Apoquel and Cancer in Dogs

Dogs are contracting cancer from a new medicine (introduced in 2013) given to control itching. 
#apoquel #canine #dog #cancer #oclacitinib

In the most basic of "summaries": You can't use it in people, and it causes new cancer in about 15-18/300 NON-elderly dogs. Severe bacterial/fungal infections in @30-35/300 dogs.

Now let's get to the meat and potatoes:

Video "Apoquel and Cancer in Dogs"

A customer asked me about a new medication called Apoquel. It is prescribed for dogs that are itching because of allergic reactions to substances, fleas, and more. Apparently it is effective in many of the cases it is used in. If you check the internet, you will read hysterical reports from some of the dog breeder sites that say that "50% of animals getting Apoquel will die of cancer". Not surprising. However a veterinary dermatologist who prescribes Apoquel regularly arrives at a more refined / conservative conclusion per the packaging material and that is that about 5% of animals getting apoquel will suffer cancer. However in that author's opinion (the dermatologist's) it was thought that 5% of non-elderly animals would have gotten cancer over the course of a year anyway. I disagree. Because, if you read the testing results more closely they were able to attribute specific cancers to Apoquel. It was not usually random; in the types of cancer contracted. Later on in this article I will list the specific answers researchers found in Apoquel studies.

In almost all of the trials, cancer was not the most common negative side effect. Severe infections and pneumonia were also noted to the extent that in some cases the trial had to be stopped for those animals. Depending upon how you interpret the results of these studies, upwards of 10 percent and possibly closer to 20 percent of animals had significant reactions that compromised quality of life as a result of this medication.

Apoquel has been around a while. It was out in late 2013 and was not tested in many animals at all. It has a fearsome list of direct effects…..and to create THAT much cancer and pneumonia in such a tiny study group of no more than 500 dogs, total. :u(

Better than twelve percent of all dogs given Apoquel developed: pneumonia, bullous foot and node infections, or any one of a dozen cancers directly related to Apoquel.

It isn't used in people, and even has hazard instructions if you simply get it on your skin. (Open / broken capsule)

300+/- Dogs in field trial: 
Eighteen dogs were euthanized because of suspected malignant neoplasms: including thoracic metastatic, abdominal metastatic, splenic, frontal sinus, and intracranial neoplasms, and transitional cell carcinoma after 17, 120, 175, 49, 141, and 286 days of APOQUEL administration, respectively. Two dogs each developed a Grade II mast cell tumor after 52 and 91 days of APOQUEL administration, respectively. One dog developed low grade B-cell lymphoma after 392 days of APOQUEL administration. Two dogs each developed an apocrine gland adenocarcinoma (one dermal, one anal sac) after approximately 210 and 320 days of APOQUEL administration, respectively. One dog developed a low grade oral spindle cell sarcoma after 320 days of APOQUEL administration.

From the above statistic, what is commonly overlooked is that those all occurred within a group of less than 300 animals.

When they went from clinical to field trials; 6% (six-point-zero-percent) of their study got cancer!

Infections were essentially twice as common (@10%) but only a few were life-threatening or lethal.

Nutshell?
It's just too immunosuppressive.

The doctor-to-consumer selling point is; "It won't cause thirst hunger and weight gain like prednisone-category meds". Which is crazy-attractive I know. But the risks are too high in most patients with the garden variety itching.

This may come as a big surprise to some people, but drug manufacturers quite possibly rely on the fact that folks won't read the fine print, and I suspect even some doctors won't. When I refer to fine print I am NOT necessarily talking about the 'massaged' fine print provided by the manufacturer. Sometimes better and more accurate information can be interpreted from National Institutes of Health, publicly funded research and university level tracts, and PubMed.

Apoquel is powerfully immune suppressive, not unlike Cyclosporine (Atopica°) however Apoquel is in a drug class and category by itself.

So far, I don't know much that is as safe, or cheap as steroids for skin issues (whose cause is exclusive to other infectious causes), but; nutrition is making headway.

