Irish Wolfhound Presentation

In May I spoke at the Irish Wolfhound Club of America’s 2017 meeting. It was held in Geneva, NY and during the day they had fantastic events of these gentle giants competing in athletic activities.

On Monday evening, I met with this great group, and discussed the vital role of proper spinal health in eventing, and a dog’s health in general.

We reviewed spinal anatomy, a number of spinal diseases (lumbosacral stenosis, spondylosis and degenerative myelopathy to name a few), and some key concepts in improving spinal mobility, as well as preventing certain aspects of disease as well.

I look forward to continuing the conversations with the member sof the group, adn future meetings.

Check out these great photos of the multiple day event.

https://maryo.smugmug.com/Irish-Wolfhounds/Events/IWCA/2017

Nutritional Supplements for the Canine Athlete

I often get asked, “What supplements should my dog be on?” There are a lot of options out there, so I wanted to provide my perspective on this for all of you.

By the end of this post you will have a working knowledge of some common (and not so common) supplements for joint health, muscular recovery and strengthening, gastrointestinal system health, and immune support. You will also be able to observe critically and identify what I call “evidence vs. claims”. And finally, you’ll apply it to your own canine athlete.

The first step is to define what a nutritional supplement is. The United States Food and Drug Administration (FDA) defines is as “a product intended for ingestion that contains a dietary ingredient to add further nutritional value to the diet.” Said ingredient may be any one or a combo of the following: vitamin, mineral, herb/botanical, or amino acid.

Well that is pretty broad and nonspecific. How about we look at what a nutraceutical is. That is defined by the North American Veterinary Nutraceutical Council as “a non-drug substance that is produced in a purified or extracted form and administered orally to provide compounds required for normal body structure and function with the intent of improving health and well-being.” So we are looking for something that can help the body. That narrows it down (sarcasm font) since it is not a drug it is NOT regulated by the Food and Drug Administration. This is important and will come up later in our discussion.

Since we do not have specifics, we need to think critically. It is important to know the difference between evidence and claims.

Evidence – These are established facts.

Examples are:

  • Double blind placebo controlled study
  • Third Party Research
  • A bibliography and sources referenced to back their statements
  • A prospective study
  • It appears in a peer-reviewed publication
  • It utilizes the scientific method

 

Claims – These are statements that something is the case, often without proof.

Examples are:

  • Catchy terms on the label
  • Copying one company’s research and using it as your own
  • Proprietary blend — don’t keep secrets. Tell us what’s in it
  • Self-published
  • Used for marketing
  • “Organic”
  • “Natural”
  • “Guaranteed”

I put those last 3 in quotes because we see those used freely and there are no regulatory methods for them. While those words sounds straightforward, they can be very misleading.

On the other hand, I don’t want you to be scared by big words. Dihydrogenmonoxide sounds scary right? But you need this every day. 65% of you is made of this. What is it? WATER!

So don’t worry about big words on your supplements. But work to identify them and make sure they’re valid and proven for your pet.

So why should we use a supplement? I think of it in “big picture” terms. We can potentially reduce or eliminate the need for medications with supplements. We want to use it as part of a whole body approach. This can include acupuncture, rehabilitation, surgery, exercise, diet (a well-balanced, appropriate feed with the CORRECT amount of calories), and use it with medications as well. We do need to use it SAFELY though. Over 22,000 trips to human emergency rooms occur EACH YEAR due to issues with supplements. So remember, you can have too much of a “good thing”.

Supplements for Joint Health

If we do that we need to understand what a healthy joint looks like and an arthritic joint as comparison. The picture on the left is what we want. It’s what we are born with. The one on the right is what can happen. It is what we are trying to avoid. Or at least DECREASE those changes if they have already occurred.

joint

Compounds for joint health:

  • Glucosamine hydrochloride
  • Chondroitin sulfate
  • Avocado/soybean unsaponifiables (ASU)
  • Long chain Omega-3 fatty acids
  • Methylsulfonylmethane (MSM)
  • Egg Shell Membrane
  • Hyaluronic Acid
  • Green lipped mussels
  • Boswellia serrata extract
  • Curcumin extract
  • Vitamin D3
  • Pilose Antler Peptide
  • Cetyl-myrestolate
  • Hyperimmune milk factor (HIMF)

And this is just the short list!

