically which is again very very small amounts of substances in the body elicit a certain effect, there is not that much evidence that we have to support the use of homeopathy. There are few studies out there with this brain tumor, and not really all that much else. If you look at all of the literature whether it’s from Europe, Germany where homeopathy came from, or Asia, or the United States, there is a very little good information there. So, all we have to rely on is people’s opinions and experiences where they call anecdotes individual case studies. The problem is, is that we were creating a full spectrum plan for a dog, we wanna make sure that we’re using something that’s high yield and we want to therefor pick things where we know again we’re gonna get a good benefit or a high odds ratio of a good benefit. My opinion on homeopathy is that the homeopathy is not one of the top therapies that we have to use for K9 cancer, although it can help a little bit potential in certain cases.
James Jacobson: You mentioned a full spectrum, there’s a whole video in the series about that but just briefly, what is your whole, your full spectrum approach? How does that differentiate itself from homeopathy, or holistic medicine, or alternative vet medicine?
Dr. Demian Dressler: One of the downside that is happening in the holistic medicine division, the area right now is that there are some veterinarians who are alternative who are willing nearly indiscriminately grabbing a whole bunch of different things to use. They’re not looking at necessarily at efficacy, and they’re not looking necessarily at safety. Both of those things are very very specific and important to us because there is whole slew of f “natural” or “holistic” things out there that we can choose from. If we’re not selective, we end up doing is picking 10 or 15, or 25 different treatments to use for a dog and we may not be benefiting the dog and in some cases we may even be hurting our loved family member.
James Jacobson: Dr. Ettinger, your thoughts.
Dr. Susan Ettinger: I think Dr. Dressler brings up a great point and I think that’s, the frustration of some of the conventional Oncologist out there, and I consider myself to be more open minded. I think people it’s important to be integrative. I think people should realize they don’t have to just pick conventional or just pick holistic. It’s great to find an integrative approach where maybe you’re gonna do a little of each but not just do everything. I think you wanna talk to an expert who can help you, guide you through all of the holistic treatments or all of the conventional treatments and then pick what is really best and you don’t have to pick one or the other. I think that’s where a lot of people feel torn is that they don’t think they can do both. I think you can do a little bit of both very safely. Again, you just probably gonna have to bring two experts together and work as a team.
James Jacobson: That sort of what the Dog Cancer Survival Guide is all about where you are just talking about the best approaches regardless of, from which field of veterinary medicine it came from. Dr. Dressler thank you so much, Dr. Ettinger thank you both for being with us.
Dr. Demian Dressler & Dr. Susan Ettinger: Thank you.
Transcript of: Dog Cancer Remission- What Can You Expect
James Jacobson: When your dog has a cancer, the words you wanna hear after you go to the treatment process is, “It’s gone, it’s cured, your dog’s in remission”. First of all, how likely are you to hear that and what are the different types of remission? We’ll start with you first Dr. Ettinger in New York.
Dr. Susan Ettinger: So, if you’re with remission usually what the Oncologist is referring to is that there’s no detectable cancer based on the tasks that they’re doing. Whether it is filling the lymph nodes for a lymphoma patient or doing a fine needle aspirate of the lymph nodes or for maybe hemangiosarcomas they did chest X-rays, and an ultrasound and there’s no detectable evidence of those cancer elsewhere in the body then you’ll hear the term remission. I think to once where lymphoma which is one of the more common malignant cancers in dogs that I treat, you’ll hear a sort of levels of remission. Complete remission meaning the cancer is no longer clinically detectable. Partial remission, stable disease, and then the frustrating one to hear is progressive disease that the cancer is on the move or getting bigger or not responding to treatment as we would like it too.
James Jacobson: Dr. Dressler, how often do you get to say that your dog’s cured or we got remission?
Dr. Demian Dressler: I think it depends on the definition of the word cancer, because usually when we think of cancer we think of “systemic malignancies”, and a systemic means that it’s involved in a system or the whole body, it spread, and the malignancy means it’s aggressive, progressive and does not stop dangerous. However, there are growths that our cancerous growths that can actually be cured in veterinary medicine. Those are usually localized. In other words, they can be removed to a surgery. Therefore, with those growths, we do a certain surgery. Usually we do a wide margin meaning we take out a lot of normal tissue, normal appearing tissue around the growth and we can occasionally get actual cures even with true malignancy. So, it is important to remember the type of cancer that we’re talking about and what our expectations are with this particular type of cancer.
James Jacobson: Dr. Ettinger, how often do you see remission with the patients that you treat?
Dr. Susan Ettinger: I think, it really varies with the different types of cancer. Again for lymphoma, the average remission for a dog is over a year. It’s about 13 or 14 months with what I say a good chemotherapy protocol and if you remember that most dogs have a shorter life span sadly than people. That can be a really good extension of their life and they feel really well and live well during that time. So again, we don’t want our pets just to live longer with treatment, we want them to really live well. So, and I think that’s a hard thing for most guardians to sort of wrap their head around when they first come in and then they start listening to statistics and numbers. We all want our pets to live many many many years, but their life span is shorter and you have to compare how long the remission rate is to know treatment, and then put out into perspective to the anticipated length of your dog’s life. So, again, I think remission is variable and it depends on the cancer and again no treatment versus the treatment itself.
James Jacobson: Dr. Ettinger, Dr. Dressler, thank you so much. There’s a lot more information in The Dog Cancer Survival Guide. Thanks for joining us.
Dr. Susan Ettinger & Dr. Demian Dressler: Thank you.
Transcript of: Metronomic Chemotherapy for Dog Cancer
James Jacobson: When you’re using chemotherapy for your dog’s cancer, there are different ways of giving it at different amount that deals with metronomic chemotherapy versus maximum tolerated dose. Do we have that right Dr. Dressler?
Dr. Demian Dressler: That’s exactly right and the traditional or conventional way of delivering chemotherapy is to give as much as possible, as frequently as possible, and we say maximum tolerated dose. Tolerated means how much can the pet’s body withstand before having side effects are unacceptable. Like serious organ failure or worst case scenario scary things like death. So these doses have been work out in such way that we give as much chemotherapy drug as possible and minimize the odds of these very very high impacts side effects, and that’s maximum tolerated dose. Now, we will see higher rates of side effects and sometimes serious side effects in comparison to other therapies or other treatments in different areas of other medicines. So for example an antibiotic or hormone therapy, or something else. It’s true that in the area of chemotherapy I’m not trying to scare everybody, but the area chemotherapy we do have higher side effect rates. Now, we contrast these maximum tolerated dose method with something called metronomic chemotherapy, and with metronomic therapy what we’re doing is we’re giving a much much lower dose and the design of that treatment method is to help to supress the cancer, spread to limit its growth and to improve our longevity.
James Jacobson: Dr. Ettinger, your thoughts on this subject.
Dr. Susan Ettinger: Yes! With the maximum tolerated dose in most of our dog patients that those limiting toxicity is the white blood cells. So, when you’re giving this high dose chemotherapy, you are trying to kill rapidly dividing cells in typically those of the cancer cells and you’re trying to kill those cancer cells directly. White blood cells are also rapidly dividing. That’s usually where you got to the top dose you can give to a dog. With the metronomic just as Dr. Dressler said, you were giving a much lower dose of chemotherapy usually with no interval, no break between the chemotherapy. So when you’re doing maximum tolerated dose, your dog will get chemotherapy once a week or every other week or maybe in every three weeks. When you’re doing low dose oral chemotherapy or metronomic chemotherapy, your pets gonna be getting probably some oral anti-cancer therapy everyday of the week or at least every other day. So again, there’s a very little break. Instead of targeting the cancer cells directly, you actually targeting the blood vessels that feed those cancers and allow them to get bigger than about a centimeter which is about the size of most people’s thumb now. So, if you can target those blood vessels, those cancer cells can’t get nutrients, they can’t get blood supply and they’re not gonna get bigger. Again that is called antigiogenesis, and that’s the goal of metronomic chemotherapy.
James Jacobson: Do you see that being use with increasing frequency?
