The Kindle version of my latest book, Breast Choices for the Best Chances:Your Breasts, Your Life, and How You Can Win the Battle! is now available; you can order it at the following link:
The paperback version should be available in the next 2 weeks!
Here is a brief look at just some of the important information in the book. This particular excerpt deals with how understanding statistics can help you decide whether or not to undertake a particular therapy.
One area of concern in particular is whether or not my wife Sandy should use the drug tamoxifen as part of her ongoing therapy. Tamoxifen is a hormonal drug that is prescribed for all women with estrogen receptor positive breast cancer (isn’t it interesting that conventional medicine prescribes a treatment for ALL patients regardless of their particular set of circumstances or individual concerns.)
Tamoxifen is a strange drug: it can block estrogen from attaching to breast cells (and theoretically lower the risk of breast cancer recurring) but also acts like estrogen as it stimulates other cells of the body (in particular cells of the uterus, which explains the possibility of uterine cancer as a side effect of tamoxifen therapy.) Since Sandy tends to not want to take conventional medications unless there is an absolute benefit to them, we wanted to find out as much information as possible about whether or not tamoxifen therapy might be of benefit to her, and if there is benefit to her taking it, find out how much benefit they would be for her.
And this is where the idea of medical statistics comes in. I’m going to include a lot of information on the research involving tamoxifen in my book, but for now I just wanted touch on the topic of understanding statistics.
Looking at the statistics of the benefits of tamoxifen for Sandy’s particular grade of cancer (which is obtained via a number of analyses performed on her tumor including the Oncotype DX test,) statistics show that 5 years of tamoxifen therapy could reduce her risk of breast cancer recurring in her affected breast, opposite breast, or somewhere else in her body by approximately 50% (notice that studies do not “guarantee” that tamoxifen will do this, only that it “could” do this.)
On the surface, a risk reduction of 50% seems pretty good. If we didn’t look beyond that number, it would make sense that most women would benefit from tamoxifen therapy (ignoring for the sake of argument that some women will develop uterine cancer or a second breast cancer which is usually more aggressive than the initial breast cancer, not to mention other side effects such as hot flashes or blood clots that could lead to a stroke, from the use of tamoxifen.)
However, in trying to understand how medical statistics apply to a treatment you’re considering for yourself, family members, or your pet, you have to look at the actual risk the patient may face in real numbers. Based on studies using the Oncotype DX test recurrence score, women like Sandy with a low recurrence score have a 10 year survival of approximately 97% if they take tamoxifen. The same women have approximately a 94% ten-year survival if they do not take tamoxifen. In other words, 3/100 women taking tamoxifen are expected to die from breast cancer after 10 years following their diagnosis, whereas 6/100 women not taking tamoxifen are expected to die from breast cancer 10 years following their diagnosis. The difference between 6 women versus 3 women is 50%! Therefore, tamoxifen is expected to lower the risk of death by 50%. If you look at the real numbers however, we’re only talking about a difference of 3 women. For Sandy, it wasn’t worth the risk associate with tamoxifen therapy to reduce her real risk of only 3%.
And this is why it’s so important to look at the real numbers rather than simply medical statistics. While doctors and pharmaceutical companies love to quote statistics in terms of percentages, it’s vitally important to understand the real numbers behind the statistics. While a 50% reduction in death sounds great, when you are only talking about 3 people surviving if they use a certain medication, that 50% reduction in death doesn’t seem so impressive anymore.
Finally, whatever the statistics or the real numbers presented in the study, keep in mind that the patients being tested are “generic” patients. As much as possible, you must try to determine YOUR real risk or YOUR PET’S real risk in order to make the best decision for therapy.
Myth #1: Anesthesia is dangerous
Anesthesia has evolved into a safe medical practice since it was first used in 1799. Initial anesthetic drugs included such things as ether and chloroform, both of which proved toxic and often fatal not only to the patient but also to the doctor administering anesthesia! Modern anesthetics are very safe and have come a long way from early anesthetic drugs. Having said that however, they are medications and like any medication they can cause harm to the patient or the doctor and the staff in the operating room.
In general, there are two types of anesthetics: injectable anesthetic drugs and inhalant anesthetic drugs (gases.) Injectable drugs can be further classified into short acting medications or longer acting medications. Short acting medications tend to be used for induction of anesthesia (getting the pet to become anesthetized very quickly) or given continuously throughout anesthesia for maintenance of anesthesia (keeping the pet asleep during the entire procedure.) Long acting injectable medications may be used as the sole anesthetic drug and will usually keep the pet asleep during the entire procedure without the need for additional anesthetic. Inhalant or gas anesthetics are used in place of injectable drugs to keep the pet asleep during the entire procedure (although short acting injectable drugs may be given to quickly anesthetize the pet before it is placed on the gas anesthesia for maintenance.)
Both injectable and gas anesthetics can be used safely IF dosed properly, IF chosen considering the pet’s medical condition (some drugs should not be used in pets with certain medical conditions if at all possible, such as the use of xylazine in pets with heart disease) and IF proper monitoring of the pet while anesthetized is done (I believe proper monitoring should include at least careful visual observation of the pet’s respiration and heart rate as well as monitoring by an electronic monitor that checks the pet’s heart rate and oxygen saturation through pulse oximetry.)
