2013年9月20日星期五

Western vs Alternative Medicine – Part 2: Canine Lymphoma



As promised, here is my second story related to Western Medicine vs Alternative Medicine,when confronting cancer. This time the patient is my golden retriever, Coco.



Prolog:

I love her very dearly.   I’ve had her since she was 5 months old, and she’s a little over 9 ½ now. We have had many wonderful adventures together, and she was my closest companion and greatest comfort in the darkest moments of my life, when my husband passed away. She is way more to me than just a pet; and while I’ve always known that I will outlive her, I’m determined to give her every chance I can to have a long, happy, healthy life.



To that end, all her life I have been careful about what I feed her and have seen to it that she gets plenty of exercise. I started out by following her breeder’s guidance on diet. That meant high-grade kibble, supplemented with glucosamine chondroitin tablets. Over the years that morphed into human-grade kibble from organic sources.



Diagnosis:

Last December, my friend and I went to Hawaii for a week, and left Coco in the care of a very good pet-sitter. When we got back, I was surprised at how little enthusiasm Coco showed at seeing me again. Usually, she’s ecstatic; this time she wagged and snuffled, but that was about it. The next day, she was lethargic and off her food. That was a red flag to me. Any time she wont eat, I know she’s sick. My pet sitter told me that she had seemed alright to her; maybe a little subdued, but she had thought Coco was just a little depressed, missing me. She had not noticed any loss of appetite. I made a vet appointment for the next day.



The vet found that her lymph nodes were “subtly” enlarged. She recommended a blood test to see if there was any infection that would account for it, but also to biopsy a lymph node. That biopsy came back positive for lymphoma.



What a shock that was! The vet told me that golden retrievers are more susceptible to lymphoma than almost all other breeds (sure wish someone – like her breeder – had told me that early on). The vet told me that the conventional treatment for canine lymphoma is chemotherapy. She said that dogs diagnosed with lymphoma, if they are not treated, usually live between 2 to 6 weeks after diagnosis. She said that usually, the condition is not found until the cancer is far advanced. She held out some hope that Coco would do better, because we had caught the disease relatively early. She referred me to a veterinary oncologist in Redmond, WA. That is a 2 hour drive from my home.



The Chemo Option:

We went to see the oncologist 2 days later. That vet told me pretty much the same thing, but that with chemotherapy, depending on which protocol is used, most dogs survive between 6 months to 1 year from the beginning of treatment. The more robust the treatment, the better the results. That sounded a lot better than 2 to 6 weeks.



She told me that lymphoma is a disease of the immune system. Since the immune system is malfunctioning, chemotherapy seeks to suppress the immune system and kill the cancer cells. Success of the treatment is judged by the size of the lymph nodes. If they reduce in size to the point where they cannot be felt, the disease is said to be in remission, i.e., no sign of the disease is detectible.



What about the side effects? She said that the dose of chemotherapy for dogs is much lighter than it is for humans, in order to minimize side effects. Most dogs tolerate even the most aggressive protocol quite well. She said the quality of life for the dog is the most important consideration.



There is an increased risk of infection, because the treatment suppresses the immune system, leaving the dog more or less defenseless against germs, bacteria, etc. that she would encounter in the environment. That is part of the reason for weekly blood tests – to check for any infections.



One of the chemotherapy drugs used in the strongest protocol – in fact, the strongest drug in the protocol – can result in heart damage (!).



Would it cure her? No. Not likely. Usually, the disease stays in remission for some period of time (varies from one dog to the next), but then comes back. Each time it comes back, they redo the protocol. Each time they do the protocol, the remission time shortens. Eventually, the disease wins and the dog dies. As it happens, I personally know someone whose dog, a black Labrador Retriever, underwent the protocol and lived for 4 more years. Pretty good. If I got a similar result, Coco would live to be about 12 years old. That is in the normal-life-span range for a dog her size and breed. I could live with that.



