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Monthly Archives: August 2019
This coming Saturday, August 17, will be the lucky day that thousands of dogs and cats find a new home. The day marks the nationwide pet adoption drive known as “Clear the Shelters” with more than 1,400 animal shelters and rescue organizations participating in events around the U.S. and Puerto Rico, all aiming to find loving homes for animals in need. Launched nationally in 2015 by NBC and Telemundo owned television stations, this annual event is becoming fixtures in their communities with more than 250,000 pets having found their forever homes since the first Clear the Shelters event.
A miraculous recovery thanks to the help of the Arizona Humane Society has led Copper, a three-year-old Redbone Hound, back from the brink of death after being stabbed by his owner. Nearly one month later Copper has regained the use of his right side and has been adopted into a deeply loving forever home.
In July, an AHS Emergency Animal Medical Technician™ (EAMT) responded to the scene of Copper completely soaked in blood after suffering multiple stab wounds. Copper was quickly transported to an overnight clinic to be stabalized before being transported to the Arizona Humane Society’s trauma hospital. Once in the care of AHS’ animal trauma hospital, chest and abdominal x-rays revealed the hound had three lacerations 1.5 centimeters deep to his neck.
Animal-assisted therapy has many benefits in health care. Yet, its biological and psychosocial effects in the military are unknown, especially for injured, airlifted patients. Researchers teamed up with a non-profit animal organization that trains therapy dogs to see if an animal-assisted intervention could reduce stress in this setting. Results showed that levels of the stress biomarkers cortisol, alpha-amylase, and immunoglobulin A, significantly decreased after a 20-minute intervention with the dogs, regardless of post-traumatic stress symptom severity.
Every year cardiovascular disease (CVD) is responsible for 17 million deaths globally, so when a recent study demonstrated that dog ownership may help to reduce CVD risk factors and maintain a healthy heart, that is an important story. When the research was conducted by the renowned Mayo Clinic it becomes an even bigger story. The findings examine the association of dog ownership with cardiovascular risk factors and cardiovascular health and reflects the first analysis of data from the Kardiozive Brno 2030 study. This work was conducted from January 2013 to December 2014 in Brno, Czech Republic, with 2,000 subjects. Further evaluations will take place until 2030 in five-year intervals.
When Orbit came into one of the classes I offer for puppies and their owners, in Santa Cruz, California, he was in most ways just like all of the other puppies. He bounced around excitedly, wanted to sniff the other pups, and was thrilled with the treat tidbits that were offered for certain behaviors. But Orbit did one thing just a little differently. He would make tight circles near his people, Melissa and Arielle, gradually spiraling outward.
Orbit, a Havanese-mix who was born blind, couldn’t visually scan his surroundings. Instead of sight, Orbit was using cognitive mapping, sounds, and scent to figure out what was going on in his immediate environment. Like many animals, dogs possess the ability to develop a mental map of their surroundings, even when they cannot see. Through exploration of the space, they learn where things are and how to navigate safely.
Orbit was born without sight due to retinal dysplasia and optic nerve coloboma. Dogs who are born blind may have a genetic component or may have developed the problem while in the womb. Dogs can also lose their sight later in life due to genetic conditions, diseases, injuries, and other changes in the eye as they get older. Some of the more common causes of vision issues include cataracts, glaucoma, progressive retinal atrophy, and suddenly acquired retinal degeneration (SARDS).
Dogs = Dogs, Sighted or Not
There is a belief that blind dogs will be more prone to behavior problems. But this really is a myth. Blind dogs are dogs first, and blind second. Some are happy, some are serious. Some are easy going, some are more easily stressed. Some like to play, others prefer to cuddle. Many love their walks, car rides, hanging out with friends, and a good chew.
Pups who are born blind may have an easier time because they do not have to adjust to a change. Being blind is their norm. A dog who becomes blind later in life may need some time and help with the adjustment, but most dogs who are blind adapt well, perhaps in part because they already rely heavily on other senses.
“Orbit is a happy-go-lucky guy,” says Melissa. “He is trusting and approaches life with gusto.” Melissa said that her family’s first consideration when thinking of adopting Orbit was whether they were really ready for a puppy. Their second consideration was how would having a blind pup be different from having a sighted pup.
“What would a blind puppy need that a sighted puppy might not need? What would be different? Could we keep him safe?” Melissa says that in some ways he’s actually been easier than the pups she’s had in foster care. For example, he doesn’t get into stuff as much as other puppies, maybe because he can’t see the things to get into. But in other ways, they have had to think differently.
One of the big differences has been in their awareness of ambient noise. Orbit uses his hearing to orient himself in new environments and to keep track of Melissa. For example, Melissa wears keys on her belt that jingle, giving him a sound to orient to as they move through life. If there is traffic noise, he may have a harder time following her footsteps or the jingle of the keys.
Melissa recalls going to new locations to socialize Orbit – a friend’s backyard and a downtown shopping area. What Melissa considered to be a normal amount of noise – such as dogs barking in the background or cars going by on the street nearby – was a symphony of sound for Orbit. The sounds created an environment that was disorienting and overwhelming.
“We learned that we have to take him out in gradients. Slowly increasing the challenges. But he likes going places. He is very friendly, social, and gregarious. I think he would be sad if he wasn’t allowed to go out and embrace life the way he does. You just have to modify it a bit.” Melissa notes that Orbit will usually have a new place mapped and be comfortable within three or four visits.
Socializing Orbit with other dogs has also been a little different. He will not see the other dog’s social cues. And when he attempts to give cues, they may be a little awkward. “He does some of the right things, but in the wrong way,” Melissa says. For example, he may do play bows facing away from the other dog or walk up to sniff a dog and instead bump into their side. Dogs he interacts with have to be patient and unflappable.
Physical safety is another big concern. For example, the family has guards on their stairs and baby gates to prevent accidents. When walking down the street, Melissa has to be very aware of things that Orbit could run into, such as bushes or poles.
Training Modifications for Blind Dogs
When using methods such as lure and reward or reward-marker (clicker) training, teaching a blind dog is remarkably similar to working with a sighted dog, though you may obviously rely more heavily on verbal cues (or touch cues for dogs that are both deaf and blind) than on hand signals or body language.
- A new behavior may be initially lured, captured, or shaped. For example, you might use a treat lure to prompt a “sit.” You can capture the dog orienting to a sound such as the dog’s name or a touch such as a shoulder tap. These can be introduced much the same way you might introduce them to a sighted dog.
