Pedigree Dogs Exposed 2
February 22nd, 2012 § Leave a Comment
Eagerly awaiting Pedigree Dogs Exposed 2 on Monday 27th, BBC4, 9-10pm.
carbs and mast cell tumours
February 18th, 2012 § Leave a Comment
As I mentioned in a previous post, I’ve spent hours over the past fortnight researching nutrition and mast cell tumours.
Perhaps I did this because I feel particularly helpless – there was nothing we could do: The vet did everything. What could we, as owners, do?
Or perhaps it was because I felt guilty about not getting this particular lump checked, earlier.
Whatever the reason, I’ve learnt a lot about nutrition in general and specifically, in relation to mast cell tumours and cancer. To be honest, it all became a bit of a headache. No sooner had I found a way forward, but I discovered something else which meant it wasn’t really a way forwards and I was back at square one.
For example, one book stated that cheese was ok as a training treat for dogs with cancer, being high in saturated fat and low in carbs. But then another source stated that lactose could be converted to a form of carbohydrate and another source said that fermented cheese like cheddar was high in histamines, so should be avoided.
Or: One book stated that fish was excellent, as were tinned fish and omega 3s. But then the same source as mentioned above stated that fish, especially tinned fish, is high in histamines, and should be avoided.
Or: I’d conclude that raw eggs were great… only to find they contain some carbs.
OR: I’d conclude that feeding only fat and protein and zero carbs was the way forwards, then my friend Mike emails me (with his far superior understanding of digestion), to say that protein can be broken down to a form of carbs – so, is there a point to avoiding all carbs?
Until finally I’m left wondering (bizarrely) if it’s possible to feed a diet of entirely saturated fat – before realising that this has gone too far…
If I applied everything I read, Slate would probably end up eating lard and nothing else. Then she’d probably die of some vitamin deficiency!
So I read as much as I could and, when something was repeatedly stated in multiple sources, I went with that. If some single radical source said something, and no one else appeared to agree, I’d override it. If there was disagreement, I went with the majority.
Carbs are bad!
This was pretty much the first thing I discovered. There’s a useful paper here by Gregory Ogilvie, which explains why they are bad for dogs with cancer in particular (read the bottom of p2). For a summary of this paper, there’s a good and useful article here.
In short, cancer feeds off carbohydrates. Cancer cannot use fats at all and – after much figuring out on my part – I believe it can only use protein in a limited way.
Unanimously, all sources I read stated that a diet low in carbohydrates, high in fat and high in quality protein, was recommended for dogs with cancer.
I was a bit puzzled, though: Despite explaining the way in which carbs feed cancer, Ogilvie goes on to recommend only a diet low in carbs. Not carb-free. I couldn’t understand why this was: There is a whole cohort of raw feeders who feed no carbs at all, giving no vegetables or grains, since they believe that dogs don’t need carbs and are carnivores, not omnivores. Why doesn’t Ogilvie recommend a carb-free diet? Do dogs need some carbs?
This then set me off on an exploration of whether dogs needed carbs in their diet or not. (You can see the hours spent online, now, can’t you?) I especially found this article from a raw feeder useful.
I would really recommend a book called ‘Raw & Natural Nutrition for Dogs’ by Lew Olson This was recommended to me by another dog owner who feeds raw. It put forth a powerful argument, from someone with a PhD in Nutrition, for the absence of carbs in any dog’s diet – not just dogs with cancer. (By the way, by ‘carbs’ I mean not just grains, but potatoes, sweet potatoes and other vegetables.)
This book was great because it also had suggestions for cooked diets, for those who don’t feed raw – and it even had suggestions for things to add to kibble, to make more nutritious meals, for those who can’t move away from kibble. Plus diet suggestions for senior dogs, puppies, pregnant dogs and dogs with all kinds of diseases – including cancer. I would really highly recommend it. (I also bought Lonsdales ‘Work Wonders: Feed your dog raw meaty bones’ – which was terrible: Overly simplistic and just the kind of pro-raw rant which I hate. I threw it out!)