Cost? Well, the protocol with the best results is, of course, the most expensive one. The cost estimate she gave me, including the chemo, blood tests, and heart evaluation, came to $ 6,480.00



It is also the longest. It is administered over a period of 26 weeks. The first 9 treatments are weekly, then every other week, with blood tests by my local vet on the off weeks. This is the Madison-Wisconson protocol. I wont detail the protocol here, but there is a lot about it online. One place to start is at: http://www.fightcaninecancer.com/lymphoma.html.



The Holistic Option:

I was anxious to get started on something, given that the shorter survival period without treatment was a mere 2 weeks. Still, as with my own health, I wanted to know what, if any, holistic/naturopathic option there was. My regular vet referred me to a holistic vet that fortunately has office hours in my town every Monday.



That vet examined Coco and said that she felt sure that a holistic approach would be helpful. She described how the immune system, when it functions correctly, attacks and kills invading pathogens and proliferating cancer cells. It recognizes that there is something wrong with the cancer cells and gets rid of them. In Lymphoma, the immune system gets lazy. It sees that the cancer cells originate from its own body – not from outside – and does not recognize them as a threat. Thus, the cancer is allowed to grow unimpeded.



The holistic treatment approach is designed to strengthen the immune system so that it does its job, recognizes the cancer cells as a threat, and disposes of them. To do this, she described a regimen of home-cooked food and supplemental herbs and mushrooms, vitamin B shots, acupuncture and chiropractic adjustments.



She also said that she, personally, would never subject a dog to chemotherapy. It is very hard on the entire body; all the internal organs are damaged to some degree by the drugs used. So when the chemotherapy is done, you have a dog that is weaker, more susceptible to infections, and whose internal organs don’t function as well as before. The holistic approach not only avoids all that damage, but strengthens all those organs along with the immune system.



However, she could not, or would not, venture to predict what I could expect for Coco’s survival time.



This was a major stumbling block for me. I was very fearful that this cancer was advancing too quickly for the holistic approach to have time to combat it. If I went the chemotherapy route, I felt that I’d be doing something to attack the cancer right away, and I could reasonably expect her to live least 6 more months.



I asked the vets about combining the approach – doing the chemo and doing some holistic things to help protect the organs from damage. The holistic vet offered me some herbs that would protect her liver, kidneys, and other organs; but the oncologist said this was a bad idea. She said the two approaches would be at cross purposes with each other. She said there was no way to know if the holistic things to protect her organs would interfere with the chemo’s effectiveness on her cancer.



The Decision:

It seemed like I was truly faced with an either-or choice. I had to pick one path or the other. Since the disease was progressing while I dithered, I felt it would be best to attack the cancer directly, with chemo. I reasoned that when the protocol was complete, if we achieved remission, the cancer would be gone. Then we could start rebuilding her immune system so that it would be able to combat any cancer that recurred.



All the vets on my team agreed with this, so that’s what we did.



Chemo Phase:

I chose the Madison-Wisconsin protocol. The chemotherapy went well enough. Coco seemed to tolerate it pretty well. Her energy and appetite were good all the way through. She did have a few episodes of nausea and of diarrhea, but not many. She developed really bad breath. It had a weird metallic smell to it; not normal doggy breath. The vets couldn’t explain it. Her blood work was normal throughout the protocol.



Her coat became thin and brittle. It looked kinda dull and fuzzy, instead of shiny and sleek. She didn’t shed, but the hairs broke easily. The biggest problem she had was that she was hot all the time. Drank a lot of water, and panted all day and all night. However, she kept her sunny disposition, and since we went for many swims and walks and ball chases, she stayed very active the whole time.



Her lymph nodes reduced to normal size after the very first treatment. This was very encouraging, and had me thinking that she would be among the longer survivors of the disease. When the time came to administer the drug that could cause heart damage (adriamycin), the vet offered a different drug (actinomycin) that would not be as strong, but was still an effective drug and would not hurt her heart.



I reasoned that, since she was already in remission, and was only 9 years old, it would be a shame to end up with heart damage in a dog who could otherwise live another 3 or 4 years. The vet agreed and made the substitution.



The protocol was completed at the end of June, 2012. I continued to take her to my local vet for blood work and physical checkups every 2 weeks.



