What Side Effects Do Pets Feel with Chemotherapy: VLOG 93

– We are told by our veterinarian that chemotherapy is
recommended for our pets, all these thoughts start
racing through our head because like I said, most of us have had a
family member or a friend or an acquaintance gone
through chemotherapy or we’ve seen something on TV, so we have so many myths
and misconceptions, and it’s not your fault. It’s just I want to, you know, erase those myths and misconceptions and give you facts and hope about pets going through chemotherapy. (upbeat music) Today we are talking about
chemotherapy side effects and I’m doing this Vlog because you guys have done what I asked you to do. You have commented, and I’m
a little bit embarrassed. Can you believe we’re at Vlog number 93 and I haven’t done a Vlog dedicated to chemotherapy side-effects. I do have lots of other videos
in the chemotherapy playlist where I address chemotherapy side effects, but I don’t have one that
is completely dedicated, so that’s what this one’s gonna be. We’re gonna talk about
five things that I think that you need to know about
chemotherapy side effects. Gonna answer the side effects
that you’re worried about and the ones that you really
don’t need to worry about in dogs and cats. So let’s do it, let’s break it down, let’s talk about chemotherapy
side effects in dogs and cats. So most of us have, unfortunately, probably known a human that
has gone through chemotherapy, and you may have heard me say this before, but you may not have, and I
think it’s worth repeating. Chemotherapy in dogs and cats
is not chemotherapy in people. Luckily, dogs and cats
tolerate chemotherapy so much better than people. So maybe if you had another pet that was treated for
lymphoma 10 or 15 years ago, just realized the experience
may not be the same, ’cause every pet is an individual. We have a much more preventative approach. So again I always encourage you to see a cancer specialist if possible. You will have the link on
how to see a specialist, you know, and I think
it’s really important to take that opportunity
and just remember, just because you see a
specialist is not signing you up to see chemotherapy. Just get the information and
make an educated decision. Now I wanna go through five
things that I want you know about chemotherapy in dogs and cats. Number one, which I already
mentioned in the intro, is dogs and cats tolerate chemotherapy so much better than people. So it’s estimated that
about 80% of dogs and cats won’t have side effects
going through chemotherapy. That’s amazing. It is much lower than
what we see in people, and if they do have side effects, they tend to be mild to
moderate, and self-limiting. What do I mean by that? So mild to moderate means
they’re not that bad, and self-limiting means if we
don’t do anything about it, they’re gonna get better on their own, but that doesn’t mean I
don’t want us to do anything. So I as a cancer specialist am going to prescribe medications at that first chemotherapy appointment, and so I do you have another
Vlog of the top medications that I want you to go home
with, and so, you know, I send all of my chemotherapy
patients home with these on first appointment so
that’s Vlog number 38, are the my top five medications. So there’s a goody bag that
all of my patients go home with and you can watch that video, but everybody goes home
with a nausea medication, a diarrhea medication, a probiotic, and now there’s two appetite stimulants that have come on to the market
in the last couple of years Entyce for dogs and Mirataz for cats. So those are like the goodie bag that you’re gonna to go home
with automatically on day one, so we take a very preventive approach, so even though they’re gonna
to get better on their own, we want to send you home with medications so you have them on hand, because we wanna help our pets
get over those side effects if they have it. So chemotherapy is very well tolerated. The risk of hospitalization
is extremely low in dogs and cats. It’s estimated that about 5%
of dogs will get hospitalized from chemotherapy-related side effects, whether that’s severe
vomiting or diarrhea, again, we’re gonna talk
about those side effects, or severe low white blood cell count, which leads to an infection
which is called sepsis. So it’s not half of the patients
that were getting chemo, less than 5%, even lower in cats. Cats tolerate chemo better than dogs. What I usually encourage pet owners that are thinking about
giving chemotherapy is, let me give her a dose or two, and so many owners are so surprised how well their pets are
doing on chemotherapy, they keep coming back
because they’re so surprised. So you know, if you can
watch my other videos, you can see we still have
dogs that still go on hikes, still do agility, you know,
still lead a very normal life as they’re going through chemo. Every day is not going to be perfect. You may have to cook some days
