Treatment Options

Before Josie got sick, I never gave much thought to treatment options for pets with cancer. Once nasal cancer was a possibility, I started researching various treatment options. The first thing to note is there is no cure – nasal cancer is pretty aggressive that way. No matter what I choose, I’m not choosing to cure Josie – just make her as comfortable as I can in her last days.

I am by no means an expert, and most of this information is found scattered throughout the internet – so take it all with a grain of salt. Also, it seems there hasn’t been a lot of studies on the topic, so most sites quote the same small studies.

Option 1 – do nothing.  Absolutely nothing. Up side – no cost.  Down side – really low survival rates. On average, dogs live 3-5 months after being diagnosed if nothing is done.

Option 2 – Anti-inflammatories (Prednisone, Piroxicam, etc). Long term, anti-inflammatories are really hard on the body.  But when dealing with a terminally ill dog, long term isn’t a big concern. Not only do the anti-inflammatories keep the inflammation down, they have been known to effect tumors. I have had more than one vet tell me they’ve seen dogs and cats survive months, sometimes years, on anti-inflammatories alone after being diagnosed with a nasal tumor. This has been my treatment of choice since December.  And the two times Josie has had to stop taking anti-inflammatories were the worst. I truly believe if not for those drugs, she would not be here today.

Option 3 – Surgery.  I briefly mentioned this before when the surgeon wanted to remove the tumor. Although it seems like a great idea – it changes nothing in the outcome and doesn’t increase survival rates at all. It just puts your dog through a lot of pain and suffering for no gain.

Option 4 – Radiation. This seems to be the treatment of choice for nasal cancer – but only for certain kinds of cancers. It is a huge time and financial commitment.  In Josie’s case, our oncologist doesn’t offer this treatment, so we would have to go to NoVA or NC.  The treatment would require daily doses of anesthesia and radiation for about a month. The side effects include burns, hair loss, blindness, just to name a few. While it seems rough, the up side is this treatment can result in survival times greater than year.

Option 5 – Chemotherapy. Although not as costly or time consuming as radiation, it isn’t that much better.  Chemo would be injected every 2-3 weeks for 6-8 treatments. Side effects are vomiting and diarrhea and possibly life threatening side effects due to effects to her immune system. The results – well, one study of 8 dogs showed 50% having a complete response and 25%  had a partial response.

Option 6 – Metronomic Chemotherapy. The alternative, less aggressive approach to fighting cancer. I don’t remember where I heard/read this, but think of chemo as giving a person the highest dose they can tolerate in order to attack the tumor. It ends up pushing the body to a breaking point – which then needs 2-3 weeks to recover. Metronomic chemo tries something different – instead of using the highest dose possible, do the low dose – and do it often.  It is easier on the body, so a recovery period isn’t needed. Its goal is to achieve angiogenesis inhibition – which cuts off the blood supply to the tumor to slow or even stop the growth of the tumor. By using a combination of chemo drugs, anti-inflammatories and sometimes antibiotics, this can be achieved.  And by finding the right low dose, tumor blood supply is managed but damage to healthy cells is minimized, in theory. Side effects – possible vomiting, diarrhea, lost of appetite, or loss of energy, but this could be caused by either the chemo drugs or the anti-inflammatory.  And if they happen, the doses can be adjusted or even stopped and the side effects should subside.

Now take all those options, and play choose your own adventure.  You can mix-n-match – do the surgery, add radiation, follow with chemo.  Or, opt out of surgery and just do radiation followed by chemo.  Or do chemo followed by metronomic.  The options are endless, and kinda confusing.  And remember – even though each has possible side effects and results – each dog is different. Some options are a good fit, others aren’t.  This is why knowing the information is just part of the battle.  Having an oncologist to help you navigate is crucial. Mine was very upfront that metronomic is the better choice for Josie over radiation and full blown chemo, a conclusion I had already come to.

I just have to trust her to pick the right drugs and doses.

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