My conclusion was that dogs don’t need carbs. But carbs are cheap. Even relatively expensive kibbles are mostly carbohydrate: James Wellbeloved is 26% meat. Symply is 26% meat. Joe & Jacks is 26% meat. This is the ‘average’ amount of meat in most dry dog foods. Visualise a 15kg sack of dog food. Now visualise only 26% of that as meat. The rest is rice. People are paying something like £45 for what is essentially and largely a sack of rice. (By contrast, Orijen is 80% meat.)
Moreover, there is a growing trend amongst dog food manufacturers to create ‘grain-free’ foods for high prices: People who have got wise to the ‘sack of rice’ idea are quick to buy these foods. But usually the rice has been replaced with the exact same quantity of potato. Which is also cheap and a massive source of carbohydrates.
As for why Ogilvie recommends only a low-carb diet and not one which is carb-free… Well, there is a little clue on p15 of his paper, where he recommends Hills Prescription Diet w/d and again on p16, where he comments that ‘the only commercially available food which meets [the recommendations for a food for cancer suffering dogs] is Hills Prescription Diet n/d’.
By the way, the third largest ingredient on the Hills Prescription Diet n/d is…. guess what…? RICE.
Further snooping around reveals that Hills Prescription Diet n/d was developed off the back of Ogilvie’s research. Call me sceptical, but I have to ask the question: Who funded his research? Was it Hills??
Calculating the carb content
I have spent many an hour figuring out how to calculate the carbohydrate content of dog foods, since these are not listed.
This article from the website dogfoodadvisor.com is very useful in that respect. It turns out that manufacturers don’t list carbohydrate amounts on their nutritional analysis labels, but this can be worked out by deducting the other quantities.
However, before you can follow those instructions to work it out, you must first work out the dry matter basis of the food – even if it’s a dry food – since dry foods contain some moisture.
This is especially important if you’re comparing a dry food and a wet food. To work out the dry matter basis of the food, there’s another helpful article from dogfoodadvisor.com here.
This did produce some interesting results: NatureDiet customer service had told me that their foods contained a total of 6.5% carbs. Yet, when converted to dry matter this turned out to be about 25% carbs.
The way forwards
I’m not sure yet what we’re going to start feeding our dogs, since I don’t think raw is an option for us – for many reasons.
For Slate, I’m looking at perhaps a combination of Orijen for one meal, and the second meal being K9 Natural (freeze-dried raw) or Ziwipeak (air-dried raw), plus the addition of: Raw eggs, tinned fish, yoghurt, cottage cheese, fish oils and garlic. (Not all of that, every day, obviously.) There are some carbs in Orijen – around 18-25%. I don’t know if we could afford to feed her Ziwipeak for 2 meals a day, but we will more than halve her carb intake through having no carbs in her second meal. We will also use no carbs in training treats, nor simple sugars. (You’d be surprised at what’s added to ham or hotdog sausages: A lot of glucose and some wheat/grain too.)
Although we can give both dogs all the added extras (raw eggs, tinned fish etc), I don’t think we can afford to feed both dogs the K9 Natural or Ziwipeak. So Grey will probably get the slightly-cheaper-than-Orijen (but still with 60% meat) Acana for both meals, or maybe Orijen itself.
Finally, my friend Mike sent me a couple of interesting articles about the effects of fasting on cancer cells. The academic paper can be found here, but there is also a readable write-up here. In essence, cancer cells can’t adjust quickly enough to environmental changes (such as sudden fasting) and it causes them to go crazy and self-destruct.
When I read this, I recalled that there are a contingent of BARF feeders who fast their dogs one day a week, to mimic natural feeding. Since this would cost us nothing to do, and I can’t see how it would do any harm, I think we should probably incorporate this into the plan for Slate.
walking baseball & MCT check-up
February 17th, 2012 § Leave a Comment
Walking baseball with Grey
Incredibly, I am actually going to write about something other than the health of our dogs… for at least the first part of this post.
As might have been deduced from a recent post, I have been missing gundog work.
I’ve been taking Grey out alone for the past 2 weeks, whilst Slate has been recovering. I’ve been working on heelwork with her (which is a notorious weak point of hers, whatever our chosen sport!) and a couple of times this week, I also did the walking baseball drill again.
I didn’t expect much, since we haven’t done any direction work since about October, when we decided to try out working trials.
