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Jabba-Bear's Blog

Osteosarcoma: clinical trials and goofy smiles

Jabba-Bear's Blog

Jabba Starts Hill’s Prescription Diet

March 23rd, 2013 · 1 Comment · diet

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On Thursday, March 7th, Jabba-bear had his staples removed (from the intercostal split they performed during the lobectomy). The incision site looked fantastic! We were very impressed. That day, the prescription diet dog food that we ordered arrived at Oldtown Veterinary Hospital, and we fed it to Jabba for dinner.

Prescription diet dog food.   It is especially formulated for dogs undergoing chemotherapy.
Prescription diet dog food. It is specially formulated for dogs undergoing chemotherapy.

This  food is supposed to be ideal for dogs undergoing chemotherapy. Keep in mind that Jabba has been off cyclophosphamide for approximately 6 weeks (and he has been off of palladia since November 2012).

It was a little drier than we expected, but Jabba-bear devoured the entire can. When he finished, he licked his lips, wagged his tail, and looked up, drool spilling from his mouth onto the floor. He was adamantly begging  for more food! Happy to see our boy eating again, we gave him a little bit of his usual diet (Nutro Natural Choice).  Jabba-bear has eaten Natural dog food since he was 7 weeks old (when we officially adopted him). Once he outgrew the puppy food, he started eating Large Breed Adult food (Chicken, Whole Brown Rice, & Oatmeal Formula).  When Jabba lost his appetite in the middle of January, we tried feeding him the limited ingredient Sensitive Skin and Stomach line (Venison Meal & Whole Brown Rice). Initially, he seemed to like this food, but only if we spoon fed him. Beyonce, on the other hand, loves it!

For more information on Nutro Natural Choice products, see the following website: http://www.nutro.com/natural-dog-food/natural-choice-dog-food.aspx

The following paragraphs  summarize the research that Jabba’s dad did concerning the potential effectiveness of the Hill’s Prescription Diet:

Way back when, when Jabba was first diagnosed, we did a lot of reading about diets. Being grad students/budding scientists in biomedical fields, we are able to read and understand most scientific literature fairly well. There actually isn’t that much info out there, especially for dogs, but one thing that turned up was a ketogenic diet (very low carb/high protein/high fat), which was shown to be potentially effective in mice and human children with brain cancer. The logic is that cancer cells are heavily reliant on carbohydrates for energy, and are much less efficient at metabolizing ketone bodies, which was used instead of carbohydrates in organisms in a state of ketosis.

NCSU actually offers diet formulation services, which run $75 for commercial diet recommendations (I’ll come back to this, but LOL at them wanting $75 to tell you the name of a brand of dog food), and about $250 for homemade diet formulations. I had always planned to ask them about formulating a homemade ketogenic diet, but with our busy lives and Jabba doing so well for so long, sadly this never got done earlier.

Now, over two years later Jabba’s cancer has returned with a vengeance and with it the extreme motivation to do everything possible. So we did some more research and got in touch with NCSU. Here is the initial email exchange:

 

Hello,

Can the diet forumation service be used to formulate specific diets at the request of the client? Basically I am interested in formulating a ketogenic diet for my 4 year old dog with osteosarcoma. I am willing to pay the $231 fee for a ketogenic diet plan (or something based on the same principle), but I not interested in a standard homemade diet formulation. Is there a way to check with a veterinarian first if a) a ketogenic diet would be safe for my dog, and b) if NCSU CVM has experience and expertise in formulating this type of diet, and C) are there any other recommended specialty diets for dogs with cancer? Thank you very much.
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Response:
Mr. Taylor –
  1. Yes an owner can directly request a homemade diet formulation. If you live outside of NC, the medical records for your dog must come from your local vet.
  2. Yes the formulations are done on an individual patient basis.
  3. A ketogenic diet can be formulated but it is very difficult to create ketosis in the dog and rarely indicated.
  4. If you wish to check our credentials, pls see http://www.cvm.ncsu.edu/vhc/vhwc/nutrition.
  5. There is a general suggested nutritional profile for cancer in general. A homemade diet can be formulated with that profile and there is one commercial product made with that formulation.

Please complete and return the attached request form to us and please request that a copy of the most pertinent medical records be sent to us by fax (919-513-6905) or email (best) (NCSUVetNutrition@gmail.com).

After receiving this info, we will email or call you if we have questions before sending the recommendations to you.

Thank you,
R Remilllard, PhD, DVM, DACVN

It was interesting to learn that ketosis is hard to produce in canines, I did not know that before, and it kind of rules out the idea of a ketogenic diet. At this point, a lot of googling had turned up Hill’s n/d prescription diet as the only commercial dog food specially formulated for dogs with cancer, so I assumed the commercial diet they mention in #5 was Hill’s n/d. I just asked  bluntly in a response email, and they confirmed it was Hill’s n/d (kindly without charging me $75), so that’s when we did some more research on Hill’s.

http://www.hillspet.com/products/pd-canine-nd-canine-canned.html

Hill’s n/d is pretty interesting because it is basically based on a single scientific paper from what I can tell. But I guess that is better than being based on nothing (which believe me, happens, there is a lot of snake oil out there)! It is a pretty good paper though; a double blind, randomized study, which is the gold standard as far as clinical trials go.