Dr. Susan Ettinger: I do, but I don’t think that every cancer is gonna benefit from metronomic chemotherapy. We’re definitely seeing a role for it for dogs that already have metastasis or cancer that has spread and that’s the big place where we’re using metronomic chemotherapy. Probably the number one place that I’m using it in my patients. For those dogs that they come in and they’re cancers spread in general maximum tolerated dose chemotherapy doesn’t help them very much and we can drive our course of metronomic chemotherapy. I’m seeing really some amazing results when dogs at metronomic therapy. I have dogs where I would have guessed that they would have live to only one or two months with cancer spread and with this metronomic approach. I am seeing some dogs that are out 8 months to 10 1/2 months, over a year and there on this drug chronically and they tolerate it really really well with good guidance.
James Jacobson: So, a lot is not necessarily better than a little and I think this applies to lots of things in life.
Dr. Demian Dressler: There’s an interesting little side note to this out in mother nature, there are natural compounds that have in test tubes and petri dishes in the molecular biology compartment, a lot of the effects that the pharmaceuticals have in attacking those enzymes and those molecular machinery that impacts the blood vessels. There are certain things out in nature that have some similar effects and we do talk about those in the book.
James Jacobson: A lot of information more than we can cover in this video is in The Dog Cancer Survival Guide. Dr. Dressler in Hawaii, Dr. Ettinger in New York. Thanks so much for being with us.
Dr. Demian Dressler & Dr. Susan Ettinger: Thank You!
Transcript of: Palladia™ and Dog Cancer- What You Need to Know
James Jacobson: One of the more common drugs that’s used in cancer therapy is one that is only recently come to market it’s called “Palladia”, and let me ask you first Dr. Ettinger, tells us a little bit about Palladia and your thoughts on that.
Dr. Susan Ettinger: Yeah, Palladia is a really exciting new drug for a lot of different reasons. First, it is the first FDA approved drug for dogs. Most of the other cancer, anticancer therapies that we use in dogs so your traditional chemotherapy drugs were designed for people and over the years, we’ve learned how to give safely in dogs. So, Palladia was designed for dogs, and it was actually targets a mutation that about a third to a half on dogs with mast cell tumors have. So it’s a class of drugs called secret inhibitors and it targets its mutations that some dogs with mast cell tumors have.
James Jacobson: Okay, you use it for what kinds of cancers?
Dr. Susan Ettinger: Well, obviously, the number one cancer that we use it for is dogs with skin or cutaneous mast cell tumors. But we’ve also learned that this drug inhibits some of the other antiangiogenic receptors. So, it can be use or something called antiangiogenesis. So, we’re learning as a drug has been available for about 2 years now that it’s having some efficacy for some other cancers specifically fibro carcinomas, anal sac carcinomas, and osteosarcomas. So, it’s being use a little bit more wide spread than it was initially designed for.
James Jacobson: Ok, and Dr. Dressler, what are your thoughts about Palladia?
Dr. Demian Dressler: I think Palladia has its certainly has its place in the tool box that we have available for treating K9 cancers. It got a lot of press because it was the first drug and as such became very well known the first drug approved for K9 cancer. Now, we should understand that most of the drugs that we use in conventional cancer care in dogs are actually human drugs that approved for use in humans and maybe more frequent than the use of Palladia.
James Jacobson: Ok. Now, there are some interesting side effects from Palladia, in cautions related to Palladia, right? Do you wanna pick up on that?
Dr. Susan Ettinger: Well, Palladia is an oral medication that you’re giving at home. Usually, every other day or on a 3 time-a-week schedule. So, commonly we’re using it Monday, Wednesday, and Friday. So, most of the time when we’re administering injectable chemotherapy at the office, if their dogs gonna get side effects, it’s usually gonna be within the first couple of days, and within a couple of days the dog has gonna get over those side effects. With Palladia, since it’s continually, continuously being given by the guardian at home, those side effects can continue to build up and it’s really important if your pet’s having any side effects. Weight loss, vomiting, diarrhea, changes in appetite or energy that you contact your veterinarian and you stop the medication. It is more important to give the pet a palladia holiday than to keep plowing through the side effects. So, it’s really important to early recognition of side effects. Stop the medication, and then contact your Oncologist or your Veterinarian who’s managing the case with you.
James Jacobson: Dr. Dressler?
Dr. Demian Dressler: Absolutely! And, if one digs a little bit either in conversation with the Oncologist or even online. There are data available that give you the odds, the statistics. Ok, what are the odds of getting a side effect? Then, I think with palladia it’s a 30/40% or something like that of some sort of GIFs, vomiting or diarrhea. These types of thing and there are more rare and more serious one as well that you can find. It is important that as a guardian if you don’t understand exactly what that means? Dr. Ettinger operates in the area of chemotherapy and as such for her it could be that seeing a dog who’s vomiting it would be more routine because that’s something that does come out from time to time. But as a guardian, one of the duties is to ask yourself, “Ok… am I prepared for this”? As long as you’ve prepared yourself for what’s going, then at that point you can make a decision. But, always ask. Ask, ask, ask. Get the data that you need.
James Jacobson: Ok. I guess final question Dr. Ettinger I’ll throw this to you. What’s the price tag for Palladia?
Dr. Susan Ettinger: Well, that probably will depend a little bit on what part of the country you’re in. But, in general for about a 70 pound dog who’s on the medication either 3 times a week or every other day. Just for their drug itself, you’re probably looking at about 500 dollars per month. So, I have to say in this spectrum of some of the other injectable drugs, it’s pretty, moderately priced, but moderately priced. It’s not one of the most expensive drugs that we have.
James Jacobson: Ok. Dr. Ettinger of New York, Dr. Dressler in Hawaii, thank you so much for being with us. More information, a lot more information on Palladia and all sorts of different cancer treatments both chemotherapy and natural in The Dog Cancer Survival Guide. Thank you both.
Dr. Demian Dressler & Dr. Susan Ettinger: Thank you.
Transcript of: Are You a Dog Lover or Dog Guardian- Helping Your Dog Survive Cancer
James Jacobson: Here’s an interesting question that I want to throw out to you first Dr. Dressler, what is the difference between being a dog lover and being a dog guardian?
Dr. Demian Dressler: That’s an excellent question. There can be confusion in our minds not only as veterinarians but also as owners, “of dogs”. The confusion is this, on the one hand we want to enjoy the things that our dog gives us, that is receiving and we have a loving relationship with the animal and works in both directions. Now there’s the other role and that’s us giving, and that’s guardianship. Guardianship is something that takes energy, and vigilance and discipline and that’s the action of looking out for your dog as a protective guardian and making decisions and the truth of it is some of those decisions can be tough, so that’s the difference between being a pet lover and areal guardian.
James Jacobson: You talk in the book a little bit about the role of a, you make the analogy of a secret service agent can you expound on that?
Dr. Demian Dressler: The secret service agent uses vigilance, they’re always vigilant, they’ve got their ear piece, they’re always scanning the horizon, they’ve got their binoculars they’re communicating with other secret agents. Their main job is that of a protector and they will go to any extreme to protect the person that they are protecting, the politician, president, or what have you. A secret service agent is kind of a useful metaphor although there’s nothing secret about it but the act of vigilance, I think is the real critical defining factor in guardianship, and it’s not always fun, it can take some work.
James Jacobson: Dr. Ettinger, any thoughts?
Dr. Susan Ettinger: One thing I always try to remind the guardians when they’re in the room because they are so worried about making the right choice for their dogs, and I think one of the gifts of being a dog with cancer they can look at it that way is that the pet themselves doesn’t actually have the process all the confusing information statistics, that may end survival times. All that information that we share with them at the appointment and the dog really just want to live in the moment be with their guardian because they are happy when they’re with them and I think actually not having to worry about all the information that the guardians is worrying about is probably not a bad way to live. I always tell my guardians we could learn something from our dogs they live in the moment they wanna be pain free, they wanna be happy but they worry a little less about the information and I think that’s probably not a bad way to live.
James Jacobson: We could all learn and benefit from that concept. Dr. Ettinger in New York, Dr. Dressler in Hawaii, thank you both for being with us today!
Dr. Susan Ettinger & Dr. Demian Dressler: Thank you!
Transcript of: Dog Cancer Surgery- The Importance of Clean Margins
James Jacobson: When you are doing a surgical procedure to remove your dog’s cancer, one of the things that you’ll often hear and the best to talk about is clean margin. So, what is a clean margin and why is important? Dr. Dressler?