- Using a reward marker, such as a clicker or the word “yes,” to let the dog know what behavior is being rewarded already relies on sound rather than sight. For a dog that is both deaf and blind, a specific signal such as a touch on the chest can be used for the reward marker.
- You can reinforce behaviors with food, praise, touch, play, or other things that the dog finds rewarding, just as you would with a sighted dog.
Training is similar enough that Orbit attended my puppy, beginning life skills, and intermediate life skills classes and excelled at all of the exercises with only a few minor modifications.
In puppy class, where the pups interacted with each other, we made sure that approaches were done slowly and carefully (something that is really a good idea for all pups!). When teaching impulse-control behaviors such as stay and leave it, we quickly discovered that adding a verbal cue immediately (rather than waiting until we had the finished behavior) actually accelerated the training, as he couldn’t respond to the initial body language cues.
With a blind dog, using multiple cues (which goes against conventional training advice) can be very helpful for certain behaviors, notably orienting skills such as attention and recall. Melissa will call Orbit repeatedly when he is at a distance so that he can follow the sound of her voice to find her.
While most of us strive to have our dogs walk on a leash while the leash is loose, with Orbit, Melissa uses gentle tension on the leash to help him navigate around objects. She trained him to follow the leash pressure.
In addition, when training a blind dog, you might consider teaching some cues that you might not need with a sighted dog. Here are a few examples:
- Careful. “Careful!” can be used to let a dog know if there is something in front of him. This can be helpful in new environments or if there is something that has changed in an environment that the pup has already mapped. While there are several ways to train a dog to stop in motion, one simple way with a blind dog is to use a physical prompt.
Have your dog on a leash next to you. Walk forward with your dog toward an object such as a piece of furniture. Say, “Careful!” and then with either gentle pressure on the leash or your hand on your dog’s chest, stop his forward motion. Click and reward the stop. Then pat the item in front of your dog so that he will walk toward it and investigate. With repetition, your dog will soon understand that the cue “Careful!” means slow down or stop and look for something in front of him.
Assistive Devices for Blind Dogs
Many blind dogs adapt to life with few if any assistive devices, but there are some things that may be helpful.
Using mats and rugs. Mats can be used to help designate specific areas in the home, such as doorways and the tops and bottoms of stairs. They can help orient a dog to a change in the terrain. Likewise, carpet runners can designate paths in a home, making it easier for a dog to navigate.
Marked garden paths. Using mulch, gravel, or another specific texture can help dog more easily follow garden paths, especially in larger spaces.
Scents and sounds. Using scents such as lemon or vanilla to mark dog doors, crates, and bedding may be helpful for some dogs. Sounds, such as the running water in fountain-type water dishes, may also help some blind dogs. Toys that are scented and those that squeak or crinkle may be helpful.
Safety barriers. Baby gates at the tops and bottom of stairs, railing guards, as well as fencing around ponds and pools can help make the environment safe for a dog who cannot see or who has limited vision.
Halos. Halos are devices that are usually attached to a harness and provide a circle-shaped bumper above a dog’s head. If a dog is going towards a wall or object, the bumper will touch first before the dog bumps into it, giving them time to stop or adjust their path.
Echolocation devices. Sometimes called sonar devices, these are relatively new. There are several types. One collar device gives a warning beep if a dog approaches a solid surface. Another uses echolocation by sending ultrasonic sounds out, helping a dog determine how close or far away something is.
- Go see. This cue can be used to help a dog know there is someone or something in front of him that is safe to check out. You might start this with a friend. Walk your dog toward the friend, say, “Go see!,” and then your friend will encourage your dog to come closer to say hello.
Another easy way to train it is to have a small box or platform in front of your dog. Place one or more treats on the platform. Say, “Go see!,” and then encourage your dog to go up and explore the box. Within a few repetitions, most dogs will get the idea that “Go see!” means there is something in front of them that is interesting and safe to explore.
- Step up and step down. Using a single small step, a curb, or a training platform, encourage your pup to explore going up and down, on and off the step. Using treats to prompt or lure your dog may be helpful. When your dog is happily going up and down on the step, you can click and treat each time he offers the behavior.
Once he is predictably going up and down, you can add the cue just before he does the behavior. Say, “Step up!” just before he goes up, then click and treat. Say, “Step down!” just before he goes down, then click and treat.
Practice in a few locations with different steps. Once he understands it in several locations, you can practice with two or more steps, eventually adding the cue “Stairs!” to mean there are multiple steps in front of you.
- Run (or Go). This is a good cue to let your dog know that he is safe to run, and may be an especially important cue for a young or high-energy dog. You can practice this in your yard or another safe open area. Just before releasing your dog to run, say the word “Go!” or “Run!” Your dog will soon learn to associate the word with a wide-open space, free of obstacles and dangers.
- Names of things. You might consider teaching a blind dog the names of things such as specific pieces of furniture, toys, people, or other animals. While this is something that many people also do with sighted dogs, many of us rely more on pointing, patting, looking, and other body-language cues.
Teaching the name of a person, animal, or item is a simple matter of creating an association. For example, to teach the name of a person, you might say the person’s name, then that person can talk to the dog in a happy voice. Repeated pairings and the dog will likely hear the person’s name and check to see if that person is nearby.
With items, you can start with pairing the name in everyday occurrences. Say, “Squeaky!” before playing with a specific squeaky toy, and soon your pup may associate the word with that particular item or action.
Living a Full Life
Blind dogs, like all dogs, can live full, active lives. With a little modification, blind dogs can participate in many of the same activities sighted dogs enjoy. Dogs who have lost their sight later in life may enjoy similar activities as before losing their sight. For example, a dog who enjoys retrieve games may still enjoy fetch, finding their toys by sound and smell. Scented toys and toys that make noises may be particularly attractive for a blind dog.
Scent discrimination games are also a great option for blind dogs. From casual “Find the treat!” games in your living room, to hide and seek in the garden, to formal or competitive K9 Nose Work, scenting activities can enhance a blind dog’s life by encouraging the use of another sense.
Many blind dogs also enjoy adventures outside of the home. Orbit has gone to training classes, travels with Melissa through her day-to-day life, and even goes to work with her. “I would encourage people not to limit their blind dog’s life,” Melissa says. “Orbit loves being out, visiting with people, and going on a ‘sniffari.’”