Hill’s (perhaps slightly biased) brochure which explains the paper and rational for the diet:

http://brf.vpweb.com/upload/Effect%20of%20fish%20oil%20arginine%20and%20doxorubicin%20chemotherapy%20on%20remission%20and%20survival%20time%20for%20dogs%20with%20lymphoma.pdf

In this packet, Hill’s makes the claim that “To achieve levels of omega-3 fatty acids found in Prescription Diet® Canine n/d®, typical pet foods need to be supplemented with 30 fish oil capsules per day for a 10-kg dog.”  Sure Hill’s, thats what you want us to think so we’ll buy your dog food, 2x  $3.50 cans/day for a 50 lb dog, dog food… right? Well lets look at the original paper this is based on to see if Hill’s is being honest.

Effect of Fish Oil, Arginine, and Doxorubicin
Chemotherapy on Remission and Survival Time for
Dogs with Lymphoma
A Double-Blind, Randomized Placebo-Controlled Study

http://www.catoils.net/v1/links/1916.pdf

Here is the breakdown of the nutritional content of the diet:

break down of fish oil fatty acids in experimental diet

break down of fish oil fatty acids in experimental diet

Fish oil contains fatty acids, and the main ones they focus on in this paper are EPA and DHA. These are rough calculations so please let me know if anyone sees a mistake. Most dog diet recommendations are based on calories, so we need to convert this to calories. Fat is 9kcal/g, CHO (carbs) and protein are 4kcal/g. So if we multiply this out, every kg of food has 2934 kcal from fat (326g x 9kcal), 1512 from protein (378g x 4kcal) and 864 from carbs (216g x 4 kcal). Total is 5958 calories. Jabba, being a mostly sedentary 50-60lb dog, needs 1200-1300 calories a day, 1200/5958/kcal = about 1/5 .

So we divide the EPA and DHA amount in grams by 1/5 to get roughly: 6 g EPA (c20:5) and 5g DHA (c22:6). These are present in fish oil at 300mg/200mg per pill, which would translate to 20-25pills per day (http://www.pureformulas.com/super-omega-3-gems-fish-oil-1000-mg-250-soft-gels-by-carlson-labs.html?CUSTOMTRACKING=CUSTOMTRACKING&CAWELAID=847734961&catargetid=1811371487&cagpspn=pla&gclid=CPrMn-TG5rUCFQ6EnQodwDYA0g#sthash.GYrwhU2W.dpbs)

CONCLUSION:  Hill’s claim of approximately 30 pills a day is pretty accurate. Damn. Not to mention the arginine which is not shown in these calculations but also present in Hill’s. I guess this is how they can charge $3.50 a can.  I am still looking into it, but there may be better sources of high yield liquid EPA/DHA that could be more cost effective and easier to implement (rather than shoving 30 pills down your dogs throat).

The rest of the paper shows a modest increase in survival times for dogs with lymphoma given the special fish oil/arginine diet:

surv curve

 

You can see that the average and max survival is substantially higher, although there is an overlap around the 25% survival mark, so it is anything but a guarantee. What is nice about this study,  and I want to re-emphasize, is that it is double blind/placebo controlled, so these results are pretty believable, even if the sample size is pretty small and the effect isn’t that huge.

Another interesting figure shows a very strong correlation between fatty acid concentration in the animals blood and survival time:

 

plasma c22 vs survival

Unfortunately it doesn’t really seem feasible to constantly measure your dogs DHA levels to see if the diet is working.

IN SUMMARY: the paper has pro’s and con’s (this is a different type of cancer, although the basic premise should work in different types of cancer), but overall I think it is enough to justify trying the diet and also Hill’s price.

I asked our family vet about Hill’s and she said she liked it but that at this point it probably wouldn’t do much to change Jabba’s outcome. We still felt it would be worth it to try, even if it just gave him a few extra good days.

Hill’s is specially formulated to be pallatable for dogs undergoing chemo, and Jabba definitely loves the taste. We did find one review that was a little dubious on the quality of the ingredients but oh well. Finally the cost: about $90/2 weeks so $180 a month. Yeah, not cheap. One other remark is that Jabba has definitely been gassier since starting Hill’s n/d!

In conclusion, Jabba-bear goes bonkers for the Hill’s Prescription Diet. He does his  “happy dance” around feeding time to signify that he is really ready to eat (he alternates lifting his two front legs and rapidly stomps on the wood floors, creating a “pitter patter, pitter patter, pitter patter” rhythm that resonates throughout the house).  This is one of Jabba’s most lovable qualities. He hadn’t “danced” in nearly 2 months.

Jabba and Beyonce begging for food.

Jabba and Beyonce begging for food.

Now, Jabba-bear is all smiles again!


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