Cortisone pour chat

Les traitements à la cortisone

La cortisone est utilisée dans le traitement de diverses maladies de la peau, dans le but généralement de contrôler les symptômes de celles-ci. Par exemple, les démangeaisons dues aux allergies peuvent être contrôlées avec un traitement à base de cortisone. Toutefois, la cortisone ne guérira pas le problème et très souvent, les symptômes réapparaissent aussitôt son administration terminée.

Les traitements à base de cortisone sont souvent redoutés par les propriétaires d’animaux étant donné les effets secondaires possibles reliés à leur utilisation. D’ailleurs, le rôle du vétérinaire est de tenter d’identifier la cause du problème afin de trouver un traitement spécifique et éviter l’administration à long terme de la cortisone. Lors d’allergies, certains médicaments comme les antihistaminiques ou les acides gras pourront à l’occasion s’avérer efficaces sans avoir pour autant les effets indésirables de la cortisone. Toutefois, de façon réaliste, ces médicaments sont moins efficaces et souvent, au mieux, ils ne permettent qu’une réduction de la dose de cortisone nécessaire pour soulager l’inconfort de l’animal.

La gravité des effets secondaires de la cortisone est généralement en relation avec la dose administrée et la durée du traitement. Même s’il est généralement souhaitable de trouver une autre modalité de traitement, plusieurs animaux reçoivent de la cortisone à très long terme et conservent, malgré tout, une excellente qualité de vie, d’autant plus si la dose requise est faible.

En appliquant les règles de base suivantes, les effets secondaires de la cortisone peuvent être réduits :

• Initialement, la cortisone est administrée à tous les jours jusqu’à ce que le problème soit contrôlé, mais après environ une semaine (variable selon chaque cas), la cortisone devrait être administrée à tous les 2 jours.
• Administrer les comprimés de cortisone le matin de préférence (chez le chien).
• Tenter de trouver la dose minimale efficace aux 2 jours qui contrôlera le problème.
• Contrairement aux antibiotiques, pour lesquels la prescription doit être respectée à la lettre, la cortisone doit être ajustée au besoin afin de trouver la plus faible dose, administrée le moins souvent possible, qui contrôlera le problème.

Les effets secondaires prévisibles de la cortisone incluent :

• Augmentation de la soif (laisser de l’eau fraîche à volonté);
• Besoin d’uriner plus souvent (surtout lorsque les doses sont plus élevées, il peut être nécessaire d’augmenter la fréquence des promenades);
• Augmentation de l’appétit (évitez d’augmenter la ration quotidienne car il y aura un gain de poids);
• Halètement;
• Dans certains cas, un changement de comportement (ex : léthargie, dépression).

La plupart des effets secondaires de la cortisone sont proportionnels à la dose et s’atténueront lorsque la dose sera diminuée et disparaîtront à l’arrêt du traitement.

Si votre chien doit recevoir de la cortisone pour des longues périodes, voire toute l’année, il peut y avoir d’autres effets indésirables (problème hépatique, infection, etc). Dans ce cas, nous recommandons de faire un examen de santé, des prises de sang et une culture d’urine (en cas d’infection urinaire occulte) 1-2 fois par année. De plus, puisque la cortisone peut accroître les risques d’infection de la peau, vous devez consulter votre vétérinaire si le problème cutané de votre animal vous semble anormal.

Information on this page is courtesy of Bath-Brunswick Veterinary Associates, Inc. from an article by Dr. Gail D. Mason, DVM, MA, DACVIM

Many of our patients require far more than routine preventative care. This may include therapy for certain types of cancers. Though there are similarities between human and veterinary cancer treatments, there are some important differences. Improved therapies can provide acceptable options for pets and their owners.

CANCER & CHEMOTHERAPY IN COMPANION ANIMALS

A cancer is a tissue mass characterized by persistent, excessive, and disorganized cell growth that is unresponsive to normal control mechanisms. Cancer is a leading cause of death in dogs and cats. Why this happens, in most cases, is not yet known. As a result of improved owner and veterinary care, pets are living much longer and thus are more susceptible to diseases of old age, such as tumors. Compared to people, dogs develop tumors twice as frequently, but cats only half as frequently. If your pet is thought or known to have cancer, a consultation with a veterinarian experienced in oncology can provide you with valuable information regarding treatment options and expectations.

Terms Used in Cancer Medicine:

Tumor: simply means a « swelling, » which may or may not represent cancer.

Benign Tumors: have many normal growth characteristics. They do not « spread » or invade other organs. They, may however, compress body organs or tissues by virtue of their size. Surgical removal is usually curative.

Malignant Tumors: often have rapid, irregular growth characteristics. These tumors can invade normal, local tissues, as well as spread to other tissues (especially the liver and lungs). New tumors can grow at these secondary sites, eventually causing the demise of the patient.

Metastasis: the process whereby a tumor spreads to secondary sites. These new tumors are referred to as «  »metastatic », » or « metastases. »

Oncology: refers to the study of tumors, including their biological behavior and treatment.

Remission: denotes a decrease in tumor size (often called « tumor burden ») over time. Remission time is the length of time in which the tumor is under control. Currently, treatment of cancer in animals can often result in fairly lengthy, good quality remission times. That still means that for many types of cancers, their return is inevitable. This fact must be contemplated and discussed before the client and the veterinarian decide to treat an animal for cancer. Having reasonable and accurate expectations will provide a more positive experience for all those involved.

Surgery: surgical removal of tumors is a very common and valuable approach for solid tissue tumors. It can be used for soft tissue as well as for bone tumors. It can sometimes be curative on its own, if the disease process is localized and detected very early.