Erik

Dr Erik Johnson
3100 Roswell Rd Suite 113
Marietta GA 
TEL: (770) 977-5377
FAX: (770) 973-0301

Dec 2017: I have posted a video of the first dog I've gotten off Apoquel (without cancer). We took advantage of information on low carb / carb intolerance in dogs. His video is somewhere in this thread. Sorry. 
I put details and citations of this article at: drjohnson.com/apoquel.html
"Sciency" folks wanted me to 'back up my random internet post' so I just linked to Zoetis' own prescriber information. That was easy peasy. I'm sure they wish they didn't have to post their fine print on the internet LOL.

For the record, I don't like Prednisone much either. It's the mildest thing (that works) for now, but I am ALWAYS on the hunt for the Grail.

Addendum: Between the above writing and July 2017, I have put five cases on it after a lot of discussion with owners about possible consequences. I am already back down to four cases on Apoquel since Bella T. now has lymphoma and has left the group. In fairness, Bella was better off dead than in the skin she lived in before Apoquel. Which is the only criteria I use these days before putting a dog on Apoquel. It works extremely well.

For more pet related videos please visit dr Johnson's Youtube Channel

Dr Johnson's Facebook Page

 

Finding Cool Dog Beds and Carpeted Pet Stairs.

So there comes a time when you need to find a set of stairs or a ramp to help your dog get up onto the bed? I mean, if your dog sleeps on the bed. 

So what I've done is curated a mess of dog beds and steps that are functional, well rated, and attractive. My personal favorite are the higher quality, furniture grade dog steps / stairs with carpet on the runners. It's amazing how many different sizes and prices are available. 

So when I built http://hscri.org/ I made the site to allow you to sort JUST dog beds and stairs and then sort them by price. I specifically omitted crappy dog beds. The kinds of dog beds that a dog wouldn't use unless they HAD to. Like if they were caged with the dog bed, they'd use it. 

And of course in the Cool Dog Beds section I put dog beds I'd like to have for ajax. 

So check out the dog steps and stairs at HRSCI.org

Thanks

Dr Erik Johnson

 

How To Tell If Your Koi Food Is Good Or Bad?

How Can You Tell If Your Koi Food is Good Or Bad?

Do You Know How To Read and Assess A Koi Food Label?

Is Your Koi Food Priced On Par With Better Foods?

src=http://2uv.com/wp-content/uploads/2018/03/Koifoods_intro_square_image_mockup-e1520538394984.jpgKoifoods.com is a curated web site where Dr Erik Johnson rates and assesses more than twenty Koi Foods and teaches about Koi nutrition, nutrients, and feed labels so you can understand what's going on, and make good choices. 

Then, the Koi foods are broken into groups (ratings) and you can even shop by quality and price. 

Some very good foods can be bought very affordably. 

Some of the very most expensive foods (over $10/lb) are poorly formulated. But you'd never know without Koifoods.com

Learn about Koi and Pond Fish Nutrition, read the articles and shop the shop. You can choose from A, B and C grade foods and for a real savings, buy food from the "I Wouldn't Feed This to MY Koi" category lol

Now, a word on that…If the food is in the "I Wouldn't Feed…" category it usually means there's a cheaper food with better formulation. NOT that the food is badly done. 

Dr Erik Johnson

 

Axolotl Content

Visit Brutle.com for a lot of interesting stuff. Just today I'm uploading a LOT of Axolotl content in a hugely Video format. All the clicking has been done for you and the videos are the best of the best. 

I hope you like it. 

http://www.brutle.com

Axolotl: Not a Little But a Lottle

Axolotls are a mix between a Pokemon, the Dragon from "How To Train a Dragon" and well, that. Cute and adorable. Interesting and now, coming out in more and more great colors and sizes. 