Well, on our first attempt a couple of days ago, Grey didn’t do too badly at all. She tried to take about 2-3 casts wrong in the series of about 13. She did no-go a couple of times. This was at least comparable to her performances last year, when we were running walking baseball.
But today she really excelled herself, as – for the first time ever – she completed the whole series of about 13 walking baseball casts without making a single mistake. Wow.
What have I done to deserve this? Certainly not any training. With Grey, though, it’s not about training, but confidence. It needs to be easy enough that she gets it right almost always, since this keeps her confidence high and keeps her trying. If she fails too many times – even when there’s no punishment involved – she gives up. This leads to no-gos and bugging (and handler frustration, which she can sense – which fuels the no-gos and so on…).
I think perhaps giving her a long break, with no direction-work, has removes some of the associations she has with it all. As in – her fear of getting it wrong. Perhaps this break has given us an opportunity to re-attempt it all with a slightly cleaner slate.
It had reached the point, last summer, after a particularly embarrassing no-go experience at a working test, that I decided she wasn’t going to be a handling dog. I’d just train her to go out and hunt up everywhere for the dummy or game.
(If you’re from North America and reading this, in the UK, HPRs/Versatile dogs are expected to handle like labradors – to take casts for retrieves. But many of them don’t do this very well, and it would be possible to be successful in FTs with a dog which didn’t handle – since most FT retrieves are relatively easy and close. Unlike working tests, where they are designed to be trickier.)
But I’m much encouraged by what I saw today.
Sheesh, it looks like we are back with gundog work. I certainly enjoyed it more than the working trials training we’ve been doing. It just seems more… real, somehow.
Check-up at the vet, with Slate
Slate was back at the vet’s again today for another check-up. The wound is looking almost totally healed, but the lower drain hole still hasn’t closed up. For as long as there is any liquid coming out and/or the hole is open, she can’t have off-lead walks. Damn it! It has been 14 days now!
But we don’t need to take her back again (hurrah!!!!) for any more check-ups. She finishes the ABs this evening and will be getting lots of probiotics after that.
The vet thinks there is not much point in repeating the FNA on the lump I’m worried about, since it came back as fatty cells. We’ve FNA-ed this lump twice now, and the vet says that the chances of it being a MCT – yet there not being any mast cells in either of the two FNAs we did – is slim.
But he is still concerned about the raised liver enzymes from the blood test 3 weeks ago. So we are supposed to wait a few weeks now, and then return for a repeat blood test to see if they are still raised or if that was a temporary result caused by something in the environment.
Which means that, yes, we might actually not have to go to the vet for a whole 3 weeks!!!! Incredible!!!! (Today was our 12th visit in about 3 weeks!).
Oh, and I got the insurance claim form back from the vet, to send to the insurance company…. (Drum-roll)
Total insurance claim/cost of: £1072!!!!!!
Ki-67 result
February 16th, 2012 § Leave a Comment
I got some very good news yesterday: The Ki-67 result came back and is good.
Slate’s Ki-67 was 0.76%, or 10 Ki-67-positive mast cells out of a total of 1317 mast cells.
This suggests that the tumour is likely to behave in a low-grade manner and is very unlikely to have spread, meaning in turn that further testing is probably not indicated at this point.
In a study of Grade 2 MCTs (which is what Slate had), the 3 year survival probability of dogs with Ki-67 index of less than or equal to 1.8% was 95%.
In short: There was a 95% survival rating for at least 3 yrs (after which the study stopped).
If anyone reading this has a dog with a Grade 2 MCT, the results of the mitotic index and the Ki-67 tests are really significant. Some Grade 2s are very aggressive and should be followed up with further tests and treatment. Others (like Slate’s, it seems) are much less aggressive and slower-growing. Knowing the ‘grade’ or ‘stage’ of the MCT really is unhelpful if it’s a stage 2, in identifying whether it will be aggressive or not. You really need to make sure these other tests are run…
Slate’s FNA results Take 2
February 15th, 2012 § Leave a Comment
The results are in for the 3 FNAs which were taken on Monday.
Two of them are probably lipomas and one was inconclusive again.