Radiotherapy: or « radiation » therapy is available at large veterinary institutions such as Tufts University School of Veterinary Medicine (North Grafton, Massachusetts) and Angell Memorial Animal Hospital (Boston, Massachusetts). It consists of the use of a radioactive beam to damage and/or kill malignant cells in a localized area. It can offer good quality remission times for many types of tumors, but usually not cure. Animals are surprisingly tolerant of radiation therapy.

Chemotherapy: is the use of certain drugs alone, or in combination to control tumor growth. All of the drugs currently given to animals are human anti-cancer drugs. Fortunately, many of the negative consequences of their use in human medicine are not experienced in veterinary medicine. Chemotherapy and/or surgery are the two most important treatment modalities in veterinary cancer medicine. A combination of therapies may also be indicated in certain cancers. Some cancers require a specific, brief number of treatments, while others requiring ongoing treatment to maintain remission.

Specific Cancers Type of Tumor Type of Treatment Lymphoma Chemotherapy (several types available) Mast Cell Tumors Chemotherapy, Surgery (+/-radiation) Fibrosarcomas Surgical +/-chemotherapy, radiation Oral Cancers Surgical, with reconstruction Mammary Tumors Surgical (+/-chemotherapy follow-up) Osteosarcomas (bone) Surgical + chemotherapy follow-up Hemangiosarcomas Surgical + chemotherapy Skin Tumors Surgical +/- chemotherapy, radiation Transitional Cell Carcinomas Surgical + chemotherapy Undifferentiated Sarcomas Surgical +/-chemotherapy, radiation

Because Dr. Gail Mason treats many patients affected withLymphoma or Osteosarcoma, specific discussions on these tumors follow.

CANINE AND FELINE LYMPHOMA

The word « chemotherapy » usually evokes unpleasant thoughts in most people’s minds. We prefer to think of it as « therapy » for a disease, in the same way people take medications for certain illnesses. The ultimate goal of therapy would be to cure the patient of cancer. In most instances at this point in time in veterinary medicine, this goal is not realistic. The goal we do strive for is to control rapidly progressive disease, prevent spread of the tumor, restore deteriorated function, and provide a good quality of life during the time of remission. The term « remission » means a time interval during which there are no outward signs that the patient has cancer. In the case of lymphoma, if the maximum combination protocol is used, it is expected that 80% or more of patients will go into full remission. The average duration of remission is longer than 12 months. Unfortunately, it is impossible to predict which animals will achieve a full remission or for how long. We do know, however, that if no therapy is used, most pets will die from their disease in a few days to a few weeks.

There are many « protocols » or treatment schedules available for canine and feline lymphoma. Unfortunately, there is not one « key » formula as yet that has been proven superior to all others. Most published protocols contain the same or similar class chemotherapy agents, with minor variations on combination agents and timing of treatments. Most veterinary internists and oncologists use the protocols that they are the most familiar with, and that best fit the particular lifestyle and expectations of the client, and well-being of the patient. A brief synopsis of treatment categories for feline/canine lymphoma is as follows:

Regimen Risk of Side Effects Expected Remission Time* Costs Prednisone (cortisone) low 2 months very low Prednisone + Cytoxan® low to moderate 2-4 months+ low COP (Prednisone, Cytoxan®, Vincristine low to moderate 6-12 months+ moderate ACOPA Adriamycin®, Cytoxan®, Predisnone, Vincristine, Asparaginase moderate to high 8-36 months higher *NOTE: No guarantee of remission times can be made. These are average lengths. The stage of the disease, protocol selected, general health of the animal, and several other factors are only some of the determinants of remission time.
Behavior & Treatment

Osteosarcoma is the most common primary bone tumor of dogs. Large and giant dog breeds are at highest risk of this malignancy. This tumor is locally destructive to normal body tissues, and has a high metastatic rate (tendency to travel to distant sites in the body). It is one of the cancers in dogs that can be painful when it is in its active stages. Bones of the limbs that are affected by osteosarcoma can be weakened to the point of a fracture (called a pathological fracture).

If no treatment is rendered, the animal usually succumbs to the disease within 1-2 months from the time of diagnosis. Surgical resection of the tumor and/or limb amputation are key to treatment of osteosarcoma. Though many owners are at first hesitant about surgery, they frequently observe that their dogs improve dramatically after this treatment. This is by and large because a source of constant pain has been removed. It is important to note, however, that surgical resection alone does little to prolong the dog’s survival time.

What about chemotherapy?

Osteosarcoma is always considered to have spread microscopically in the dog’s body by the time the diagnosis is made. This is the reason that surgery alone fails to control the disease. To attack the cancer cells both locally and systemically, chemotherapeutic agents can be used. The goals of therapy are to preserve a good to excellent quality of life for the dog, eliminate pain, and provide as long a remission time as is possible. Cure is not a reasonable goal at this time, and this fact must be realized by the owner prior to initiating therapy.The two most common chemotherapy agents used for osteosarcoma are Adriamycin® and platinum compounds such as Carboplatin or Cisplatin. Because Adriamycin® and Carboplatin are synergistic with respect to their anti-cancer activity, they are often alternated in treatment protocols. Treatments are done as outpatient visits, every 3-4 weeks, for a total of 4-6 treatments. The actual treatment time takes approximately 30 minutes.