Dr. Demian Dressler: A clean margin refers to the edge of a submitted specimen. So, if I’m a Veterinarian, I’m doing a surgery and I removed the growth and I will submit it to a pathologist, and the pathologist will go around the edge at certain specific locations to see if there are still cancer cells at the edge of the submitted specimen. Why is this important? Well, this is one of the ways that we can tell or at least get information about whether or not there are still cancers cells left in the dog. So, when we talk about “clean margins” we’re saying, ok, the pathologist didn’t find any cancer cells on the edge of the submitted specimen, so, maybe the cancer cells are out of the dog, or we can say we have dirty margins where the pathologist found cancer cells along the edge and therefore we can say very likely that there are still cancer cells left at surgical sight around the edges of the incision.
James Jacobson: What happens if you don’t get clean margins if the pathologist comes back and says you don’t have a clean margin, what happens, then?
Dr. Susan Ettinger: I think before we jump to what to do next, I think it’s also important to take those margins with respect to the cancer and the location. If your dog has a benign tumor that remove a couple of millimeter could be considered clean, and I think it’s really important to make sure you and your veterinarian make sure that those margins are quantified that they give you an actual measurement because I’ve seen all too often what I call the margins clean. But then you read the fine prints and they say it’s 2mm. 2mm is not gonna be considered really clean or adequate for most malignant cancer. So, it’s really important that it’s taking in respect with what the cancer is, because i think that’s really important and it changes.
James Jacobson: So you can’t really think as big a chunk are otherwise obviously you’re doing more you could potentially be doing more damage to the dog.
Dr. Susan Ettinger: Well, and it’s just important for the tumor type for malignant cancers are somewhere 1-2cm margins is considered the gold standard and adequate, but there are some cancers where you may need some soft tissue sarcomas where, it maybe 3, 4cm margins, and so if it’s just clean, and then you find out that it was only a half centimeter margin, it puts your dog at risk for reoccurrence, and if you know that earlier, then you can do something like either scar remission where they’re gonna go back and get more tissue if it’s on a part of your dog’s body where that’s an option, or maybe you’re gonna look towards radiation therapy to prevent reoccurrence. You might choose to do a wait and watch approach, but at least you know that your dog is at risk for recurrence, and interestingly the metronomic approach has also been showed it in some cancers to delay the recurrence as well. So, that might be something more of talking to your veterinarian about depending on the tumor type.
James Jacobson: Great information. Dr. Ettinger thank you so much, Dr. Dressler thank you so much.
Transcript of: Vomiting and Dog Cancer What You Need To Know
James Jacobson: From the letters that we get, I understand that one of the side effects that people sometimes deal with when their dog has cancer is vomiting, this dogs with sick bellies. I would like to ask either you Dr. Dressler or you Dr. Ettinger your thoughts on dogs that are vomiting when they have cancer and what you can do about it?
Dr. Susan Ettinger: I can start on this one I think vomiting is something that you see as a result of the cancer itself. That’s due to the toxins that are released from it so sometimes patients will present as vomiting as one of their symptoms. and then also some of the treatments, specifically chemotherapy can cause vomiting in some patients as well because the chemotherapy drugs attack the intestinal tracts which can cause vomiting or can actually trigger through some brain receptors as well, luckily there’s some really good medications in the market some of them are specifically for dogs some of them are even medications and they’re relatively inexpensive and they can be started once a patient has a vomiting as a result of treatment or in some drugs we now know if your dog is getting erythromycin which is also called doxorubicin there’s a great new study that choose that starting the nausea meds with treatment for 4 days after treatments will decrease the incidence of vomiting associated with that…
James Jacobson: Dr. Dressler, your thoughts…
Dr. Demian Dressler: Absolutely! It is calm and unfortunately on the pharmaceutical side we’ve got medications like the Mirtazapine or Metoclopramide and these are pharmaceutical ways of decreasing the nausea then in times it raised the tummy by limiting the intake of water and then often for a few days we’ll serve the patient on what’s called a bland diet, highly digestible diet which is little bit of rice, a little bit of non-fat cottage cheese, perhaps a little bit of fried meat chicken it’s kind of like how you give babies bananas, rice stuff or sauce in toast in humans, in dogs that’s the equivalent.
James Jacobson: Okay, make sense. How do you know when there’s too much vomit, and there’s when your dog is really, really sick and you want to talk to your vet about that?
Dr. Susan Ettinger: I usually tell owners if it’s 1 or 2 episodes of vomiting within the first couple of days after chemotherapy it’s usually not a big deal. I agree with Dr. Dressler that you wanna rest the intestinal tract, if there’s some vomiting a lot of people get really anxious and they try to feed their pets through it which usually just exasperate the problem. But if there is 4, 5, 6 episode within 12 to 24 hours, that pet’s gonna get dehydrated and is really gonna benefit from coming in to the hospital and given intravenous fluids and injectable anti-nausea meds. So that would be a good time to bring your pet in to the hospital.
James Jacobson: Okay, great. Well, Dr. Ettinger in New York, Dr. Dressler in Hawaii, thank you so much. A lot more information’s available in The Dog Cancer Survival Guide.
James Jacobson: When the dog has cancer one of the things that can happen is the dog can feel nauseous and that happens i guess, not only as a result of some treatments produces it as a by-product of having cancer. Is that right Dr. Ettinger ?
Dr. Susan Ettinger: Yup! It can be, i mean sometimes it’s more direct or just a cancer in the abdominal cavity and pushing on some receptors making a pet nauseous, or just some like chemicals that are released from it and then sometimes from the treatment itself specifically chemotherapy.
James Jacobson: Ok, and Dr. Dessler, when you see dogs that are nauseous with cancer are there certain things you can do natural things to make a dog feel better?
Dr. Demian Dressler: Yeah! Absolutely! I mean, when we’re talking about using full spectrum care, we need to contemplate, everything that we have in our disposal. Some of these dogs are quite nauseous. It will just take 2 seconds to go over signs of nausea. Probably the number one sign of nausea in dogs is decreased the appetite. Sometimes they’d go up to their food bowl, started to look at it act interested and then turn tail and walk away. It’s very strange thing because many times guardians will ask, “well, he looks like he wants to eat but he can’t”. But the strange things is the brain pattern is there and when it’s time to actually do the eating, well, there’s very little interest and they walk away from the food bowl. So, there’s other sign of nausea too. Many times that we can have is lips smacking which is kind of, leaking of the chops so to speak and then obviously vomiting would be an obvious sign of nausea. Now that Dr. Ettinger talk about some of the conventional practice of dealing with nausea and it something that does come up another one with the cancers as a consequence of this certain reactive chemicals that get secreted in the blood stream many times to the dying tissue, dying cancer cells, or inflammation in the body that is connected with cancer and also has Dr. Sue is talking about the pressure and would not, but also sometimes..
Dr. Susan Ettinger: But I think also in another quick one to add is drooling a lot of dogs will drool at the smell of food so the similar thing they may walk up to their food, and they’ll just start to drool, and that could be that really stringy, gooey stuff just coming out of their mouth and that’s a really common sign of nausea that I also see.
James Jacobson: Yeah! So, what is some things to be done about it?
Dr. Susan Ettinger: I mean, there are definitely from my stand point anytime I’m starting chemotherapy interestingly as opposed to people most dogs do not need to be pre-medicated with nausea medications but I will always send all of my guardians home with what I call “just in case medications” Those will be some medications that have been shown to be very effective for nausea. A really common one that’s approved for dogs now is called seronia. The nice thing about seronia is it’s a once a day medication. So, usually I tell owners if you are noticing that your dog is showing any of the symptoms, you know Demian just mention go ahead and give a dose of seronia. If they start eating normally, you don’t have to continue, its not like antibiotic so you can really use it as needed and use it quite safely. There are few chemotherapy drugs such as doxorubicin which also called erythromycin with some recent studies have shown than just go ahead and using seronia for the 4 days after treatment has been shown to really decrease some of the GI side effects to the gastrointestinal side effects that we see with those. So your Oncologist may recommend, just go in ahead and using the seronia with automatically after some drugs, or if we start to learn that your dog get sick from a certain drugs, we will go ahead and use the medications propolactically because in some instances it is easier to prevent nausea than to treat it after it get started.
James Jacobson: Then rather natural from anything Dr. Dressler that you’d recommend to counteract nausea?