for them and encourage them, and you may have to medicate them with the medications that I talked about, but owners look back and tell me time after, time after time, “Thank you so much, Dr. Sue. I feel like the time that I
got was such quality time, and I got so much more time,” and that’s what helps
me help you to think, you know, to recommend, think about. Again, it is so well tolerated
in the majority of pets, and the other thing is,
it’s not a contract. You can always stop giving chemotherapy if you change your mind. Just because you give one
or two doses of chemotherapy does not mean that you sign
up for the entire protocol. You can stop if you change your mind or if your pet is in that
small percentage of pets that’s not tolerating. The other thing with that is
if they are having side effects we can adjust chemotherapy, lower dose, use more preventative medication, so we can tweak things and adjust things, and that’s really one of the advantages of working with a specialist or someone who gives
a lot of chemotherapy. We have a lot of experience
with these medications, of the side effects, and things like that, so again, chemotherapy can
be very well tolerated, but you know, just this week, I was dealing with Daisy who
didn’t like one of the drugs that, you know, Vincristine, so I’ve had to lower the dose and add not only Cerenia, but Entyce, and now she’s having
much less side effects. There are things that we can
do to adjust the chemotherapy, but again, the majority of dogs and cats, chemotherapy is extremely well tolerated. So we’re talking about
the top things about, the top side effects of chemotherapy, so for two, three, and four, I wanna talk about the main
chemotherapy side effects, but before I can do that, I kinda have to go through
chemotherapy works, because if we understand
how chemotherapy works, we can understand why we see
the side effects that we see. So the goal of chemotherapy is to kill the rapidly
dividing cancer cells. That makes sense, right? These are cancer cells that
are dividing uncontrollably and rather quickly. There are certain cells in
our body which turn over and divide more quickly, and those are what I call
the innocent bystanders, and those are the ones that
get damaged from chemotherapy and those are the ones that
we tend to see side effects. So the three main cells that divide pretty quickly in the body are the hair follicle,
and that’s why people will lose their hair as they’re
going through chemotherapy, the gastrointestinal tract cells, these crypt cells which are
certain cells in the GI tract and some of the cells in the bone marrow, because they have high turn over. And the ones that have
the quickest turn over are the white blood cells. These ones called the neutrophils, which are the infection fighting cells. So those are the ones that
are damaged from chemotherapy. So that makes sense, when we
think about the side effects of chemotherapy. People and certain dog breads have continuously growing hair and that’s why they lose their hair. Luckily, most dogs do not lose their hair, because they don’t have a
continuously growing hair coat. That’s why most dogs
going through chemotherapy look as normal as ever. There are some breeds
that your veterinarian or your oncologist can go through. The top breeds that I think about are, some of the terrier breeds, like Westies, poodles, Scottish terriers,
old English sheep dogs, some of those breeds, Havanese. Their hair coat will thin out
they will have some patchy areas of baldness as their
going through chemotherapy, but, their hair coat will grow back. If your dog is part poodle,
like a golden doodle, they are likely to thin
out pretty decently as their going through chemotherapy. Kitty cats, they do not lose their hair, they can lose their whiskers and again they will grow back, or their whiskers can thin out. Some cats that are on chronic chemotherapy get a really soft, we call it chemo coat, just super, super soft. So that was number two, was hair. Again, rapidly dividing cells. Number three, is Gastrointestinal cells and that is one of the reasons that we see GI or gastrointestinal signs. Which can manifest as vomiting,
diarrhea, loss of appetite and then can lead to weight loss. Chemotherapy can also
cause nausea and vomiting through the brain as well,
because it can hit some of the receptors in the brain as well. But again kill rapidly
diving gastrointestinal cells or one of the reason that
we can see these GI signs. When do we see GI signs
after chemotherapy? Usually, if its from damage
to the gastrointestinal cells about one to five days after chemotherapy and in general, it will last
about three to five days. Because that’s how long it takes the body to replenish those cells. So again, now that we
understand how chemo works, we’re understanding why we
see the signs that we see. So we talked about hair,
we talked about GI, and then the third set of cells, I told you are those white blood cells, those neutrophils, so it’s