As previously mentioned, a dog that is given no treatment, or treatment with surgery alone is expected to live 1-2 months from the time of diagnosis. However, for a dog that undergoes surgery plus adjunct chemotherapy, the expected 1 year survival rate is 50%, the 2 year survival rate falls to about 20%. The cancer eventually starts to grow in the lungs which leads to coughing, weight loss, and malaise.

Side Effects of Therapy?

Healing from surgery is usually rapid and complete. The results in terms of cosmetics, function, and owner acceptance is excellent in most cases. All chemotherapeutic agents have potential side effects, which should be understood by the owner so that proper intervention can occur if the need arises.

Adriamycin®

Adriamycin is a potent anti-cancer drug used in both humans and animals for many different types of cancers. It has been shown to be beneficial in treating canine osteosarcoma, but is best used with a platinum compound. Occasionally, nausea and vomiting can occur within 2 days of administration of the drug. These episodes are infrequent and can usually be mitigated by using anti-nausea medications. The most serious side effect results from the dog’s white blood cells being lowered (infection fighting cells). This usually occurs about 5-8 days after treatment. Symptoms include sudden lethargy, refusal to eat, reluctance to rise, and fever. If this happens, follow the directions you have been given and/or call the hospital ASAP. This side effect can be rapidly and successfully treated. However, ignoring these important signs can be lethal!

Carboplatin

Carboplatin is the « gold standard » in treating canine osteosarcoma. It is useful as a single agent, or in combination with Adriamycin®. Carboplatin occasionally causes dogs to act « subdued » or have a decreased appetite for 2-3 days after administration. This effect tends to be mild. Carboplatin, like Adriamycin®, has a tendency to lower the white blood cell/platelet counts. This is less common and usually less severe than with Adriamycin®. It occurs approximately 10-13 days after administration. This drug could theoretically cause damage to the kidneys over time, but this is very uncommon. Your dog will be monitored for side effects during treatment. Unfortunately, because the « platinum » compounds actually do contain platinum, they are very costly! A cost estimate of treatment will be given to you during your visit.

Quality of life?

Fortunately, most dogs who undergo treatment for osteosarcoma are lucky enough to have an excellent quality of life! They are pain free, and done with treatment after 4-6 rounds (3 week intervals). They rarely have to be hospitalized, so that they can be at home with « their people. » Dogs can continue to do virtually every activity that they are used to doing (yes, even hiking..). We hope to make your dog’s remission as long and enjoyable as possible!

What is Life Like for Chemotherapy Patients?

Veterinarians who treat animals for cancer use many of the same chemotherapy agents that human oncologists use. Yet, in many ways the experience for pets seems very different. Why? For one thing, dosages of chemotherapy agents used in animals tend to be much lower than those used in people. Humans are given the highest doses possible, the consequences of which may require bone marrow transplantation, extended hospitalization, and numerous costly medications – all with good cause. However, for veterinary patients, this process would be unacceptable and cost prohibitive for most owners. The general quality of life for many veterinary cancer treatment patients can be surprisingly good and very close to normal. Most of the time they can maintain their normal activities, travel, and have fun with the families that love and care for them.

Most currently used anti-cancer agents do not specifically target cancer cells. Rather, they target and damage or kill rapidly growing cells. For the patient, this means cells lining the stomach and intestine (high turnover rate), cells of the bone marrow that make up the immune system (white blood cells, in particular), and cancer cells. It then is little surprise that the most common side effects of chemotherapy agents include mild to moderate nausea, vomiting, diarrhea, and increased risk of infection. Hair loss, in contrast to humans, is uncommon in dogs and cats on chemotherapy. The good news is that the normal cell lines can almost always regenerate themselves, while the less well organized malignant cells suffer great damage. However, even at higher dosages, microscopic malignant cell clones remain alive, albeit dormant in the body. Eventually these give rise to drug-resistant cell lines. This is the biological basis of recurrent or metastatic cancers.

It is not a « given » that untoward side-effects will occur in any one patient. In fact, the majority of our patients complete their therapies without major complications. If they do occur, however, you should be prepared to recognize them and take appropriate action. Over time, the tendency is to have less frequent side effects, as the individual animal’s sensitivity to the drug agents become known, the treatments are less frequent, and the cancer is in remission.

Risks to People Living with Chemotherapy-treated Pets

The anti-cancer drugs are excreted from the animal’s body via urine and feces. This usually happens in the 48 hours following treatment, but can be as long as 5 days for Adriamycin®. If it is possible, you should try to have the animal eliminate in an area away from the immediate yard or play area. Cat boxes should be changed regularly, and waste material handled with a scoop. If urine or feces must be handled, use heavy rubber or latex gloves and disposable wipes/towels. Place all waste/towels in a plastic bag and seal it, before disposal. Smooth surfaces may be washed with a dilute bleach solution (¼ c. to 1 gallon of water). Humans and other household pets living with treated pets are generally thought not to be at any health risk, just as in the case with humans. Pregnant women should not handle ANY animal waste or anti-cancer medications. If any family member living with the pet has a condition that would suppress his/her immune system, it would be prudent to let the veterinarian know.

Gastrointestinal Side Effects

Nausea (and refusal to eat) can occur in veterinary patients, and seems to occur more frequently in cats than in dogs. If this happens 1-3 days post-treatment, it is usually transient and requires no specific treatment. Tempting the pet with favorite foods, and warming the foods slightly will often increase palatability. For dogs, adding cooked eggs, pasta, lean chicken, or hamburger can be helpful. If this condition persists, medication to reduce nausea and promote appetite can be used; Reglan® is most commonly used in dogs; Periactin® for cats.

