The Dog Cancer Survival Guide (75 page)

Of course, dogs differ widely in their personality and habits, so some of these behaviors might not indicate pain in every dog. The key for you is to know what is normal for your dog, and then look for differences from the norm, using the listed behaviors as a guide. Have your veterinarian or oncologist help you assess pain in your dog.

There are some circumstances in which you can be sure your dog is in pain. If your dog just had a biopsy or other surgery, he will likely experience temporary pain at the incision site. Good pain management protocols can help a great deal until the pain fades away completely.

The best you can do is to identify possible pain in your dog and bring it to your vet’s attention. Believe it or not, a recent study found that dog owners could be quite skilled at diagnosing chronic pain in their dogs. According to the study, once guardians were educated about the signs and symptoms of their dogs’ pain, they could detect it better than any test (heart rate, cortisone levels or other clinical tools). Once you bring the pain to your vet’s attention, your vet will try to find the source, which will help her to decide how to manage it.

It’s very common to prescribe an anti-inflammatory drug to reduce pain and inflammation. Anti-inflammatories are good for mild to moderate pain and can also be used in combination with the opioid pain medications described below. Current common anti-inflammatories include: Metacam, Deramaxx and Previcox. Rimadyl has been in use for some time and is currently being phased out. As mentioned elsewhere, the ingredients in Apocaps have shown anti-inflammatory effects, also.

Although many opioid drugs can suppress pain, some dogs may experience agitation on these drugs: panting, pacing, whining or weaving and, generally, fighting the effects of the drug. Tramadol usually (although not always) is the exception to this rule. This prescription opioid narcotic not only produces good pain control (especially when used with other medications like NSAIDS), but also is well tolerated. Another useful combination is Tylenol with codeine. All these drugs are to be used under veterinary supervision.

Combining pain control drugs is a very useful strategy (called multimodal therapy). When single drugs are used for pain control, such high doses are sometimes required, that side effects become more likely. By using different drugs together, even though the pain control of each one contributes, since its side effects are often different, they are minimized.

I use this strategy for dogs in pain who have been admitted to the hospital. I often use a constant rate infusion (CRI), where the pain control drugs are used at lower doses, in combination, and given continuously through an IV drip. Low dose ketamine is selected often, along with lidocaine, fentanyl, Dexdomitor or other drugs (the ketamine dose is much lower than that used for anesthesia, see
page 120
).

For at-home pain control, sometimes a Fentanyl patch is prescribed. This patch looks like an adhesive bandage; it sticks to the skin, so that it can administer Fentanyl steadily, over time. If your dog gets a patch, make sure that she doesn’t lick, bite, or eat it, because it’s toxic if ingested. To cover the patch you can put a t-shirt on him and use an Elizabethan collar.

These drugs – NSAIDS, Tramadol, Tylenol with codeine, CRIs and Fentanyl patches – are examples of drugs used for controlling what is called adaptive pain. Adaptive pain is a response to specific, direct injury. It can be caused by tumors, trauma, or surgery, and the pain seems to arise from the injured area itself.

There is another type of pain that is not directly related to tissue injury. The nervous system (brain, spinal cord and nerves) can react to the original injury and create neuropathic pain, sometimes called “wind-up.” This additional pain adds to the adaptive pain, which worsens both. Anxiety sometimes seems to worsen neuropathic pain and even more with chronic pain. Medications like Elavil (amitriptyline), gabapentin and amantadine can help with neuropathic pain and can be used right along with other pain medications.

Morphine is a popular drug for pain control, especially for advanced, chronic pain. However, I do not generally recommend its use for dogs with cancer, because recent research shows it may support tumor growth, increase metastasis and shorten survival times. These findings in rats are raising red flags for both human and veterinary oncologists. Some severe or chronic pain cannot be controlled in any other way, so you will need to weigh these factors with your veterinary professional.

Another common drug, which I do not generally recommend, is Torbugesic (Torbutrol). Although prescribed as a medication for use at home, it is not strong enough and does not last long enough to offer real relief. It is, therefore, becoming outmoded for a pain medication in dogs.

Other tools that can help with pain are acupuncture, palliative radiation, pamidronate (for osteosarcoma), warm or cool compresses and gentle massage.