You don’t have to have a dog to stay in one of the resort’s nine custom-built, compact hideaways, but if you do, there are lots of ways for both of you to unwind. Take a leisurely pack walk with other guests and their dogs or wander the resort’s 28 acres on your own; grill a meal to share on the patio; hang out in the new enclosed off-leash play space, which includes a seating area for you and a fine selection of doggie toys for your co-pilot. (We don’t know for sure, but we’d bet the goat yoga class is off-limits to the pooch!) atinyhouseresort.com
Lymphoma accounts for 7 to 24% of all canine cancers and approximately 85% of all the blood-based malignancies that occur, making it one of the most common cancers found in dogs. Lymphoma – also referred to as lymphosarcoma – is not a singular type of cancer but rather a category of systemic cancers with over 30 described types.
Lymphoma occurs when there is a genetic mutation or series of mutations within a lymphocyte that causes the cells to grow abnormally and become malignant, ultimately affecting organs and body functions. Lymphocytes are the infection-fighting white blood cells of the immune system and are produced by the lymphoid stem cells in the bone marrow and lymphoid tissue in the bowel. Their role is to prevent the spread of disease, to provide long term immunity against viruses, aid in wound healing, and provide surveillance against tumors.
Lymphocytes are part of the lymphatic system – a network of tissues and organs that help rid the body of toxins, waste, and other unwanted materials. The primary function of the lymphatic system is to transport lymph, a fluid containing lymphocytes, throughout the body. Unfortunately, cancerous lymphocytes circulate through the body just as the normal lymphocytes do.
Although lymphoma can affect virtually any organ in the body, it most commonly becomes evident in organs that function as part of the immune system – the locations where lymphocytes are found in high concentrations – such as the lymph nodes, spleen, thymus, and bone marrow. Swelling occurs when the numbers of cancerous lymphocytes increase; one of the most common sites of accumulation are in the lymph nodes themselves, resulting in an increased size of these structures.
Canine lymphomas are similar in many ways to the non-Hodgkin’s lymphomas (NHL) which occur in humans, though dogs are two to five times more likely than people to develop lymphoma. The two diseases are so similar that almost the same chemotherapy protocols are used to treat both, with similar responses reported. NHL has been featured recently in the high-profile cases involving individuals who developed non-Hodgkin’s lymphoma after using the weed killer glyphosate (most highly recognized under its best-selling brand name, Roundup).
Because of its similarity to the human form, canine lymphoma is one of the best understood and well-researched cancers in dogs. It is one of the few cancers that can have long periods of remission, even lasting years, and although rare, complete remission has been known to occur.
The cause of canine lymphoma is not known. It is suspected that the cause may be multifactorial. In an effort to determine what factors affect the possibility of developing the disease, researchers are looking at the role of environmental components such as exposure to paints, solvents, pesticides, herbicides, and insecticides; exposure to radiation or electromagnetic fields; the influence of viruses, bacteria, and immunosuppression; and genetics and chromosomal factors (changes in the normal structure of chromosomes has been reported). It is thought that dogs living in industrial areas could be at a higher risk for developing lymphoma.
BREED DISPOSITION AND RISK FACTORS
Although the direct cause of lymphoma cannot be identified, studies have found that there are certain breeds that are at higher risk of developing the disease. The most commonly affected breed is the Golden Retriever, equally represented by B-cell and T-cell lymphomas (see below).
Other breeds showing increased incidence include the Airedale, Basset Hound, Beagle, Boxer, Bulldog, Bull Mastiff, Chow Chow, German Shepherd Dog, Poodle, Rottweiler, Saint Bernard, and Scottish Terrier. Dachshunds and Pomeranians have been reported as having a decreased risk of developing canine lymphoma.
Lymphoma can affect dogs of any breed or age, but it generally affects middle-aged or older dogs (with a median age of 6 to 9 years). There has been no gender predisposition noted, but there are reports that spayed females may have a better prognosis.
A recent large scale study published in the Journal of Internal Veterinary Medicine (Volume 32, Issue 6, November/December 2018) and conducted by the University of Sydney School of Veterinary Science in Australia, examined veterinary records for breed, gender, and neuter status as risk factors for developing lymphoma. A number of breeds were observed to be at risk that had not been previously identified as being in that category.
The study also demonstrated the opposite: Several breeds previously documented to have an increased risk of lymphoma failed to show an increased risk. Additionally, the study found males had a higher risk overall across breeds, as did both males and females that had been neutered or spayed. Mixed breeds generally had a decreased risk when compared with purebred dogs. While these findings may be inconsistent with other generally accepted risk factors, the study states, “These three factors need to be considered when evaluating lymphoma risk and can be used to plan studies to identify the underlying etiology of these diseases.”
LYMPHOMA TYPES AND SYMPTOMS
Typically, a dog who gets diagnosed with lymphoma will initially be taken to a veterinarian because one or more lumps have been found under the neck, around the shoulders, or behind the knee. These lumps turn out to be swollen lymph nodes. The majority of dogs (60 to 80%) do not show any other symptoms and generally feel well at the time of diagnosis.
Advanced symptoms depend on the type of lymphoma and the stage and can include swelling/edema of the extremities and face (occurs when swollen lymph nodes blocks drainage), loss of appetite, weight loss, lethargy, excessive thirst and urination, rashes, and other skin conditions. Breathing or digestive issues may be present if the lymph nodes in the chest or abdomen are affected.
Because the lymphatic system aids in fighting infection, fevers are often one of the first indicators of the disease. Additionally, since lymphoma affects and weakens the immune system, dogs may be more susceptible to illnesses, which can lead to complicated health issues. Lymphoma itself, however, is not thought to be painful to dogs.
Lymphoma can occur anywhere in the body where lymph tissue resides and is classified by the anatomic area affected. The four most common types are multicentric, alimentary, mediastinal, and extranodal. Each type has its own set of characteristics that determine the clinical signs and symptoms, rate of progression, treatment options, and prognosis. Furthermore, there are more than 30 different subtypes of canine lymphoma.
- Multicentric Lymphoma. This is the most predominant type of lymphoma, accounting for 80 to 85% of all canine cases. It is similar to non-Hodgkin’s lymphoma in humans. The first noticeable sign of this form is usually enlargement of the lymph nodes in the dog’s neck, chest, or behind the knees, sometimes up to 10 times their normal size, with the patient not showing any other distinctive signs of illness.
Multicentric lymphoma tends to have a rapid onset and affects the external lymph nodes and immune system; involvement of the spleen, liver, and bone marrow are also common. The disease may or may not involve other organs at the time of diagnosis, but it eventually tends to infiltrate other organs, causing dysfunction and eventually leading to organ failure.
