Frequently Asked Questions

We know you have questions. We also know that some questions can't wait to be answered or would serve you better if answered prior to your appointment with us. In this section, we have attempted to answer the most common questions asked by clients.

Let your pet decide their activity level. Every pet is going to be different, but the majority of our patients have no appreciable change in activity level the day of chemotherapy.

If you think it’s a cancer related emergency, call ER phone. If anything else, call RDVM. If there is ever a question about which to call, don’t hesitate to call us.

Depending on the pet, the cancer and the chemo there are safer times than others. Please check with the doctor.

 

Other pets can be around the chemo patient with no risk, but obviously should not be allowed to lick urine or ingest stool of the patients, though they would need to ingest a lot of it for it to be a problem. Most metabolized chemotherapy is out of the patients system in 72 hours. If you have concerns about this please speak to your oncologist.

 

Pet insurance is a financial arrangement between owner and pet insurance company. Clients pay the bill and get reimbursed from the insurance company. We can help fill out any necessary paperwork and get pertinent records to the insurance company to assist you.

Your pet speaks to you in nonverbal ways every day. You know your pet better than anyone else. If there is any reason for you to think that they are acting differently, let us know. Some signs of pain are panting, not eating, seeming uncomfortable when they walk/move, not wanting to move, crying, whining, and restlessness.

Treatments should be as close to schedule as possible. A one or two day schedule variation is usually all right, but we prefer to stay on schedule. Depending on the protocol, your pet is receiving and where in the protocol your pet currently is, timing of treatments can be extremely important. We understand issues will arise such as vacations or scheduling conflicts, our staff will work with you to insure your pet gets the best care possible.

Why is this important?

The timing of chemotherapy administration is designed to maximize treatment effectiveness and minimize the toxicity. By giving chemotherapy too early, you can increase the likelihood and/or severity of toxicity; by giving chemotherapy too late, you can decrease the effectiveness.

How is the schedule/timing of treatments determined?

Most protocols are based on years of study and altered based upon our years of experience with the specific drugs in the drugs in the protocol.

What should I do if I cannot make my appointment within 3-4 days?

Please call one of our staff members to let them know as soon as possible. We may be able to make arrangements that enable your pet to stay on schedule. Alternatively, we will reschedule your appointment to keep your pet as close to schedule as possible.

When is it too late?

It is never too late to reschedule your appointment.

Where else can I go?

If you are traveling and cannot make your appointment, please let us know and we will try to find a veterinary oncologist as near to where you are traveling as possible.

Some medications need to be given before or after others. In addition, some drugs are never given with other drugs. In most cases, it is fine to give all the prescribed medications together. If certain medications need to be given at certain times, we will alert you and write it on the label of the prescribed medication.

Why is this important?

Some medications can interact with each other making them either more or less effective.

 

How do I remember when to give what drug?

It is best to write down what drug you are giving and what time you are giving it—the calendar we provide you with serves this purpose well. Weekly pill containers sold at most drug stores can also help.

What should I do if I give the wrong drug at the wrong time?

Please call us or your local veterinarian for advice. In most cases, we will have you re-start the correct medication at the correct time the following day.

When will my pet begin to show signs from a drug interaction?

Hopefully, this will never happen, but drug interactions can begin within hours. Again, if your pet is given medications together that were not meant to be given at the same time, please call us immediately.

Where should I take my pet if he/she does show signs?

Please take your pet the closest veterinary facility that is open.

Vaccines need to be discussed with the doctor. There are different recommendations dependent on the type of cancer that your pet has, the type of treatment they are on and the risk factors for exposure that your pet may have.

 

Giving your pet metronidazole is the most effective for diarrhea but there are other options that may work. You can try mixing some canned pumpkin with your dog’s food. Plain Metamucil (1/2 of the human dose by weight- a 50lb dog would get about  1 teaspoon and small dog ½ teaspoon). If the diarrhea persists you should call our office and speak with a doctor.

First, you should alert your physician that your pet is currently on chemotherapy. Second, if possible, have another member of your household clean up any pet related waste products—urine, stool or vomit. If you must handle these waste products, use gloves, pet waste bags, or wash your hands thoroughly. 