Dr. Demian Dressler: Yeah! There’s a couple of different things we talk about the addition of plain old ginger which interestingly has some anti-nausea effects and these are published to everything that we talk about in the dog cancer survival guide has data. The full spectrum approach is always data driven. There’s nothing that you’re going to be reading that comes out of the dog cancer survival guide, the blog, the dog cancer diet that’s just sort of made up. It is all backed up by a good Science. So, anyway, the ginger which is one of the additions of the dog cancer diet has some anti-nausea effects. It blocks chemical signal called substance P and also some other inflammatory mediators that things cause inflammation in the tummy and it’s a really nice gentle way to help with nausea.
James Jacobson: Great! Lots more information on the subject of nausea and what you can do about it if your dog has a cancer, and lots of other information in the dog cancer survival guide. Dr.Ettinger in New York, Dr. Dressler in Hawaii. Thanks so much!
Transcript of: Cyberknife Use with Dog Cancer- Cutting Edge Technology
James Jacobson: One of the interesting things is seeing how human medicine is applying to veterinary medicine and the technology is constantly changing. One of the tools that’s use increasingly in human cancer treatment is to be called the cyberknife. Dr. Ettinger you know a little about that because you’re using that in the veterinary medicine at your hospital in New York. Tell us about that.
Dr. Susan Ettinger: The cyberknife is a type of unit for type of treatment called radio surgery which is a little bit of a confusing name for most people cause there’s no surgery involved but actually we’re using the radiation beam in place of surgery. One of the big requirements for a dog or a cat to be treated with cyberknife radio surgery is that they actually have measurable tumor. It’s not gonna be good for your dog if they have a surgical scar that was determined to have incomplete margins or tumor cells left at the surgical scar. In general, we’re using it for non-surgical cancers. The number one type of tumor that we’re treating is brain surgery so you can imagine a lot of dogs with brain cancer there in parts of the brain that are not very accessible when they have a measurable tumor in that area. The second most common type of tumor that we’re treating with the radio surgery with the cyberknife unit is nasal cancers. We’ve treated over about two hundred and fifty dogs to date, we’ve been treating dogs for about three years here, uh, and we…
James Jacobson: Your one of the only places in America where you’re using a cyberknife on animals, right?
Dr. Susan Ettinger: Yeah, I think we’re, there may be another place that’s using one, Colorado State University has a different type of radio surgery unit, but there may be one other place out there at this point, but when we first open, we were the first place to be using cyberknife radio surgery.
James Jacobson: So this is still pretty cutting-edge…
Dr. Susan Ettinger: This is very cutting-edge…
James Jacobson: So pun intended, which cancers again are the best candidates for cyberknife?
Dr. Susan Ettinger: I have to say that hands down brain cancer, cyberknife is the treatment of choice for brain cancer. For these non-surgical brain cancer patients, the advantage of cyberknife is that we can treat their tumor in one to three treatments. If it’s three treatments it’s done in consecutive days. The alternative is fifteen to twenty treatments with daily anaesthesia which is required for dogs for radiation therapy. Again, one of the other differences besides decreased number of treatments again one to three decreased numbers of anaesthesia, decreased number of trips to the hospital; is also we’re getting less side effects and the main difference with cyberknife radio surgery in conventional or traditional radiation therapy is our type of radiation that’s very conforming to the type of the tumor. So we treat within sub-millimeter accuracy around the tumor and we do not….
James Jacobson: Meaning, very, very small, very precise.
Dr. Susan Ettinger: Very precise treatment and we get very little side effects from our treatment because we’re not treating much of the normal tissue if any that is just around the tumor. Again, that’s the huge difference between conventional radiation and the cyberknife radio surgery.
James Jacobson: Dr. Dressler, what do you think, you’re in Hawaii, obviously there are no cyberknifes in Hawaii, what do you think about this leading edge technology that’s being moved from humans to dogs?
Dr. Demian Dressler: Well, I think it’s great. I honestly believed that this is a prime example of getting rid of our biases. I have always advocated something I call full spectrum care and by full spectrum care, what we’re talking about is using any tool that can benefit our dogs. For us to be able to use any tool that can benefit our dogs, regardless of the color of the wrapping paper that is being delivered in, we need to get rid of our own biases. We see bias happening a lot in many different camps, say in conventional veterinary care, I come from a conventional veterinary care background, I’m a trained conventional veterinarian, graduated from Cornell University and I learned conventional veterinary care and practice conventional veterinary care.
James Jacobson: Both of you guys graduated from Cornell.
Dr. Demian Dressler: That’s right… Sue and I went to school together.
Dr. Susan Ettinger: We did…
Dr. Demian Dressler: A funny story… but anyway, back to what we’re talking about, the important thing for say a conventional veterinarian is to say, “Okay here we have a circumstance a brain tumor, nasal tumor something like that where we don’t have a lot of very successful option, so what we’re dealing in terms of success rate, it’s increasing survival times, it’s not really all that great, for most guardians and frankly for most veterinarians also”. So we need to search for other sources of information so that we can do better, we can do a better job and the cyberknife is an example of these. For example, there may be veterinarians out there who would call themselves holistic or alternative veterinarian or something like that and they’ve got bias there, where they may say, “Okay we don’t want to use antibiotics, we don’t want to use this tool”, and you as a guardian may lose access to something that may benefit your dog just like a conventional veterinarian may say, “Hey, I’m not gonna use acupuncture”, or meanwhile on places like the Mayo Clinic which are a huge cancer treatment centers for people they built acupuncture and is now a standard of care that’s part of proper treatment for cancer. So we need to avoid these biases when we’re contemplating high tech advances in the conventional front such as a cyberknife which by the way is very cool. I was out in New York recently, went up to Yonkers, went up to the animal specialty center, saw all the cyberknife the thing is amazing, and for the right case and the right guardian and the right type kind of cancer, the cyberknife would be something that we should be considering.
Dr. Susan Ettinger: Yeah, I mean we’ve actually treated dogs from Canada, we’ve treated dogs from couple weeks ago, we have some guardians drive in with their dog from Chicago, Virginia, Florida. So, one of the nice things because it’s so few treatments is that a lot of people will come into town for a week and we got the treatment done for them. It’s nice if they can travel lot of people will drive on in after giving us a call on making sure obviously that it’s the right case for cyberknifes…
James Jacobson: If it’s the right case, what’s an average ballpark figure for a cyberknife treatment?
Dr. Susan Ettinger: The cyberknife, including all of the imaging, we have to do CT Scans beforehand even if they’ve been done just because we have to do some markers for our machine for the planning. But in general, somewhere between 7500 and 8,000 dollars for the treatment. That includes all the imaging, all the anaesthesias.
James Jacobson: Okay, great. Dr. Ettinger in New York, Dr. Dressler in Hawaii, thank you so much.
Transcript of: Which Dog Cancers are Best Treated with Chemotherapy
James Jacobson: The next question we have here is dealing with chemotherapy. Are there certain cancers which are best treated with chemotherapy? For that I will give it to you Dr. Ettinger, as a Veterinary Oncologist. What are the best cancers that response the best to chemotherapy?
Dr. Susan Ettinger: Well, the number one cancer that we treat almost exclusively with chemotherapy would be lymphoma which is one of the more common malignant cancers in dogs and a very, very treatable cancer in one where chemotherapy makes a significant difference in the dog’s life, not only from how long they lived but to the quality of life. Just a quick example, dogs with lymphoma without treatment in general sadly only live about a month to really quickly, very rapidly progressive cancer. But with chemotherapy in which most dogs feel phenomenal in quite normal during treatment, they lived over a year on average thirteen or fourteen months. So, that’s probably the number one cancer that we treat exclusively with chemotherapy and are related cancer would be leukemia which is cancer of the bone marrow. Again, that’s another cancer that we treat with chemo. There are a lot of solid cancers, cell cancer that starts in one part of the body, but if they have a very high chance of spreading, typically, chemotherapy will be recommended after the primary cancer is treated either with surgery or radiation. So again, that’s gonna be really important information to ask your Veterinarian or an Oncologist if your dog has a solid cancer that’s a malignant cancer, does it have a high chance of spreading and what are the chances that chemotherapy will delay that, and have your dog live longer which is everyone’s call.
James Jacobson: Dr. Dressler, when do you like to use chemotherapy?