Vomiting can also occur at any time during treatment. When it occurs 1-2 days post-treatment, and the pet is otherwise bright, active, and alert you can use Pepto Bismol® using the label « adult dose » for dogs over 40 lbs.; « children’s dose » for dogs under 40 lbs., and ¼ tsp. for cats (dosed up to twice daily). Remove food for 12-24 hours, and replace it with a pile of ice in a dish. This will help to maintain hydration without stimulating further vomiting. If the vomiting is repetitive (greater than 4X), contains blood, or the pet seems weak and/or depressed, your pet probably requires veterinary attention.

Diarrhea may occur, but is often mild and transient. Several over-the-counter treatments may be given safely to pets and may reduce intestinal discomfort. Imodium A-D® or Kaopectate® is dosed at « adult dose » for dogs 40 lbs. and over; « children’s dose » for dogs less than 40 lbs.; and ¼ tsp. for cats up to 2-3X daily. If the diarrhea is severe, persistent, contains blood, or the animal seems weak or depressed, veterinary attention is required.

Fever/Sepsis As previously mentioned, virtually all chemotherapeutic drugs have the ability to at least temporarily suppress the body’s own immune system. The normal range of white blood cell counts in animals is about 6,000-17,000/cmm. If the white blood cell count (neutrophils or « wbcs ») are below about 2,000, then the pet runs the risk of systemic infection. The pet will usually manifest fever (but not always). If the bacteria travel through the bloodstream, it is known as « sepsis. » In rare cases, shock can occur (septic shock), and without rapid treatment, the risk of death is high. Though this period of susceptibility is brief, and occurs at a fairly predictable time, its consequences can be life-threatening. Below is a list of the most commonly used drugs and the expected low point in cell counts (the « nadir »), given in days post-treatment:

Drug High Risk Period Adriamycin® (doxorubicin) 7-10 days Vinblastine < 7 days Cytoxan® (cyclophosphamide) 7-10 days Lomustine (CeeNu®) 7 days, then again at 21 days Mitoxantrone 7-10 days Carboplatin 10-13 days Signs of Fever or Sepsis

• fever > 103F (temperature taken by rectal thermometer should be between 100 and 102.8F.
• extreme lethargy (refusal to get up off of dog bed, etc.)
• complete disinterest in food
• extreme weakness
• pale and somewhat « sticky » gums
• severe vomiting/diarrhea

• Immediate action is necessary.
• Start the antibiotics you have been given; double the first dose, then continue as label directs.
• Track the temperature at hourly intervals.
• If pet is not significantly better in 1-2 hours, call your local veterinarian or Bath-Brunswick Veterinary immediately. DO NOT WAIT OVERNIGHT!. This situation can be treated rapidly and almost always successfully. However, an extended delay before initiation of treatment may result in health complications or even death. Your local veterinarian has been given treatment protocols for this situation and in most cases this will be more convenient for you. However, our hospital will see this type of emergency AT ANY TIME.

Care & Feeding of The Veterinary Cancer Patient

One of the most important goals of cancer treatment in animals is to maintain as much of the pet’s normal lifestyle as possible. This can often mean that once a pet has recovered from cancer surgery, and/or passed the induction (initial) phase of chemotherapy, restrictions on activities are very few, and will be discussed by your veterinarian. For patients with lymphoma, prednisone is usually administered every other day throughout the entire treatment period. In cats, prednisone is given daily. Cancer patients may be more easily fatigued with strenuous activity, so moderation is best. Daily walks and « playtime » are encouraged. Many pets will actually gain weight during therapy and this should be monitored. Obesity increases the pet’s risk of concurrent disease, and should be avoided.

It is now known that cancer results in significant alterations in carbohydrate, protein, and lipid metabolism. Fortunately, research findings by Dr. Gregory Ogilvie and others at Colorado State University’s Comparative Oncology Unit have lead to the creation of a specific dietary program which depletes cancer cells of their required nutrients. It has been demonstrated that Hill’s Prescription n/d diet 1.) increased survival times of dogs receiving chemotherapy treatment; 2.) reduced painful side effects of radiation therapy; 3.) produced statistically longer remission times; and 4.) counteracted many cancer-induced metabolic side effects in veterinary patients. The diet is comprised of limited quantities of simple sugars, modest amounts of complex sugars, modest amounts of highly digestible proteins, and calculated amounts of certain types of fat (including n-3 fatty acids which have a negative effect on tumor growth, and improve survival times). This diet and others that will follow, help improve the quality and quantity of life for the veterinary cancer patient!

**Information from Ogilvie, Gregory and Davenport, Deborah. From Canine Cancer, Information released by Hill’s Pet Nutrition, Inc. and The Morris Animal Foundation (1998).

Drug Dosages

Chemotherapy treads a narrow path between effectiveness and toxicity. In fact, chemotherapeutic protocols are most often limited not by the ability of drugs to kill tumor cells, but by their toxicity to the patient. The goal is to destroy as many malignant cells as possible while leaving enough normal, « organized » cells to recover organ function. It is important, therefore, that we use the highest dosages that we think the patient can tolerate. The more cancer cells surviving any one time, the sooner the patient will become resistant to the beneficial effects of the drugs.