Why is this important?

It is possible that toxins the mother is exposed to during pregnancy can adversely affect the developing baby. By knowing what precautions to take, you and your child’s safety are protected.

How will exposure affect my unborn child?

New research has found that children born to mothers treated with chemotherapy during the last two trimesters of pregnancy appear to be normal, completely unaffected by the experience. It is always better to be safe and minimize any exposure to chemotherapy, especially during the first trimester of pregnancy.

What are the risks if I have to clean up after my pet if I am alone?

With the appropriate precautions—gloves, pet waste bags, thorough hand washing, and the proper disposal of contaminated materials—the risks are minimal.

When is it alright for me to clean up after my pet?

If it is possible to have someone else clean up the waste for the first 48-72 hours after each treatment, you can minimize your exposure. In addition, if you do not directly handle the medications, you will minimize the exposure to yourself and your child.

Where should I dispose of the waste from my pet?

Feces or flushable litter may be flushed down the toilet or put in a plastic bag and disposed of in the garbage. If your pet urinates or defecates in your yard, hosing the area down on a regular basis is advisable. If your pet’s bedding becomes contaminated with waste—feces, urine or vomit—it should be washed in the laundry separately.

If your dog is on prednisone, as many cancer patients are at some point during treatment, this could be causing urinary accidents in the house as the medication makes them more thirsty than usual. If your pet is not on prednisone, please check with your oncologist as there are several causes for an increase in urination.

Our first recommendation would be to check a rectal temperature to rule out a fever which could indicate that medical attention is needed. You can go to your local drug store and purchase a rectal thermometer and take your pets temperature. Designate this thermometer for your pets use only – use a small amount of Vaseline on the end of the probe and insert about an inch into the rectum. A normal temperature for dogs and cats is 100-102.5°F. If you pets temperature is elevated, we will likely ask you to bring your pet in for evaluation either with us or your local veterinarian. You can also look at the color of your pets gums you want them to be pink – if the gums appear pale or white we will likely recommend immediate evaluation. Some pets just take a few days to get back to normal after treatments so this may be normal for them. Always call if you are concerned.

 

Depending on the type of chemotherapy given, it is possible that in the first 48-72 hours after treatment, your pet might excrete some of the metabolized drug in their waste (urine, feces, vomit). 

Why is this important?

Knowing when your pet’s urine, stool or vomitus is free of chemotherapy metabolites is important for your safety. We always try to keep you and your pets safety forefront in our recommendations.

How should I clean up after my pet?

It is a good idea to use gloves whenever cleaning up after your pet. You should limit your exposure to your pets urine and fecal matter and vomitus if your pet vomits. If you must handle these waste products, use gloves, pet waste bags, or wash your hands thoroughly.

What should I use if I need to disinfect?

To disinfect in the house, use 1 part bleach to 10 parts water with a disposable cloth/towel.

When is it ok to let my pet go the bathroom when outside?

For the first 72 hours after you pet receives any chemotherapy, it may be good idea to try to have your pet urinate/defecate away from areas where children may play.

Where can I get gloves?

Gloves can be purchased at any local drug store, pharmacy or surgical/hospital supply store. If you cannot find the appropriate gloves, please contact our office for assistance.

Dogs will very quickly learn that sometimes if they decline their regular food that you may give them some people food – cold cuts, chicken and rice, etc. If they get used to this it may be difficult to get them back to a dog-food exclusive diet.

Cats may get very finicky with what they will and will not eat, and can develop aversions if, for example, they are given medications with a particular food.

Our goal needs to be to keep your pet eating as close to a normal, balanced diet as possible. We can provide contact information for a nutritionist if there are questions.

Cyclophosphamide (Cytoxan) can cause irritation to the bladder wall, resulting in bloody urine. If you notice this, please contact our office as soon as possible.