Now, the problem is that one of the two probably-lipomas, changes in size. It is usually very small, but sometimes it gets bigger – from the size of half a lentil to a very large pea size. And both times it has been FNA-ed, it has reacted by swelling up like this.
For this reason I’ve been worried about it being a MCT: MCTs release histamine into surrounding tissue, causing the lump to appear to be swelling up. It’s not really the lump itself swelling, it’s the surrounding tissue which is inflamed from the histamines being released. Prodding and poking a MCT (or sticking a needle in it) makes it more likely to release histamine and cause this allergic response.
Slate has been suffering from itchy eyes for some years now, which have not been improved after anti-bacterial eye-drops. When she was diagnosed with this MCT, I wondered if the allergy symptoms were all due to the histamines released into her by the MCT. (Worryingly, if that’s the case, she still has itchy eyes now, 2 weeks after it was removed. Does she have more??)
Although the result has come back as probably a lipoma, FNA results are not always accurate. (Unfortunately, the more accurate you want to be, the more invasive you have to be.) And why would a lipoma swell up or change in size? (I asked the vet this, and he said it could be fluid coming back into the lump or something about ‘planes’ in the dermis – he lost me on that one.)
I’m also a little worried that the vet – or vet nurse, or lab – has mixed up the results, since there were 2 lumps very close to each other: A very large one, which the vet bet was a fatty lipoma and then this tiny one I’m worried about. I’m worried that the inconclusive result is really for this size-changing little one, and the lipoma is this other big lump. The vet really thinks this is unlikely, since he labelled them clearly, but he is going to check if the vet nurse is sure she didn’t confuse the slides.
The vet said we can repeat the FNA again on this lump, with a bigger needle to try to get more material. But it is in a sensitive place on her rib-cage, and Slate really didn’t like the lumps there being FNA-ed with a regular-sized needle. (She didn’t care about the lumps in other places that much.)
At the moment we are going to ‘pause’ here for a few weeks, since we are waiting for the Ki-67 result on the MCT which was removed and we need to decide if we want to run further tests. (Ie: Biopsies of the lymph nodes in the groin). Since that would be under GA anyway, a biopsy could also be taken of this lump. However, as things stand, I don’t think we’re planning on further invasive tests because the mitotic index was so good on the MCT.
Ah yes, and then there are the raised liver enzymes from the bloods which were taken, which we still have no explanation for. To pursue that further would mean repeating the bloods in a month’s time, to see if it was a temporary raise or if they are still high. (In which case further investigation is needed.)
Sometimes I just think: She is 7.5 yo. We have done what is reasonable and necessary. Dogs fifty years ago, before all these tests were available, didn’t get subjected to all this. Perhaps we should just let her live out her life, whatever it will be. And then I feel guilty, because, if she were a person, obviously all tests would be super-duperly run at whatever cost. This is all impossible.
Here is what we have, so far. (The lump I’m worried about is the lipoma in green which says ‘changes size’ next to it.)
Slate check-up & FNA reattempts
February 13th, 2012 § Leave a Comment
Took Slate back for another check-up today. This was our 11th vet appointment in the past month, with one or other of the dogs. Between Grey’s stitches and Slate’s MCT scare, we seem to be living at the vet.
Slate’s wound looks really good and is pretty much healed up now, but one of the holes where the drain came out is still open and leaking some clear fluid. The vet says this is probably good, because it’s better that it comes out than stays inside and has to be reabsorbed by the body.
However, she can’t have any off-lead exercise until this hole has healed up, because the risk of infection would be too high.
She is still on the ABs, and we have another 4 more days of them. We have to go back on Friday for another check-up.
Today we also repeated the 3 FNAs which came back as inconclusive last week. If they are inconclusive again, I’m really not sure what we’ll do. A biopsy (the next most invasive option) would probably require general anaesthetic and I don’t know that we’re prepared to put her through that when, statistically, the lumps are likely to be benign.
But let’s wait and see, we’re not there yet.
I’ve been doing a lot of research into nutrition and oncology over these past few weeks. It has been a steep learning curve, which deserves its own post, so I’m saving it up for a rainy day with no other news to report.
snow, bleeding nails & rude men
February 11th, 2012 § Leave a Comment
It is only lunch-time and Grey and I have had a bit of an adventurous morning.