Visits and Costs

For a cancer such as lymphoma, therapy involves a significant time commitment on the part of the owner/family. Outpatient visits are generally once weekly for 4 weeks, then every 3 weeks for up to 18 months. However, we make every effort to accommodate the owner’s schedule, and most visits require 20 to 30 minutes. Many clients like to leave their pet with us temporarily while they go do errands, and you are welcome to do this. You may halt therapy at any time, but we like to have the owner commit to at least 4 weeks, so you will have the benefit of seeing how well a pet can do. Due to the new OSHA hazard laws, and the fact that the animal must make no movement during the intravenous injections, we regret that it is not feasible to have the owner present during the few minutes of chemotherapy injections. Rest assured that your pet will be gently and expertly restrained by the oncology technician and the doctor. Relative to most other treatments in veterinary medicine, chemotherapy is a costly service to provide. The costs reflect the professional time and expertise required, the high costs of chemotherapy agents (the same used by humans), the special equipment and personnel protection required, and the removal of biomedical hazard waste. Realize however, that this therapy is unique in that it can successfully prolong an animal’s life!

Is It Worth It?

This is a difficult question for us to answer. Every situation and client-pet relationship is different and must be dealt with individually. If it were ever obvious that therapy was not working, or that the pet was indeed experiencing pain or discomfort, we are ethically obligated to inform you. What we can say is that most pets do indeed appear to enjoy their extended life period and do not even realize that they are « ill. » However, the owner(s) must believe that they are doing the right thing for their pet, for their situation.

Prednisone is the least toxic of all the chemotherapy agents. It is not a specific chemotherapy drug, and has many different uses in medicine. It is usually well tolerated by pets. It commonly causes increased thirst, urinations, and appetite. It can have irritating effects on the stomach lining.

Elspar© (Asparaginase) is also well tolerated. In rare instances, it can cause vomiting due to pancreatitis. Since it is a protein, there is a (rare) possibility that an animal can have an allergic reaction to it. We would ask that your pet remain in the lobby for about 15 minutes after this injection.

Vincristine© has little tendency to make an animal ill. Occasionally, there will be 1 or 2 episodes of « innocuous » vomiting 24 hours after the injection, which disappears without treatment. It is very irritating to the surrounding tissues if it leaks from the vein at the injection site. If you notice any inflammation where the injection was given, notify the doctor.

Cytoxan© is a potent chemotherapeutic agent and can lower the white blood cell count about 7 days after it is given. The tablets should be given in the morning (all at once with food), and the pet should be given ample opportunity to empty his bladder throughout the day. Occasionally, bloody urine can occur due to bladder effects. If this occurs, call the doctor and the medication can be changed. If your pet should get sick about 1 week post treatment, follow the instructions on the owner’s sheet given at the start of treatment.

Adriamycin© is the most potent of the agents, and like Cytoxan©, can lower the white blood cell count. Mild nausea can occur, and the adult dose of Pepto Bismol® can be given as directed on the label. If there is irritation at the injection sites, notify the doctor. Long term effects can involve the heart, but our protocols have been calculated to lower this risk. If your pet gets ill about 1 week after therapy, follow the instructions on the owner’s sheet.

Most of the drugs are excreted in the urine within about 48 hours after administration. It would be wise to walk your pet away from his usual elimination spots (in a more out-of-the-way spot) for those two days. If he does urinate in the house, the urine should be promptly cleaned up, and the owner should wear latex gloves so no direct contact is made. You are in no danger living with an animal on chemotherapy, but it is prudent to avoid human exposure to these drugs when we can. You will be instructed to wear latex gloves, for your protection, while giving certain medications.

Local Treatments Other than Surgery for Basal and Squamous Cell Skin Cancers

Several techniques other than surgery can be used to treat basal and squamous cell skin cancers (or pre-cancers) that haven’t spread beyond the skin. These include:

• Cryotherapy
• Photodynamic therapy (PDT)
• Topical chemotherapy
• Immune response modifiers
• Laser surgery
• Chemical peeling

These are called local treatments, and some are even described as types of surgery, because they destroy a targeted area of body tissue. But these techniques are different from surgery because they don’t use scalpels or cut into the skin. (Radiation therapy is also a type of local treatment.)

Cryotherapy (cryosurgery)

Cryotherapy is used most often for pre-cancerous conditions such as actinic keratosis and for small basal cell and squamous cell carcinomas.

For this treatment, the doctor applies liquid nitrogen to the tumor to freeze and kill the cells. This is often repeated a couple of times in the same office visit. After the dead area of skin thaws, it will swell, blister and crust over.

The wound may have fluid draining from it for a while and take a month or two to heal. It will leave a scar, and the treated area may have less color after treatment.

Photodynamic therapy (PDT)

PDT can be used to treat actinic keratoses. But its exact role in treating basal and squamous cell skin cancers still needs to be determined.

This treatment uses a drug that is applied to the skin as a gel or liquid. The drug collects in the tumor cells over several hours or days, where it is converted to a different chemical that makes the cells very sensitive to certain types of light. A special light source is then focused on the tumor(s), which kills the cells. Another option to activate the drug, especially when large areas need to be treated, is to have the person go out into the sunlight for a specific amount of time (known as daylight PDT).

PDT can cause redness and swelling on the skin where it is used. Another possible side effect of PDT is that it can make a person’s skin very sensitive to sunlight for some time, so precautions may be needed to avoid severe burns.

To learn more about this technique, see Photodynamic Therapy.

Topical chemotherapy

Chemotherapy uses drugs that kill cancer cells. Topical chemotherapy means that an anti-cancer medicine is put directly on the skin (usually in a cream or ointment) rather than being given by mouth or injected into a vein.

5-fluorouracil (5-FU): The drug most often used in topical treatment of actinic keratoses, as well as some basal and squamous cell skin cancers, is 5-FU (with brand names such as Efudex, Carac, and Fluoroplex). It is typically applied to the skin once or twice a day for several weeks.