Why is this important? Cyclophosphamide can cause a chemical irritation to the bladder that can cause the urine to become bloody (hemorrhagic cystitis) and the bladder to be painful. However, there are a number of causes for blood to be present in urine, such as the possibility of infection -- Therefore, if you notice blood in your pets’ urine we urge you to contact our office as soon as possible, so that one of our oncologists may better assess the situation.

What can be done to prevent this? The risk of developing cyclophosphamide-induced cystitis (bloody urine) can be reduced by giving cyclophosphamide in combination with prednisone or with a diuretic (i.e. Furosemide/Lasix), which may cause your pet to drink and/or urinate more often. As you will be informed both during and after your visit; it’s very important to offer plenty of drinking water and allow for more frequent urination. This will allow for the drug to be appropriately expelled from the bladder, hopefully preventing any such complications.

How can we fix this problem? If Cyclophosphamide is determined to be the cause of the bloody urine, treatment with this drug may be stopped and another drug may be used in its place. As previously stated, if you see blood in your pets’ urine we urge you to call our office as soon as possible so that any such decisions to alter treatment may be made by one of our oncologists.

When would I see these effects? Adverse reactions to chemotherapy normally do not occur directly after treatment. Side effects such as bloody urine may appear 2-3 days after treatment; however every patient will have an individualized response to chemotherapy.

Do not give the next dose of Palladia and contact our office for advice.

 

Red blood (called frank blood) on stool is not necessarily alarming – this can be caused by stress or straining.  Black tarry stool (called melena) means bleeding from stomach or high up in intestines. If you are concerned about the amount of red blood in the stool, please call. If you are noticing black tarry stool we will likely recommend immediate evaluation to identify the cause. If your pet is actively bleeding from the rectum, please contact an emergency center if we are unreachable.

There can be many causes for blood in the urine. If you notice this, please contact our office.

If your pet vomits after receiving medication, please check to see if the medication is in the vomitus and note how long after the medication was given the vomiting occurred. Please call our office for recommendations. Please do not just administer another dose.

Why is this important?
It is important to know how long after receiving a medication or what medication it is that was so we may better assist you into taking the next best step.

How do I know if they got any of their medication into their system?
If you are unable to find the pill or capsule within the vomitus, it would probably be safe to assume that the pill remained within the pet. Please call our office if you have any questions in regards to this.

What should I do if this happens?
If your pet happens to vomit after getting an oral medication we have no way of determining how much of that drug was absorbed during that period of time so it is best to consult with the prescribing veterinarian.

Misoprostol is used to protect the stomach when piroxicam is given (piroxicam is an NSAID – non-steroidal anti-inflammatory drug).

Why is this important?
Piroxicam can cause ulcers in the stomach if misoprostol is not given. You should start it when you get the piroxicam. Women who are or may become pregnant should not handle misoprostal without gloves.

How do I administer it?
Misoprostol is a pill that should be taken with food to decrease any possible side effects. Diarrhea is a possible, but very uncommon side effect. As with any medication take misoprostol exactly as directed by your doctor.

What happens if I forget to give it or miss a day?
If you miss a dose never double the dosage the following day; just restart the medication as it was prescribed by your doctor. Always consult your doctor if you have any questions or concerns.

When should I start the misoprostol?
Our doctors will prescribe misoprostol when piroxicam is used to help prevent gastrointestinal ulcers and kidney damage. You should start the misoprostol and the piroxicam together.

Where should I store the misoprostol?
Misoprostol can be stored at room temperature out of the reach of children, like all medications.

Side effects of chemo can be seen (depending on chemo) anytime from immediately after treatment to more than 1 week. Most commonly we see nausea, diarrhea, loss of appetite and loss of energy. Every animal reacts differently to the chemotherapy they are receiving. Be observant of your pet starting immediately. If side effects do occur, please let us know so that we can offer supportive care and hopefully prevent future occurrences.

For most patients, as long as they start antibiotics within 24 hours of getting the chemotherapy, it should not make a difference.