Axolotls are the "neotinic" form of Salamanders. The form BEFORE they drop their gills and become salamanders. They’re laid as eggs in a mucinous egg mass not unlike a mess of frog eggs. There may be hundreds and even thousands. 

They hatch out and immediately start eating freshly hatched Brine Shrimp and other tiny live food. A good breeder can keep the water clean and preserve a LARGE percentage of the brood. 

The parents don’t take any care of the babies. I’ll post another article soon about how the Axolotls actually "breed" which, too, is pretty impersonal. 

Have you seen the Axolotls of Georgia Facebook Page? 

You might also like my Youtube Channel linked below. 

I’m just starting to keep Axolotls as pets and I will share my experiences on these as I go. Right now I just love the way they move around, and how smart they seem to be. At feeding time they brighten up and approach the front of their enclosure and their babies are simply adorable. 

Dr Erik Johnson

Renal Disease in Dogs: TUMS?

Kidney Failure in Dogs

How to Improve the Survival of Dogs With Kidney Failure

Hyperphosphataemia in patients with chronic kidney disease, particularly those on dialysis, can be ameliorated by oral phosphate binders in conjunction with dietary phosphate restriction.

Although phosphate binders reduce serum phosphate in these patients, it remains uncertain whether they improve clinical outcomes.

Calcium-based binders are frequently used, but their popularity is waning due to emerging evidence of accelerated vascular calcification.

The use of aluminium-based binders has been limited by a perceived risk of aluminium accumulation.

The non-calcium-based phosphate binders – sevelamer hydrochloride, lanthanum carbonate and sucroferric oxyhydroxide – have become available and subsidised by the Pharmaceutical Benefits Scheme for patients on dialysis.

The pill burden and adverse effects (particularly gastrointestinal intolerance) associated with the expensive, non-calcium – non-aluminum phosphate binders (sevelamer ) often contribute to poor medication adherence.

Calcium carbonate is the most common form of phosphate binder prescribed, particularly in non-dialysis chronic kidney disease. It is typically given to patients with advanced chronic kidney disease, including those receiving dialysis. As with all phosphate binders, calcium-based binders are most effective when taken with meals (which also limits calcium absorption).10 They should be prescribed in conjunction with moderate dietary phosphate restriction, ideally supervised by an accredited practising dietitian. Phosphate-rich foods with a high phosphate to protein ratio (processed foods, fast foods and cola drinks) are best avoided, while foods with a high biologic value (e.g. meats and eggs) should be retained to maintain nutritional status.11,12

Calcium-containing phosphate binders
Calcium binders have historically been an appealing first choice, because they also address the hypocalcaemia that is often seen with hyperphosphataemia in patients with chronic kidney disease. However, hypercalcaemia and accelerated vascular calcification are the main concerns with calcium-containing phosphate binders, particularly when they are combined with vitamin D therapy.5,15-18 The Kidney Disease Outcomes Quality Initiative Guidelines suggest that doses should not exceed 1500 mg/day of elemental calcium,19 based on evidence that this produces a positive calcium balance (excess body stores of calcium leading to soft-tissue and vessel calcification) in chronic kidney disease.20 However, there is little evidence of patient outcomes to support this recommendation. Another common adverse effect of these drugs is gastrointestinal upset, particularly constipation. The other main advantage of calcium-based binders is that they are inexpensive.

Calcium-based binders were associated with significantly lower serum phosphate (mean difference 0.07 mmol/L) when compared with sevelamer. However, sevelamer was associated with a lower risk of hypercalcaemia (risk ratio 0.45, 95% CI* 0.35–0.59) and a higher risk of adverse gastrointestinal events (risk ratio 1.58, 95% CI 1.11–1.25). There was no difference in all-cause mortality between calcium-based binders and sevelamer.51

Phosphate binders therefore effectively reduce serum phosphate in patients with chronic kidney disease, but it is uncertain whether they improve clinical outcomes. There may be a mortality difference between calcium-based and non-calcium-based binders, but it is not clear if this reflects a harmful effect of calcium-based binders, a beneficial effect of non-calcium-based binders or both.