Glucosamine

This is an amino sugar found naturally in the body. It is a building block for the cartilage matrix. It stimulates cartilage cells positively. It is readily available and relatively cheap in the marketplace. Even though it sounds like glucose, it is NOT a factor in diabetic pets. There are studies (EVIDENCE) that show the sulfate form may be absorbed better than the hydrochloride. Perhaps because the hydrochloride is found in the joint. We do need a loading dose, which is 2x maintenance for 4-6 weeks to build up levels in the joints. What is maintenance? For a 75-pound (34kg) dog it’s 500mg/day.

Many dog foods on the market will supplement with glucosamine. This needs to be carefully looked at. If the average 34kg Labrador Retriever eats 1400kcal/day and the food is 4.0 kcal/gram, then they eat 350 grams of food per day. Well if that food has 475ppm (parts per million) of glucosamine that equals 475mg per kg of food. That same food may have 250ppm chondroitin sulfate (foreshadowing!) that equals 250 mg/kg of food.

Our Labrador Retriever is only eating 350grams (1/3 kg). So, it’s only getting 160mg of glucosamine and 85 mg of chondroitin. It SHOULD be getting 1000mg of each for 4-6 weeks and then 500mg daily. So we still need to supplement. We also don’t know if it is absorbed the same when it is built into the food. So check your inclusion rates and do some math. Do not just trust the bag. It may contain glucosamine but not nearly enough to be a benefit.

Chondroitin Sulfate

Up next is chondroitin sulfate. It is also naturally occurring in the body. It helps to form the matrix that cartilage forms to support joints. Chondroitin inhibits cartilage-destroying enzymes. It can be difficult to get a reliable source and extract into an edible form. Therefore it will cost more than glucosamine. Again, we need a loading dose. Both glucosamine and chondroitin are inherently safe. Some dogs that eat too much of it can get mild gastrointestinal (GI) reaction (vomiting, diarrhea). If this happens, you should stop the supplement and immediately consult your veterinarian.

There is good evidence that glucosamine and chondroitin work together. In fact, the two have a synergistic effect. That means that 1+1>2 in this case. They have been shown to lessen inflammation and lameness when given BEFORE a joint injury. Remember that these are chondroprotectants. That means they will PROTECT cartilage from damage. They can still help cartilage after an injury but work more effectively as a pre-emptive agent. They help to maintain healthy cartilage metabolism.

Now to talk about a claim with regards to these products. I was recently on a checkout line at a pet store (Yes, I go to pet stores—I have fish.) and saw a box of dog treats that said “contains glucosamine”. Having a minute as I waited, I flipped the box over and started to do the math. Calculating how much was in each treat and how many treats they would need to reach MAINTENANCE levels per day. Our 75 pound Labrador Retriever would have to eat TWO BOXES of treats PER DAY to get the 500mg glucosamine it would need for its joints. Not only is that not financially smart, it is BAD due to the amount of calories that dog would be eating. Obesity and joint health is a whole topic for another day. So be smart in the stores and READ.

Avocado and Soybean Unsaponifiables

Moving on to our next joint supplement: Avocado and Soybean Unsaponifiables. Let’s keep this simple and just refer to them as ASU. The ASUs are extracted out of the oils of the plants. These extracts have been shown to inhibit inflammation in the joint. They also complement the effects of glucosamine and chondroitin (1+1+1>3). Adding ASU decreases the amount of chondroitin needed which saves money in the long run for the consumer.

ASU supports cartilage matrix production and helps protect against cartilage damage. The safety has been widely demonstrated and there are even studies that show Dasuquin (made by Nutramax), which contains all 3 products, may be SIMILAR to the effect of non steroidal anti-inflammatory drugs (NSAID) in dogs for joint problems.

Omega-3 Fatty Acids

Next up, let’s look at the long chain Omega-3 fatty acids. Get ready for more big words.

Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). These are found in oil from wild caught COLD water fish (anchovies, sardines, salmon). The farm raised has low levels of omega-3 and high levels of omega-6.

Omega-3’s have been shown to support heart health, joint health, skin and coats, the nervous system, the kidneys, and the immune system. GREAT! What’s the catch, you ask? They work in all those different systems at DIFFERENT DOSES.

