By Dr. Kathy Boehme
As a veterinarian, I am too often the bearer of bad news for pet parents. Despite years of experience, it never gets easier to handle the illness of a pet, whether that pet is a patient or a member of my own family. Fortunately, we have more options now than ever before.
This is the story of my dog’s recent battle with T-cell lymphoma and how I am treating him with an integrative approach.
It all started on a trail in Anza Borrego. During a family hike, I noticed that Otis, our pit bull mix trail leader, seemed overly hot and tired. He rallied for the hike and watched out for us as usual, but his tongue dragged and he was lagging behind me on the way back to the car.
When we got home, I performed an exam and discovered that Otis had an enlarged spleen. At the hospital the next day, his lab work showed a dangerously low platelet count—low enough to allow for life-threatening bleeding. An ultrasound was performed and although his spleen was abnormal, nothing else appeared to be wrong.
We tested for all the infectious causes of enlarged spleens and low platelets. We started treatment with steroids to stop the destruction of the remaining platelets and an antibiotic to ward off possible infection. Tick-borne illnesses like Lyme disease and Ehrlichia are on the rise and since we had recently been hiking a lot, I was praying that was our answer.
Unfortunately, all of Otis’s tests came back negative. We were now looking at the likelihood of cancer. Up to this point, I hadn’t really told the kids much, partly because I really wanted to bury my head in the sand. I could not face losing Otis after losing our other dog months earlier. My son and Otis are best friends. His school even had a club last year called The Otis Nation. The students made a movie trailer about Otis saving the world and have a full-length feature planned. I just wasn’t ready to accept that he was sick.
We saw an internist, Dr. Steve Hill, at Veterinary Specialty Hospital in Sorrento Valley. He recommended removal and biopsy of Otis’ spleen, but first we had to try and get his platelet values up to lessen the danger of intraoperative bleeding.
However, after immunosuppressive doses of steroids, a dog urinating oceans all over my house and so hungry he was eating the baseboards (all side effects of the medication), his platelets were no better. We knew they were being destroyed by his giant, platelet-eating spleen and that it needed to come out. Otis was given a platelet transfusion and a surgeon removed his spleen just before Christmas. He recovered beautifully from the surgery and within a week, his platelets were plentiful again.
Unfortunately, the news from his biopsy was not so great. Otis was diagnosed with a form of cancer called T-cell lymphoma. Lymphoma is not really one disease, but a spectrum of diseases with varying survival times based on location and cell population. In general, T-cell lymphoma carries a poor prognosis. I hope the fact that Otis’ cancer was located primarily in his now-removed spleen will improve his prognosis, but I don’t know for sure. What I do know is that dogs who do not undergo chemotherapy do not live very long, even with alternative approaches.
Because Otis is easily stressed and very dog aggressive, we decided not to give him injectable forms of chemotherapy, which require regular trips to the hospital. Instead, we consulted with an oncologist, Dr. Brenda Phillips, and opted to treat him with oral chemotherapy every three weeks, which I give him at home. Prior to each treatment, his blood work is checked at The Drake Center.
During treatment, I wanted to support Otis’ body and protect his liver from the effects of the chemotherapy. An integrated approach to cancer helps provide this support by reducing stress, balancing the diet and strengthening the immune system.
The use of supplements in the treatment of cancer is controversial, especially for lymphoma.Because lymphocytes are immune cells, many believe that stimulating the immune system with supplements may not seem like a good idea. On the other hand, cancer can also be viewed as a breakdown in the immune system. In this case, enhancing the immune system, which is responsible for destroying abnormal cells before they grow and reproduce, may be beneficial. The truth is, no one truly knows if immunostimulants are helpful or harmful.
Antioxidants can help with the effects of chemotherapy and are generally seen as beneficial in cancer treatment, although oncologists may stop them temporarily during the administration of the chemotherapy because some forms of treatment rely on oxidative damage to kill cancer cells. Dr. Phillips suggested a combination of milk thistle and Denamarin, a high-quality, safe and bioavailable SAMe, to help protect his liver.
There is an extensive amount of research supporting the use of Denamarin to protect the liver from the toxic effects of chemotherapy and various other causes; however, I would caution to always research supplements thoroughly before use. There are only a handful of brands that I trust as there is no oversight of these products and too often, the product labels are misleading or may even contain harmful substances. (For more on supplement safety, click here.)
I also give Otis a daily Chinese herbal supplement to boost his red blood cell count, which gets knocked down by the chemotherapy. The particular formula I chose was based on a Traditional Chinese Veterinary Medicine (TCVM) and pattern diagnosis.
Finally, I started him on a curcumin supplement. For decades, curcumin (a substance found in turmeric) has been researched for its ability to lower levels of various inflammatory proteins within the body. The product I am using contains a few other antioxidants as well.
It is important to note that curcumin is not absorbed particularly well, so choosing the right formula is critical. A concentrated, highly absorbable form needs to be used, otherwise a great deal of money is wasted.
I do not know if the curcumin will help, but I am intrigued by what I have learned reading scientific studies and contacting the manufacturer with questions. I guess you could say Otis is my cute little guinea pig.
Diet is less controversial. Initially we tried one diet that was formulated specifically for cancer and tested on dogs with lymphoma. It was high in protein, fat and Omega 3 fatty acids and very low in carbohydrates. Unfortunately, it gave Otis loose stool. We then changed the kibbled portion of his diet to higher protein, low carbohydrate product which I supplement with cooked meat and vegetables. He is also on a high quality Omega 3 supplement.
The role of dietary support is to maintain weight and lean muscle mass, which is very important in cancer patients. Some dogs experience very poor appetites and nausea as a side effect of chemotherapy. Not Otis. He will never turn down a meal and I hope it stays that way.
I feel very good about the approach I have chosen for Otis. It involves several specialists helping us to traverse a frightening time and a traditional Western approach to cancer (chemotherapy). It also involves support of Otis mentally and physically in the form of affection and play as well as various supplements and traditional Chinese medicine in the form of an herbal formula and functional foods.
Three months post-surgery, I am happy to report that Otis is doing great. He is energetic, has a great appetite and feels better than he has in a long time. He has gained weight and spends a tremendous amount of time in our laps (did I mention that he is almost 60 pounds?). We are so grateful for this time with him, however long it lasts.