Why is this important?
Chemotherapy kills the rapidly dividing cells in the body. There are 3 groups of rapidly dividing cells in the body--the cancer cells, the bone marrow cells and the cells lining the gastrointestinal tract. When chemotherapy kills some of the bone marrow cells, they tend to kill the cells that make white blood cells (WBC). These WBCs are the cells that protect pets from infection. If the WBC count gets too low, infections can occur. We therefore recommend antibiotics to try and prevent infections from taking hold and therefore preventing your pet from feeling ill due to the low WBC/infection.

How do doctors check for low WBC counts?
A simple blood test, either run in the hospital or sent to a lab is a complete blood count (CBC). This blood test indicates the number of red blood cells, white blood cells and platelets that your pet has. These tests are very routine and are run before each and every time your pet receives chemotherapy.

What are the signs of infection?
The most common signs of infection are fever (high temperature--in dogs and cats the normal temperature is 100-102.5). The other common signs are lethargy (loss of activity level), anorexia (loss of appetite) and sometimes diarrhea and nausea.

When will my pets WBC count drop?
This low WBC counts may occur anytime from 1 to 14 days after chemotherapy, depending on the drug.

Where should I go if my pet shows greater than mild signs of infection?
If your pet is showing any of the above signs and they seem more than just mild to you, please contact The VCC, your local veterinarian or the closest 24 hour emergency center.

Some chemotherapy protocols will ask that the owner administer oral chemotherapy at home. It is important to wear gloves when handling these medications-as these medications are prescribed for your pet, not you—so we want to minimize your exposure. If you do not have gloves The VCC will provide them for you.

Why is this important?
It is best to act conservatively when handling chemotherapeutic medications. Although the possibility of having a serious reaction is rare, these drugs are known to be carcinogenic and mutagenic in humans. Using gloves and disposing of them properly minimizes any unnecessary exposure. Pregnant women and immuno-suppressed people should not handle chemotherapy drugs.

How do administer the chemo pill?
With the exception of wearing the gloves the administration of the chemotherapy pill is the same as any other oral medication. If you need assistance the first time one of our technicians will be happy to show you before you leave the office

What happens if I touch the pill without gloves? 
Most if not all of these types of medications are safety coated. Wearing gloves is a precaution to help minimize any possible contamination. Wash your hands if you accidentally touch the pills.

When should I put the gloves on and take them off?
The exterior container of prescription is contamination free. Put your gloves on, open the container, remove the pill and give it to your pet. Once you have completed pilling your pet, take your gloves off by pulling them inside out and then put the cap back on the container.

Where should I dispose of the gloves?
Again, these pills are safety coated and the chance of contamination is very low. The gloves can be disposed of in you every-day garbage. If you are still concerned you may bring them back to us and we will dispose of it for you.

It is common in cancer patients receiving IV treatment to see scarring of the veins due to repeated injections. In order to preserve the integrity of the veins of the legs for chemo injections, blood draws should ideally be pulled from the jugular vein in the neck.

Most non-chemo medications are dosed based on weight in kilograms; also it’s an easier conversion to metered square, which is the unit how most chemotherapy medications are dosed.

This is a question for a doctor; there can be many reasons why weight loss occurs.

Let your pet decide their activity level. Every pet is going to be different, but the majority of our patients have no appreciable change in activity level the day of chemotherapy.

Depending on the pet, the cancer and the chemo there are safer times than others. Please check with the doctor.

 

Other pets can be around the chemo patient with no risk, but obviously should not be allowed to lick urine or ingest stool of the patients, though they would need to ingest a lot of it for it to be a problem. Most metabolized chemotherapy is out of the patients system in 72 hours. If you have concerns about this please speak to your oncologist.

 

Treatments should be as close to schedule as possible. A one or two day schedule variation is usually all right, but we prefer to stay on schedule. Depending on the protocol, your pet is receiving and where in the protocol your pet currently is, timing of treatments can be extremely important.

Why is this important?

The timing of chemotherapy administration is designed to maximize treatment effectiveness and minimize the toxicity. By giving chemotherapy too early, you can increase the likelihood and/or severity of toxicity; by giving chemotherapy too late, you can decrease the effectiveness.

How is the schedule/timing of treatments determined?