Let’s look at some evidence for them. Studies in dogs with arthritis fed a diet with high levels of EPA and DHA had improved weight bearing on a force plate. They also had subjective reports from owners with regards to being able to walk and play more. Omega-3’s can be used in the diet or as a supplement. They are safe and well tolerated. However, like anything in life, we can have too much of a good thing. When we reach 500mg/kg/day we can run the risk platelet dysfunction. And before you ask: NO. Flax oil or coconut oil will not provide the same effects. In fact coconut oil has been shown to decrease the dog’s ability to SMELL. So for you working dogs out there lay off the coconuts.

It’s been a bit so let’s do some math again. (I know. You love it as much as I do.) Let’s use some round numbers to make it easier. A 100-pound (50kg) dog has arthritis. For arthritis we know that dogs need 80-120 mg/kg/day of Omega-3’s. Let’s go with the median dosage and use 100mg/kg/day which means our 50kg dog will need 5000 mg/day. (100×50). That equals 3 pumps of Welactin twice a day. 3 cups of Hill’s J/D twice a day or up to TWENTY-FIVE omega-3 capsules TWICE a day. So, be careful with those over the counter gel caps. Are you really saving money? And as we will learn later, not all supplements have in them what they say they do.

Methylsulfonylmethane

MSM or Methylsulfonylmethane is up next. This is a sulfur-containing compound found in small quantities in the body as well as fruits, veggies, and grains. It is a byproduct of the breakdown of DMSO (dimethylsulfoxide). DMSO for those of you who haven’t had the pleasure, smells like onions and garlic. It can be used in horses and dogs for neurological conditions and people for interstitial cystitis. (And before you ask, yes that means if your urinary bladder is inflamed we can make your pee smell like onions. Isn’t medicine great?)

Thankfully, MSM doesn’t have that special trait. There’s good evidence with two studies in humans with knee arthritis that MSMs helps them. There’s no published research in dogs yet. So this means we aren’t sure on the dosage needed. But the safety in dogs has been shown. And like other supplements, we can have a bit of GI issues in some cases. But otherwise, no reported problems.

Eggshell Membrane

Moving on, we have eggshell membrane. (Anybody else getting hungry with all these supplements coming from food?) This is a new supplement. It’s been shown to be of benefit to people. I’m contributing to research on it for dogs. A water soluble, (hydrolyzed) powder of the eggshell has been shown to contain elastin, collage, desmosine, and isodesmosine. And yes, we are talking about the thin tissue paper like layer on the inside of the hard eggshell. It also contains glucosamine and chondroitin. So, if we can prove it beneficial in dogs, this could become another available supplement.

Hyaluronic Acid

Hyaluronic acid is our next joint supplement. It is naturally found in the body as a component of joint fluid. It can be given in the joint or in the vein in horses and dogs. It is given in the joint directly in people. There are some thoughts that it can be orally administered but the one case report in German Shepherds shows that it had benefit, but those dogs were also on other joint supplements. Therefore we are not sure about it for oral routes at this time. However, it is one of my preferred therapies for injecting directly into problem joints.

Green-lipped Mussels

OK, back to food. Green-lipped mussels. These are a New Zealand shellfish. They are also known as Perna canaliculus. There are studies in dogs that suggest benefits, but the results are not consistent. They may contain Vitamins C and E, minerals, Omega-3’s, and even chondroitin. So, we are not sure how they help. More research is needed.

Boswellia serrata Extract

Boswellia serrata extract. You may also know this as frankincense. The bark of a tree found in India. It is a mix of boswellia acids that have an anti-inflammatory effect. The benefits have been seen in human arthritis patients. A study in dogs showed improved clinical signs with problems such as lameness, pain, stiff gaits. Is it good enough as a stand-alone therapy? No. But it can help.

Vitamin D3

Vitamin D3 is next. We know this helps support good bone health. Strong bones helps support good joints. Vitamin D3 also modulates the oxidative stress that can occur in the body. It also helps in immune responses (another subject of supplements later in this class). Finally, Vitamin D3 contributes to cell differentiation. So it helps to assign cells to be workers in different arenas. Definitely helpful, but a well-balanced dog food should have this already. A little extract can help but we want to avoid toxicity.

