Will that be One Lump or Two? A Guide to Lumps on Your Dog

August 4, 2011

My telephone and email have been ringing and pinging this week with questions about lumps on dogs.

Lump near the tail base of a standard poodle.

The subject line of the first email said “Lump on Rump” which sounded like a line from an oncology book written by Dr. Seuss. When I examined the dog, I found a firm mass below the skin just to the right of the tail. Since this was a standard poodle, I suspected a sebaceous cyst, a common lump in this breed. But since you can never determine a benign or malignant lump by observation, I performed a fine needle aspiration using the same size needle I would use to administer a vaccination. Within 24 hours the laboratory confirmed my diagnosis. The worried owners were relieved, especially since no surgery was required for this benign lesion.

Small pea sized lump on the shoulder of a dog

The second call was from an AMC colleague who has just adopted a foster dog. He’s been vaccinated, groomed and has a spiffy new collar. His owner was petting him and found a lump over his right shoulder. The combination of the recent vaccination and the location of the lump (right where he would have been vaccinated for distemper/parvovirus) made me think it was a small-localized vaccine reaction. Since this dog comes to AMC most days, we carefully measured it on the first day and again a week later and it was already getting smaller. I will continue to monitor this lump but suspect it will go away in another couple of weeks.

The third call was from a friend of mine who is a veterinarian. She had found a lump on her own dog and performed an aspiration which diagnosed a mast cell tumor.

Because these tumors sometimes require specialist level care, she wanted input from the AMC about how best to approach this tumor surgically and input from me regarding an potential chemotherapy.

If you have a lumpy dog, have each lump evaluated by your veterinarian. I keep a line drawing of a dog’s body in each dog’s medical record. On the drawing I sketch the lump, record the size based on measurements and indicate the date aspiration cytology was performed. This process makes short work of determining if this is a new lump or not.

If your veterinarian recommends aspiration cytology or a biopsy, go for it. Without additional information, it is impossible for me or any veterinarian, to give an owner bad news or good news about the lump on their dog.

Don’t hesitate to seek the opinion of a specialist. A dog with a lump in a difficult location may need a advanced imaging to define the tumor location, a specially trained surgeon to successful remove a lump or a cancer specialist to provide follow up chemotherapy.

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This may also be found in the “Tales from the Pet Clinic” blog on WebMD.com.

For over a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit www.amcny.org. To make an appointment, please call 212.838.7053.


Why Do People Treat Their Pets for Cancer?

April 11, 2011

People I meet socially are often surprised when I tell them I treat pets with cancer. The first level of surprise occurs because many non-pet lovers don’t know pets get cancer, so of course they are doubly surprised to meet some who treats it. For me, cocktail party conversation frequently centers around the question, “Why do people treat their pets for cancer?”

Since many pets are considered members of the family, pet owners want the same level of medical care for their pet as they do for themselves. At specialty hospitals like The Animal Medical Center, this high level of medical care includes surgery, chemotherapy and radiation therapy.

I am often asked if a dog is too old to get treatment. My patient population and that of most oncologists is elderly. To be trite: “Age is not a disease.” But some older pets may have diseases which complicate cancer therapy or have such a delicately balanced treatment regime that cancer treatment is not a good idea. Other older pets sail through cancer treatments, like Spenser.

Cuddles/Photo by Dr. Ann Hohenhaus

Cuddles the Cat is a chemotherapy patient. Notice the short stumpy whiskers on the right side of her face, which are the only outward sign of chemotherapy treatment she has.

Side effects — nausea, vomiting, hair loss — become another worry for pet owners based on their experiences with human family members. Veterinary cancer treatment goals are different. We strive to improve the quantity of life as well as the quality of life for our dog and cat patients. We usually can achieve this goal and if we can’t, we understand if the owners choose to discontinue therapy.

Since I am an oncologist, I bet you think all the pets I see get treatment for their tumors. Not so fast. The decision to treat cancer in a pet belongs to the pet’s family, not me. My job is to provide information about prognosis, complications and expectations. The family has to weigh the tough stuff and this decision is never taken lightly. I had one lovely, but unlucky cat owner client. Both her cats developed the same uncommon tumor. She chose to treat one, but not the other. Why? The two cats had diametrically opposed personalities. We treated the gentle, cooperative cat, but much to my relief, she perceived treatment of her ultra-cranky cat would be stressful for him, a tribulation for her and dangerous for the oncology staff.

If you are worried your pet might have cancer, click here to find the warning signs of cancer in pets.

If your pet is showing any of these signs, see your veterinarian right away.

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This may also be found in the “Tales from the Pet Clinic” blog on WebMD.com.

For over a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit www.amcny.org. To make an appointment, please call 212.838.7053.


Thinking Outside of the Box: Creative Medical Solutions

March 21, 2011

Creative solutions to manage tough medical issues.