Dr. Demian Dressler: Well, I think after a good discussion with the guardian on the treatment plan analysis. What I mean by treatment plan analysis and we talked about this in the Dog Cancer Survival Guide is a breakdown of what do you get, compared to what does your dog put in, and what do you put in? So, it’s almost like a bank account, you make deposits and you make withdrawals. So, on the withdrawal side, we need to look and say “Okay, if we’re gonna be doing chemotherapy, what do we get? What’s the gained life expectancy?” By gained life expectancy we’re saying “Okay, here we have a dog, here’s a typical life expectancy for this dog.” We talk about again the different life expectancies in the book and we say, “What do we gained from a certain chemotherapy protocol with this individual cancer and as Doctor Sue was alluding to, different cancers respond more or less well to chemotherapy. So, maybe we’ll gain an extra so many months however long it is, or a year, or whatever so it’s gained life expectancy. Then we say, “Okay, what do we have to put into this? What do we have, what are the deposits that our dog is gonna need to make and we’re gonna need to make?” By deposits I’m talking about what is our special family member have to go through to receive the chemotherapy? What do we have to go through both in terms of the financial investment and also in terms of the time and logistic investment? So we need to have a clear idea of side effects, what the odds are, what the costs are and what the commitment is and what the lifestyle adjustment is on the part of the guardian and also of the love dog. Then you, as an empowered primary advocate for your dog, you make the decision as to whether or not the chemotherapy is the good choice.
Dr. Susan Ettinger: I think there’s a couple of things to add that we all want our beloved dogs to be with us as long as possible. A lot of people get very shocked when a Veterinarian or Oncologist says like I just said for lymphoma that the average or the medium survival is thirteen to fourteen months cause that doesn’t sound long enough for me for how long I want my dog to be with me. But you have to put it into perspective of couple of things one is, how long again is, as Demian is saying will they live without treatment but again, also the overall life span of our dogs. They don’t live seventy, eighty, ninety years like people. In people they often talk about five-year survival time, so a year or two survival time for our dog’s cancer is a significant chunk of time that your dog may live with this cancer. I think it’s important to think of cancer sometimes as a chronic disease. We would all love to cure cancer but again a lot of times dogs can live with their cancer and live relatively normal lives. They may require treatment long term but again, it may be something that they can live well with and I think that’s an important thing to remember.
James Jacobson: Well, when you talked about the thirteen or fourteen months that’s what for a particular type of cancer and particular type of chemo. Is that the average what do you call extended life the average amount of time that you get with chemotherapy or is it the average?
Dr. Susan Ettinger: It’s very cancer dependent, for lymphoma, that’s the median. I have dogs with lymphoma; I just had a dog that the owners found me on Facebook that I treated out in California, that dog’s out six years with lymphoma. So obviously, that dog’s on one end of the spectrum which is great. Then sadly there are some dogs that are treated very aggressively with the recommendations that an Oncologist makes and they may only live a couple of months. So these numbers are never written in stone and you always hope that your doctor’s wrong in a sense that your dog’s gonna live longer that the statistics. I think statistics are just to give you a reasonable expectation but realize there are no guarantees hopefully, your dog will live beyond the statistics. But it’s very, very cancer specific and I think that’s again an important time to talk to an Oncologist service specialist and get the information that’s specific to your pet your pet’s cancer.
James Jacobson: Dr. Dressler, you are looted to making deposits and talking a little bit about money. Is there an average price tag if you decided to go with a traditional route like an Onco… like chemotherapy?
Dr. Demian Dressler: That’s a little bit tough to answer with a single answer. Cause it’s gonna depend on cancer, it’s gonna depend on what the chemotherapy protocol is. It’s also going to depend on where you’re located because Veterinary prices an Oncologist prices will vary depending on the geographic location because cost of living is different and these types of things. There’s gonna be a lot of variability, I would say that on the average, many thousands of dollars over the entire course of the chemotherapy would be the magnitude of the expenditure. When we talk about the sort of published numbers with conventional cancer care, five to eight thousand dollars for some combination of surgery, radiation and chemotherapy, how much of that is going to be consumed by chemotherapy, well that’s gonna vary. It’s an excellent point that you bring up Jim, because it’s important to get an itemized estimate, it’s an estimate so it needs to be taking with some grain of salt. But of what it is gonna be costing because it’s, not just the chemo drugs, you’ve got the monitoring, you’ve got a little hospital stay, you’ve got catheters, fluids, blood test whatever, these things can be built in to the treatment plan to give you an idea because you do have to budget for these things. Back to the idea of making deposits, what will your dog, the deposit that your dog has to make? What about these side effects and there are things that can be done. As Doctor Sue pointed out, the side effects are not what they are compared to human chemotherapy, but nonetheless, there are some side effects that do really need to be contemplated here and some of them can be severe. You need to be advised of those, the frequency of them. Also, take some steps when we talk about this in the guide there’s steps that one can do to deal with, to manage side effects and we talk about this in the guide so you really need to look at that. Also sometimes, pre-emptively minimize side effects by getting information about your particular dog. There’s a test that can be run called BMDR1 test, mutant, this genetic mutation that can increase the odds of side effects. There might be certain heart condition; there could be a tendency towards pancreatitis, anyway, all these things before you jump in to chemo as much as you can, you need to be taken into account so you go about this in an intelligent way, and in a very, very kind way for you love dog.
James Jacobson: Dr. Dressler, oh go ahead Dr. Ettinger…
Dr. Susan Ettinger: No, I just wanna add one quick thing. A lot of people when I tell them what I do for a living they just can’t imagine dogs getting chemotherapy and they manage, or they imagine them hooked up to injections for long periods of time. Most of my patients are outpatients, they come in weekly or every other week or every third week for their chemotherapy. They’re in and out in about an hour to two on a good day where they hang out with us during the day where my mom and dad goes to work. Most of these patients really live well, they’re doing all of their things that they really enjoy doing, going on walks, hiking, swimming with the family. Most of these dogs are really living well and most of the people look back and they say “Gosh, you told me that, but I really couldn’t imagine it then I’m so happy that I did it. I think chemotherapy is overwhelming reasonably for a lot of people cause we think about people going through chemo, but most dogs just really tolerate treatment phenomenally well. Most people that decide to do it, though it’s not for everyone are truly happy that they did. So if it’s something that you’re thinking about doing, do and talk to a specialist and find out more about your dog’s cancer and the recommended protocol and I think it’s gonna be really helpful for everyone.
James Jacobson: There’s lots more information on chemotherapy if you’re considering that in the Dog Cancer Survival Guide. Dr. Ettinger in New York, and Dr. Dressler in Hawaii, thanks so much for being with us.
Transcript of: Amputation for Dogs with Osteosarcoma Cancer
James Jacobson: If your dog has been diagnosed with Osteosarcoma, you may have heard that it’s time to amputate. I’ll just throw it to our Veterinarians, Dr. Dressler in Hawaii, and Dr. Ettinger in New York and talk about the possibility of amputating a limb when you have an Osteosarcoma diagnosis. Which of you would like to take that first?
Dr. Demian Dressler: You wanna go for it Sue?
Dr. Susan Ettinger: Sure, you want me to go first?
Dr. Demian Dressler: Why not?
James Jacobson: Sure! Dr. Ettinger, what do you think about a surgery for Osteosarcoma?
Dr. Susan Ettinger: So, Osteosarcoma is an aggressive cancer in two ways. I think it’s really important for that to understand that before you go in for the surgery because the surgery is only gonna deal with half of the cancer. So, for most malignant cancers we talk about two things, the local disease which is in the primary bone for this cancer where it is growing. At the shoulder joint, or the knee joint, it’s not at the joint but one of the bones in that area. So, that’s the local disease and so amputation is gonna deal with local disease. Again, the cancer growing in the bone, but again, we’re also gonna have to think about the systemic disease which is that cancer spreading. But for the local disease, amputation is a good option because it will completely remove that dog’s cancer in most situations when it’s on the limb of the dog. It’s really radical and I can sit here and really comfortably talk about it. But I know, owners come in their head swirling, “How do I possibly remove a leg from my dog. Most dogs do really well; we belovedly call those dogs’ tripods, which sound a little bit funny. But dogs get along really well, and I think one of the cool things about treating dogs and cats with cancer is that they don’t necessarily deal with all the emotional baggage that we as their guardians do. They will obviously deal with some pain in the surgical time period that we can control with injectable pain medications. But after that, most dogs don’t really look back and adapted very well. So, I think an amputation is a very good way to deal with a very painful bone tumor to remove the tumor completely from the dog.
