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: 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.
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 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: 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.