Curcumin Extract

OK, back to food. (Can you tell what drives me?) Curcumin extract. This is the active part of turmeric. We know turmeric from good cooking. The extract has antioxidant and anti-inflammatory effects. One study in dogs showed improvement in clinical scores. The standard extracts are not well absorbed by dogs, but particular ones are. And before you go “wait, I can just flavor my dog food with turmeric” don’t bother, it will not work. Dogs can’t process pure turmeric.

Pilose Antler Peptide

Let’s talk about some antlers. The velvet parts of elk or deer antlers specifically. This is a Traditional Chinese Veterinary Medicine (TCVM) modality. It is from the antlers in a fast growing stage when the antler is CARTILAGE. We can use farmed deer or elk, but we have to consider the ethics of collecting this. What is the active ingredient you ask? Good question. It is pilose antler peptide which is a good source of chondroitin sulfate, minerals, amino acids, collagen, and Omega-3 and Omega-6’s.

Is there any evidence? Another good question. In dogs some gait parameters and owner assessments were good. The same dogs graded by veterinarians at the same time did not show any improvement. We have potential safety concerns with this too. Antlers can be chewed down and get stuck in the mouth, throat, or the GI tract. Use with caution and always under adult supervision.

Two more joint supplements and then we’ll move on to muscle supplements.

Cetyl-myrestolate

Cetyl-myrestolate is a fatty acid found in Swiss albino mice. The mechanism of action is decreasing inflammation and joint lubrication. However there are NO STUDIES in dogs and we do not know how or why this MIGHT work.

Hyperimmune Milk Factor

 We will end with (shocking) another food product. Hyperimmune milk factor is a natural component of milk. We can use it to manage inflammation. The cows that are immunized with intestinal bacterial agents grow the factor for us. The high molecular weight IgG and low molecular weight anti-inflammatory components aid in reducing inflammation by blocking the entry of neutrophil attachment to the endothelial wall of cells. The concentrated version of this factor is called MicroLactin and it is the active ingredient in Duralactin.

A study of 8000 people with arthritis was done and 80% reported considerable improvement in joint pain and 72% reported less stiffness in the morning. There are also studies in dogs that pet owners felt the dog moved better. These are subjective and more studies are needed but it remains a promising product.

Well, can’t I just give my dog milk? Nope. This is a milk factor from specifically stimulated cows. On top of that, dogs lose the ability to digest lactose from a very young age. So, unless you want a lot of diarrhea and other GI issues for your dog, do not give it milk. Same goes for our feline friends.

Nutritional Supplements for Muscle Recovery

Moving on to nutritional supplements for muscle recovery and strengthening. While these are very popular for people we need to be very critical of them in dogs. Many of the muscle supplements will contain creatine, whey protein isolate, or specific amino acids; they can also contain chromium, dimethylglycine, or lecithin. Let us look at these individually.

Creatine

 Creatine is an amino acid derivative in the body. It is found in skeletal muscle, heart, brain, and other organs. It is made via the anaerobic formation of ATP (Adenosine Triphosphate). Human studies show it may help performance and strength in repeated bouts of MAXIMAL exercise of short duration (<30 seconds): weight lifting, sprinting, cycling, etc. There are no studies in dogs at all. The biggest side effect is weight gain. This would not be helpful for dogs with arthritis. It would be borderline helpful in dogs trying to become pulling and working dogs to build muscle. I think there are better ways to do this (like rehab and conditioning and a proper diet plan).

Whey Protein Isolate

Whey protein isolate (Yep, curds and whey, just like in the nursery rhyme). This is made from milk. In human studies that looked at resistance training they had mixed results for muscle recovery, muscle mass, and strength. Again, we have no doses in dogs and, as I’ve mentioned earlier, we can’t just offer them milk.

Chromium

Chromium is an essential trace mineral found in many foods: meat, cheese, whole grain foods, fresh fruits, fresh veggies, and brewer’s yeast. It is needed for fat and carbohydrate metabolism. It can be helpful for people with diabetes but is not of benefit to diabetic dogs. The supplement is promoted for building muscle. There is absolutely no research that proves this claim in dogs or people.