James Jacobson: Dr. Dressler?
Dr. Demian Dressler: Yeah, it’s such a heart-rending proposition for your average guardian. It’s so difficult to contemplate because the truth of it is, it is a radical procedure. It feels almost barbaric. “How am I going to put my dog through this? Chop off a leg? It sounds like inconceivable now that is unless you start to interact with those on three legs. As soon as you become familiar with dogs who walk around on three legs, it may seem almost impossible to contemplate. But, in our position as Veterinarians and Oncologists, we see dogs on three legs all the time. We can say very, very safely, that a dog on three legs can have a fabulous life quality, an excellent life quality. As Dr. Ettinger pointed out, they do not have the baggage in the mind that accompanies removal of a limb, that’s our problem. They are not bothered by it particularly. The other thing to remember is dogs have four legs, and humans have two legs. They still have three legs, they don’t need crutches, they don’t need wheelchairs, they can move around just fine. A couple of days…
Dr. Susan Ettinger: Well they run, they run, they swim. I’ve had dogs still herd sheep. Some of these dogs run faster than some of the dogs with four legs that I know. Some of these dogs are just absolutely amazing.
Dr. Demian Dressler: Absolutely! As a matter of fact, recently, I was down on the beach and I was so pleased with this dog running around in the water and on the sand. Three weeks before I had amputated that dog’s leg. There it was, enjoying the beautiful sky and the beautiful water happy as can be. So the hang up with the three legs versus the four legs is in the mind of the person. As long as we can make sure that the pain is controlled properly, we’ve got a good surgeon doing the procedure, we’ve taken the steps that we need to gather the information for ourselves so we know what to expect on the horizon. We’ve done it properly the technical elements of the procedure. The aftermath for the dog is nowhere near as bad as it is as we would imagine in 99.99% of the dogs out there.
Dr. Susan Ettinger: I think, just to add is that most of the dogs, the majority of dogs that develop Osteosarcoma are middle-aged and older dogs. Most of those dogs have pre-existing Osteoarthritis so a lot of these dogs people are concerned that my dog has arthritis so how are they gonna be okay on three legs. The majority of that, even the dogs with some pre-existing Arthritis, do absolutely great as on three legs and I think that’s really important to know.
James Jacobson: Awesome information. Dr. Ettinger in New York, Dr. Dressler in Hawaii, thank you so much.
Transcript of: Dog Breeds Most Likely to get Cancer
James Jacobson: Let’s talk a little bit about dog breeds, and which breeds are more likely to get cancer. Are there certain breeds that are more susceptible to cancer? Dr. Ettinger?
Dr. Susan Ettinger: Unfortunately, a lot of the pure breeds are at risks for cancer, and there’s a lot of inbreeding unfortunately in those line that pre-disposes them to cancer. Some of the top breeds that I see in my practice are Golden Retrievers, we see Labrador Retrievers, Rottweilers, German Shepherds and Boxers, I think those are some of the breeds. Unfortunately, there’s no breed that’s completely cancer free. But again, those are some of the top breeds that I see.
James Jacobson: Dr. Dressler, what do you see? Are there…I imagine the same types of breeds are you see presenting with cancer.
Dr. Demian Dressler: Yeah, absolutely. I live and practice in a different geographic location other than Dr. Ettinger, and there are breed-related interactions to the environment. For example, I practice in Hawaii, and here we have a lot of sun exposure. So I will see a lot of the sun exposure-risk breed, so it’s interesting because dogs, the cancers that increase risk as a consequence of sun exposure are going to be say, hemangiosarcomas of the skin or of the eye. Another one would be squamous cell carcinoma. We don’t see, which is different from humans, we don’t see increased risk of melanoma. People have heard of melanoma as the pigmented cancer that pops up on your skin if you’re fair complexion and you have sunlight exposure. So, in dogs, they lack that association, melanoma does not increase as a consequence of sun exposure.
James Jacobson: What about a smaller dog versus larger dogs, is there any correlation between how big the dog is and its likelihood of getting cancer?
Dr. Demian Dressler: One of the main differences there and each breed can be more or less prone to individual cancers. Certainly, the size of the dog impacts in particular osteosarcoma which is a cancer that usually happens in the long bones and sometimes in some other bones and other areas as well. So, certainly, the size of the dog can impact which of the different types of cancer when we are talking about bone cancer in particular. There’s other physical characteristic such as pigmentation, Chow Chows, Poodles, and breeds that have pigmentation inside of their mouth. You may see more cases of malignant melanoma which is a pigmented cancer that occur inside the mouth. I’m not sure if you see this Dr. Ettinger or not where you practice, but it is documented that dogs that have shorter muzzles versus dogs that have longer noses are more or less prone to nasal cancers. The ones that have the longer muzzles, your Koolies and breeds like that are more prone to nasal cancer in particular as a consequence of inhaled carcinogens. When you compare those dogs to dogs that have shorter noses like Boxers, Pugs, so what we are talking about are nasal cancers in particular.
Dr. Susan Ettinger: That’s true, and the thought behind that is that they’re breathing in more of those carcinogens and pollutants in the air and the long nose breathes are getting trapped in the nose and there is greater exposure to those carcinogens as opposed to the Pugs and the Boxers and some of those other ones. Then, interestingly, there are other cancers that we see in smaller dogs for example Westies and Scotties, we see a lot of bladder cancer, the transitional cell carcinoma, and they’re actually one of the highest breeds that we see that. Shelties are also pre-disposed for that bladder cancer as well. So interestingly, there are some strong breed dispositions and there’s a great list in the book in The Dog Cancer Survival Guide where you can kind of look at your dog’s breed and see what cancer they may be pre-disposed to. It’s a pretty exhaustive list and it’s a good place to check out.
James Jacobson: With that, thank you so much Dr. Ettinger in New York, Dr. Dressler in Hawaii. Thanks so much.
Transcript of: Dog Cancer and Apoptosis and Apoptogens
James Jacobson: In The Dog Cancer Survival Guide, Dr. Dressler, you talk a lot about the role of Apoptosis in dog cancer. First of all, easy question but I never heard of Apoptosis, what is it and why it’s important?
Dr. Demian Dressler: Well, it’s a really basic process in Science and we’ve all learned about this assuming that we took high school Science. It gets about two paragraphs in your Biology text book. What it is, is called programmed cell death or programmed cell suicide. It’s the body’s way of clearing out derange cells. When the cell becomes deranged, when it becomes pre-cancerous, or cancerous or other situation, say if it’s infected, or it’s injured or other variety of different derangements that can happened in a cell to screwed it up, the cell is supposed to, in many cases, turn on specific genes that cause it to simply destroy itself. It’s a very quiet process when we talk about cell suicide it sounds very violent because suicide is a charged word. But Apoptosis is a very machine like, very deliberate, very healthy in life giving process. The cell turns on certain little machines enzymes and what not within the cell, chops it up into little pieces and the little pieces just get recycled into new body components. So, that’s Apoptosis in a nutshell.
James Jacobson: There are way, there’s a ways like to cause Apoptosis to happen because in the book you talk about that cancer cells don’t experienced Apoptosis.
Dr. Demian Dressler: That’s right. Cancer’s one of the hallmarks of cancer that we see widespread in almost all cancers is that they lack Apoptosis. They’ve been able to maneuver around this genetic machinery that’s supposed to be turned on. What that allows them to do is, they’re deranged, but they don’t commit suicide, they just keep on living, keep on growing and can overwhelm the body. Yet, there are ways to turn on this special genetic signal to help those cells commit suicide in a way that’s healthy for the body. As a matter of fact, the huge industry right now, the pharmaceutical industry, its huge amount of money invested in new and creative ways of turning on Apoptosis or programmed cell suicide of cancer cells with the use of drugs and other therapies. Interesting thing is that in Mother Nature there are naturally occurring compounds that had been shown in labs, in test tubes, in petri dishes and also in living animals. These substances are capable of turning on Apoptosis in the body when taken by mouth when orally available. Then a matter of fact…oh sorry Jim, go ahead.
James Jacobson: I was kind of started lead you into that… so in addition to the pharmaceutical methods there are natural ways which include the nutriceutical that you created, which is Apocaps.