As it progresses, additional symptoms including lethargy, weakness, dehydration, inappetence, weight loss, difficulty breathing, fever, anemia, sepsis, and depression may be observed. This form can also metastasize into central nervous system (CNS) lymphoma in later stages, which can cause seizures and/or paralysis.
- Alimentary (Gastrointestinal) Lymphoma. This is the second most prevalent form of canine lymphoma, however it is much less common, accounting for only about 10% of lymphoma cases.
Because it is in the digestive tract, it is more difficult to diagnose than the multicentric form. It is reported to be more common in male dogs than females. This type forms intestinal lesions, typically resulting in the manifestation of gastrointestinal-related signs, including excessive urinating or thirst, anorexia, abdominal pain, vomiting, diarrhea (dark in color), and weight loss due to malabsorption and maldigestion of nutrients.
The disease affects the small or large intestine, and it has the potential to restrict or block the passage of the bowels, resulting in serious and complicated health risks or fatality.
- Mediastinal Lymphoma. This is the third most common type of canine lymphoma, but it is still a fairly rare form. Malignant lesions develop in the lymphoid tissues of a dog’s chest, primarily around the cardiothoracic region. This form is characterized by enlargement of the mediastinal lymph nodes and/or the thymus. The thymus serves as the central organ for maturing T lymphocytes; as a result, many mediastinal lymphomas are a malignancy of T lymphocytes.
The symptoms of mediastinal lymphoma tend to be fairly apparent, involving enlargement of the cranial mediastinal lymph nodes, thymus, or both. It can also cause swelling and abnormal growth of the head, neck, and front legs.
Dogs manifesting with this disease may have respiratory problems, such as difficulty breathing or coughing and swelling of the front legs or face. Increased thirst resulting in increased urination can also occur; if it does, hypercalcemia (life-threatening metabolic disorder) should be tested for as it seen in 40% of dogs with mediastinal lymphoma.
- Extranodal Lymphoma. This is the rarest form of canine lymphoma. “Extranodal” refers to how it manifests in a location in the body other than in the lymph nodes. Organs typically affected by this type include eyes, kidneys, lungs, skin (cutaneous lymphoma), and central nervous system; other areas that can be invaded include the mammary tissue, liver, bones, and mouth.
Symptoms of extranodal lymphoma will vary greatly depending on which organ is impacted; for example, blindness can occur if the disease is in the eyes; renal failure if in the kidneys, seizures if in the central nervous system, bone fractures if in the bones, and respiratory issues if in the lungs.
The most common form of extranodal lymphoma is cutaneous (skin) lymphoma, which is categorized as either epitheliotropic (malignancy of T lymphocytes) or nonepitheliotropic (malignancy of B lymphocytes.) In the early stages, it usually presents as a skin rash with dry, red, itchy bumps or solitary or generalized scaly lesions and is fairly noticeable as the condition causes discomfort.
Because of this presentation, it is sometimes initially mistaken for allergies or fungal infections. As it becomes more severe, the skin will become redder, thickened, ulcerated, and might ooze fluids; large masses or tumors can develop. Cutaneous lymphoma can also affect the oral cavity causing ulcers, lesions, and nodules on the gums, lips, and roof of the mouth (sometimes mistaken at first as periodontal disease or gingivitis).
Within each of the four types described above, the disease can be categorized further into subtypes. There are more than 30 different histologic subtypes of canine lymphoma identified; some researchers theorize that there may be hundreds of subtypes, based on molecular analysis of markers, classifications, and subtypes of lymphocytes.
At the moment, further knowledge about the various subtypes would probably not result in significant changes in treatment protocols. In the future, targeted therapies for subtypes could lead to more effective treatments and improved prognosis.
The two primary and especially relevant subtypes are B-cell lymphoma and T-cell lymphoma. Approximately 60 to 80% of lymphoma cases are of the B-cell lymphoma subtype, which is a positive predictor; dogs with B-cell lymphoma tend to respond positively to treatment with a higher rate of complete remission, longer remission times, and increased survival times. T-cell lymphoma constitutes about 10 to 40% of lymphoma cases and has a negative predictive value based on not responding as well to treatment and for being at a higher risk for hypercalcemia.
DIAGNOSING CANINE LYMPHOMA
Early detection and treatment are essential to ensuring the best possible outcome for lymphoma cases. Because dogs generally feel well and there are often only swollen lymph nodes (with no pain exhibited) as a symptom, catching the disease early can sometimes be quite difficult. As a result, the cancer can be quite advanced by the time a diagnosis is made. (Lymphoma is not the only the disease that creates swollen lymph nodes; this symptom does not guarantee your dog has lymphoma.)
Because multicentric lymphoma accounts for the majority of cases, an aspirate of an enlarged peripheral lymph node is usually sufficient to reach a presumptive diagnosis of the most common types of lymphomas.
Although diagnosis from cytology is fairly easily obtained, it does not differentiate the immunophenotype (B versus T lymphocyte). Histopathologic tissue evaluation (biopsy) is required in order to identify the type with the process of immunophenotyping.
Immunophenotyping is a molecular test usually performed by flow cytometry (a sophisticated laser technology that measures the amount of DNA in cancer cells) that classifies lymphomas by determining if the malignancy originates from B lymphocytes or T lymphocytes. Determining whether a lymphoma is B-cell or T-cell is invaluable as it provides the best predictive value; the adage “B is better, T is terrible” reflects this in its simplest form.
Diffuse large B-cell lymphoma (DLBCL) is the most common histologic subtype of lymphoma occurring in dogs. Most intermediate to high grade lymphomas are B-cell lymphomas – they tend to respond better and longer to chemotherapy than T-cell lymphomas; however, dogs with T-cell lymphoma have been known to go into remission for several months.
Another phenotyping test, the PCR antigen receptor rearrangement (PARR), can determine whether the cells are indicative of cancer or more consistent with a reactive process. For example, because the lymph nodes in the area of the jaw are reactive, the PARR test can help determine if cancer is present or if the dog just badly needs his teeth cleaned. The PARR test can also be used to detect minimal residual disease. Research is continuing to determine if this will be a useful clinical marker of early recurrence.
To ascertain the patient’s overall health, a complete physical exam will be performed; additional diagnostics often include a blood chemistry panel, urinalysis, x-rays, ultrasounds, and other forms of diagnostic imaging (these tests are also used for staging the disease).