In my practice, I’ve performed what I call holistic anesthesia which includes careful monitoring and low doses of anesthetic drugs properly chosen for the patient’s condition so that the pet can wake-up immediately following surgery without any anesthetic hangover effects.
Thanks to modern anesthetics and monitoring equipment, anesthesia should no longer be considered dangerous as long as it is properly administered, as is the case with any conventional medication.
Myth #2: My pet will be groggy following anesthesia
One of the most common complaints I hear from pet owners who seek out my help for anesthesia and surgery is that their pets are groggy for several hours or several days following prior anesthetic procedures. While this commonly occurred many years ago as our anesthetic drug choices were more limited, in my opinion it should never occur today. I believe it is malpractice to send the pet home if it is barely awake following anesthesia or surgery. In general, this hangover or groggy effect occurs when injectable ketamine and xylazine (or similar) drug combinations are used for anesthesia. These drugs, while safe when used properly, are often given by injection for spaying and neutering procedures, especially when these procedures are offered at a discount or low cost (these medications are much less expensive than using gas anesthesia or other injectable medications.) A very common side effect of these medications, especially when given under the skin or in the muscle, is prolonged recovery periods. Many of these pets are groggy for 24 hours or more, and I’ve seen pets that required hospitalization for supportive care as it took them several days to fully recover. In my opinion a safer (although slightly more expensive) approach is to use a short acting anesthetic followed by gas anesthesia for anesthetic maintenance for surgical procedures including spaying and neutering. Using this anesthetic regimen, pets wake-up quickly following surgery and can be sent home fully awake. If sedation is needed at home to keep the pet from becoming overactive, oral sedatives can be used.
Myth #3: My pet can’t be anesthetized too often
Some pet owners are concerned if their pets require several anesthetic procedures over a short period of time, such as for cleaning severely infected ears or changing bandages or splints following fracture repair. Once again if the proper anesthetic drugs are chosen, these quickly leave the body and do not require extensive metabolism by the liver or kidneys. This is especially the case with gas anesthetics, as the anesthetic leaves the patient while the patient continues to breathe following the procedure. While it is true that we never want to anesthetize a pet more than necessary, some procedures such as those I just mentioned require sedation or anesthesia with some frequency. Rest assured that as long as the proper anesthetics are chosen, there is no increased risk to your pet from having several procedures done over a short period of time (as an example, keep in mind that in human medicine, burn patients are often anesthetized daily to allow cleaning of their wounds and skin grafting.)
Myth #4: Sick pets can’t be anesthetized
Sick pets can be safely anesthetized as long as the proper anesthesia is chosen and the pet is carefully monitored, although it is always preferable to get the sick pet healthy first before anesthesia is done. However, this is not always possible. For example, in my practice I often see older pets with very bad dental disease that are not eating and are feeling pretty crummy. It is often hard to determine if the pet has stopped eating because of the severe dental disease or because of its underlying illness. In these cases, the pet must be anesthetized in order to clean its teeth to allow us to determine if the dental disease or the internal disease is causing the lack of appetite. The good news is that once again with properly chosen modern anesthetics, antibiotics, fluid administration, additional supportive care, and careful monitoring, these pets rarely have anesthetic problems and feel much better following the procedure (and most resume eating as the severe dental disease was the cause of their lack of appetite!)
Myth #5: My pet is too old for anesthesia
I don’t believe that any pet is too old for proper medical care. If that proper medical care includes anesthesia, then the anesthesia must be done in order to help the pet. It is true that some owners choose not to have an anesthetic or surgical procedure done for a pet that they deem too old (for example, performing a total hip replacement on a 15-year-old Labrador with arthritis,) but this is the owner’s choice that is made after careful discussion of all the options available for her pet. It is true that older pets don’t metabolize some drugs as well as younger pets, and for these reasons the correct anesthesia must be safely chosen for the pet’s age and more importantly its state of health or presence of medical problems at the time of the procedure. I see far too many pets who have not been given proper care (especially dental cleanings and tumor removals) because their current veterinarians deem them “too old” for anesthesia and refuse to do the procedure.
In my area I’m known as a veterinarian who anesthetizes old and often sickly pets on a daily basis, and pet owners seek out my assistance because they want these procedures done on their older pets and recognize the health benefits the pets receive by having the procedures done. I always tell these owners that if their current veterinarians don’t want to anesthetize their pets, then the veterinarians should not anesthetize their pets as there is likely to be a problem if these veterinarians are scared of the anesthesia. I can honestly say that I have not had a single anesthetic problem or death in an older or sickly pet using our carefully chosen holistic anesthesia regimens. I hope that if you get nothing else out of this article, you’ll appreciate that older pets and those with illness deserve proper medical care and can receive it safely if the veterinarian is comfortable performing anesthesia and carefully monitoring the pet during the procedure!
Breast Choices for the Best Chances:Your Breasts, Your Life, and How You Can Win the Battle!, will be available shortly. I’m finishing the final edits now.
Once everything is ready to go and the book is available for purchase, I’ll let you know.
Help me spread the word so we can save as many lives as possible!
Shawn Messonnier DVM