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- [Dr. Sue] Hey everyone,
it's Dr. Sue, Cancer Vet.
Thanks so much for watching.
This video's gonna be all
about steroids and cancers.
I get so many questions about
what cancer should we be
using steroids to treat.
Why do we use steroids
to treat some cancers?
So the most common of
what we use is Prednisone
and Prednisolone in kitties,
and I'll go into that in this video.
And we'll be talking about lymphoma,
which is the most common
cancer that we use it for.
And definitely why you don't want
to start steroids right away.
And what are some other
cancers, like mass cell tumors.
So we're going to dive into it,
we'll talk about side effects,
cause they definitely
are some side effects
especially with chronic
use and there's some
medications you don't
want to use with steroids.
So that's it, that's
what we'll be talking.
Let's get into it.
What are the top things you need to
know about steroids and cancer patients?
Glucocorticoids, which are steroids,
have been used to attempt to treat
practically every malady
that affects man or animal.
But there's really four main uses for
Prednisone and Prednisolone,
and again, we're gonna circle back
to the difference for that.
So four main categories.
So the first one is gonna be replacement
and supplementation for the adrenal glands
when the adrenal glands are
not making the steroids.
So the adrenal glands make
lots of different hormones
and that's gonna be one of them.
Second one, as I already
mentioned, is anti-inflammatory.
So steroids are a great anti-inflammatory.
They're not perfect because
they do have their side effects,
but again, they're often used
as an anti-inflammatory agent.
Immunosuppressive, so
higher doses of steroids
can suppress the immune system.
So they're often used in patients
with auto-immune or
immune mediated diseases.
That's another common use for them.
And then the other one is actually
what is called an antineoplastic agent.
So where the steroids
actually have an effect
to kill the cancer cells.
And the most common one is lymphoma.
And people are often surprised
to learn that for lymphoma
Prednisone actually
kills the cancer cells.
So we're not using it
as an anti-inflammatory
like we will in some other
cancers, we're actually
using it to kill the cancer
cells just as chemotherapy.
We'll learn that it doesn't
typically last as long
as chemotherapy and that's why it's
not as affect as chemotherapy.
So those are the main uses
that we use in Veterinary
Medicine, we're gonna focus
for this video on how we
use it in cancer patients
and really most specifically
on lymphoma is what we're
probably gonna spend
the most time on it.
You know a couple of really
important things that we're
taught as Veterinarians
and that I think are really
important if you're watching
this as a pet owner,
is steroids can really mask the disease.
What do I mean by that.
They can make it difficult
to diagnoses the disease,
you try not to use them
until you have a diagnosis.
And lymphoma is one of the
most screaming examples
of that because it will
actually start to treat
the cancer and make it harder
to make a diagnosis after.
So that is a good example
of where you want to hold
off on using steroids until
you've made your diagnosis.
And there's another reason
that we'll circle back
to why that is so important
with lymphoma patients as well.
And again you really want to make
a specific diagnosis as well.
You want to determine what
the course of treatments
gonna be before you add your steroids
and determine what the
end point of that is.
The other thing that's really
important is as a Veterinarian
there's gonna be times where steroids
are gonna be not appropriate
for the patient, as we
say, contraindicated.
So, sometimes in a sudden
infection you not gonna want
to do it because it can
make the infection worse
or diabetics, it can actually
make them insulin resistant
and make it harder to
regulate their diabetes.
So, there're gonna be
times when steroids are not
gonna be the right thing for a patient
and there're gonna be complicated cases
where there's gonna be pros and cons
and you're gonna talk to
your cancer specialist
or internist about
balancing the things out.
So that is the overall view.
So why do we use steroids
in Veterinary Medicine,
now let's think about how we use
it in some of the cancer patients.
So I think the number one
thing that I want you to know
about steroids and cancer
patients is when we
use it the most and that
is going to be lymphoma
in both dogs and cats.
And again as I mentioned
in the introduction,
the reason we're using
Prednisone in lymphoma patients
is that it actually
kills the cancer cells.
So it's not for the inflammatory effects,
it's for the anti-cancer effect,
it will actually kill lymphoma cells.
That sounds great right?
Yes, you know you want to
get your pet on Prednisone
as quickly as possible, no you don't.
Okay, there's two main reasons
that I think about why,
especially if you have a dog,
you would not want to get your pet,
so you go in and your
dog has big lymph nods,
you can definitely watch
the other lymphoma videos,
I have lots of other videos
in the lymphoma playlist.
But, you know the most common
symptom is that your dog
has big lymph nods and
your Vets gonna tell
you this is most likely lymphoma.
And you're gonna wonder
why are you not going home
with Prednisone, cause their
gonna aspirate the lymph nods
and send them off to the
lab so you would think,
we'll give me my Prednisone,
I want to start killing those
cancer cells right away.
But you need to wait for
the cytology to come back
from your Veterinarian
and confirm the diagnosis
because there's gonna be additional tests
that we're most likely going to need to do
and if your killing those cancer cells,
those other tests are
not gonna be accurate.