In particular, it is important to screen for hypercalcemia. Hypercalcemia is a condition in which the hormone PTHrP (parathyroid hormone-related peptide) creates dangerous elevations in the blood calcium level. This well-documented syndrome is associated with lymphoma in dogs and is most often seen in T-cell lymphomas.
About 15% of dogs with lymphoma overall will have elevated blood calcium levels at diagnosis; this increases to 40% in dogs who have T-cell lymphoma. The condition causes additional clinical signs including increased thirst and urination, and, if left untreated, can cause serious damage to the kidneys and other organs and be life-threatening.
Unfortunately, due to the rapidly progressive nature of lymphoma, decisions regarding treatment need to be made as soon as possible after diagnosis. Unlike most other forms of cancer, lymphoma requires urgent care; without treatment, the median survival time is one month after diagnosis. Therefore, owners should be prepared to start treatment on the day of diagnosis, or within a day or two at most.
Once a diagnosis of lymphoma has been made, the stage (extent) of the lymphoid malignancy should be determined, and to assess this, several tests are recommended: lymph node aspirate, complete blood count, chemistry panel, urinalysis, phenotype, thoracic and chest radiographs, abdominal ultrasound, and a bone marrow aspirate.
Staging is prognostically significant; in general, the more extensive the spread, the higher the stage, the poorer the prognosis. However, even dogs with advanced disease can be successfully treated and experience remission. These tests also provide information about other conditions that may affect treatment or prognosis. The World Health Organization (WHO) five-tier staging system is the standard used to stage lymphoma in dogs:
- Stage I: Single lymph node is involved.
- Stage II: Multiple lymph nodes within in the same region are affected.
- Stage III: Multiple lymph nodes in multiple regions involved.
- Stage IV: Involvement of liver and/or spleen (in most cases lymph nodes are affected but it is possible that no lymph nodes are involved).
- Stage V: Bone marrow or blood involvement, regardless of other areas affected and/or other organs other than liver, spleen and lymph nodes affected.
In addition, there are two categories of clinical substages. Dogs are categorized with substage A if clinical signs related to the disease are absent, and categorized as substage B if clinical signs related to the disease are present (systemic signs of illness).
Although canine lymphoma is a complex and challenging cancer, it is one of the most highly treatable cancers and most dogs respond to treatment. In fact, many dogs with lymphoma outlive animals with other diseases such as kidney, heart, and liver disease. While lymphoma is not curable, the goal with treatment is to quickly achieve remission for the longest period possible thus giving dogs and their owners more quality time together. It is essential that the type of lymphoma is identified as the type impacts treatment and prognosis. And because lymphoma is a very aggressive cancer, it is important to begin treatment as soon as possible.
Since lymphoma is a systemic disease that affects the whole body, the most effective treatment is also systemic in the form of chemotherapy, which provides many dogs with prolonged survival times and excellent quality of life, with little or no side effects.
The specific type of chemotherapy treatment used will vary based on the type of lymphoma. Other factors to consider when choosing a protocol are the disease-free interval, survival time, typical duration of remission, scheduling, and expense. Again, dogs with B-cell lymphoma tend to respond much more favorably to treatment than those with T-cell.
Because lymphoma is so common in dogs, there has been a substantial amount of research and testing of many different combinations of chemotherapy treatments. Multiagent chemotherapy protocols are considered the gold standard of treatment and have shown to provide the best response in terms of length of disease control and survival rates, as compared to single agent protocols.
The Madison Wisconsin Protocol, also known as UW-25 or CHOP, is a cocktail of drugs modeled after human lymphoma treatments and is widely considered to be the most effective treatment for intermediate- to high-grade canine lymphomas. This protocol utilizes three cytotoxic chemotherapy drugs – cyclophosphamide, doxorubicin (hydroxydaunrubicin), and vincristine (brand name Oncovin) – in combination with prednisone (CHOP). The prednisone is typically given daily at home as a tablet with the remainder of the protocol agents administered by an oncology specialist.
On average, 70 to 90% of dogs treated with CHOP experience partial or complete remission. For dogs with B-cell lymphomas, 80 to 90% can be expected to achieve remission within the first month. The median survival time is 12 months with 25% of patients still alive at two years. For T-cell lymphoma, about 70% will achieve remission with an average of six to eight months survival.
Other treatment options include the COP chemotherapy protocol (cyclophosphamide, Oncovin [vincristine], and prednisone), vincristine and Cytoxan; single-agent doxorubicin; and and lomustine/CCNU. As a primary treatment, single-agent doxorubicin can result in a complete remission in up to 75% of patients with median survival time of up to eight months, though cumulative treatment with doxorubicin may result in cardiotoxicity, so the protocol may be contraindicated in any dog with evidence of or a history of pre-existing heart disease. Lomustine/CCNU is reported to be the most effective treatment for cutaneous lymphoma.
Remission is the condition in which the cancer has regressed. Partial remission means that the overall evidence of cancer has been reduced by at least 50%; complete remission indicates that the cancer has become undetectable to any readily available diagnostic screening (but it does not mean that the lymphoma has left the dog’s body, only that it has been treated into dormancy).
A dog in remission is essentially indistinguishable from a cancer-free dog. The lymph nodes will return to normal size and any illness related to the cancer usually resolves. Overall, there is approximately a 60 to 75% chance of achieving remission regardless of the protocol selected.
Studies show that the average time for a dog to be in remission the first time is eight to 10 months, including the period of chemotherapy administration. Remission status is continually monitored; for dogs with enlarged lymph nodes it typically involves checking the size of the lymph nodes. For dogs with other types of lymphoma, periodic imaging may be recommended. The Lymphoma Blood Test (LBT) from Avacta Animal Health can also be used monitor status since LBT levels can increase less than eight weeks before relapse.
Unfortunately, remission eventually relapses in most cases, but many dogs can restart chemotherapy with the hope of regaining remission status. At times, the same chemotherapy protocol may be used. For dogs successfully treated initially with the CHOP protocol, restarting CHOP at the time of the first relapse is typically recommended. About 90% of those treated with a second CHOP protocol will achieve another complete remission, however, the duration is usually shorter than the first time.
If a patient does not respond to the first CHOP protocol before completion or the treatment fails during the second protocol, the use of rescue protocols can be attempted; these consist of drugs that are not found in the standard chemotherapy protocols and kept in reserve for later use.
