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- Hey everyone, it's Dr Sue Cancer Vet,
thanks so much for watching,
this video, I am gonna
answer some of your questions
that you asked me about
steroids and cancers.
So I've put some questions
out on social media asking,
what were your questions about steroids?
So Gill asked, why does predniSONE
decrease the efficacy of lymphoma?
So we talked about that,
it causes this thing
called multidrug resistance,
so basically it puts
a pump in the cell
membrane of lymphoma cells
that allows the cancer cells
to pump the chemotherapy
outside the cell, so it doesn't get killed
by the chemotherapy, so
again just as a review,
we talked about, we don't know how long
the pet has to be on steroids before
that effect is soon,
but usually it's thought
to be about one to two
weeks, probably two weeks
so don't get too worried if
you're pet's been on steroids
for a week or two, but you
know I've had some patients
come in on a month or
two, I do get worried.
The other part of Gill's question was,
why do we use steroids
in the CHOP chemotherapy?
So it's not just the CHOP
chemotherapy that we use steroids
as I mentioned, POCI, it
was on COP for a while,
it's included in that protocol as well
so a lot of these protocols
because predniSONE
has an anticancer affect, it
was included in the protocol.
The idea is if they're
getting chemotherapy,
they don't need usually
to stay on chemotherapy
so the CHOP which is also
the University of Wisconsin,
Madison protocol, they're
usually on chemotherapy
tapering over the first four weeks
and then they can come off the steroids.
So the benefit of getting
benefit is your dog doesn't
need to stay on steroids, the
other benefit, if you watched
the other lymphoma videos is
that they have much higher
remission rates, so higher
rates of going into remission,
they stay in remission
longer and they live longer
if they get chemotherapy
combined with their steroids.
This resistance with
chemotherapy has only been seen
in dogs, so I don't
worry about that in cats
so if you have a cat
that was diagnosed say,
with high grade lymphoma
of the intestinal tract
all your diagnostics have
been collected, you had
your ultrasound, you've had your surgery,
your biopsy's been done
and you're not gonna see me
for a week, yeah and you're
vet calls me, I'll say,
"Go ahead and start the predniSOLONE,"
which leads me to the
next part of my question,
why do we use the version of predniSOLONE
instead of predniSONE in cats?
And so that is the active form of pred,
what do I mean by that?
So a dog will take in predniSONE
and the body converts it
to predniSOLONE which is
the active form in the body.
Not all cats can convert
pred to predniSOLONE
so we don't know which cats can
so I prescribe predniSOLONE
for all kitty cats,
not every doctor does,
not every internist does
but I do, so if you're
seeing me and your kitty cat,
you're gonna be going
home with predniSOLONE,
so that is the active form of pred.
All right so Michelle
asked a great question,
Michelle unfortunately that
study has not been done yet
for cats with lymphoma
and actually usually cats
for lymphoma they stay on
their predniSOLONE longer
so at this point, I'm still
keeping cats on their steroids
until we have evidence that
they will do just as well
without their steroids
as the study with dogs.
One of my colleagues was
talking about a paper,
this was actually a couple years ago
but still worth mentioning
because it's good information
for oncologists, so they
looked at dogs that got
the multi agent
chemotherapy CHOP protocol,
so lymphoma dogs with and without pred
and actually, the dogs
that didn't get pred
didn't do any worse, so that's great.
It was always thought that
the predniSONE was really,
really important for remission
rates and survival times
so this study showed that it
was okay not to get predniSONE.
My colleague Dr Tham who
is at Colorado Straight
which is a great cancer center in the US,
he still includes predniSONE,
that four week taper
like I mentioned, I do
as well because again,
it gets dogs eating, they feel well,
it does get their lymph nodes,
their lymphoma responding,
but the take home message
from me is that the high doses
of predniSONE, some dogs
are just more sensitive
than others, if the owner
calls me, they're like,
"Oh my god, they're
panting, they're peeing,
they're having accidents,
it's just driving me crazy."
I'm gonna taper them without
hesitation more easily
than I did before this
paper came out in 2015.