Most protocols are based on years of study and altered based upon our years of experience with the specific drugs in the drugs in the protocol.

What should I do if I cannot make my appointment within 7 days?

Please call one of our staff members to let them know as soon as possible. We may be able to make arrangements that enable your pet to stay on schedule. Alternatively, we will reschedule your appointment to keep your pet as close to schedule as possible.

When is it too late?

It is never too late to reschedule your appointment.

Where else can I go?

If you are traveling and cannot make your appointment, please let us know and we will try to find a veterinary oncologist as near to where you are traveling as possible.

The metabolites (by-products) of chemotherapy will stay in the system for different lengths of time depending on what drug has been given. Most chemotherapy drugs are cleared from the body’s systems in 48-72 hours. This does not mean that the effects of that chemo go away in that time period.

Why is this important?

Knowing when your pet’s urine or stool is free of chemotherapy metabolites is important for your safety. We always try to keep you and your pets safety forefront in our recommendations.

How is it still effective after 48-72 hours?

Chemotherapy kills cancer by targeting rapidly dividing cells – and the cancer cells are usually among the fastest growing in the body. The cancer cells may take more than 48-72 hours for them to die.

What are the precautions I need to take while chemotherapy is still in my pets system?

You should limit your exposure to your pets urine and fecal matter and vomitus if your pet vomits. If you must handle these waste products, either use gloves or wash your hands thoroughly.

When is it safe to allow my dog or cat to lick me?

The amount of chemotherapy in animal saliva is extremely low, so it is usually safe. If you have a medical condition, are immunosuppressed, very old or have very young children, please contact your physician for the best medical advice for your particular situation.

Where is chemotherapy excreted?

Most chemotherapy is excreted either in the urine or in the stool and sometimes both. It depends upon the type of chemotherapy drug as well as the method of administration—orally versus intravenously.

If your dog is on prednisone, as many cancer patients are at some point during treatment, this could be causing urinary accidents in the house as the medication makes them more thirsty than usual. If your pet is not on prednisone, please check with your oncologist as there are several causes for an increase in urination.

Depending on the type of chemotherapy given, it is possible that in the first 48-72 hours after treatment, your pet might excrete some of the metabolized drug in their waste (urine, feces, vomit). 

Why is this important?

Knowing when your pet’s urine, stool or vomitus is free of chemotherapy metabolites is important for your safety. We always try to keep you and your pets safety forefront in our recommendations.

How should I clean up after my pet?

It is a good idea to use gloves whenever cleaning up after your pet. You should limit your exposure to your pets urine and fecal matter and vomitus if your pet vomits. If you must handle these waste products, use gloves, pet waste bags, or wash your hands thoroughly.

What should I use if I need to disinfect?

To disinfect in the house, use 1 part bleach to 10 parts water with a disposable cloth/towel.

When is it ok to let my pet go the bathroom when outside?

For the first 72 hours after you pet receives any chemotherapy, it may be good idea to try to have your pet urinate/defecate away from areas where children may play.

Where can I get gloves?

Gloves can be purchased at any local drug store, pharmacy or surgical/hospital supply store. If you cannot find the appropriate gloves, please contact our office for assistance.

Dogs will very quickly learn that sometimes if they decline their regular food that you may give them some people food – cold cuts, chicken and rice, etc. If they get used to this it may be difficult to get them back to a dog-food exclusive diet.

Cats may get very finicky with what they will and will not eat, and can develop aversions if, for example, they are given medications with a particular food.

Our goal needs to be to keep your pet eating as close to a normal, balanced diet as possible. We can provide contact information for a nutritionist if there are questions.

Do not give the next dose of Palladia and contact our office for advice.

 

Yes, both medications should be started the same day the injectable chemotherapy is given.

Why is this important?

The reason that both medications are to be given on the same day is that this particular protocol works best with a combination of chemotherapy agents.

How do you administer the drug?

Both prednisone and procarbazine are to be given orally. We also suggest handling the procabazine with gloves as it is chemotherapy, and we want to minimize exposure to you.

What are the side effects?