Commonly used rescue protocols include LAP (L-asparaginase, lomustine/CCNU, and prednisone) and MOPP (mechlorethamine, vincristine, procarbazine and prednisone). These are less likely to result in complete remission and some dogs will only achieve a partial remission, with an overall response rate of about 40 to 50%, and a median survival rate of 1.5 to 2.5 months.
Because cancer cells evolve over time, the disease can become resistant to certain drugs. Further treatments can be given, but it can become more difficult to achieve remission a second or third time and there does not appear to be any substantial effect on survival times.
OTHER TREATMENT OPTIONS
Here are some compelling alternatives to consider in addition to the standard protocols described above:
- Prednisone. This is usually a component of most lymphoma treatment protocols because it actually destroys lymphoma cells. It can even be administered as a standalone treatment. The average survival time without chemotherapy is about one month but treating with prednisone alone can increase this to about two to three months, with an average of 50% responding.
- Tanovea-CA1 (rabacfosadine). This is a promising new advancement in treating canine lymphoma. This drug has been conditionally approved for use by the U.S. Food and Drug Administration (FDA), pending a full demonstration of its effectiveness (additional field studies are currently taking place to obtain full approval).
A Note About Prednisone
Prednisone, a commonly used corticosteroid, is often used for its anti-inflammatory effects and anti-cancer-properties (it can kill malignant lymphoma cells). When prednisone is administered to a dog with lymphoma, cancer treatment has essentially begun. However, the administration of prednisone can complicate diagnosis, staging, and treatment of lymphoma. Therefore, it is strongly advised that prednisone not be administered until after diagnostics have been completed, results received, and a course of action decided upon.
Specifically, prednisone can interfere with obtaining an accurate diagnosis from aspirate cytology, thus causing a delay in treatment. It can also affect the test for the lymphoma phenotype (subtypes B and T). Staging the cancer involves identifying how far the cancer has spread, provides information for treatment, provides a baseline for monitoring response, and allows for a more accurate prognosis. If prednisone has been started prior to staging, the data obtained may be influenced and inaccurate.
Also, it has been found that dogs with lymphoma who have been pretreated with prednisone prior to chemotherapy don’t respond as well. In particular, it can trigger Multidrug Resistance (MDR), a mechanism that enables cancer cells to resist the chemotherapy drugs being administered to the dog (this can also occur during chemo treatment without prednisone as well); accordingly, dogs with MDR have a worse prognosis. Furthermore, it can cause resistance to other agents of chemotherapy so that it will be especially difficult to get a second remission after the first remission is lost.
Bottom line: Wait to start prednisone.
Tanovea-CA1 is designed to target and destroy malignant lymphocytes and can be used not only to treat dogs that have never received any treatment but also those no longer responding to chemotherapy. It has demonstrated a 77% overall response and a 45% complete response rate. It is administered by veterinarians in five treatments every three weeks via intravenous infusion and is shown it to be generally well-tolerated.
- Bone Marrow Transplant. One of the newest approaches to treating canine lymphoma is the bone marrow transplant – a form of stem cell therapy – modeled after a method used in human medicine. The process involves the dog receiving and completing CHOP therapy (which puts the cancer in remission); the harvesting and preservation of healthy stem cells from the patient; the administration of radiation to destroy any remaining cancer cells; and the returning of healthy cells to repopulate and restore blood cells.
In humans, the cure rate is about 40 to 60%; the procedure has been determined to be safe for use in dogs with cure rates of 33% for B-cell lymphomas and 15% for T-cell lymphomas. The process is expensive ($19,000 to $25,000) and requires about two weeks of hospitalization. Currently there are only two locations in the U.S. offering the procedure: the North Carolina State College of Veterinary Medicine (in Raleigh) and Bellingham (Washington) Veterinary Critical Care.
At some point lymphomas become resistant to treatment and no further remissions can be obtained. Eventually the uncontrolled cancer will infiltrate an organ (often the bone marrow or the liver) to such an extent that the organ fails. Under those circumstances, it is best to focus on high quality of life for the longest possible survival time.
Like most cancers, the eventual prognosis for dogs with lymphoma isn’t very uplifting. But it is a very treatable cancer, and dogs live well and longer with treatment. Several prognostic factors have been identified for estimating a dog’s response to treatment and survival time:
- Dogs with signs of systemic illness (substage B) tend to have a worse prognosis than dogs with substage A.
- Dogs with lymphoma histologically classified as being either intermediate- or high-grade tend to be highly responsive to chemotherapy, but early relapse is common with shorter survival times.
- Dogs with lymphoma histologically classified as being low-grade have a lower response rate to systemic chemotherapy yet experience a positive survival length advantage when compared to intermediate- or high-grade tumors.
- Dogs with T-cell lymphomas have a shorter survival time when compared with dogs with B-cell based malignancies.
- Dogs with diffuse alimentary, central nervous system, or cutaneous lymphoma tend to have shorter survival times when compared to dogs with other anatomic forms of lymphoma.
- Presence of hypercalcemia or anemia or a mediastinal mass are all associated with a poorer prognosis.
- Intestinal lymphoma has a very poor prognosis.
- Expectations for cases with Stage V lymphoma are much lower than those assigned to Stages I to IV.
- Prolonged pre-treatment with corticosteroids is often a negative prognostic factor.
- Ultimately, the estimates for survival times depend on the type of lymphoma combined with the stage and the treatment option selected (if any).
- In the absence of treatment, most of the dogs diagnosed with lymphoma succumb to the disease in four to six weeks.
- The median survival time with a multi-agent chemotherapy protocol is 13 to 14 months.
- Traditional chemotherapy results in total remission in approximately 60 to 90% of cases with a median survival time of six to 12 months.
- In about 20 to 25% cases, dogs live two years or longer after initiation of standard chemotherapy treatment.
- Dogs treated with rescue protocols have a survival rate of 1.5 to 2.5 months.
- Studies indicate that dogs who underwent splenectomy show a median survival rate of 14 months.
- Complete cure is rare, but not unheard of. Bone marrow transplants show promise and potential for increased cure rates.
Above all, remember that prognoses are only guidelines based on average accumulative experiences. They are numbers, and as a dear friend and veterinary oncologist has said to me many times, “Treat the dog, not the numbers.”
The post Canine Lymphoma: Risk Factors, Symptoms, Diagnosis, and Treatment appeared first on Whole Dog Journal.
If competition isn’t your thing, you can do a simpler activity at home with your dog that we call Nose Games. You can do just the easy parts – hiding treats in a room while your dog watches – or go all the way to the advanced stages, where your dog can find missing pets and people.
