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.
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.
2nd post-op check-up & FNAs
February 6th, 2012 § 1 Comment
Took both dogs to the vets today!
Grey’s toe has completely healed, but was looking red and puffy, so we thought we’d get the vet to take a quick look, since we were there with Slate anyway.
Conclusion: We have to watch her foot closely, since it could go either way, but it will probably be fine with no further treatment. So let’s get on to Slate.
No results back yet… Bummer, especially as we’d really psyched ourselves up to receive them today.
The vet said that the pathology result should be back in the next few days, and this will tell us if the vet got good margins and removed all of the MCT. But the histology result – which will tell us whether it’s stage 1, 2 or 3 – could take up to 2 weeks (!) to come back, apparently. So we wait on…
Meanwhile, today we got the vet to take FNAs of the remaining 5 lumps which haven’t been checked out yet. Poor Slate was tortured with 5 needles being stuck in various parts of her body, but she was brilliant.
Last time we had the FNA results in 2 days. So we should soon know if we have any more MCTs to deal with, and whether further surgery is going to be needed. Please keep your fingers crossed, as I’m especially worried about one of them in particular. (One which has changed in size, in the course of a day!).
We can now stop the Metacam, but are continuing the Nisamox 250mg antibiotics.
Finally, since there is still fluid coming out of the drain, the vet decided to leave it in for another couple of days. I have to take her back on Wednesday, when hopefully it will come out. So she still has this weird drain sticking out either end of the wound. The drain looks like two pieces of penne stuck in her. This was taken a couple of days ago:
Slate’s MCT removal
February 2nd, 2012 § 1 Comment
Slate is back from the vet now…
The vet believes he got good margins on the MCT. He said you have to go deep as well as wide to get it all, though, so Slate now has a drain in. This might be able to come out on Monday. She is also on Metacam and Nisamox 250mg twice a day (ABs to prevent wound infection).
The MCT will now be sent off and analysed to see if we got good margins on it and also what ‘stage’ of MCT it is. If it is a stage 1 or 2, we should be ok. If it is a stage 3 or 4, we will be worried because it is likely to have spread. We should get these results by Monday.
The ultrasound showed her liver is normal, which was great news. However, her spleen was enlarged to about 4x the size it should be.
The vet said this is common when dogs are under GA, and that it could just be the spleen responding to the GA. (I asked him what percentage of dogs this would happen for, and he said ‘most’.). However, it could also mean that the MCT has spread to the spleen. We just can’t know, from the ultrasound. He did say that the spleen, in appearance, looked normal and he could see no black pits or obvious signs of cancer.
So we are going to wait and see what the results from the MCT are. If the results are good (stage 1 or 2), it is unlikely to have spread anywhere and the enlarged spleen is likely just due to the GA. Then we will probably take things no further except checking out the remaining 3 new lumps with fine needle aspirates. If the results are bad, then we can do a fine needle aspirate on the spleen to see if it has spread there.
It is a little too soon to celebrate, but we will have a better idea come Monday.
Slate is now very drugged up and a bit disorientated after the GA. She was at first restless and reluctant to settle, despite nearly falling asleep on her feet. But she is now lying in front of the fire and dozing.
I am now researching a diet which completely eliminates carbohydrates, since apparently these feed the MCTs and it is possible to starve MCTs through the elimination of carbs in the diet. More on this once I’ve done a bit more research, but since there is no carb-free dry food, it would mean going over to a specific BARF diet which involved only green veg & meat. We don’t have much freezer space, so this is going to take a bit of planning, if it’s possible and affordable at all. Any food suggestions much appreciated.
We have received lots of emails and positive thoughts from lots of lovely people, so thank you all very much for that, it is a scary time and good to know we’re not alone. We’ll keep you all updated.