Dimethylglycine

Dimethylglycine is an antioxidant that naturally occurs in the body, in cereal grains, and beans. It is marketed to support performance by decreasing lactic acid build up. Once again, we have absolutely NO research to back this up. There is conflicting research that it MAY support immune function.

Lecithin

Lecithin is a fat in the body that is also found in egg yolks and soybeans. It’s an emulsifying agent, which is a substance that helps an emulsion become more stable. An emulsion is usually a mixture of two products such as oil and water that do not mix together or that are also referred to as immiscible. An emulsifying agent is added to an emulsion to prevent the coalescence of the globules of the dispersed phase. Lecithin may support the gut barrier and it is marketed to support athletic performance, but yet again, there’s absolutely no data to support this.

We haven’t talked about food in a while so let’s talk about supplements for the GI system.

Nutritional Supplements for the GI and Immune Support

We’ll first take review probiotics for GI and immune support, then review a variety of options for immune support specifically. Some I’ve listed earlier and some are new. New to the list are bovine colostrum, Vitamin A and C, L-glutamine, Echinacea, Reishi mushroom, Maitake mushroom, Astragalus membranaceus, Thymus (sweetbread) Coenzyme Q10, Zinc (which can be toxic in dogs), glutathione, and sulforaphane glucosinolate (broccoli). These may act as antioxidants or support the body’s own production of them. They may reduce inflammation and they may directly affect immune cells.

Probiotics

These are beneficial bacteria used to help reestablish the normal GI microflora. They may be useful for stress diarrhea. The studies done in various brands have shown benefit in reducing the severity of diarrhea. More is BETTER in this case. We want multiple strains and high bacterial counts in our supplements. Much of the body’s immune tissue is in the GI, so it may also support the immune system.

Bovine colostrum

Moving on to immune support, we have bovine colostrum. Yep, this is the third time we’ll talk about cow’s milk today. Colostrum is the “first milk” full of antibodies, growth factors, and hormones. Some research in humans has shown it can support the immune system of people when they are stressed by high intensity or prolonged exercise. Research has also looked at effects on performance in people – these have been contradictory. In dogs: no research.

Echinacea

Echinacea is a perennial herb used for centuries. It is potentially helpful for stimulating the immune system to fight off infections. You do need to take it early in the course of the disease if you are feeling sick in order to have any effect. In veterinary medicine, it is a short-term aid and not for chronic use. It is suggested in literature that chronic use creates tolerance.

Maitake mushrooms

Maitake mushrooms can be fractioned into a polysaccharide called D-fraction. This may have immune modulating effects. One study for lymphoma, a cancer of the lymph glands, in dogs, showed that when given ALONE it had no effect. I am not a big fan of this study because we have so many proven good options to help with cancer treatment. Maitake mushrooms can be used for general immune function support. It is commonly used in TCVM, Traditional Chinese Veterinary Medicine.

Astaxanthin

Astaxanthin (pronounced as-ta-zan-thin) is a potent xanthophyll carotenoid antioxidant. Here are big words again. It is not converted to Vitamin A in the body. Astaxanthin is found in microalgae, yeast, salmon, trout, krill, shrimp, crayfish, crustaceans, and the feathers of some birds. It provides the red color of salmon meat and the red color of cooked shellfish. It is used for enhanced immune response in dogs.

Chinese Herbs

A brief side note here for Chinese Herbs: I use them in my practice, but use only one specific company, Jing Tang Herbal, because they verify their source material and their compounds afterwards. Many herbs will have different combinations of mushrooms, antler, and other compounds in them. A trained professional is needed to advise in this area for your pet.

Conclusion

Well that is a lot of options right? How do we implement a plan? We need to look at the breed, job, goals, and medical record of each individual canine athlete. From there, we can identify certain risks and where certain supplements may be of benefit. Remember, many of these take time to have an effect and are not a quick fix. In fact, they work better as preventatives and therefore they will need to be on them consistently (read: DAILY) for weeks to months to have a benefit for your pet.

Another important fact is that the manufacturers are NOT held to the same standard as pharmaceuticals. We therefore have to question the accuracy of information on the label, and the purity and source of the material used. Are they free from contaminants? Do we have any PROOF or do we have CLAIMS?