infection fighting cells, that we make in the bone marrow. Most chemotherapy drugs, if we’re going to damage those cells it’s usually day seven after the chemotherapy. So that is why my chemotherapy
patients are often told you’re gonna come back seven
days after chemotherapy so I can check the white blood cell to see if the neutrophils count go low. If it’s a drug that is very likely to cause a low white blood cell count, ’cause it’s a strong drug, what we call highly myelosuppression. I may put them on preventative antibiotics while I’m checking that
first white blood cell count after chemotherapy. And then have them come back when I expect that low white blood cell count. Which is called a nadir, N-A-D-I-R. So that’s what the nadir appointment is when we’re checking for that
low white blood cell count, we also want to make sure the
patient doesn’t have a fever. Because again, if they get a
very low white blood cell count and they have a fever,
that’s actually an oncologic, a cancer emergency, because
they could be getting septic. And that would be those 5% or patients that need to get hospitalized
for a couple of days of supportive care with
IV fluids and antibiotics. Remember it’s really, really uncommon but that doesn’t mean if it doesn’t happen we don’t need to hope on
it and get them admitted, because that can be life threatening. So, uncommon, but there
are some real side effects of chemotherapy so I
don’t want to make is all you know, oh there’s
nothing to worry about. Because even though chemotherapy
is very well tolerated, you know about once a
year maybe twice a year, I do have some chemotherapy patients that get very low white blood cells counts and need to be hospitalized, or severely, you know, they’re vomiting five to seven times a day
or two after chemotherapy. And the owners can’t get
any of those oral nausea, vomiting medications in at home. So they do need to come to the hospital, because they’re getting so dehydrated, we’re going to admit them to the hospital, get an intravenous catheter into them, replenish their fluids intravenously, get them injectable nausea medications and they’re usually home
within a day or two. So we can correct these abnormalities with aggressive fluid
therapy and hospitalizations. Most of the time when your dog or cat has a low white blood cell count they’re usually feeling well, it’s just we want to makes
sure they’re not getting in that low range where they might need, if they haven’t been
prescribed antibiotics, because sometimes it
happens after we’re done. We’re not expecting for them to get low, so if they come in and
they have a very low white blood cell count,
we may need to delay their next chemotherapy treatment and we may need to put
them on antibiotics. And so that’s probably a good
time for me to remind you that, you know chemotherapy,
one of the annoying parts, I’ll be honest, you know,
for me the cancer specialist whose trying to trying to
direct treatments for the family and the family going through is, there’s a little bit of uncertainty. Like sometimes, oh, we
went in for treatment and got delayed or we needed antibiotics. So it goes back to, you need
to be a little bit flexible with your budgets, make sure
you have some room in there for extra antibiotics,
extra nausea medications and things like that. And there are maybe times and the white blood cell count was low. So maybe the oncologist
had to rearrange the order or told you we needed to wait a week ’till the white blood cell count rebounded. And that’s another good question that I often get is, well what can I do when my dog or cat’s
white blood cell count is low to get it back up. In general we don’t give
a routine medication to get the white blood cell count back up. The body is really good at sensing that the white blood cell count is low and it releases a natural
substance in the body and that’s going to
stimulate the neutrophil, the white blood cell count to rebound. And usually, most cats and
dogs will rebound on their own within a couple of days. So it’s very rare that
we’ll use this product called Neupogen, which is a human product, to stimulate the white blood cell count. The only time that I really
use that product is… Or that medication, is
a dog, it’s usually dogs that are in the hospital,
their white blood cell counts are really, really low and
they’ve been in the hospital for like, 48 hours and we
haven’t seen any improvement with the dogs neutrophil
white blood cell count on their own. That’s when we’re going to use Neupogen. But if you go in and the
white blood cell count, the neutrophils count,
was too low for chemo, you may get some antibiotics, even if it’s mildly low, you
may not need antibiotics, you may just need a day or two, or they may tell you to
come back in five days, depending on, you know, the
scheduling and things like that. But you may or may not get antibiotics, you may just be told that
we’re going to delay treatment. It really depends on the cancer, you know, Osteosarcomas