When put directly on the skin, 5-FU kills tumor cells on or near the skin’s surface, but it can’t reach cancer cells deeper in the skin or those that have spread to other organs. For this reason, 5-FU is generally used only for pre-cancerous conditions such as actinic keratosis and for some very superficial skin cancers.

Because the drug is only applied to the skin, it doesn’t spread throughout the body, so it doesn’t cause the same side effects as systemic chemotherapy (treatment that affects the whole body). But it does make the treated skin red and very sensitive for a few weeks. Other topical medicines can be used to help relieve this, if needed. 5-FU can also make the skin more sensitive to sunlight, so treated areas must be protected from the sun to prevent sunburn for a few weeks after use of this cream.

A very small portion of people have a condition called DPD deficiency, which makes it hard for their bodies to break down and get rid of 5-FU. This can result in serious or even life-threatening side effects. If you are applying 5-FU and have any reactions beyond those you were told to expect on your skin, call your doctor or nurse right away.

Diclofenac (Solaraze): A gel containing the drug diclofenac is sometimes used to treat actinic keratoses. This drug is part of a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs), which includes aspirin and ibuprofen. The gel is usually applied twice daily for 2 or 3 months. It may cause less severe skin reactions than 5-FU, but it can also take longer to work.

Ingenol mebutate (Picato): This is a gel used to treat actinic keratosis that might work more quickly than other topical gels. It is applied to the skin daily for 2 or 3 days. The gel can cause bothersome skin reactions, but these usually start to go away within a week of starting treatment.

Immune response modifiers

Certain drugs can boost the body’s immune response against the cancer, causing it to shrink and go away.

Imiquimod (Zyclara) is a cream that can be applied to actinic keratoses and some very early basal cell cancers. It causes the immune system to react to the skin lesion and destroy it. It’s typically applied at least a few times a week for several weeks, although schedules can vary. Like other topical products, it can cause severe skin reactions in some people. It can also cause flu-like symptoms.

Interferon is a man-made version of an immune system protein. It can be injected directly into the tumor to boost the immune response against it. It might be an option when surgery isn’t possible, but it may not be as effective as other treatments.

Laser surgery

This approach uses a beam of laser light to vaporize cancer cells. It’s sometimes used for actinic keratosis, squamous cell carcinoma in situ (Bowen disease), and for very superficial basal cell carcinomas (those only on the surface of the skin). It’s not yet known if this type of treatment is as effective as standard methods of treatment, and it’s not widely used.

Chemical peeling

For this technique, the doctor applies a chemical such as trichloroacetic acid (TCA) to the skin tumor, killing the tumor cells over the course of several days. This approach is sometimes used to treat actinic keratosis.

Breast Cancer & Weight Gain: What You Need To Know

Nearly 80% of people who are diagnosed with breast cancer will experience weight gain,1 reported to range between two pounds and 18 pounds. Not only is this an alarming trend for general health and self-image, but also some evidence suggests that pre-menopausal women who gain weight have a 1.5 fold increase risk of cancer recurrence.2 Other studies have shown that some types of treatment, such as anastrozole (Arimidex®), are less effective at treating breast cancer in patients who are obese.3

Stephanie Graff, MD, Director of the Breast Cancer Program at Sarah Cannon Cancer Institute at HCA Midwest Health and Associate Director of the Breast Cancer Research Program at Sarah Cannon Research Institute shares what people should know about the risk factors for weight gain after a breast cancer diagnosis.

Simultaneously hitting menopause

Women who become post-menopausal within the year they are diagnosed with breast cancer are the most likely to gain weight. An average woman without breast cancer gains three pounds with menopause.4 The risk of weight gain with menopause is highest in women who were at a healthy weight when reaching menopause. There does not seem to be a significant weight gain in women who quit hormone replacement at the time of a breast cancer diagnosis.

Treatment effects

Research has shown that nearly two-thirds of women who receive chemotherapy gain weight.1,5 Many patients are surprised to learn this—carrying their own mental stereotype of a bone-thin cancer patient. The weight gain for breast cancer chemotherapy regimens are dependent on a several variables including length of treatment and total steroid use. Steroids are necessary with many chemotherapy regimens to decrease risk of allergic reaction or to minimize nausea and other side effects. More and more, we are moving to “steroid low” approaches. However, on average the weight gain while on chemotherapy is five to six pounds; whereas little to no increase in weight has been seen in patients treated with surgery alone or tamoxifen.

In addition to the direct effects of the chemotherapy and associated medications on weight gain, in one study, up to 66% of patients reported that they ate to minimize symptoms of nausea, another way chemotherapy may lead to weight gain.6

Interestingly, many patients attribute weight gain after breast cancer to endocrine therapy, medicines like tamoxifen or anastrozole. Yet in the original research that compared tamoxifen to placebo both for the treatment of breast cancer (NSABP-B14 trial7) and the prevention of breast cancer (NSABP P1 trial8), there was weight gain between the tamoxifen treated group and the placebo treated group. This was later confirmed in the WHEL study.9 Certainly conflicting reports exist, which speaks to the reality that weight gain is a common struggle.

Emotional wellness & coping skills

Studying weight gain as it relates to our emotional wellness is difficult. But we can all certainly acknowledge the concept of “comfort food,” and that many people turn to food in times of stress, anxiety, boredom or discomfort. Sugar in particular is associated with a significant reaction in the brain similar to the most addictive drugs mediated by dopamine—the chemical in our brain most associated with happiness. In prior research, weight gain has been associated with an “inability to express emotion and with repressive coping styles.”10

Decreased physical activity

96% of patients treated for breast cancer report fatigue. Shifts in energy expenditures vary but exist across all treatments including surgery, chemotherapy, and radiation.10 Even small shifts in household tasks like housekeeping or laundry may have a net effect on a patient’s energy expenditure, and subsequently weight and body composition, while they are on treatment.