It might take a little tweaking to find the right combination of medications for your dog; when you do, it can seem almost miraculous. Dogs can perk up, become more loving, move around more, eat better, and engage more – sometimes so much so that the guardian asks me
What’s in that pill?
, as if the drug is a stimulant or a euphoria-inducing hallucinogen. In reality, pain control just makes the dog feel better. If you’ve ever had a splitting headache and taken an aspirin, you know how good it feels to be restored to your normal state. This is likely how our dogs feel, too.

When pain management protocols work, I always feel a sense of relief and accomplishment. Not only have I have addressed a real problem, but I have also found out more information about the dog’s condition. Pain relief – whether it comes from a prescription pain medication such as Tramadol, a nutraceutical such as Apocaps, or from a gentle massage – is very important to dogs with cancer.

“We use both krill oil and fish oil capsules. We’re just too busy to do the home cooked meals, but he gets a mixture of ZiwiPeak Venison (real meat, air-dried, no grains) and Preference foundation mix from The Honest Kitchen to get him vegetables. He often gets raw broccoli florets with his breakfast and if we make a salad, asparagus or cauliflower for dinner he always gets some of the leftovers. He’s also bug for blueberries and blackberries.”

- Al Marzetti, Raleigh, North Carolina

I
s my dog happy? How do I know?

These are important questions that deserve careful consideration at any time of life, not only when cancer is present.

It is hard to know for sure whether anyone is happy or not, including our dogs. But there are certainly things that make dogs seem happy. Here is a list of what I call the Joys of Life:

• The Joy of eating and Drinking
  : Most dogs, like most people, enjoy eating when they are hungry and drinking water when they are thirsty. Hunger and dehydration are unpleasant and uncomfortable conditions for humans, and I think they’re uncomfortable for dogs, too.
  
• The Joy of Motion:
  Most dogs enjoy walking, running, frolicking, frisking and generally moving around. Even if your dog is normally less athletic than others, when he is unable to move freely, he will likely experience a lower quality of life.
  
• The Joy of Social Interactions:
  Your dog is a social creature, biologically designed to thrive in groups. When something interferes with her ability to interact normally with you or with other dogs, her potential for taking pleasure in social interactions diminishes.
  
• The Joy of Having a Fully-functioning Body:
  Dogs seem to feel good when their bodily functions operate normally. It may seem simplistic, but if you’ve ever had problems urinating, defecating, breathing, smelling, seeing, hearing, tasting or sensing the world with your hands, you know how disorienting and unpleasant it can be. Normal bodily functions are important for feeling good.
  
• The Joy of a Healthy Mental State:
  Depression, stress, senility, chronic pain and other unpleasant altered states, likely decrease life quality for dogs, just like they do for people.
  
• The Joy of Play:
  Dogs are by nature playful creatures. While they tend to slow down as they get older, they never completely lose their desire for fun, whether it’s chasing balls, tug of war or wrestling. If your dog is incapable of playing to the same degree as before, I believe that his quality of life suffers.
  
• The Joy of expression:
  Dogs have unique personalities, and they express themselves in many ways. Some dogs are naturally affectionate and helpful. Others are natural watchdogs or protectors. Some are clowns or goofballs. When your dog’s normal natural self-expression becomes muted or disappears, there is probably a slipping of life quality associated with the change.
  

Paying attention to your dog’s joys – and what increases or decreases them – can help you to determine his overall quality of life. Go down this list and see which are affected right now, and how many are left. Then ask yourself whether most of the ones that matter to your dog are still there. This assessment is one of your primary responsibilities as his guardian. For some guardians, this will reveal unwelcome and hard truths; for others it will offer reassurance that their dogs still have good life quality.

I understand that sometimes guardians feel that any loss of life quality is bad. While I understand how distressing it can feel to see your dog’s quality of life slipping, I have a more nuanced perspective. When only one of your dog’s joys is gone, life quality can stay quite good. For example, blind people can have a good overall quality of life, and so can blind dogs. They can still enjoy many other things, including the pleasure of food, physical activity and close relationships.

I will never forget a case, early in my career, when I was forced to amputate a dog’s front leg. I was really bothered by it, because I imagined he would be suffering terribly from the loss. Imagine my relief and surprise when he ran through the surf to greet me, just a few weeks later, tail wagging and completely delighted to be alive. It was clear that the loss of one leg did not lessen his quality of life. His guardian told me he was eating, drinking, engaged, playing, and free of pain, depression and stress. (There is a wonderful online community called
www.tripawds.com
just for guardians of three-legged dogs.)