Holistic Phase:

I started the holistic approach, as planned:




  • home-cooked meat – grass fed, organic beef



  • cooked shiitaki mushrooms – organic



  • ground-up veggies – organic carrots, broccoli, cauliflower, chard, kale, beet greens, burdock root, parsley



  • herbal powder mix from the holistic vet



  • Fish Oil capsules



  • Cod liver oil capsules



  • Seven Forests (Paris 7) tablets – to aid in detox



  • reishi mushroom capsules



  • maitake mushroom capsules – just started this last week



  • GeniKinoko GCP – shown to kill canine lymphoma cells in vitro (see http://www.sciencedaily.com/releases/2009/04/090408140210.htm)



  • Green Tea Extract (EGCg) – kills cancer cells



  • Probiotics from Metagenics



She LOVED the diet. I put the herbs, pills, and capsules in her food, and she didn’t even know they were there. Her coat returned to its normal healthy gloss. Her energy was great, checkups were good, her tongue color returned to a healthy pink (I confess, I didn’t notice it getting kinda greyish as the chemotherapy went along, but I do see the difference now.). Life was good.



Relapse:

Everything went well, checkups and blood work, every 2 weeks, until September 3rd. At that checkup, the vet noticed that her lymph nodes were getting big again. Her remission had only lasted 2 ½ months from her last chemotherapy treatment. That was a hard blow. The oncologist recommended that I repeat the Madison-Wisconsin protocol, or choose one of the other chemotherapy protocols that she provides. She was sure that chemo would get Coco back into remission, but she predicted an even shorter remission period before the disease came back. Whichever protocol I decided to use, she urged me to get her an Elspar treatment right away, to put her back in remission quickly.



Elspar is an enzyme that targets and kills cancer cells without affecting normal, healthy cells. The down side is that when the cancer cells die, they release toxins into the body. If there is enough toxin released, it can overwhelm the dog’s ability to process it out quickly enough, and the dog can die. I think this is a rare outcome, but the more cancer there is, the higher the chance it will occur. Dogs can also die of an allergic reaction to the Elspar, but the vet takes precautions to prevent this. They give the dog a dose of antihistamine (Benedryl) before giving the Elspar. My web research tells me that Elspar can also cause nausea and diarrhea, but Coco did not have this the first time around (it is the first thing given in the Madison-Wisconsin protocol).



The holistic vet was not particularly concerned that her lymph nodes had swollen up again. She said that in holistic medicine, the state of the disease is judged by the over-all health of the dog; not just by the state of the lymph nodes. She said she has had many lymphoma patients who live for years with swollen lymph nodes. She was quite pleased with Coco’s overall condition, and urged me to stay the course with the holistic approach.



Once again, I was faced with this either/or choice. Neither vet could predict how much time their approach would buy me. Neither approach claims to cure the disease. The chemo would reduce the lymph nodes to normal again, while degrading the rest of her health. I felt sure that the holistic approach would be far more comfortable for Coco than the chemo, and might do just as well in terms of length of life. I decided to continue on the holistic path as long as Coco seemed to feel good and was eating well.



It is now mid-November, 2012. Coco has survived 11 months from her initial diagnosis, and 5 months since her last chemo treatment. She’s been doing well up to now. Her energy is good; loves to go for long walks, play with her doggie friends, and chase balls. She’s happy and friendly to everyone as she has always been. However, the last few days, she’s been reluctant to eat her meals. She eats them, but not with her former eagerness. She doesn’t run to the dish like before. She eats some, then stops and walks away, then goes back for more. This is not a good sign. The best diet and supplements in the world are no help if she wont eat.



She is still interested in treats (dried lamb lung; no more starchy carbs for her) and table scraps, so maybe she’s just bored with the food, or is getting picky. I’ve read about other dogs that became finicky eaters while on this path.



I’m considering taking her back to the oncologist for an Elspar treatment. If the toxin release doesn’t kill her, the Elspar should knock the cancer out without damaging her overall health. We wouldn’t lose all the healthy ground we’ve gained with the holistic approach. We have an appointment with the holistic vet on Monday, I’m going to talk this over with her then. Stay tuned . . .


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