gonna be different, what I may recommend then Lymphoma and where you are in your pets protocol. But again most of the time,
we can’t give chemotherapy if the white blood cell counts low so we’re usually gonna delay it. The fifth thing that I
want you to think about, when I think about
chemotherapy side effects again, is that very preventative approach. And over the years, so
I’ve been an oncologist, you know, going on twenty years now, you know, even I have modified
the way that I do things and a preventative
approach is so important. So again on that first
day of chemotherapy, everybody’s going home
with their goody bags of a nausea medications, so
currently I’m using Cerenia, a diarrhea medication,
Metronidazole, a probiotic. I have a whole separate Vlog on probiotics and why I think they’re so important and we’ll put that link in there as well. Couple months ago I just
went to that whole symposium in Canada on probiotics. So again, nausea, vomiting medication, diarrhea medication, probiotic and then an appetite stimulant, Entyce for dogs and
Mirataz for kitty cats. So you know, you want
to go home with those and then there are additional medications, you know, if your pet is
still having diarrhea, we can use products like Rx
Clay and things like that. So again we just want to take
a very preventative approach. I often give injectable nausea medication with many of the chemotherapy drugs, part of that preventative approach may be preventative antibiotics for
these chemotherapy drugs, that are highly likely to cause a low white blood cell count. I may use a preventative antibiotic. So not after all chemotherapy drugs and I know you’re thinking, which ones? So let me give you an
example, Doxorubicin, really common drug, it’s in
the Lymphoma chemotherapy protocol, can be used
as a single agent drug for Lymphoma, it’s given to
dogs with a Angiosarcoma, just a really common drug for cats. We often use it for mammary cancers also in the Lymphoma protocol as well. So what we know is that it is a drug that’s likely to cause nausea and vomiting and likely, highly likely, to cause a low white blood cell count. So we take a very preventative approach, what do we do, I give Cerenia injectable with chemotherapy, before the chemotherapy and that’s going to
last for about 24 hours. For dogs I instruct the pet owners, starting the day after,
so say we gave it today, starting tomorrow you’re
gonna give oral Cerenia, a vomiting a nausea medication for at least four to five days. Even if they’re eating like a champ and then we are also
going to do a course of preventative antibiotics,
we know that most dogs likely get low on day seven. So we’re going to make
sure they’re on antibiotics for a window around that time and I’m going to see them
or they’re going to go back to their veterinarian on day seven, so a week after chemo to check
CBC, a complete blood count which allows us to check
their white blood cell count. The neutrophils count, that’s
what we’re interested in. We’re also going to check,
see how they’re doing, are they eating okay,
how did they handle chemo and make sure they don’t have a fever. Cats, again, they tolerate
chemo, so usually we just… I give the injectable Cerenia,
but I don’t actually have the owners give the oral Cerenia at home, because cats tolerate chemo better. The way that I think about chemotherapy in dogs and cats is a way we
think about pain and surgery in dogs and cats and people too, right? So we know it’s better to prevent pain than to wait for it to happen and treat. And I can tell you with my two c-sections and one of them we took
a preventative approach and it was way better than the one where they let the pain build up and then tried to deal with it. So preventative approach is way better, so we want to prevent
nausea, prevent inappetence, prevent vomiting. So if it’s a drug that is highly likely to cause that, we are going to take a preventative approach. What if your pet had a bad reaction to, so this drug called Cyclophosphamide, most dogs have very
little GI side effects. Recently I had a pet
that didn’t want to eat for a few days after, so what do we do? We’re gonna add Cerenia, we’re going to add appetite stimulants. So that’s why we have to
adjust for each patient. So I didn’t automatically do Cerenia, but for that patient, after I
knew that they didn’t like it, I said this time we’re
automatically gonna do Cerenia. So they’re just you know, that was Arly. Sometimes you have to adjust things for the individual patient, so make sure you tell your
cancer specialist, you know what, they didn’t eat after
Cyclophosphamide for a couple of days. We have to adjust things for
the individual and we can. So again, it’s your job,
your job as the pet parent to tell me, the cancer
specialist or your veterinarian how did they respond to it,
because we can adjust things. So speak up, tell us how they’re doing, because just know that we
can typically adjust things, lower the dose, use more