Not long ago we had a client in our Nose Games class with her 8-year-old son. The family’s enthusiastic 20-pound Terrier mix ultimately learned to find the boy when he hid in the woods!
In Nose Games, you teach your dog to look for and find hidden objects when you ask her to. This is an exceptionally useful activity, as it uses lots of energy and can tire out even a very active dog. Also, it has very practical applications as well – including helping shy or fearful dogs gain confidence. And dogs love it!
We start with treats, since most dogs will happily look for food. You can eventually ask your dog to look for hidden objects (such as favorite toys, or your lost keys) and even hidden or missing humans and other animals!
1. Start by “hiding” treats as the dog watches, in the dog’s plain view.
- Have your dog sit and wait/stay. (If she doesn’t know wait/stay, have someone hold her leash.)
- Walk about six feet away, show her a treat, remind her to stay, and place the treat on the ground.
- Return to her side (remind her to stay!). Turn and face the treat, then tell her “Search!” (If she won’t get up until you release her from the stay, say “Search!” and then give your release cue.) She should run right out and eat the treat. Repeat a half-dozen times.
2. Next, “hide” the treats in really easy places, while your dog watches.
- Have your dog sit and stay. Let her watch you “hide” a treat in plain view (behind the leg of a chair, by a waste basket, etc.).
- Return to her side (reminder her to stay!). Turn and face the treat, then tell her “Search!” She should run right out and eat the treat. Repeat six or so times.
3. Ask her to sniff an item that has the scent of a treat and add a cue, such as “Scent!”
- Have your dog sit and stay. Let her watch you hide several treats in plain view.
- Return to her side (remind her to stay!). Turn and face the treats, rub one of the treats you’re using on a paper towel, hold the towel in front of her nose (don’t let her eat it!) and tell her “Scent!” (Don’t worry if she doesn’t appear to sniff it.)
- Then tell her “Search!” She should run right out and eat the treats. Repeat six or seven times, asking her to sniff the item that contains the treat scent and giving her the “Scent” cue before each attempt.
4. Hide treats in locations that require a little more effort to detect.
- Have your dog sit and stay. Let her watch you hide a treat in a harder place (behind a chair leg, etc.).
- Return to her side (don’t let her get up!). Turn and face the treat, do “Scent!”, then tell her “Search!” She may have more difficulty finding this treat. Don’t help her! This is where she starts learning to use her nose. If you help her, she won’t use her nose – she’ll learn to wait for you to tell her where it is. If she truly can’t find it, reset, and hide it in an easier spot. Make sure she watches you! Repeat a half-dozen times.
- Gradually hide the treat in harder places, having her “Scent!” before each set. “Harder” spots are on top of things, inside of other things (like a shoe, or on a shelf in a partially opened cupboard or closet), or inside open containers on raised surfaces.
- Now hide multiple treats, in easy and challenging spots. Have your dog sit and stay. Let her watch you hide two to three treats in somewhat easy places (behind a chair leg, etc.).
- Return to her side (don’t let her get up!). Turn and face the treats, do “Scent!,” then tell her “Search!” She may have more difficulty finding multiple treats. If necessary, indicate an area by spreading your arms and saying “Search here!” Don’t point to the treat! This is where she really starts using hers nose. If she truly can’t find it, reset, and hide it in a slightly easier spot. Make sure she is watching you! Repeat a half-dozen times.
- Gradually hide treats in harder spots, having her “Scent” each time before you send her.
5. Hide the treats when the Dog is Out of the Room; NOW IT GETS REALLY FUN!
- Put your dog in another room. Hide two or three treats in somewhat easy places.
- Bring her back to the room, have her “Scent!” then tell her “Search!” She may have more difficulty finding multiple treats. If necessary, indicate an area by spreading your arms and saying “Search here!” Don’t point to the treat! If you help her, she won’t use her nose. If she truly can’t find it, reset, and hide it in a slightly easier spot. Repeat a half-dozen times, doing “Scent!” each time.
- Gradually hide treats in harder spots.
6. Generalize “Search” to Other Objects. Start with her favorite toy!
- Generalize her “Search” behavior to other objects as you desire, starting with a favorite toy. Rub the toy on the paper towel, and start back at Step 1, placing the toy in plain view and move quickly through to Step 5.
- Next, use less favorite or neutral objects. For humans, rub the human’s scent on a paper towel (have them rub their neck with the paper towel). Then have the human hide, in an easy spot at first (let the dog find the human in plain view, then watch the human hide behind a barrier, or around a corner, then through Step 5.)
7. Teach your dog to perform a specific behavior that will indicate when she has found something.
- Pick a behavior that your dog already knows well, or teach her a new behavior like “Speak,” “Down,” “Touch with your paw,” etc., that you want to be the indicator behavior. Teach her a new cue for that behavior, by saying (for example) “Mark!” and then cueing the behavior.
- With your dog watching, put a treat in a box with holes in it, or out of her reach, so she can find it but not get to it.
- Tell her “Scent!” and “Search.” Follow her to the treat, and when you can tell she has found it, tell her “Mark!” and cue her indicator behavior if necessary (if she doesn’t do it on the “Mark” cue). Repeat until she starts to automatically offer her indicator behavior when she gets to a treat that she cannot access herself.
- Stop following her to the treat, and invite her to come back to you to offer the mark behavior, until she comes to you automatically to mark.
- Then add other objects, and eventually increase the difficulty by having her out of the room when you hide your objects or humans.
- Now you have a dog who can find a lost child in the woods, and come back and use her mark to you to tell you she has found him!
Actually these five simple tricks will also reduce stress in classes, so if your dog’s stress starts there then read on!
First, Allow your dog to acclimate to the area. The days of crating your dog and not letting them look around unless they are actively working are over. Yes, some dogs will stress up as a result of lack of acclimation and that might create nervous energy. And soon enough, you will discover the difference between an anxious dog who is moving a lot and one who is paying attention to you and showing usable drive. It’s not fun to try and work with a dog who is screaming, barking, and moving a lot without giving you the time of day.
Let your dogs look around! How you do that varies depending on what works best for your team. Some dogs do best if they are allowed to physically explore as much of the space as is practical. Others dogs do best if they watch quietly from their crates for short periods of time. Regardless, let your dog see where they are so they can become comfortable.