And if you watch my other
video, one of the most important
test is something called
Phenotype where we figure
out if it has B versus T cell.
B is the more responsive so it's
the better type of lymphoma.
If your dog's on Pred and we're
killing those cancer cells,
you're most likely not
gonna be able to get a good
diagnosis with flow
cytometry or one of the other
tests to determine B versus T.
So it's gonna make getting
those accurate test to figure
out more details, what's
called the staging
of your pet's lymphoma,
more difficult to do.
So it's gonna be less accurate.
So that's one really important reason
to hold off on the Prednisone.
The other really important
reason to hold off on Prednisone
for dogs with lymphoma is,
Prednisone prior to chemotherapy
makes the chemo less affective.
So they will not respond as well.
So it's unlikely that one
or two days of steroids
is going to cause this what's
called multidrug resistance.
We don't know how long they
need to be on steroids,
probably about a week or two
but, it's really important.
I've had pets that have been
on steroids for a month,
three weeks, and that makes
me really really concerned
that they're not gonna
have that good response.
And you know it's hard to treat
cancer and we need to have
every advantage that we can,
so we don't want to start dogs
on Prednisone until I have
all of my testing done.
My blood work, potentially
asprids, phenotyping,
chest x-rays, if needed ultrasound.
People often say, well
steroids are great because
they're increase the
appetite and we'll talk about
that in side effects and that pets
not eating when they
came in with lymphoma.
Guys there are plenty of
other medications that we
have now that can help get that pet eating
while we're waiting for the
confirmation of lymphoma
and waiting to see the Oncologist
or waiting to start chemotherapy.
We have Cerenia, we have Entyce,
we have Mirtazapine, and
so we have other videos
where you can go, I have
other vlogs where you can go
and find out about those
other medications to stimulate
the appetite and what to
do if your pets not eating.
We're gonna put the links below but,
specifically we have vlog
number 38, which talks about
medications and then
vlogs 68 and 69 are things
you can do if your pet's not eating,
medications that you can
get from your Veterinarian,
and also just some other things that you
can do to get your pet to eat.
And also vlog number 70 is how to pill
your pet if you don't know how to do that.
And that's okay guys, I just
want you if you're getting
medications prescribed
to get them in your pet.
So that's really important.
So Pred treats lymphoma,
that's great, that's really
really good, it also has
an anti-cancer affect.
The other really common
cancer that comes to mind
is mass cell tumors, so
there are other ones as well
but, those are the most common cancers so
those would be the ones that
you would most likely go home
with steroids, again
whether it's lymphoma,
mass cell tumor, plasma cell tumor.
Multiple myeloma is another
cancer that comes to mind
where steroids has a good effect.
The leukemias, the chronic
lymphocytic leukemias,
low grade lymphomas in
cats, we'll talk about that.
Those would be other
cancers where steroids
can have a good effect even alone,
not as good as with steroids but,
if you absolutely decide
against chemotherapy,
if it's not right for you and your family,
you definitely want to use steroids.
But again you want to make sure
that you got that information.
And the reason I harp on that
guys is there are so many
clients, I have been doing
this for 20 plus years,
there are so many clients
that initially say no
to their Veterinarian
and then they go home
and think about it, they
get some information,
they come meet an Oncologist like me
and they learn about chemotherapy
and how well tolerated it is.
And we have another video
about the misconceptions
about chemotherapy and
then they decide to treat
with chemotherapy and they're so happy
with how their pet does.
And so there are many people
that really change their mind.
I know it's shocking when your
pets diagnosed with cancer.
I really really do.
But there are many people
that change their minds.
So I want you to give your pet the benefit
of the doubt and not start steroids.
But if you've learned all this information
and you say you know what
it's really not right
for my family, whether
it's due to scheduling,
finances or any of these other reasons
and you say you know what
we've though about it,
we've waited and we've
decided that we don't want
to do nothing but, we want
to do something for our pet.
So I really think if you're not going
to do chemo, you should do steroids.
And so that would be a great
reason to get steroids.
And you're usually going
to be on steroids lifelong
until your pet's cancer progresses
because the cancer
especially with lymphoma
typically will progress,
usually for dogs about
two to three months, cats about the same.
So they're gonna be on steroids longer
and they're gonna stay on
that medication longer.
So that's something important to know.
So you definitely should get
steroids from your Veterinarian
once you've eliminated the
option of doing chemotherapy.
I would definitely like
you to do steroids.
So, that would be a
good thing to consider.
Okay so what are some
things that you should
know about it your pet is on steroids.
Let's talk side effects because guys
Pred causes side effects for sure.
The main side effects
are increased urination,
increased drinking and increased appetite.
Increased appetite is
often not a bad side effect
if your pet hasn't been eating well.
So again I mentioned that
earlier that's one reason
why vets and pet owners
often want steroids
when their pets aren't
eating, but again we have
Cerenia, for dogs and
can be used for cats,
and Entyce for dogs which is
a great appetite stimulate,
and Mirataz for cats which
is transdermal so it can go
in their ears, you don't
even have to pill them.