Let’s look at an example from the human literature. There was a study published in the Journal of the American Neutraceutical Association in 2000. It looked at the correlation between price and % label claim of chondroitin sulfate in 32 products.

supplement-graph

We can see that separate from the price per DAY for a maintenance dose of 1200mg that only SIX of the 32 had at least 90% of what they claimed to have as far as chondroitin sulfate. This report did not look at the source or the efficacy of the product, but merely if there was chondroitin IN THE PRODUCT.

Yikes, so what should you do?

Ask your veterinarian. They are the best source of information for pets. After that, trusted colleagues in the field of canine health, like Dr. Deb Gross, is a valuable asset. My general rules are to avoid products only backed by testimonials. I also recommend you contact the companies and ask for their research papers. You should also require that what’s on the label is actually in the product. Also, do a background search on the reputation of the manufacturer. You don’t always get what you pay for, and it’s easy to be taken advantage of. In the chondroitin study above, all the very costly supplements FAILED to reach 90% of their claim.

You may want to know what I use for my dogs?

Penny is my 2-year-old pit bull. She is my running partner (already has done a half marathon) and is working on agility and mountain climbing. She’s on Hills’ Science Diet Healthy Mobility and Dasuquin Advanced.

Adelaide is my 14-month-old Newfoundland. She has mild hip dysplasia and had surgery for OCD lesions in each shoulder. She is on Hill’s Prescription Diet J/D and Dasuquin Advanced. When she was growing (under a year of age), I fed her Hill’s Science Diet Large Breed Puppy.

I hope that you have found this helpful. There is a lot of information out there and it is important to take time and review your options. Again, remember to consult with your veterinarian about specific needs for your dog. If you have questions, please leave them as comments so that everyone can see them.

Quality over quantity

Last week, I made the final decision to have my own dog humanely put to sleep. Skeeter was 15 years old and had been part of my life since 2001. She was diagnosed with cancer almost 2 years ago. In the end, it wasn’t the cancer but her overall quality of life that was the deciding factor. Let me explain.

Skeeter found her way into my life when I was living on St. Kitts for veterinary school. As a stray dog, she was a little under weight but overall healthy. And throughout the first 12 years of her life, she pretty much stayed out of trouble health-wise.

In December of 2013, I was in Florida taking the final exam for my acupuncture certification. Skeeter was staying at the emergency room where I worked. They were looking to get a new ultrasound machine and had a demonstration model in one day. They used her to check out the machine and accidently found a mass on her spleen. There was no evidence of rupture (many splenic masses, benign or malignant will rupture and bleed internally).

Since she was otherwise in good health, the doctors waited for me to return from my exam to fill me in on their findings. I was concerned but needed to know more information. I ran baseline blood tests (all normal) and took chest x-rays (also normal). This was the week of Christmas and I was uncertain about what to do next. So, I reached out to some friends for help.

Louie-Philippe de Lorimier is one of the world’s leading veterinary oncologists. I am lucky enough to know him as both a colleague and a friend. When I told him what was going on, I took a drive up to his office the next day in Montreal for an ultrasound and consult. We checked out and measured the mass on her spleen. We also found a few small suspicious areas in her liver. The ultrasound images were not conclusive, so we did an aspirate of the questionable areas to find out what cells were inside of them. An ultrasound of her heart didn’t show any masses (some forms of cancer spread here as well).

A few days later I got the results. The spleen samples showed no cancer cells but further testing was recommended. The samples from the liver showed cancer cells of hemangiosarcoma. This means that the mass in the spleen probably was also. Either way, the spleen had to be removed. If the mass (benign or malignant) continued to grow she was at risk for rupture and bleeding internally.

Later that week, I removed Skeeter’s spleen and biopsied her liver. Lucky for me I didn’t see any other masses in her abdomen and there was no evidence of internal bleeding. She did great through anesthesia and recovery. I then sent the liver samples (to confirm) and the spleen (to double check) out to the lab.

About a week later, I got the news. The spleen was also cancerous. This happens on aspirates vs. biopsies. When you get larger amounts of tissue, you get a better chance to know what is going on. Sometimes aspirates don’t get the base of the mass and just the outer shell.

Stage 3 hemangiosarcoma. One of the toughest types of cancer to deal with. It likes to spread from the spleen to places like the liver, lungs, heart and bone marrow. Average survival time with chemotherapy is about 9 months.