Side effects of prednisone are excessive panting, increased appetite, increased thirst, and increased urination (more frequent and larger amounts). The side effects of procarbazine can be loss of appetite, nausea or vomiting, diarrhea and loss of energy level. These side effects are uncommon and if they do occur are typically mild. If you have any questions about side effects, contact your veterinary oncologist.

When should I give these medications; the morning or evening?

Medically it does not matter, but some pets handle these drugs better in the morning and some better in the evening. Whatever you decide to do regarding the time of administration, please try to be consistent.

Where should I store the procarbazine?

Procarbazine can be stored at room temperature and should be out of reach of any children in the household. 

Yes, you can give the Cerenia; remember it is given once daily. If your pet continues to vomit or vomits up the medication, please contact us or your referring veterinarian.  We may suggest he/she come in for an injection to control the vomiting, or in more severe cases, to supplement with some fluids to avoid dehydration.

Although Palladia is not a "chemotherapeutic", similar side effects may be observed. These reactions are usually mild to moderate and temporary. The most common of side effects is associated with gastrointestinal (GI) toxicity, with presenting symptoms such as: diarrhea, bloody diarrhea, loss of appetite, vomiting, and weight loss. Other less commonly reported side effects are temporary lameness (difficulty moving) and lethargy (lack of energy), but these issues will often resolve on their own. If you notice your pet is experiencing any of these side effects, please give our office a call as soon as possible.

Why is this important?

It is important to address these side effects immediately as patients left untreated for gastrointestinal toxicity may develop more serious clinical signs. GI toxicity is relatively simple to treat, as long as symptoms are detected early on. Dependent upon the severity of side effects, the veterinarian might decide to lower the dose of Palladia or to stop treatment. If you notice your pet is experiencing any side effects from Palladia, please give our office a call as soon as possible.

How can these Issues be prevented?

There are a number of commonly used drugs that one of our doctors may prescribe to your pet to be administered at home, treating prophylactically(i.e. Metronidazole and/or Cerenia). In most cases, these side effects can be treated easily with some additional medications or by adjusting the treatment schedule.

If your pet vomits after receiving medication, please check to see if the medication is in the vomitus and note how long after the medication was given the vomiting occurred. Please call our office for recommendations. Please do not just administer another dose.

Why is this important?
It is important to know how long after receiving a medication or what medication it is that was so we may better assist you into taking the next best step.

How do I know if they got any of their medication into their system?
If you are unable to find the pill or capsule within the vomitus, it would probably be safe to assume that the pill remained within the pet. Please call our office if you have any questions in regards to this.

What should I do if this happens?
If your pet happens to vomit after getting an oral medication we have no way of determining how much of that drug was absorbed during that period of time so it is best to consult with the prescribing veterinarian.

Side effects of chemo can be seen (depending on chemo) anytime from immediately after treatment to more than 1 week. Most commonly we see nausea, diarrhea, loss of appetite and loss of energy. Every animal reacts differently to the chemotherapy they are receiving. Be observant of your pet starting immediately. If side effects do occur, please let us know so that we can offer supportive care and hopefully prevent future occurrences.

For most patients, as long as they start antibiotics within 24 hours of getting the chemotherapy, it should not make a difference.

Why is this important?
Chemotherapy kills the rapidly dividing cells in the body. There are 3 groups of rapidly dividing cells in the body--the cancer cells, the bone marrow cells and the cells lining the gastrointestinal tract. When chemotherapy kills some of the bone marrow cells, they tend to kill the cells that make white blood cells (WBC). These WBCs are the cells that protect pets from infection. If the WBC count gets too low, infections can occur. We therefore recommend antibiotics to try and prevent infections from taking hold and therefore preventing your pet from feeling ill due to the low WBC/infection.

How do doctors check for low WBC counts?
A simple blood test, either run in the hospital or sent to a lab is a complete blood count (CBC). This blood test indicates the number of red blood cells, white blood cells and platelets that your pet has. These tests are very routine and are run before each and every time your pet receives chemotherapy.

