Interview With A Cancer Specialist
* The following information has been provided by Dr. Phil Zeltzman, a board-certified veterinary surgeon from Whitehall, Pennsylvania as a courtesy to goodnewsforpets readers. To subscribe to his newsletter, click here.
Dr. Sara Fiocchi is a board-eligible veterinary oncologist (aka cancer specialist) at the Veterinary Cancer Group in beautiful Tustin, CA.
I first met Sara during my residency, near Chicago. She was both a veterinary student and an emergency technician. It takes a lot of courage and hard work to do that. The hard work paid off. Sara continued on with her success story.
She provides some answers about questions that clients faced with cancer in their pet commonly ask.
What is your background?
I graduated from the University of Illinois College of Veterinary Medicine in 2005 and have since completed an internship at Texas A&M University and a residency at the Veterinary Cancer Group in Tustin, CA.
What does a veterinary oncologist do?
First and foremost, we educate. When I first meet a pet who has cancer, I speak with their family about what cancer is. I describe the predicted behavior of the specific type of cancer that their pet has, treatment options and prognosis (aka outcome). I perform "staging" tests (blood work, X-rays, ultrasound, sampling lymph nodes or undiagnosed masses, sometimes even CT scan, MRI, or nuclear medicine scans) to determine if the cancer has spread, and if so, how far.
Once you have a diagnosis, what are the treatment options?
In general, treatment recommendations include surgery, radiation therapy and/or chemotherapy. We discuss what the family's goals are, and decide together what tests and treatments are in the best interest of the pet.
If surgery is indicated, I usually send the pet to a Board-Certified Veterinary Surgeon. Studies have shown that, in certain tumor types, having cancer surgery done by a Veterinary Surgeon actually improves the pet's prognosis.
If chemotherapy or radiation therapy is the best treatment choice, I do those in my clinic and can often start treatment at the pet's very first appointment.
Can chemotherapy be dangerous for the pet owner or for other pets?
When handled properly there is little risk to the family and other pets. Most chemotherapy drugs are given by injection in my clinic. Occasionally, chemotherapy pills are given by mouth at home, and the pills are coated in a thick shell to minimize the risk of exposure to the chemotherapy.
Despite that shell, I still recommend that people wear latex gloves when giving chemotherapy pills, in case their pet bites into that shell. I advise pregnant or nursing women (or people attempting to become pregnant) not to handle any chemotherapy or even handle the waste of patients receiving chemotherapy.
With certain drugs, chemotherapy may be present in the pet's urine, feces or vomit, and families should be cautious to avoid exposure when cleaning up after their pet during the first day or two after chemotherapy is given.
Do pets get sick from chemotherapy, like people do?
The majority of pets do not get sick from chemotherapy. This is very important to me because my goal in treating pets with cancer is to prolong a good quality life. In my experience, about 15% of dogs and about 5% of cats will get sick temporarily. Fortunately it is rare (less than 1% in my practice) that they become sick enough to need to be hospitalized. In the few pets that do get sick, we change their treatment to try to make sure they don't become sick a second time.
Do pets lose their hair, like people do?
Most pets do not lose their hair, but shaved areas may grow back slowly. Cats may lose their whiskers. Terriers, Sheepdogs, Poodles and other dogs who get hair cuts are likely to have some degree of hair loss, but I have yet to see a pet go completely bald!
What are the most common side effects of chemotherapy?
Gastrointestinal (tummy) upset including nausea, decreased appetite, vomiting or diarrhea may occur in about 15% of dogs and 5% of cats. If this happens, it is typically mild and can be treated by feeding a bland diet or giving oral medications at home. Some pets' white cell count may become low, and antibiotics or other medications may be recommended if that happens. Side-effects usually resolve within a day or two if they even occur.
How long is the chemotherapy treatment?
The length of the treatment plan depends on many factors, including the type and stage (how advanced it is) of the cancer. Treatment can range from months to years. One important thing to note is that, if your pet has been receiving cancer treatment for years, it is because the treatment is working!
How often do I need to bring my pet for treatment?
The schedule depends on the type of chemo given, which in turn depends on the type of cancer the pet has. Some chemo drugs are given daily at home, others are given in the oncologist's clinic once every week or every 2-3 weeks. There are some types of cancer for which we do not even recommend chemotherapy.
Can a special diet help my pet?
Some oncologists, including myself, recommended a low carbohydrate or grain-free diet in pets with cancer. This can be a commercial dog food such as Inova EVO, Nature's Variety Instinct, Wellness CORE, Dick Van Patten's Natural Balance, and several others.
The reason to feed a grain-free diet is try to starve the cancer cells of their favorite food: simple carbohydrates (aka sugar).
An alternative is to contact a veterinary nutritionist for guidance in preparing a home-cooked diet for your pet. It can be tricky. When choosing a diet, other illnesses the pet may have need to be taken into account such as diabetes, kidney or liver disease, or bladder stones.
Can supplements help my pet?
There are a few supplements, including omega 3 fatty acids (found in fish oil and some other oils), that have proven benefits in 4-legged patients with cancer. There are many supplements that support the immune system, and whole food vitamins are another excellent way to help support the body's normal functions.
Hundreds of supplements are being sold on the internet that may or may not provide benefit to cancer patients.
I recommend speaking either with your family vet or your veterinary oncologist to obtain supplement recommendations that are specific to your pet. I would warn against taking advice about supplements from someone who has never met your pet and does not know his/her complete medical background.
Can alternative medicine help my pet?
Acupuncture, chiropractics and nutrition are three alternative therapies that I utilize in my practice in order to provide holistic care and maintain the best possible quality of life in my cancer patients. Many of my patients also see holistic vets who have additional training in the areas of nutrition and herbal supplements as well as homeopathic remedies and energy work.
Please note that the second half of this interview will appear next week.
For more information on cancer, please visitwww.drphilzeltzman.com