Time for a side bar. Cancer in pets. A few things about this. A dog’s life expectancy is much shorter than a person’s. So, if the dog would live to be 13 and got diagnosed with cancer at 11 we would only expect 2 years anyway. That influences how we treat cancer in veterinary medicine. Most importantly, we always aim for quality over quantity. We want whatever time for our patients and their families to be positive. In human medicine, they aim as best they can to cure you, or to get you 10, 20, 30 years or more from the time of cancer diagnosis. This means using much different doses of chemotherapy and other treatments. And when we talk about average survival time, it’s just that, an average of all the patients we have records on. It’s our best guess. Some live less, some more.

Most veterinary chemotherapy patients don’t lose their fur. Most don’t even know they are sick. Even fewer have vomiting or diarrhea from their treatment. And if they do, they usually respond well to supportive care and we can adjust doses of chemo. Again, always for quality over quantity.

Back to Skeeter. Having Dr. de Lorimier in our corner was a huge help. I had access to all the latest research, journals and studies. If I did nothing, I would have on average 3-6 months; with chemo, 9-12 months. Chemo would be one different medication each week for 3 weeks, (this would be one cycle) we would aim for 3-6 cycles. That means 9-18 weeks (3-4 months) of chemotherapy to get maybe another 4-6 months past that.

It took me a week to make my decision. I went back and forth. Read articles on low dose oral chemo (less invasive, but also less survival time). I added in acupuncture and Chinese herbal therapy to help support her while I pondered. The benefit of being a veterinarian is not only having access to all this information but also being able to do my own chemo. Some of the medications in her 3week protocol I was comfortable with. One I was not.

Ultimately, I asked Dr. de Lorimier for one more summer with my island dog. We both knew this meant going forward with injectable chemotherapy. In order to give the best chance, we also added in a new option. There is a mushroom derivative that has shown very promising results in hemangiosarcoma treatment. Hemangiosarcoma literally means blood vessel tumor. It likes to “seed” a patient similar to how you lay down grass seed. It then grows tiny tumors of cancerous blood vessels that can grow and grow until they rupture. This mushroom derivative has been shown to slow down the rate of growth of those new blood vessels.

So here is my 13-year-old dog, who had barely been sick a day in her life, now taking a literal pharmacy. She was on acupuncture and Chinese herbal therapy to support her immune system. She took Deramaxx (an arthritis medication) because hemangiosarcoma has been theorized to use the same receptors that joints use for arthritis to grow itself new tumors. To minimize her risk of getting an upset stomach following her chemotherapy, she took an anti-nausea medication the day before and a few days after one of her chemo drugs. She also had to take antibiotics if her white blood cell count was too low. And she was awesome about it. I got lucky. She liked canned dog food, so we just mixed it all together.

Her first drug in chemo was Adriamycin (doxorubicin). This was the one I traveled up to Dr. de Lorimier to have him calculate, adjust and administer for me (with his awesome team of nurses, Nancy and Carol). It is a great medication but I was not comfortable enough with it to give it at home.

A week later, I would check her blood count and if all was okay she got cyclophosphamide. This is an oral medication but it had the potential to irritate her bladder. So with it she got furosemide (Lasix, a diuretic) to help her make urine to flush out her kidneys and bladder. That also went well.

The third week, I gave her Vincristine as an injection into her vein. This she also tolerated very well.

And we repeated this, after 2 cycles her liver lesions (I couldn’t remove all the cancer in her liver at surgery) had shrunk by 50%.

After 4 cycles, the liver lesions were completely gone. We were in remission. This was springtime. There were a few problems along the way. She had some coughing and vomiting occasionally but otherwise was her happy, cheerful self. The coughing and vomiting is a story for another day.

We did 6 total cycles of chemo. After that, most patients still have some visible evidence of cancer in them. Being that she was still in remission, there was no indication to continue chemo or an oral chemo (lots of patients will benefit from low dose oral chemo after injectable chemo to keep the cancer cells from growing).

At this point, I slowly weaned her off the mushroom extract and Chinese herbs. Partly because there was no indication for her to be on them, and partly because her appetite was not that great. After a few months of medications, herbs and such, her body needed a break.