My colleagues at The Animal Medical Center have recently come up with innovative solutions to two very interesting cases that I’d like to share with you.

The PEG Tube for Bloat

Rufus/Photo: Dr. Ann Hohenhaus

Rufus has a percutaneous endoscopically-placed gastrotomy tube (or PEG tube for short). These tubes are commonly used at The AMC in both canine and feline patients who cannot or will not eat voluntarily.  Rufus eats fine.   His problem is gas in excessive amounts, so much so he becomes dangerously bloated – commonly known as belly bloat.

Dr. Sarah Stewart of The AMC’s Internal Medicine Service determined that a strategically-placed PEG tube would relieve pressure and allow removal of excess stomach gas from Rufus’ stomach without the need for an ER visit.

Low profile tube in rufus/Photo: Dr. Ann Hohenhaus

The AMC team helped Rufus’ owners learn how to use the PEG tube at home to keep Rufus comfortable — and prevent hospital stays — while The Animal Medical Center team formulates a special diet and adjusts medications.  I am happy to report that the PEG tube is working so well, in fact, that Rufus’ owners have already managed several bloat episodes at home, by themselves, without any medical support from us.  The new diet is working and gas production is way down.  Yesterday, Rufus had a low profile tube placed to make him more comfortable.  I have included a photo of the new tube taken just after it was placed.

A Pleuroport  for Fluid Removal

Mencheese, a beautiful, 13-year-old cat, has a tumor in front of his heart. The tumor is producing fluid which accumulates around his lungs. This fluid build-up makes it difficult — and uncomfortable — for Mencheese to breathe.

Dr. Janet Kovak, a member of The Animal Medical Center’s Soft Tissue Surgery Team, placed a pleuroport which provides a device that quickly and painlessly allowed us drain the fluid from Mencheese’s lungs until the chemotherapy controlled the tumor and stopped the fluid production. Dr. Kovak treats many types of soft tissue injuries or illnesses through the use of minimally invasive surgery such as thorocoscopy and laparscopy.

Mencheese/Photo: Dr. Ann Hohenhaus

Take a look at the photo to see the pleuroport in action. Mencheese is sitting comfortably on a treatment table in the oncology treatment area at The AMC. You can’t see the pleuroport — it is under his skin — but you see the special needle and the tubing we use to drain the fluid. Keeping the fluid drained off his lungs has really improved Mencheese’s quality of life. He has been wolfing down cat food like he hasn’t seen a square meal in months!

Some readers may be familiar with a similar device called a vascular access port (VAP). Like the pleuroport, a VAP is surgically implanted. But instead of being placed into the space around the lungs, it is placed into a blood vessel. The VAP is used to draw blood samples and administer chemotherapy to cancer patients without the need for repeated blood draws or catheter placement.

The stories of Mencheese and Rufus are just two stories about “pets on the road to recovery” because of some creative care by The AMC staff and hard work on the part of devoted pet owners.

This blog may also be found in the “Tales from the Pet Clinic” blog from WebMD.

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For over a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit www.amcny.org. To make an appointment, please call 212.838.7053.


Traditional Chinese Medicine and Cancer Therapy for Your Pet

March 3, 2011

My inspiration for today’s blog post comes from two wonderful patients of The Animal Medical Center, Baby and Basil, who benefited from both traditional Chinese medicine and Western chemotherapy during the management of their cancer and inspired me to research the topic further.

Basil/Photo: Dr. Steven Chiros

Traditional Chinese medicine is an alternative medical system different from our more familiar Western medical system. Traditional Chinese medicine is based in the Taoist religion and encompasses acupuncture, herbal therapy, mind-body therapy and Chinese massage, Tui-na. Although these treatment modalities have been used to treat diseases for five millennia, their use is not widespread in the Western world.

Despite this, there are people in the West seeking traditional Chinese medicine for themselves and requesting the same for their pets.

Some traditional Chinese therapies have been used in pets. Acupuncture is one of them. According to the Leukemia and Lymphoma Society, acupuncture has been shown to be safe in human cancer patients and may help to ameliorate treatment associated nausea.

The AMC’s acupuncturist, Steven Chiros, DVM, CVA used acupuncture to help decrease Basil’s nausea, improve her appetite and increase her energy. The photo of Basil shows an acupuncture treatment in progress. In addition to acupuncture, Basil received two Chinese herbal formulas. Basil’s owner reported a significant improvement from the two therapies. Based on its safety in humans with cancer and experience with acupuncture in my patients, I do not hesitate to have my patients see AMC’s acupuncture specialist.

Baby/Photo: Leo Weinberger

Baby was a cat with intestinal cancer whose Chinese medicine practitioner referred him to The AMC for treatment with Western medicine chemotherapy in addition to the traditional Chinese therapies. Baby received an herbal antioxoidant, coenzyme Q and other herbal therapies as well as well as traditional chemotherapy. The use of Chinese herbal therapies in cancer patients is not as straightforward as the use of acupuncture.