We had a beautiful walk at one of our favourite walking locations. We saw two deer and the biggest pheasant I’ve ever seen. In fact, I’m not even sure it was a pheasant, it ran so quickly across our path. It looked more like a small turkey.
However, the snow had resulted in people who don’t usually frequent places like this, descending on it for a bit of tobogganing. Grey and I were on the other side of the field, when a black lab came haring up to us, closely followed by his collie x friend. I waited for the people to call their dogs, in vain. The dogs were perfectly friendly and Grey ran about with them a bit, but that’s not the point. Grey might not have been friendly, or she could have been in season, or she could have been recovering from an operation.
I continued walking, as I had to walk right through this area to get back to my car. (This is Open Access land.) This meant walking past the tobogganing family. Their two dogs were constantly chasing Grey, and this was all happening around my feet. Then the black lab noticed I had treats in my pocket and, labrador fashion, started walking beside me and occasionally leaping up and throwing himself at me. I just ignored this and turned away the first few times, but then I did push him off me (not violently, but firmly) the last couple of times. I wondered if the family might see me push him off and realise that I was being besieged by their dog, but no such luck.
There is absolutely no way these people can’t have noticed what was happening, because I was walking right through them: Some of them were higher up the slope, and others had already tobogganed down and were at the bottom. Yet they made no attempt to get their dogs back.
I this point I became pissed off and threw their lab a bit of hotdog sausage. I thought it might demonstrate the point of keeping your dog under control, if he followed me right out into the car-park and if that gave them a scare.
I walked into the car park, and what did I find?!?
My car was one of three, sensibly parked in a normal fashion along one side of the icy car park. This is a very spacious car park, by the way, with a lot of room to turn in and space to park in.
Then there was a Mercedes at 90 degrees to the end of our car, inches away from it. I couldn’t see any damage to our car.
I put Grey in the car. A woman was also putting her dog in her car, two cars along. She said, “That car belongs to the man in the field who is tobogganing. He asked me if yours was my car. He said he couldn’t see any damage, but he was against it.” She was very sympathetic and said: ”It must be a man-thing.”
Well, I don’t think it’s a man thing, but a stupid and rude person-thing. People tend to be stupid and rude in multiple dimensions if they are stupid and rude in one. It was no surprise that the same arsehole who’d let his dogs besiege me and my dog was also the one who had skidded up to my car in his Mercedes and then left it at 90 degrees and only inches away.
Then his dog turned up again, looking wistfully at me for another hotdog sausage. This was annoying. It is hard enough to take your boots off when it’s icy, without having a dog to fall over. So much for the idea that it might scare the man, if his dog ended up in the car park. Obviously he didn’t care where his dog was, since he was no where to be seen.
I searched long and hard for a pen in the car, so I could leave him a note telling him just what an arsehole he is, but I didn’t have a pen.
With careful reversing, I got our Landrover out. Whilst I was just doing this, the man and his kids came out of the field. I got out of the car on the pretence of examining it one last time before driving off, but also so I could give him a few choice words.
I said: ”It’s not like the car park is too small, really, is it?”. All I was hoping for was some sort of apology or acceptance of responsibility. That would have been really nice.
Instead he replied (non-sequitur), “We nearly hit you several times whilst we were tobogganing, you just walked right through us.” (!!!!). This is Open Access land. Why should pedestrians who need to walk on this route to get back to their cars, be blamed if they are nearly hit by toboggans??! Surely any crashes would be the fault of the tobogganers for not making sure the path was clear before they came down!?
I didn’t even bother to reply to this. I said: ”Your dogs were jumping up and pestering me the whole way. They were clearly not under control.” The man then said to one of his kids “Get in the car, it’s just a grumpy lady”, and turned away.
So I drove off, fuming. Twat-face.
Then, getting home, I found that all of Grey’s nails are bleeding slightly at the nail beds. I think it must be due to the snow. It hasn’t happened before in snow, but this snow is particularly old and crunchy and I think the hard snow might have pushed up at the nails, forcing them away from the nail bed each time.
I’ve bathed them in warm water and antiseptic and she’s now wearing a buster collar so she doesn’t lick them.