Dr. Demian Dressler: Apocaps and that was the fundamental mechanism that was used in the engineering of Apocaps. Apocaps is designed specifically to include compounds called a pathogens which are special substances found in nature, found in plants that have been demonstrated to turn on this healthy process of Apoptosis.
James Jacobson: Dr. Ettinger, what as an Oncologist, what’s your perspective on the role of Apoptosis and getting it started?
Dr. Susan Ettinger: I think it’s another mechanism, or another treatment modality that we have. I think it’s actually very in it, much in its infancy, and I think we’re really learning how to incorporate it into the protocols and you know to maximize a therapeutic benefit for all of our patients. But I think it’s a really exciting approach and another arsenal, another tool we have to combat cancer.
James Jacobson: Do traditional chemotherapy protocols deal with Apoptosis or not?
Dr. Susan Ettinger: They do, I mean just by some of the mechanism of cell death, with cancer cells, but not really as directly as the Apoptogens that were being designed now or implemented now.
James Jacobson: In other words, when they’re developing chemotherapy, they’re not specifically looking at using the mechanism of Apoptosis to kill the cells, but it’s a by-product or is that what you…
Dr. Susan Ettinger: I mean most of the chemotherapy drugs are more into direct sell, killing mechanisms by damaging some aspect of the cancer cell usually in the mitosis which is the division, so they target some aspect of that…
James Jacobson: Yeah, I’m just sort of curious about the mechanism of Apoptosis, there’s mitosis and what’s the other way of killing cells?
Dr. Demian Dressler: Yeah, there’s a couple of thrusts of the therapy, the targets. So you’ve got cell division and then you’ve got cell death. That’s the gas pedal and the brake pedal. The emphasis traditionally in traditional chemotherapy has been on eliminating the cell divisions. So the problem that we’re getting into with this though is that chemotherapy agents actually in many cases will induce Apoptosis. They’re actually are Apoptogens. The reason why this is sometimes difficult to answer when we’re talking about traditional chemotherapy, is that the truth of it is, is that we have a few different explanations for why these chemo agents work, but there actually is more going on than we really know about. The mechanism by which the chemo agent work is very well described in one particular aspect but then the more that you look at it, the more you realized, hey wait, this thing is actually increasing mitochondrial release of cytochrome B and it is increasing free radical concentrations on the cancer cell it’s not only paralyzing the mitotic spindle or whatever. So we talk about the chemo agent as if they do blanketing blank but when you really start to look at how they work, we find that the situation is much more complex. But the thrust of the way that the chemotherapy agents have been designed is through cytotoxicity most of the time, if I’m not mistaken. But as it turns out there is overlap also in…
James Jacobson: Is the cytotoxicity is poisoning cells?
Dr. Susan Ettinger: It’s just a direct cell death, I mean toxic to the cells.
James Jacobson: Toxic to the cells, and when you contrast that with an approach like Apocaps, which is not, Are you poisoning the cells? Or no, you’re not, right?
Dr. Demian Dressler: It’s a different process of cell death. It’s one that’s characterized by a very specific metabolic pathway where there’s a certain sequence of events that involve the DNA, involve cast bases and two different paths, one of them that involve caspase and of them that doesn’t and the end result is a particular cellular change that can be observed under a microscope that has a certain characteristic look to it. Traditional chemotherapy has not been oriented to towards amplifying that specifically it just as it involved and okay we’re gonna kill these cancer cells we don’t really care how we’re doing it. It’s more of a sort of a shotgun approach, cytotoxicity is just cell death and will kill as many cancer cells as we can before it hurt the body at the end. We’re looking at a more targeted strategy in capitalizing on a specific cancer cell death mechanism.
James Jacobson: Great! Dr. Dressler, Dr. Ettinger, thank you. There’s much more information on Apoptosis and the role it has on dog cancer in The Dog Cancer Survival Guide. Thank you both for being with us today.
Transcript of: Dog Cancer Diet What to Feed a Dog with Cancer
James Jacobson: What happens when your dog has cancer? Do you have to change your dog’s diet? Dr. Dressler, I know you write a lot about the dog cancer diet in your book, but what is the role of diet once the dog already has cancer?
Dr. Demian Dressler: Well, a dog cancer diet is a critical piece of the clinical management of cancer. A lot of the thoughts that I put into the PDF “Dog Cancer Diet” that you can download from dog cancer blog it’s an entirely free publication there to help you. A lot of that information is actually taken from human literature. We use a lot of a human literature in the Dog Cancer Survival Guide and the reason is because a lot of the science and the basic in cutting edge research that’s going on in cancer is on the human side. As a matter of fact dogs are models for human cancer and I think that in many times its very, very logical for us to use information from the human side and then put it in our treatment plan for our dog. As a matter of fact, if you look at diet in humans, it’s estimated that one in three cases of human cancer, can be directly cause by dietary choices. We also are seeing a lot of information about the composition of the diet affecting the outcome of the cancer. We can use this information in veterinary medicine so that we can maximize not only the longevity, not only how long our dogs live, but also life quality. In the dog cancer diet recipe we talk about things like carbohydrate restriction we know that simple carbohydrates are the preferred cancer food sources, actually cancer cells like sugar, it’s called the Warburg effect. We talk about the impact of certain omega fatty acids. We talk about the impact of certain natural compounds that are found in the dog cancer diet recipes. By taking all of these things, and putting them together into a dog cancer diet, we can really, really help our dogs with cancer. We can also provide a diet that tastes really good, and so the dog’s life quality can go up. In addition to that, because we’re actively involved in feeding and nurturing our special family members, we can feel really good about what we’re doing to help our dogs because dog cancer unfortunately is a situation where some dog guardians will feel powerless. This is a really good way to feel really good about what we’re doing for our dogs.
James Jacobson: So, this is a special diet, is this something that you should be able to feed to any kind of dog or just dogs with cancer?
Dr. Demian Dressler: No, this a specially modified diet that specifically designed to address the metabolic derangements that happen when a dog has cancer particular a systemic cancer meaning, a cancer where its spread throughout the body or there’s still cancer cells left in the body. So this is not a normal sort of everyday diet for your average healthy dog.
James Jacobson: So you can pick up the recipes and basically the whole process of how to do that for free in the dog cancer diet book which is available at dogcancerblog.com. Dr. Ettinger, do you have any comments about the role of diet while dog is being treated for cancer?
Dr. Susan Ettinger: No, I think the role of diet is very important and I think that the homemade diet that Dr. Dressler’s come up with his great option, but I also like to point out for some of those busy people out there that if you can’t do a homemade diet, he has included some other commercial diets, where other ways, that you can go about in and improving your dog’s diet and it doesn’t always have to be completely homemade diet because that can be a little overwhelming for some people as well, but it’s an option for you and I think it’s a good resource for everyone.
James Jacobson: Great! Well, Dr. Dressler, Dr. Ettinger thank you so much for joining us today.
Transcript of: Dog Cancer Diagnosis Not An Immediate Death Sentence
James Jacobson: Here’s a question that we get and that probably resonates a lot with people, as soon as they hear that their dog has cancer. Some people think “oh my God, my dog…” It’s like an immediate death sentence. What are your thoughts? I throw this out to either you Dr. Ettinger or you Dr. Dressler. What are your thoughts in terms of is getting a cancer diagnosed as an immediate death sentence?
Dr. Dressler: Well I will jump in on this one. You know, it’s interesting when you look at the grieving process: there’s a different form of grief. And there’s interesting form of grief that happens before the event even is experienced. That means that we are anticipating something bad coming up and we start to become sad about it. And this form of grief can be completely overwhelming and incapacitating and many, many times when a guardian receives a dog cancer diagnosis from a Veterinarian, they will start to experience anticipatory grief before anything bad has really happened or anything that’s really significant in terms of the well-being of the dog. So it’s important to realize that in many, many cases we are experiencing grief for something that hasn’t even happened yet. We have abundant time and many cases were we can do so much good, where we can take proactive steps, where we can improve our life quality, where we can get increases in life span, and increases in life quality of our special family member and we don’t yet have to be experiencing the grief that accompanies with the departure of a pet.
James Jacobson: So Dr. Ettinger, any thoughts about is the clock ticking, and how much time does one have to make decisions about treatment?