Herbal therapies must be carefully selected in pets on chemotherapy. Strong evidence exists indicating St. John’s wort (Hypericum perforata) extract decreases blood levels of various anticancer agents in human cancer patients and this herb should not be used in conjunction with chemotherapy. Other herbs, such as ginko, may decrease the ability of the blood to clot, resulting in excessive hemorrhage during surgery.

Investigation of natural compounds active against cancer is currently an area of enormous interest. Between 1981 and 2002, 62% of cancer drugs approved by the FDA were of natural origin. Today, the National Cancer Institute Office of Cancer Complementary and Alternative Medicine is funding studies on tumeric (Curcuma longa), a spice commonly used in African and Asian cultures, often as a component of curry powder, and in traditional Chinese medicine.

In the November issue of the American Journal of Veterinary Research, a laboratory study showed the carotenoid lycopene slowed growth and killed canine bone tumor cells grown in cell cultures. Even more promising was the fact that lycopene did not interfere with chemotherapy drug effects on the tumor cells. These are hopeful findings, not yet ready to be translated to use in clinical patients.

Right now, what is critical to treatment success is an open dialogue between your veterinarian and your traditional Chinese medicine practitioner. Be sure to tell them you are giving your pet herbs or they are undergoing chemotherapy.

This blog may also be found in the “Tales from the Pet Clinic” blog from WebMD.

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For over a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit www.amcny.org. To make an appointment, please call 212.838.7053.


Big News in Cancer Treatment for Dogs!

July 21, 2009

Palladia

Just last month, veterinary oncology had a first and as a board certified veterinary oncologist, this news just made my day. Until now, all chemotherapy agents administered to dogs were human drugs adapted for use by veterinarians. In June, the Food and Drug Administration’s Center for Veterinary Medicine approved the use of Palladia® (toceranib phosphate) which was specifically developed for use in dogs and has safety and efficacy data from canine studies backing its use. Palladia is licensed for the treatment of recurrent mast cell tumors.

mast-cell-tumorVeterinary oncologists have effective therapies for some dogs with mast cell tumors.  These treatments include surgery, human chemotherapy agents and radiation therapy.  But not all dogs have tumors amenable to surgical removal, not all tumors are in a location where radiation therapy can be safely administered and currently available chemotherapy agents do not cure every dog. So the first drug specifically developed for canine mast cell tumors is big news. 

Mast cell tumors are one of the most common skin tumors in dogs and are one of the most important cancers veterinary oncologists treat. Some dogs are unlucky enough to have multiple mast cell tumors or a mast cell tumor that keeps coming back in the same location. So a drug to help manage this common tumor is big news, redux.

Palladia belongs to a class of drugs known as tyrosine kinase inhibitors. The presence of abnormal tyrosine kinases in tumors results in the proliferation of tumor cells and the growth of new blood vessels to the tumor. These blood vessels provide nutrients to the growing tumor. Inhibition of tyrosine kinases by drugs like Pallada (or for humans, Gleevec®, another tyrosine kinase inhibitor) stops both cell proliferation and new blood vessel growth. Without nutrients and without cell proliferation the tumor shrinks. More big news.

Pfizer Animal Health is working with veterinary specialists to help them use Palladia effectively and safely. It is currently available from board certified veterinary specialists in oncology, internal medicine and dermatology. To find the specialist nearest you go to http://www.acvim.org/ for oncologists and internists and at http://www.acvd.org/ for dermatologists. Pricing for Palladia has not yet been announced.

Click here to download an information sheet about Palladia from The AMC.

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The Oncology Team at The Animal Medical Center

At The Animal Medical Center, specialists certified by the American College of Veterinary Internal Medicine in the sub-specialty of Oncology and the American College of Veterinary Radiology in the sub-specialty of Radiation Oncology provide dedicated care for pets with cancer Monday through Saturday.  We take a team approach to cancer care, collaborating with specialists in the fields of diagnostic imaging, pathology, surgery and internal medicine to create a customized plan for the care of your pets .

You can reach The AMC Oncology staff by email or phone:

• Ann Hohenhaus, DVM, DACVIM (Oncology, Small Animal Internal Medicine)    
(212) 329-8612, Ann.Hohenhaus@amcny.org   
• Nicole Leibman, DVM, DACVIM (Oncology)
(212) 329-8696, Nicole.Leibman@amcny.org   
• John Farrelly, DVM, DACVR (Radiation Oncology), DACVIM (Oncology)
(212) 329-8794, John.Farrelly@amcny.org  
• Andrea Flory, DVM, DACVIM (Oncology)
(212) 329-8687, Andrea.Flory@amcny.org


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