BIBLIOGRAPHY:

Excerpts from:     https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5313253/

What to Do About Cats Peeing Outside the Box

Cat Box Problems

Inappropriate Elimination in Cats

My Cat Pees Outside the Litter Pan

Cats that pee outside the litter pan may have a simple "issue" that is fixed by a very simple solution. A bigger litter pan. Did you know there was a study that revealed a 75+% successful method to get a cat to pee in its litter box again? Yeah it works. 

At Drjohnson.com there's an article that explains it all. There are FIVE Main Points to master and it's likely you'll fix the cat pee problem you're facing. 

Here's the link to Solving Cat Pee Problems in Two Easy Ways

Thanks

Doc Johnson

Disinfect Dog Mouths: Fight Infections

How to Improve or Fix Bad Breath In Dogs or 

How to Prevent Vegetative Endocardiosis (Bacterial Heart Valve Flap Disease) In Dogs

Infections Spreading from Mouth to Lungs and Heart in Dogs. 

Wow! I just found out Oxyfresh is available on Amazon! 

For oral infections: http://amzn.to/2E9iwCl

I've been recommending it to clients for literally YEARS except I've hesitated because it used to be a pyramid scheme behind the product. 
So how does it work and why?   

Well crust / tartar on the teeth comes from calcification (calcium hydroxyapetite) of the colonies of slime bacteria on the teeth. 
If you have slime bacteria, sooner than later you have plaque / tartar / crust. 
Well that's fine in dogs; because you can keep them in front of hard dental exercise which increases saliva, helps remove slime bacteria and can even mechanically chip away at tartar. 
In cats, not the same. 
Well anyway, enter Oxyfresh. It's basically good-tasting Listerine you can swallow. Great for pets for that very reason. They can drink it in their water, and it kills all their slime bacteria, hence, NO TARTAR, ever. 
Breath also improves A LOT. 
I recommend Oxyfresh for my older dogs to keep infections minimal. Especially older dogs who could be metabolically destabilized by a dental under anesthesia. 
But even for younger dogs, if you can eliminate the slime bacteria you do TWO things, first you improve breath and secondly, you short-circuit the formation of tartar. 

You can't drink Listerine! But with Oxyfresh they figured out a molecule with disinfectant properties that is instantly NEUTRALIZED by Hydrochloric acid in the stomach. 
So no gastrointestinal flora upset.

There is no substitute. Every year the drug reps come to the clinic with products that as "as good as Oxyfresh" and I've tried most of them, and they do not have the same molecule nor the same effect. Not even close. 

(We had a dog named Trudy that had fish breath and that's what worked. Exclusively. Even though we tried everything else available at the time)

Anyway, so now Oxyfresh is available easily at Amazon. Here's a link that makes me 0.12 cents a bottle lol

For oral infections: http://amzn.to/2E9iwCl

Koivet.com Resources for Fish and Koi Diseases, Illness Symptoms, Diagnosis, Treatment and Cure

Youtube has provided me with an avenue to reach lots of people with valuable messages about fish health. Saving Koi, goldfish and tank / aquarium fish has been a "thing" for me for decades and I've made a name for myself that way. Which is a double-edged sword. (My Youtube Channel)

I like helping people? But not constantly. And folks need to learn on their own, a little, too. 

So when people call the office asking what to do about a sick fish, I made some online resources for this. 

The single, most important series of videos I've done is the "Twenty Steps of Fish Diseases Diagnosis and Treatment." which basically takes a struggling person with a sick fish, and talks them COMPREHENSIVELY through twenty assessments and along the way, they ALWAYS figure out what's wrong. 

Twenty videos on fish health and diseases, symptoms and cure: "My fish is sick, what should I do?" 

So the above is a great set of videos. Actually, even if there's no problem because in this, you will discover the twenty MOST IMPORTANT things affecting fish health. 