So we have other appetite
stimulants for dogs and cats
that can be used but, a
good side effect of steroids
is that it will increase the appetite.
There are some dogs that will become,
we call them garbage divers,
they are so veracious when
they are on the higher doses
of steroids that they'll
start going into garbage,
jumping on counters, counter
surfing and things like that,
cause they are really really hungry.
The other thing, another
side effect I mentioned
is increased urination, so
steroids cause the urine
to be more dilute so the
dog and cat is going to make
more volume of urine, so
they're going to have more
dilute urine and they're going
to pee more larger amounts.
To compensate for that they
are going to need to drink more
so that they don't get dehydrated.
So please fill up their water
bowl as often as they need it.
You don't want to uh they
are urinating so much
it's driving me crazy, I'm
just not gonna fill the water
bowl cause you now what then
they're gonna get dehydrated.
If it's driving you crazy
what you need to do is call
your Veterinarian or your
internist or your Oncologist
who prescribed it and say
the urination is making
me crazy or they're having
accidents throughout the night,
can we talk about tapering the steroids.
So that's what you would want to do.
And that's another really
important point especially dogs
if they're on steroids,
we never stop cold turkey.
We need to slowly taper
them, what do I mean by that.
We need to slowly lower the dose,
usually at least a couple days,
so three days at minimum
and then three days.
For my dogs on their lymphoma
protocol they're usually
on a week and then we lower for a week,
lower for a week, and
then lower for a week.
If I need to get them off of
it more quickly we'll usually
do three days and then three
days and then three days.
Why do we need to taper?
The adrenal glands which
make these steroids
they kind of go to sleep, they're resting
and they haven't been
making steroids because
the body has been getting
it from an outside source,
the pill that you've been giving your pet.
So you need to taper it so they wake up,
they go oh it's time to get to work
and make some steroids on our own.
You got to get those adrenal
gland, the factory pumping
again, so again you're
gonna want to taper that.
So those are the main side effects.
The other thing is it
can be immunosuppressive.
So it can lead to things
like urinary tract infections
and things like that.
So Pokey, if you guys have
watched any of my other videos,
I've been treating for two
and a half years almost
for lymphoma, when she
relapsed she was on a protocol
called COP and the P in the
COP protocol is Prednisone
and for one year she was on
Prednisone every other day.
And you know what, she got
a bunch of urinary tract
infections throughout the
year and one of the reasons
we thought it was occurring
was because of the steroids,
which it is immunosuppressive.
So sometimes dogs will
get skin infections,
sometimes they will get
urinary tract infections,
so there are not, it's
not a benign medication,
so a lot of people say oh I'd
rather just be on steroids
but, sometimes people hate the steroids
more than they do chemotherapy.
And actually I just got a
comment online where someone
said the docs are rebasing
chemotherapy for her dog
as the chemotherapy protocol was
way better than the steroids.
So there definitely are some side effects.
Okay, other things I want
you to think about is,
you never want to be giving
steroids like Prednisone
with nonsteroidal anti-inflammatories.
So there's a lot of them
in Veterinary Medicine,
it's hard for me to list them all.
But these are like the Aleves for dogs,
nonsteroidal anti-inflammatories.
The common ones are Carprofen
which goes by Rimadyl,
we have Meloxicam which is Metacam,
we have Deramaxx, we have Previcox,
we have Galliprant, so we have a lot
of these nonsteroidal anti-inflammatories
and you can risk stomach ulceration
if you use them together.
So if your dog is diagnosed with lymphoma
and was on a nonsteroidal
anti-inflammatory
we're gonna get them off that nonsteroidal
anti-inflammatory, we usually
give them a couple day
wash out period before they can start
their steroids and visa versa.
So again you never want to have them on,
more than one nonsteroidal at one time
and you never want a dog
on Prednisone steroids
with a nonsteroidal anti-inflammatory.
Another thing that steroids
can do is they can cause
diabetes to kind of get messed up,
they make the insulin resistant,
so it's not uncommon for dogs that if
they have to go on oral
steroids for something
or any type of steroid it will
mess up their diabetes mellitus.
So that's something
that you'll want to talk
to your internist about
and your Oncologist
about keeping that managed.
So that wraps up steroids and cancer.
Thanks so much for watching.
We went over the common uses of steroids,
the side effects, things that
you should be looking for,
and the common cancers that we use it,
with the most common one being lymphoma.
Don't forget to check out
the playlist that I have.
So you'll find all of my videos.
I have playlists for dog
lymphoma and cat lymphoma.
Remember those are the
common cancers that we use
steroids for and if you're
curious or interested
in learning more about
chemotherapy I have a separate
playlist all about chemo,
what does it entail,
side effects, home
safety with chemotherapy.
There'll be a part two
where I'm gonna answer
some of your questions that you asked
me about steroids and cancer.
So come on back for that,
leave your comments,
don't forget to subscribe, share this.
Thanks so much for watching.
I'm here to help you get
through this difficult time
and I look forward to seeing
you at the next video.
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