Dr. Ettinger: Well when people call our hospital and are trying to make an appointment with an oncologist, we really tell them that for most cases a week or two is plenty of time for them to get in. They don’t need to rush in the next day. There are a few exceptions to the rule, where we really encourage the owner to come in the following day or the next day after and I think if your dog is diagnosed with lymphoma or leukemia, those are really important ones to go and see an Oncologist, because we know that those are rapidly moving cancers and that starting treatment as soon as possible is really going to end up benefitting their pet. But for majority of all the other cancers (again excluding lymphoma and leukemia), I think within a week or two is really the right time to make sure you get in and see an oncologist and make some treatment decisions. But again for non-lymphoma, non-leukemia dogs, I always tell owners you a couple of days or two to go home and think about the information and make a decision. It’s probably not going to impact the outcome of their pet– meaning you want to make a good level headed decision and not feel rushed into that decision for their dog.
James Jacobson: Dr. Dressler, any follow up?
Dr. Dressler: Yeah, I think that what Dr. Ettinger has said is good wisdom. We also of course need to pay attention to each of the different aspects of dog cancer treatment. But getting the information as soon as feasible is sound wisdom. Coming up with treatment plan as soon as feasible is sound wisdom. But any feelings of panic or overwhelm– they’re very, very understandable– but keep in the back of your mind that only very, very few cases of dog cancer is an immediate death sentence. The vast majority we have a little bit of time. So allow yourself as a guardian and as an advocate for your dog to take a little bit of time to experience what you’re going through to gather your data and to come up with a treatment plan that really, really make sense.
James Jacobson: And during that time , obviously during the analysis, that’s a good time to bone up on all the information in your book– both of your books, The Dog Cancer Survival Guide. Thank you so much Dr. Dressler, Dr. Ettinger in New York, Dr. Dressler in Hawaii, thanks for being with us.
Transcript of: Should You See an Oncologist for Your Dog’s Cancer
James Jacobson: Here’s a question that we get a lot. When should I see a Veterinary Oncologist? I’m gonna throw this question to you Dr. Ettinger in New York since you are a Veterinary Oncologist. When should someone see a Veterinary Oncologist and I guess the other question is why?
Dr. Susan Ettinger: Oh that’s a great question. I think you should come and see an Oncologist as soon as the diagnosis of your pet’s cancer has been confirmed by your regular Veterinarian.
James Jacobson: Okay, now I know Dr. Dressler not everyone chooses to go the route of a traditional, the traditional things in terms of chemotherapy and radiation. Do you have any thoughts about when it’s appropriate to see a Veterinary Oncologist is it all the time and are there certain situations when you would, you would not? What are your thoughts?
Dr. Demian Dressler: Well, It is a really good question. One of the fundamental skills that we talk about in dealing with dog cancer is really becoming an advocate for your pet and being a real guardian. A big piece of guardianship is decision making and you can make good decisions unless you have information. You need to gather the information and an Oncologist is really very, very skilled at giving you information concerning in particular chemotherapy and radiation and in some cases surgery. So if you’re contemplating using those treatments which are the conventional treatments for dog cancer, you should at least try to see an Oncologist so you can get the information to arm yourself to make a good decision concerning the well-being of your dog. You may also wanna ge…Oh go ahead Jim.
James Jacobson: Now Dr. Ettinger…I was gonna say Dr. Ettinger, what happens usually, I mean I know every case is different, but what happens usually the first time a client or patient comes in? What do you normally go through?
Dr. Susan Ettinger: Well, we get a good history of the pet and when the symptoms are, of this cancer were first noticed by the owner, when a bump was noticed or when it was picked up on X-rays or some sort of imaging, we do a complete physical exam just like the regular Veterinarian. Then we will really gonna talk to the owners about the biopsy, about the diagnosis of cancer and we can make some generalizations of how this cancer behaves. Is it a malignant cancer, is it going to spread? One of the really things that’s super important is to figure out has it spread at time of diagnosis, so for different cancers it may be different but we may do some chest X-rays or CT scans or ultrasounds that are gonna help us figure out has the cancer spread and then what are the recommendations after that point.
James Jacobson: Dr. Ettinger, I understand that there are approximately 200 or less Oncologists or Veterinary Oncologist in North America, is that right? What happens if…
Dr. Susan Ettinger: I think it’s about…
James Jacobson: What happens if, well, do you know what the number is cause I…
Dr. Susan Ettinger: I think it’s about 300.
James Jacobson: 300, okay.
Dr. Susan Ettinger: Yup.
James Jacobson: What happens if you are in a community where there isn’t an Oncologist nearby?
Dr. Susan Ettinger: Yeah, unfortunately that’s a common problem in certain parts of the country. It’s less of a problem in the urban areas where there may be more Oncologists. You can go to acvm.org and there’s a little tab where you can try to find a specialist near you and you could put in your state or your zip code. It could at least tell you what Oncologist maybe near you. In other parts of the country you may need to turn into an Internist, Internal Medicine specialist. In those areas where there is not an Oncologist they often become pretty savvy and have, can be a good source, referral source for you for that situation.
James Jacobson: Okay, Dr. Dressler, any final thoughts on when to see an Oncologist?
Dr. Demian Dressler: Well again there, the bottomline is when you’re contemplating chemotherapy, when you’re contemplating radiation and in many cases surgery, it’s always useful to get all of the information you need. Don’t forget that we have a wide variety of different tools in our toolbox for dealing with dog cancer. Diet, supplements, brain chemistry modification, life quality enrichment, all these various things and we need to use a full spectrum approach so that we can maximize the outcome and get the benefit of the use of each of these different tools. The benefit is very real.
James Jacobson: Okay, Dr. Dressler in Hawaii, and Dr. Ettinger in New York, thank you very much for being with us.
Transcript of: Mammary Tumors- What You Need to Know About Your Dog’s Cancer
James Jacobson: One of the cancers that you talk about in The Dog Cancer Survival Guide are mammary tumors. Dr. Dressler, I’ll start with you first. If a dog has been diagnosed with mammary tumors, what is it, that the guardian may be seen?
Dr. Demian Dressler: The most common way of mammary tumors shows up is the exact same way that a breast cancers shows up in a woman and that is with a growth in mammary gland. We don’t usually think above breasts in dogs because it’s a human term. However, dog’s mammary glands are exactly that, they’re breasts. And instead of having one pair, K9 species has five pairs; there is a total of ten. And every ones in a while, they will be an added one year there and maybe one missing here or there are the given dog, but usually around ten. The mammary tumor for shows up as a bump. And this is a bump that many times can be under the skin within the mammary gland itself which is around the nipple, and the best way to feel those is by very gently massaging actually jelly squeezing or pinching the mammary gland itself, and you can often feel them inside the gland as a firm nodule sometime if there a small little beady and other time if they are larger, you can even see them on the surface of the skin and in worst cases they’re big angry and inflamed.
James Jacobson: Dr. Ettinger, your thoughts on mammary tumors.
Dr. Susan Ettinger: I think it’s important to realize that mammary tumors is a very treatable cancer in dogs as Dr. Dressler points out just feeling your dog along their belly is of really important for early detection to find these. There are some several guidelines in general but fifty percent are benign and fifty percent are malignant and even the malignant aggressive ones, fifty percent of those will be cured with just surgery alone. So, seventy five percent of dogs with mammary cancer with just surgery is all they’re gonna need. They have a nice good adequate surgery, and I think that’s important. It is to know that it’s a very treatable cancer in the majority of dogs.
James Jacobson: Dr. Dressler, what are your thoughts on treatment options for mammary cancer?
Dr. Demian Dressler: I think the surgery is important, this brings up an interesting topic which has to do is spaying and a dog that has been diagnosed with mammary cancer recent evident shows now. I went back in forth but the most recent sort of trends seems to be that’s spaying a dog who has mammary cancer later in life may be beneficial. We also need to, I believe in those cases limit exposure we can to red meat, if we use the human data red meat is a risk factor, and we need to limit the exposure to dietary carcinogens and improve the diet, and also of course throw in some supplements that can help hopefully decrease the development of new mammary cancers in the future. So I think using all of the different tools that we have in our tool box with these cancers is very, very critical to have the best longest life with their dogs.
James Jacobson: There is a tremendous amount of information on mammary cancer in The Dog Cancer Survival Guide. I wanna thank both of you Veterinarians for joining us today. Dr. Ettinger in New York, and
Dr. Dressler in Hawaii, thank you.