Can we please have no more dog-health issues for a while!?!
results for MCT & FNAs
February 8th, 2012 § Leave a Comment
Just when I was worrying about not having enough results, we are suddenly drowning in results… but what to make of them? Things are perhaps only slightly clearer.
Here we go:
The vet got good margins on the MCT, meaning that the cells around the edge of what was removed were healthy cells and hopefully we have all of it.
It was a Stage 2 MCT. This makes it a difficult one to call. Stage 1 MCT means that (in theory) the lump is whipped out and that’s it, it is unlikely to spread. Stage 3 means your dog is at death’s door, and it’s likely to have spread. Stage 2 is the category everything else gets chucked in, so it is a bit of a catch-all category with a variable outlook. The report from the lab stated that 5-22% of Stage 2 MCTs metastasise (spread elsewhere). Which is a huge variation.
This helpful article says: ”It is reported that 50-75% of dogs with Grade 2 MCT survive long-term (beyond 35 weeks). Another study concluded that 44% of dogs with Grade 2 MCT survived long-term (over 4 years) after nothing more than complete surgical removal of their tumors. Yet another author reports a 45% mortality rate.” So that’s nice and clear, then. Go figure. Apparently, there are other indicators to help you further… such as…
The ‘mitotic index’, which is a measure of how fast the cells were dividing. The higher, the faster and the more aggressive the cancer; the more chances of it recurring or spreading. For Slate, this result was <1 (less than 1). Apparently this is great, since anything up to 5 is really good, and less than one is great.
As this paper states in an abstract, “For grade II tumors with a [mitotic index] < or =5, the median survival time (MST) was 70 months”. So, the average survival time of dogs with a stage 2 MCT and a mitotic index of 5 or less is 70 months. 70 months doesn’t sound long, but is actually 5.8 years. If Slate, at 7.5yo, lived another 5.8 yrs – to be 12 or 13 – we would be lucky, even without all this! So this is an excellent result, really.
Another nice and more easily-readable article about the ‘mitotic index’ and why it is important for prognosis can be found here, on the Dog Cancer Blog. I can now perhaps stop beating myself up for not acting sooner.
We are still waiting on a Ki-67 result, which will apparently give us more info on how likely it is to have spread. But this doesn’t seem to be as important/significant as the mitotic index.
The fine-needle aspiration results on the remaining 5 lumps: Two of these came back as follicular cysts (benign). The remaining 3 lumps were ‘inconclusive’, meaning that there was not enough material for the lab to be able to analyse what it was. The lab did say they found no mast cells in these samples. But neither did they find much else, it seems. However, this is one thing we are going to pursue further on Monday, possibly repeating the 3 FNAs to see if we can get any better results. (More Slate-needle torture.)
So that’s it, for today.
The vet did talk about us seeing an oncologist, and mentioned the centre in Cambridge as being the best in the country, and there also being the North Downs Specialist Referrals Centre to consider if we wanted somewhere a bit closer to home. This would be for a CT scan and further diagnostic testing to see if it has spread. He also mentioned doing a lymph node biopsy, since the lymph nodes in the groin are where any MCT cells would have drained to, from the MCT – this wouldn’t need a referral.
However, all these would require more G.As and we’re reluctant to go all out on invasive testing and further G.As “just to be sure”. On the other hand, our insurance will only cover us for MCTs for 12 months and up to £4K. So, from a financial perspective it makes sense to use that up now, with further tests – because if we miss something now and it crops up in a year, we won’t be covered.
Finally, none of this quite answers why her liver enzyme results were raised in the bloods taken beforehand, or the slightly-yellow poos. The vet said this indicates inflammation of the liver, to some degree, yet any number of things could cause raised liver enzymes and mild pancreatitis: If you had a few too many to drink, your liver enzymes would be raised the next day. Or exposure to any toxins (environmental) could also cause them to be raised. Metronidazole has been known to be a cause of pancreatitis, and the very yellow poos came immediately we stopped the metronidazole before Xmas.
He suggested we might re-test some more bloods in a month or so, so we can see if they are still raised or if this was a one-off thing.
Anyway, it is now a case of – how far do we go with all this testing and how invasive should we be?
But the results are pretty good so far and we are cautiously optimistic.