In light of the data, there is much that can be done to combat weight gain during and after a breast cancer diagnosis. Talk to your physician about support available to you including physical therapy and/or cancer exercise therapy, nutrition consultations, and psychosocial support in terms of counseling or support groups. Monitor your lifestyle for opportunities to be active, increase healthy choices around food, and reflect on your emotional wellness during and after your cancer diagnosis. Ask your physician to optimize use of supportive care medications, including steroids, nausea medications, and anti-depressants to help you maintain or lose weight during breast cancer treatment.

1. Goodwin PJ, Ennis M, Pritchard KI et al. Adjuvant treatment and onset of menopause predict weight gain after breast cancer diagnosis. J Clin Onc 17:120-129
2. Camoriano JK, Loprinzi CL, Ingle JN, et al: Weight change in women treated with adjuvant therapy or observed following mastectomy for node-positive breast cancer. J Clin Oncol 8:1327-1334, 1990
3. Ligibel JA and Winer EP. Aromatase inhibition in obese women: How much is enough? J Clin Oncol 2012 Aug 20; 30:2940.
4. Wing RR, Matthews KA, Kuller LH, et al: Weight gain at the time of menopause. Arch Intern Med 151:97-102, 1991
5. Basaran G, Turhal NS, Cabuk D, et al. Weight gain afteradjuvant chemotherapy in patients with early breast cancer in Istanbul Turkey. Med Oncol 2011; 28: 409-415
6. Mukhopadhyay MG, Larkin S: Weight gain in cancer patients on chemotherapy. Proc Am Soc Clin Oncol 5:254, 1986 (abstr 992)
7. Dignam JJ, Wieand K, Johnson KA, Fisher B, Xu L, Mamounas EP. Obesity, Tamoxifen Use, and Outcomes in Women With Estrogen Receptor–Positive Early-Stage Breast Cancer. Journal of the National Cancer Institute. 2003;95(19):1467-1476
8. Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst 1998; 90: 1371-1388
9. Saquib N, Flatt SW, Natarajan L, et al. Weight gain and recovery of pre-cancer weight after breast cancer treatments: evidence from the women’s healthy eating and living (WHEL) study. Breast Cancer Res Treat 2007; 105: 177-186
10. Levine EG, Raczynski JM, Carpenter JT: Weight gain with breast cancer adjuvant treatment. Cancer 67:1954-1959, 1991

Les effets secondaires des anti-inflammatoires chez les chiens et les chats

Les médicaments anti-inflammatoires sont des produits pharmaceutiques dont l’action consiste à réduire l’inflammation, la douleur et la fièvre. Ils sont principalement divisés en deux groupes: les non stéréoïdiens (AINS), tels que l’aspirine, et les stéroïdiens (connus généralement sous le nom de « cortisone »). Ces deux catégories possèdent des effets secondaires similaires, bien que les stéroïdiens sont plus problématiques (en particulier chez les chiens), tout en procurant des effets bénéfiques également plus puissants.

Les problèmes les plus importants se présentent dans ces deux cas:

• Utilisation d’anti-inflammatoires non-stéroïdiens pour humains chez les chiens et les chats: il ne faut JAMAIS les donner à des animaux sans une ordonnance vétérinaire préalable. Les animaux ont beaucoup de problèmes à les métaboliser correctement, cela pouvant facilement aboutir sur un empoisonnement potentiellement mortel, même à faibles doses.

• Utilisation incorrecte d’anti-inflammatoires d’usage vétérinaire, cela étant généralement dû à une utilisation sans ordonnance préalable, à des doses trop élevées ou à une prise trop prolongée, et ce sans contrôle vétérinaire, pouvant conduire à de graves problèmes.

Il faut également veiller à prendre encore plus de précautions s’ils sont utilisés chez des chiens âgés, très jeunes, affaiblis ou qui prennent déjà d’autres médicaments ou traitements.

Il faut donc éviter leur utilisation, à moins qu’un vétérinaire n’indique le contraire, dans ces cas:

• Maladie cardiovasculaire, rénale ou hépatique

• Déshydratation

• Quand ils prennent d’autres types d’anti-inflammatoires

• Lorsque certaines protéines du sang (en particulier l’albumine) sont faibles

Les symptômes d’intoxication

Ils correspondent à des ulcères ou perforations d’estomac, des dommages au niveau des reins ou du foie.

• Intoxication légère: douleurs abdominales, vomissements, diarrhée, faiblesse ou fatigue, anorexie (perte de l’appétit)

• Intoxication grave: déshydratation, pâleur, tachycardie, diarrhée ou vomissements avec du sang, ecchymoses (aspirine), augmentation de la température (aspirine), jaunisse, incoordination des mouvements, convulsions, mort.

Il existe de rares cas d’hépatopathie (lésions au foie) du fait des AINS. Cela se produit chez les animaux sensibles. Ses symptômes apparaissent quelques jours après l’ingestion.

Dans le cas des anti-inflammatoires stéroïdes (cortisone) utilisés de manière prolongée, des maladies peuvent survenir du fait de leur accumulation (hypercorticisme iatrogène). En outre, il est TRÈS IMPORTANT de ne pas interrompre brusquement le traitement lors de la prise de ces médicaments. Le vétérinaire vous conseillera sur la meilleure façon de procéder.