Then, a successful hobbyist will know all about "The Cycle" also known as the Nitrogen Cycle (See video). That's the natural process where fish waste is converted through a series of bacterial processes to reduce it to plant food. If any step in the nitrogen cycle is defective or for some reason there's a build up of nitrogen (There's a test) the fish will be sick. 

Here's the first compound in the cycle that hurts fish:   Ammonia

The second water quality parameter of extreme import:   Nitrite

Thirdly, accumulation of algae food "Nitrate" is eventually hazardous to Koi and fish. 

Finally, the conditions of acidity / alkalinity in the water are critical for some species of fish. In particular, the "PH" of the water is crucial. It's common to see the PH collapse in the system, especially with too-infrequent water changes – dropping two or three points over night and kill most if not all the fish. How to support pH with carbonates is discussed in this video, as well.  There's an easy test for pH that is well worth having. 

For those of you trying to find test kits, foods, nets, medicines and other things recommended in my web sites and videos, please check out http://koivet.com/resources     Some of the links there support my internet educational outreach. And it's appreciated. 

There are more resources for you. But for this article, it's enough for now. Subscribe to the Newsletter of Fish and Koi Diseases Diagnostic Treatments and Cure. I'll update about once a month and will never send an advertisement. 

Thanks

Doc Johnson

 

What is the Most Important Fish Water Quality Parameter?

Some would argue that it's Ammonia. The FIRST product of the nitrogen cycle and the primary waste product of fish. 

Environmental Threats to Goldfish Health.

Youtube Video about Ammonia with Dr Erik Johnson

Goldfish health is impacted by far more than just the ‘way’ we care for the fish, or the parasites they may contract. Indeed, their very environment is often the greatest threat to their survival. This is especially true in new, unbalanced systems where the new load of livestock and the relative lack of beneficial bacteria negatively influence water quality. Perhaps the greatest effort in the care of Goldfish is in the management of the precarious balance of the water quality.

Perhaps the most important element of “water quality” which the hobbyist should master is the nitrogen cycle. The “nitrogen cycle” refers to a natural process, which is carried out by beneficial bacteria. The process reduces fish wastes and excretions into harmless compounds in the environment. The “cycle” reduces Ammonia into Nitrite. Then Nitrite is reduced into Nitrate. Plants then use the Nitrate. 

Ammonia represents the primary waste product of fish, which starts the cycle as its initial fuel. Ammonia is a nitrogen-based molecule, which may ionize and de-ionize depending upon the pH in which it exists. Ammonia is more toxic at a higher pH. At a lower pH the Ammonia molecule becomes the Ammonium ion and is less toxic.

Twenty five percent of fishes’ Ammonia excretion is in the vented wastes. Another 75% of the fishes’ Ammonia excretion is via osmosis through the gills. Ammonia is not actively excreted and leaves the fish because an osmotic gradient exists between the higher physiological [bloodstream] level and the water’s natural amount. The problem arises when the water contains high ammonia levels. When the water has a high Ammonia level, the Ammonia does not leave the fishes’ bloodstream and so they die of “auto-intoxication”.

Ammonia is removed naturally from the environment by a beneficial bacterium that lives on all underwater aquatic surfaces [term: Biofilm], and in the filter. This beneficial bacterium is called Nitrosomonas. Nitrosomonas pares off Ammonia’s Hydrogen ions and replaces them with Oxygen molecules, creating a Nitrite molecule.

The need for Oxygen in this reaction is illustrated in the following equation:

NH3 + (O2 required)—(Nitrosomonas) —à NO2 (Nitrite) + 3H+

 

In the above equation you will notice that Hydrogen ions are liberated in the reaction. These may accumulate and depress the pH of the system. It is an illustration of how the very biological activity of the beneficial bacteria in the system can “crash” or reduce the pH.

Ammonia is a clinical threat in aquariums that are ‘new’ or have not established a colony of beneficial bacteria yet. Ammonia accumulation is a big part of the “New Tank Syndrome” and one of the leading killers of fish. Once Nitrosomonas has proliferated to adequate levels, the Ammonia levels decline and the Nitrite levels increase.

