Question 1

Chemotherapy Side Effects

Answer

All anticancer drugs have the potential to produce side effects. Since the doses used in animals are less than the doses used in people, the side effects that can occur in pets are usually not as severe as those seen in humans. The main goal in the treatment of cancer in dogs and cats is to preserve a good quality of life and to avoid significant toxicity from chemotherapy. The most common side effects of chemotherapy are immune suppression and gastrointestinal upset. Dogs with non-shedding hair (i.e. Poodles) may experience hair loss and cats may develop blunted whiskers. Dogs who shed do not usually experience noticeable hair loss. Immune suppression primarily manifests as low neutrophils (“neutropenia”), which are a type of white blood cell important to the immune system. Platelets, which are important to clotting, can also decrease with chemotherapy. Low neutrophils and platelets are usually noticed on routine bloodwork (“complete blood count”), but do not make animals feel sick. Bloodwork (complete blood count, or CBC) is repeated 7-10 days after each chemotherapy dose and occasionally a course of antibiotics are prescribed to protect the pets immune system if neutrophil counts are below a certain value. Subsequent chemotherapy may also be delayed. Although rare, about 5% of animals may experience severe immune suppression and become sick and develop a fever- this usually occurs 5-7 days following chemotherapy (although can be closer to 10-14 days with some chemotherapy types). When hospitalized and treated appropriately, animals generally make a full recovery within a few days. GI upset may manifest as inappetance, nausea, vomiting or diarrhea, and generally occurs 3-5 days after chemotherapy. Approximately 20-30% of veterinary patients undergoing chemotherapy experience mild, self-limiting GI signs that are easily managed with medications at home.

Question 2

How to Manage Side Effects

Vomiting

Withhold food for 12 hours and start anti-nausea medications (cerenia or ondansetron)
If your pet does not vomit, offer small amounts of bland, easily digestible foods (ie. boiled chicken and rice) frequently throughout the day
Once your pet has not vomited for 2-3 days, start to slowly reintroduce the normal diet. Mix the normal diet in increasing amounts into the bland diet, over 3-4 days.

Call PETS:

If the vomiting is severe (more than 2-3 times in 1 day)
If the vomiting lasts longer than 24 hours
If your pet is also lethargic or febrile, or displaying other symptoms that concern you

-------------------------------------- Diarrhea

Withhold food for 12 hours, and start anti-diarrheal medication (metronidazole or tylosin)
Offer your pet small amounts of bland, easily digestible foods (ie. boiled chicken and rice) frequently throughout the day
Once your pet has not had diarrhea for 2-3 days, start to slowly reintroduce the normal diet. Mix the normal diet in increasing amounts into the bland diet, over 3-4 days.

Call PETS:

If the diarrhea is severe (watery, contains blood- bright or tarry, frequent)
If the diarrhea lasts longer than 48 hours
If your pet is also lethargic or febrile, or displaying other symptoms that concern you

-------------------------------------- Low white blood cell count (ie. “neutropenia”) and fever

If your pet is suddenly lethargic and/or feels warm to the touch, please take a temperature rectally with a normal thermometer
If your pet’s temperature is >102.5F, this is considered a fever and if this occurs, your pet needs to be immediately taken to a veterinarian, and likely needs to be hospitalized for treatment. You can bring your pet to PETS ER for evaluation.

You can download this information HERE.

Answer

Oncology hours: Tuesday through Fridays, 8am to 6pm. PETS general phone number: 510-548-6684 Email: oncology@petsreferralcenter.com * The email is monitored during business hours, please call if your question is urgent or your pet is sick! * PETS Emergency Service is open 24-7, in the case of an emergency (no appointments needed)

Answer

Appointments:

Answer

Medications:

Answer

The risks to a person handling their pet who is receiving chemotherapy are generally very low and we do not recommend changing your pet’s lifestyle as a result of the chemotherapy treatments. Pets can still sleep in bed with you and do not need separated from other household pets or children. Chemotherapy drugs are meant to destroy cancer cells, but they are capable of harming healthy cells in the process. If healthy humans are repeatedly exposed to chemotherapy drugs or their breakdown products over a long period of time, severe health problems can result. For this reason, some general precautions are recommended. Most chemotherapy drugs are eliminated from the body through the urine and feces. Drug elimination occurs for a period of time (usually a few days) following each chemotherapy treatment. In order to protect yourself and your loved ones, we recommend that you handle your pets bodily fluids with care for 3 days following each chemotherapy treatment. General Recommendations:

Question 3

Oncology Hours and Contact

Question 4

Appointment and Recheck Exam Scheduling

Please schedule by calling PETS or making your appointment in person when at PETS (recommended). We will not take appointments via email.

Recheck for exam +/- blood/urine tests +/- chest x-rays (30 min scheduled slot):

After filling out a purple sheet about how your pet is feeling, we will bring your pet to the treatment room for an exam and to collect blood/urine, if needed. Dr. Shaffer will talk with you after the exam.

Rechecks IF your pet requires an ultrasound: Drop-off by 1-1:30pm

Radiologists travel to PETS each afternoon (typically ~2-5pm) to perform ultrasounds - we will not be able to tell you the exact time the ultrasound will be performed. We will call when your pet is ready for pick-up (often around 5-6pm) and Dr. Shaffer will talk with you at discharge or over the phone.

Chemotherapy: 30-45 min slot OR drop-off and half-day stay:

For drop off appointments, your pet will stay at PETS for ~4-5 hours for exam, blood tests, and treatment.
If you need to speak to Dr. Shaffer PRIOR to your pet receiving chemotherapy, please make sure to alert the staff and we will do our best to accommodate this request. Dr. Shaffer will either call during the day to talk about your pet, or speak with you in person when you pick up your pet.

Question 5

Medications and Refills

Some medications are from PETS and some are prescribed from outside compounding pharmacies.

Refills:

Please request a refill 7-10 days PRIOR to running out of the medication
If you need a refill, please call PETS Oncology during business hours. Please do not email medication refill requests. If you call outside of PETS Oncology hours, the ER service may not be able to provide you a refill.
For compounding pharmacies, you can request a refill from them directly, and they will alert PETS Oncology for approval.

REQUEST A MEDICATION REFILL HERE.

Question 6

Chemotherapy Safety Information

If you are administering chemotherapy to your pet at home, wear protective gloves when handling the chemotherapy

Use latex or nitrile gloves and dispose of used gloves immediately. Follow with careful hand washing.

Wear protective gloves to clean up urine or feces or when handling soiled bedding or toys

Urinary and fecal accidents may be safely cleaned up using a household bleach solution (1 part bleach to 10 parts water) while wearing protective gloves
Any soiled bedding or toys should be washed separately

The amount of chemotherapy that is eliminated in saliva is very low – no special precautions need to be taken to prevent dogs from licking people or other animals

*Pregnant or nursing women and people who are immune suppressed should not handle chemotherapy and excretions from pets receiving chemotherapy DOGS:

You may also want to consider walking your pet in an area away from other animals during the 3 days following chemotherapy treatment.

CATS:

It is likely safe for cats to use the same litter box as healthy housemate cats. Wear gloves when cleaning out the litter box for the first 3 days after chemotherapy administration.

You can dowload this information HERE.