One of the other side
effects that they do mention
is some dogs really get muscle wasting,
and if you've ever not
worked out for a while
you know how really frustrating it is,
because you can loose muscle really easy
but it can be really hard to
get that muscle mass back on.
If I have a diabetic, I used
to be like, "I hate to not
put pred in, it's so important
for the protocol," now
I'm like, "They're a diabetic,
I don't wanna mess up their
diabetes, I'm happy to not
put the pred in the protocol."
So Tina asked some great
questions about using
steroids for mast cell tumor
and yeah as I mentioned,
we do recommend, it's
often part of the protocol
with chemotherapy so we
often use it with a drug
called vinblastine for
dogs with mast cell tumor.
So we talked about the
side effects, that was one
of her questions so I
think we covered that
and talked about what to do
if your pet's not eating,
so steroids will often
improve the appetite
but again, watch the other
vlogs that we talked about
68, 69 about what to do
if your pet won't eat,
the different medications,
think about Cerenia
and then Tise as well, often be helpful.
With mast cell tumors often
they will have increased
histamine which can cause
increased acid in the stomach,
so sometimes an antacid
will be helpful as well,
so if you talk to your
veterinarian about that.
Michelle, I have a couple of
videos about mast cell tumors
that will put the links as
well so that might be helpful
if you're looking for more information
but predniSONE also
does have an anticancer
affect for mast cell tumors as well.
The tripods community
wants to know about using
steroids for bone cancer
patients that have metastasis
which I'm guessing to the
lungs 'cause that's the most
common place that bone cancer spreads,
would there be any benefit
to using predniSONE there?
So really important thing,
so we wanna make sure again
that any patient that
we're considering steroids
are not on a non-steroidal
antiinflammatory,
'cause as I mentioned that's a no-no,
but it's a good question
because it circles
back to what about the other cancers,
just all the other cancers
out there where steroids
don't have an anticancer
affect, what is the role
that we have for steroids
and so 'cause steroids
have been used for years for
lots of different cancers
and you have to remember that cancers
as they're growing in
a tissue or in the bone
so it can create inflammation
and so usually steroids
were used and people thought
the tumors were getting smaller
but it was really just that
antiinflammatory effect and they
don't have as good as a
anti-pain effect, what's called
analgesic effect as
non-steroidal antiinflammatories.
So in general I don't use
steroids unless they have,
if I'm looking for something
as an antiinflammatory,
really for its antiinflammatory
effect and it's pain effect,
I'm usually gonna have
picked a non-steroidal
antiinflammatory unless there's
other reason that it has
an anticancer affect, like
lymphomas, the leukemias,
some of the other cancers
that we talked about.
So going back to the tripod's question,
would there be benefits to
using steroids for a dog
with metastasis end stage,
metastasis to the lungs,
it may be if they're coughing
and you're just looking
for an antiinflammatory
effect but again, I'd have
to go over the case and really figure out,
do we wanna use a
non-steroidal antiinflammatory
verus a steroid like predniSONE
because they're to my
knowledge not a anticancer
effect the way that
some of the other cancers
that we talked about.
Finally I found some questions
about what dose do we use
and so there's a very wide range
of dosages used for steroids out there.
The low dose which would
be physiologic dose
where you're just trying to
replace what the adrenal glands
would be making, as you get higher you get
to the antiinflammatory doses
and then the higher doses
you get to immunosuppressive
doses, so there is a range
of doses out there,
some dogs as I mentioned
will have side effects,
two same sized dogs,
could put them on the
same doses of predniSONE
and some of them will have
side effects and some of them
will not, so we have to treat
everyone as an individual.
Good news for cats, is they
tend to be much more tolerant
to predniSONE so they tend
to have less side effects,
tends to be easier to taper them off of it
and they just tend to handle
their steroids much better
and that's one of the reasons that we tend
to be able to keep them on their steroids
longer during their chemotherapy protocol.
So that's it guys, that was
101 for steroids in dogs
and cats and cancer,
I hope I answered most
of your questions, we could probably talk
all day but I really hope
that I answered them.
If I didn't, leave your comments below,
don't forget to subscribe,
share, I hope you're enjoying
these videos and I'll
see you at the next one.
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