Second, cover your crate! I am amazed at the number of people who do not cover their dog’s crates, and then offer every reason under the sun for not doing so. Just because your dog needs to see where the are does not mean they should be uncovered for an hour, two hours, or an entire day. That is downright exhausting. My dog’s crates are covered from the time they are very young unless I want them to be looking at the space for 10 or 15 minutes at a time to acclimate. And they learn to sleep! Even at IPO where ever other car is rocking with a screaming dog, my dogs sleep in their crates. It makes an enormous difference. Speaking of crating out of cars or away from other dogs…it’s awesome! Do it whenever you can.
If your dog barks in the crate, spins in the crate, watches alertly from the crate, etc.? Cover the crate. If your dog sleeps in the crate and it is uncovered? Do what you want. But I mean sleeping; eyes shut and snoozing! Dogs spend the majority of their day in their home sound asleep. If you go to a dog show and every time you look at your dog they are awake? They are being exhausted for no reason, which causes cumulative stress. Cover your crate.
Third, place an enormous amount of space between yourself and other dogs in crates as you walk through the space. Because most people will not cover their crates, their dogs will watch you as you pass. Understandably a high percentage of dogs don’t think much of having your dog walk within a few feet of the front of their crate. That means they will bark and react towards your dog. That will cause your dog to have a nervous reaction.
When given a choice, dogs give each other space. They do not walk two feet in front of unfamiliar resting dogs, yet a leashed dog has no choice. Being yelled at by other dogs builds up stress in both dogs. Do not walk within 8 feet of a crate if you can possibly help it. Treat it like the dog’s personal bedroom- which it is supposed to be. Stay away! Anytime you notice a dog bark at you when you move by then make a mental note that you were too close. Take that as a learning opportunity. You’re stressing out your dog! You’re stressing out the dog in the crate! You’re stressing out every dog in the space that is listening to the reactive display! And you are stressing me out as well, even though I am currently sitting in my quiet house, because I know what is happening out there!
Giving plenty of space to crated dogs is particularly important until people routinely cover their dog’s crates, which brings us back to number two. Which we’re done talking about.
Fourth, teach your dog what you want them to do when they are not actively working and they are out of their crate. If you are talking to your instructor, what should your dog be doing? How about a down stay? Now your dog knows that he can rest quietly and wait. If you want your dog to have energy when you are running, you don’t want your dog using that energy up mindlessly, either physically or mentally through frustration and stress. Not to mention, we want to have positive relationships with our dogs. We don’t want our dogs frustrated with us! Teach your dog what you want in the crate, which I have already addressed, and now teach your dog what you want when you are talking to another person like a judge, a fellow exhibitor, an instructor, etc.
This is about clarity. I have addressed this several times on this blog recently, so feel free to scroll back and read my thoughts about the importance of a “waiting behavior” when your dog is not working.
Finally, pay attention. Rarely do bad things “come out of nowhere” when you are on the show grounds. Of course it happens, but…it’s rare. If your dog learns that you do not pay attention, and random dogs yell at him (from their crates or otherwise), and that you disconnect for no particular reason in the middle of training, setting up for competition, etc., then your dog will learn to pay attention, but not to you. To keeping himself safe because he’s not sure you’ll do it! Don’t let that happen.
If there were one thing I wish I could give to people it would be to develop the skill of paying attention. It’s a hard one! If you find yourself at the dog show and your dog is out with you and you are feeling relaxed? You’re not paying attention. Put your dog in the crate if you need to relax. Otherwise, pretend that your dog is a toddler without a leash near a busy road. Are you feeling relaxed now?
I recently wrote a blog for FDSA on ” Understanding hyper awareness: What happened when I showered with a spider“. If you don’t understand how the above points are critical to your dog’s comfort in a competition or training setting, please read that blog.
Dog sports are awesome for people! But sometimes for dogs? Not so much. Let’s do everything we can to make sure that our dogs enjoy training and competition environments just as much as we do.
Someone sent me a link to this news story about a Texas dog owner being caught on video (taken inadvertently by a neighbor’s Ring security camera) beating her dog. The person whose security camera caught the event posted the clip on a social media site, where it was viewed by neighbors – and eventually, a local law enforcement officer. The local police department shared the video even more widely, asking for the community’s help in identifying the woman. Eventually, the woman was identified and questioned. Her explanation for her behavior? “Police say the woman admitted she hit her dog after she was forced to chase him when he ran from home.”
Well, beating and kicking him is a great way to make him
want to be home. (SARCASM ALERT.)
It should be obvious that hitting and kicking a dog teaches
a dog NOTHING (except perhaps to run faster from his or her abuser next time).
It’s strange to me, however, that many people struggle with
keeping their dogs inside when their doors or gates are open – and with being
able to recall their dogs from some tempting fun.
Train a recall often and make it fun
When people come to my house, they will undoubtedly be met at the door by my canine greeters. When I open the door, many (if not most) people who don’t know my dogs personally will initiate some sort of blocking maneuver, as if to prevent the dogs from escaping out the door. I am forever saying, “It’s okay! They aren’t going anywhere! Look, they come right back!” (Of course, I could tell my dogs to stay inside instead of allowing them to go outside when I’m letting someone into the house; they’re perfectly capable of holding a sit-stay or down-stay indoors – but I rarely consider this, as it’s not even slightly a problem if they slip outdoors; I can call them back without fail.)
I’m not bragging; their recall is something we practice constantly, if not daily. And it’s not a
chore or a drill, I keep it fun! Often when I call them, it’s to initiate a
game of fetch or hide-and-seek. Sometimes they get lunch meat, or scraps of my
lunch. Sometimes I call them in from chasing a squirrel – and their reward for
a prompt recall is encouragement to go chase the squirrel again! I keep our
recall practice unpredictable, enjoyable, and always rewarding in some way.
Here’s how to train – and maintain – a solid recall
For more about keeping your dog’s recall fresh and quick,
see the following WDJ articles:
Training an “Extremely Fast” Recall: https://www.whole-dog-journal.com/training/leash_training/training-your-dog-to-execute-an-extremely-fast-reliable-recall/
Using a Long Line to Teach Off-Leash Recalls: https://www.whole-dog-journal.com/training/on-leash-training-blossoming-into-off-leash-reliability/
Games for Building a Reliable Recall: https://www.whole-dog-journal.com/training/leash_training/games-for-building-reliable-recall-behavior-for-your-dog/
Also, here is a good one about stopping a door-dasher, without any beating or kicking required: https://www.whole-dog-journal.com/behavior/put-a-stop-to-door-darting-dogs/