Now, we were into summer and Skeeter had a great time. Fall came, she was still going strong. Got through winter with the help of arthritis medications. The following spring came and we checked for any evidence of re-growth of cancer (we had checked every 3 months since ending chemo) and still she was in remission.

This summer, she was noticeably slower and enjoyed napping more than going for walks. She got to visit some of her favorite places (a beach trip, hiking in the park and a trip to Ithaca, NY).

This fall, I checked again for cancer and still she was in remission. She turned 15 a few weeks ago. For a person, that’s roughly 110 years old. She would get confused about things, get stuck in corners, pace late at night. Tried some simple adjustments and treatments with her, not much improvement. Right along, I had kept her on arthritis medications, a joint supplement and a special food.

Finally the time came where it was a decision of quality over quantity. Sure I could keep her going, but last winter was rough enough on her. A year older would be just as tough, if not worse. In the last months, she stopped being active in the house. She would not greet people; she would not let them pet her. She just lay in her bed.

That was not the quality of life Skeeter had ever led. It was not the dignity she had filled my life with. It was time to change that.

With the help of friends and family near and far, I processed all these thoughts. With the love and support of those people, I came to the decision I had been avoiding since we had started down this road almost two years ago. And on a quiet day, I sat by the water with my dog, my friend and fed her BBQ ribs. I thanked her for the amazing good times and stories. She napped, curled up in a circle around my arm.

Later that afternoon, my friend Dr. Andrea Kitson helped me lay Skeeter to rest. The quality at which Skeeter lived her life is exactly how her life came to a close. Her story though lives on.

I can’t guarantee you an outcome like mine. I am lucky and thankful for all the 22 months I got with Skeeter. Dr. de Lorimier modified the chemo protocol specifically for her. With other patients, we may or may not see similar results. Talk with your veterinarian about options. It’s always best to get a referral to a specialist to find out about what’s available.

Continuing Education

This coming year I will be expanding my knowledge and capabilities by attending the Chi Institute (http://www.tcvm.com) in Florida for my acupuncture certification. This process will require 3 trips to Florida for hands on learning, as well as extensive online courses.

Acupuncture can be beneficial to those pets with chronic pain from arthritis, cancer and other conditions. It is one part of Traditional Chinese Veterinary Medicine (TCVM). The other components of TCVM are: Chinese herbal medicine, tui-na (a form of chiropractic massage and acupressure which uses the same points as acupuncture, but no needles), diet/nutrition, and Qi Gong (a form of energy exercise). Each branch is a specialized area requiring expertise to perform effectively.

I will start my TCVM training with acupuncture, and will investigate adding the other aspects to my practice as appropriate.

If you have any questions regarding acupuncture and your pets, please contact me. I look forward to incorporating this into my practice.

One Step Closer

I am proud to announce that I have passed my certification exam for the International Veterinary Academy of Pain Management (http://www.ivapm.org/). Over the next six months, I will be submitting two case reports for review to the academy. Pending review of those, I will then have the title CVPP, which stands for Certified Veterinary Pain Practitioner. In order to keep my certification current, I will have an annual requirement of continuing education hours specifically in the area of pain management

The certification covers all aspects of pain management. Acute aspects of pain such as trauma and controlling pain during and after surgery, to managing chronic pain from arthritis, cancer and nerve damage. It includes aspects of pain control from medications such as morphine

If you have questions on whether your pet is in pain, because it can be hard to tell, please contact me. Together we can work on maintaining your pet’s active happy lifestyle.

The Best of Both Worlds

As I am getting settled back here in the area, I am privileged to be working at two phenomenal practices. This allows me to provide my services and experience to different parts of the capital district.

At New Baltimore Animal Hospital http://www.newbaltimoreanimalhosp.com/ I am able to do general practice, as well as orthopedic consultations and surgery. I am also developing a rehabilitation and pain management clinic here.

At the Northway Animal Emergency Clinic http://northwayanimalemergency.com/ , I am available for those patients in need of critical care. This practice is open overnight (from 6pm-8am on weekdays), as well as all weekends and holidays. My background in pain management is applied here to the critical patient and stabilizing them. When indicated, I can also provide emergency surgical services.

Each of these practices has a dedicated and knowledgeable staff with training specific to my patients specific needs. I have had great experiences already at each location, and am looking forward to many more.