Traitement de l’intoxication

• Vomissement provoqué (en fonction du temps écoulé depuis l’ingestion)

• Prise de charbon actif

• Utilisation de protecteurs gastriques tels que l’Oméprazole

• Fluides intraveineux

Pronostic: en cas d’irritation gastrique, lésions rénales ou hépatiques légères, la récupération est généralement bonne si le traitement est commencé rapidement. Le pronostic sera par contre réservé voire mauvais si survient une perforation gastrique due à la péritonite ainsi causée.

Alternatives aux anti-inflammatoires traditionnels

Il faut tout d’abord garder à l’esprit que si un vétérinaire prescrit un anti-inflammatoire, c’est parce que celui-ci est nécessaire pour l’animal. La plupart du temps, ses effets bénéfiques l’emportent largement sur ses effets secondaires. Cependant, il y a des cas où il est possible de les remplacer ou d’aider l’animal par des alternatives plus sûres pour ainsi réduire leur dose.

Attelles (protecteurs articulaires): ce sont des aides orthopédiques techniques qui réduisent les effets de l’arthrose. Elles s’utilisent de la même manière que chez les humains et permettent normalement de réduire la dose nécessaire d’anti-inflammatoires voire même de l’éviter. Tout en stabilisant l’articulation affectée, elles y augmentent la circulation sanguine, réduisant ainsi l’inflammation et les douleurs, stimulant l’activité musculaire et limitant l’atrophie des muscles concernés. Elles s’utilisent également pour accélérer le processus de récupération postopératoire.

Acides gras Oméga-3: ils agissent comme anti-inflammatoires naturels. Ils peuvent aussi aider lors de longs traitements. Ils sont particulièrement recommandés dans les processus inflammatoires et les altérations cutanées.

Anti-inflammatoires naturels non conventionnels: il existe des produits anti-inflammatoires ayant moins d’effets secondaires que les traditionnels. Ils sont intéressants pour une utilisation chronique ou chez des animaux pour lesquels les anti-inflammatoires traditionnels sont contre-indiqués.

Textiles intelligents: il existe sur le marché des attelles et des orthèses fabriqués à partir de matières textiles qui utilisent la propre chaleur de l’animal pour soulager la douleur et accélérer la récupération.

Physiothérapie et électrostimulation: ces deux techniques peuvent permettre de réduire la douleur et de parvenir à une récupération plus rapide. Il existe des professionnels se consacrant à la physiothérapie canine et féline. L’électrostimulation peut même être utilisée à la maison, réalisée par le propriétaire du chien et ce, à un prix très raisonnable.

Chaleur: les lampes à infrarouges et l’application directe de chaleur peuvent être d’une grande aide pour soulager la douleur de l’animal.

De manière générale, la meilleure façon de profiter des bienfaits des anti-inflammatoires est de les utiliser sous ordonnance vétérinaire, reconnaître les symptômes qui permettent de déterminer que « quelque chose ne va pas » et connaître les alternatives et autres solutions qui nous permettent d’améliorer la vie de notre chien.

Laura Perez – Vétérinaire

Surdosage de cortisone pour mon chat ?Soigner son chat

Bonjour à tous, C’est la première fois que je fais la démarche d’écrire sur un forum..
Par avance, veuillez m’excuser de la longueur de mon histoire…. J’ai vraiment besoin d’avis sur ce que je viens de vivre avec mon chat Frimousse qui a été euthanasiée la semaine dernière alors que nous étions en vacances !
Frimousse avait 12 ans elle n’a jamais été malade de sa vie, je l’ai emmenée chez le vétérinaire que pour la faire stériliser étant petite, et il y a quelques mois pour lui faire retirer une tique…
Il y a environ un mois, je remarque qu’elle boitait (en regardant de près je constate qu’elle souffre d’un coussinet). Je décide de l’emmener chez le vétérinaire qui constate qu’elle n’a plus de phalange au coussinet en question (je n’avais pas vu cela), et me donne un traitement antibiotique et anti inflammatoire pour 5 jours en pipette. Malgré ce traitement Frimousse boitait toujours, et de plus elle saignait à son coussinet. Je décidai de la ramener chez le vétérinaire. La véto à qui j’ai eu affaire à ce moment là (débordée par une journée chargée), regarde son coussinet et avec une froideur incommensurable me dit « c’est un cancer » ! La portée de ce mot me fit tourner de l’œil et je n’ai pas eu le réflexe de lui poser des questions ! Elle m’a dit « je ne peux pas la garder, il faudra la ramener ! » puis a proposé 5 jours de cortisone en comprimés. Mais voilà nous devions partir en vacances quelques jours plus tard, et la véto a alors proposé une injection de cortisone avec effet retard de 3 semaines (je ne sais malheureusement pas le nom du produit ?!) – sachant que ma minette pesait 3,2 kg-elle a toujours été plutôt menue ! 15 jours après l’injection pendant que nous étions en vacances Frimousse a fait un AVC…. :=(
Aujourd’hui je suis effondrée car je m’interroge sur le traitement qu’elle a reçu : 15 jours de cortisone…j’ai l’impression que ce traitement a été trop lourd pour elle et que cela a provoqué l’AVC ? Je ne vois pas le lien entre un AVC et un potentiel cancer ?!
Pouvez-vous me donner votre point de vue car je suis totalement attristée par la façon dont ma Frimousse est partie, pour moi 12 ans ce n’était pas vieux pour un chat !!!