The diagnosis of Ammonia accumulations is as simple as a water test. I favor Aquarium Pharmaceuticals’ Nessler’s reagent drop-type test kit. At this writing there is a simpler pad-test, which does not require mixing of reagents.  The easiest Ammonia measurement tool.

I prefer water changes in the control of Ammonia accumulations. There is a beneficial effect for overall water quality with each water change. Fish are beenfited more by this method, and there is no adverse effect on beneficial filter bacteria with the water changes. Always be sure to dechlorinate.

In the hobby right now, perceived as a simpler method of Ammonia control, folks are using water additives in lieu of proper water quality maintenance. When Ammonia starts to rise, they apply a water additive instead of reducing Ammonia production by reducing feeding of the fish. Instead of changing water, they add toxic aldehydes to bind the Ammonia. More recently, newer and safer Ammonia binding agents are available which use Sulfide ions to bind the Ammonia and are far less toxic to fish. I am very impressed by the performance of Kent Marine’s “Ammonia Detox” however even this test gives false positive Ammonia readings after it’s application. The amazing ability of this product is that the fish perk right up, and seem to be able to ignore the Ammonia after application of the “Detox” product. A similar Sulfide molecule is used in the SeaChem® product, “Prime”.

After the application of most Ammonia blocking agents, you should use a Salicylate technology test to get an accurate reading. The Nessler’s reagent in the traditional tests tends to cross react with the bound Ammonia and the ammonia-binding agent.

The clinical presentation of fish suffering under a high Ammonia accumulation is exactly like a fish that is suffering under any other water quality deterioration, or a parasitism. Hence the need for accurate testing of this parameter so you can separate the possible causes for this ‘illness’. Ammonia is directly caustic to fish surfaces, fins, and gills. Redness in the skin, excess mucus production, depressed appetite, clamped fins and lethargy are all seen in fish living in Ammonia-rich waters.

An excellent method is to take a sponge or mat from an established tank. Wring this out in a five gallon bucket and extract as much of the green to brown ‘filth’ from it as possible. This “sponge extract” has an abundant number of nitrifying heterotrophs in it. You’d simply pour the ‘extract’ into the tank that you need “Cycled” and, within 24-36 hours, you will see tangible reduction in the Ammonia levels of the system. This method does not obviate the need for a water change or two after the application, to further improve the water quality and clarity. It would be wise to cycle an un-inhabited system this way, because when you add a sufficient quantity of the “sponge extract” initially, and for a few hours, the water becomes foul in the recipient system. If the water does not go “murky brown” you did not add enough ‘extract’ to make a difference. Of all the things you could do, short of a water change, this “sponge extract” system is my favorite.

(Video on bioseeding by Dr Erik Johnson)

Zeolites are a clay resin related to clinoptilolite, cat litter, bentonite and the water softening resins used by Culligan®. In fact, rumor has it that except for the price (Bentonite is sold by the yard or ton and Zeolites are sold by the ounce) they are one and the same.

Zeolites are put in a mesh bag and when the water flows through, the resin binds up the ammonia. This does not occur in water that has been salted to any extent, and you should be aware that the resin is rapidly exhaustible. Zeolites may be recharged a couple of times by immersion in a stiff salt solution. Twenty minutes in 3.0% (seawater) can cause Zeolites to release up to ninety percent of its bound Ammonia.

To a lesser extent, the Zeolites will release some of their Ammonia when you are salting out a ciliated protozoan. You should be alert to this if you have any Zeolite in your filter when you’re salting.

Ammonia Remedies in review

  • Water changes
  • Aldhehyde binders
  • Sulfide binders
  • Zeolites
  • Suspend or abbreviate feedings
  • Only a few bacterial adjuvants
  • Established 'Filter Extraction" Technique (Bioseeding)