preventative medication, because I want your cancer experience, your pets chemotherapy experience to be the best possible
because that’s my job. Alright, so we talked about five things that I wanted you know know
about chemotherapy side effects. One, chemotherapy is well tolerated. Two, three and four, were
the three main categories of side effects. Hair loss, which is really
not a big deal in the majority of pets and guys remember
if it does happen, your dog doesn’t care. Like if I lost my hair from chemotherapy, huge psychological impact, but if your dog is one of those breeds
it’s not going to effect their quality of life. The two that are more likely
to effect their quality of life are GI side effects, so vomiting,
diarrhea, loss of appetite and we talked about the fourth one, which is predominantly the
low white blood cell count. I do want to point out that
for the Gi side effects, I do have a good number of Vlogs that are related, that I think
are really, really important. If your pet is not eating we
have Vlog number 68 and 69 which are the secrets
to get your pet to eat. Some of these have to
do with the medications that I talked about and
some of these are just tips of things that you can do
that are in your kitchen. You know, heating food,
trying different plates and things like that. So if your pet is not eating
related to chemotherapy I would encourage you
definitely to check out Vlogs number 68 and 69. And another thing, I’ve been talking about how to give all these
pills and medications but you may not know how to give a pill, because a lot of times
I think pet owners rely on putting it on their food
or putting it in a treat, but if they’re not eating,
how do we give a pill. So you definitely want to
check out the video after that which is Vlog number 70, of
course I will put links below. And then the fifth thing
that we talked about, was that we want to take
a preventative approach. And so want to make sure you
go home with your goodie bag of medications at that first visit. Because if your pet is not
eating at 9 o’ clock at night or at 5 a.m. you want to have that. You don’t want to run out
to an emergency clinic, you want to have that,
because side effects seem to always happen after
hours and on the weekends. So I really want you to
have all of the medications that you need. I also have a chemotherapy handout and you don’t have to
come see me to have that. It is on my website and
we will put a link below, this is a recently
updated information sheet on what to do, you know, all about chemotherapy side effects. Talks about the things that
we talked about in this video in addition to home
safety with chemotherapy. And that is the last video
that I want to point out. So the tops things that you need to know about chemo therapy safety in you home which is Vlog number 66. So guys, why do I have all
these videos about chemotherapy? Because I know that it’s scary and I want you to have as
much information as possible. I also want you to realize,
I didn’t cover every chemotherapy related side effect. There are going to be some
other chemotherapy drugs that have unique side effects. For example, Cyclophosphamide
is a drug that we give for Lymphoma in dogs, not kitty cats, can cause bladder irritation. So we give Furosemide, which is lasix to promote urination and we talk about, giving it in the morning,
the drug in the morning and making sure your dog
as ample access to water for about three days and extra walks so the breakdown product doesn’t sit up against the bladder
wall and cause irritation. We don’t see that kitty cats, so we don’t have to worry about it. Doxorubicin, the drug that
I was mentioning earlier, can cause cardiotoxicity
with six or more dosages. So most oncologists will
cap out at six doses and that’s life time,
so again for Lymphoma, which I keep going back to, they get four Doxorubicins
in the first protocol. If they relapse and they go back to the chop multi-agent chemotherapy, they can only get two more and then we need swap in another drug. So again your cancer
specialist will go over these, you know, different side effects with you, but I wanted to really hit the main ones. Which was, GI, low white blood
cell count and hair loss, because those are really
the main side effects and we talked about why we see them. That’s it guys, I really hope
that you found this helpful. Again, I can’t believe that
we got to Vlog number 93 and without me having a
full video on chemotherapy side effects, this is
a super important one. I think it’s really important to have everything in one spot. And guys, it was you who reminded me that this wasn’t all in one spot. So comment below, tell me
what else you want to see, because it really helps, I’m listening, I read all those comments and I really appreciate it. Please don’t forget to subscribe and I’ll see you at the next video. (upbeat music)

One thought on “What Side Effects Do Pets Feel with Chemotherapy: VLOG 93

Leave a Reply

Your email address will not be published. Required fields are marked *