What are the signs of infection?
The most common signs of infection are fever (high temperature--in dogs and cats the normal temperature is 100-102.5). The other common signs are lethargy (loss of activity level), anorexia (loss of appetite) and sometimes diarrhea and nausea.

When will my pets WBC count drop?
This low WBC counts may occur anytime from 1 to 14 days after chemotherapy, depending on the drug.

Where should I go if my pet shows greater than mild signs of infection?
If your pet is showing any of the above signs and they seem more than just mild to you, please contact The VCC, your local veterinarian or the closest 24 hour emergency center.

When handling chemotherapy drugs, it is best to be as careful as possible so as not to expose yourself or others to these drugs. Splitting a pill or opening a capsule could potentially aerosolize the drug and increase your and your household’s exposure to these medications. The other reason why chemotherapy tablets should not be split is that the active drug is not always evenly distributed throughout the tablet.

Why do I not need to wear gloves when I am taking oral chemotherapy?

If you are prescribed chemotherapy then you and your physician have discussed the risks and benefits of taking and handling these medications. If you are ingesting/swallowing the drug, handling them will not increase your overall exposure.

How should I handle these types of drugs?

Chemotherapy pills/capsules should be handled carefully. Gloves should be worn to minimize any exposure to you. If you cannot or have not worn gloves, it is best to thoroughly wash your hands after touching or handling any chemotherapy pill or capsule, again, in order to minimize your exposure.

What should I do if I have already split a pill or opened a capsule?

Chemotherapy medications require special disposal. Please place them in a container and bring them to your local veterinary oncologist or us for the proper disposal. In addition, the area where the pill or capsule was opened should be cleaned/washed thoroughly to minimize household exposure.

When or if my pet bites the chemotherapy pill or capsule are we both at risk of exposure?

Yes, you both are at risk, but because the medication was prescribed for your pet, we are not worried about your pets exposure—only about yours and your household’s.

Where should I call or go if I am exposed?

Depending on the amount of chemotherapy you were exposed to, you should call your local physician. Thoroughly washing the exposed area with water is one of the quickest ways to decrease your exposure.

Some chemotherapy protocols will ask that the owner administer oral chemotherapy at home. It is important to wear gloves when handling these medications-as these medications are prescribed for your pet, not you—so we want to minimize your exposure. If you do not have gloves The VCC will provide them for you.

Why is this important?
It is best to act conservatively when handling chemotherapeutic medications. Although the possibility of having a serious reaction is rare, these drugs are known to be carcinogenic and mutagenic in humans. Using gloves and disposing of them properly minimizes any unnecessary exposure. Pregnant women and immuno-suppressed people should not handle chemotherapy drugs.

How do administer the chemo pill?
With the exception of wearing the gloves the administration of the chemotherapy pill is the same as any other oral medication. If you need assistance the first time one of our technicians will be happy to show you before you leave the office

What happens if I touch the pill without gloves? 
Most if not all of these types of medications are safety coated. Wearing gloves is a precaution to help minimize any possible contamination. Wash your hands if you accidentally touch the pills.

When should I put the gloves on and take them off?
The exterior container of prescription is contamination free. Put your gloves on, open the container, remove the pill and give it to your pet. Once you have completed pilling your pet, take your gloves off by pulling them inside out and then put the cap back on the container.

Where should I dispose of the gloves?
Again, these pills are safety coated and the chance of contamination is very low. The gloves can be disposed of in you every-day garbage. If you are still concerned you may bring them back to us and we will dispose of it for you.

Most non-chemo medications are dosed based on weight in kilograms; also it’s an easier conversion to metered square, which is the unit how most chemotherapy medications are dosed.

Cats don’t get Lasix-- a diuretic-- with Cytoxan because they are not prone to developing sterile hemorrhagic cystitis (a severe irritation to the bladder wall) that is sometimes seen in dogs.

Why don’t they?

The reason why cats don’t commonly get sterile hemorrhagic cystitis from cyclophosphamide is unknown, but it may have to do with a different way they metabolize the drug or a different way their kidneys excrete it or their bladder’s sensitivity to cyclophosphamide.

How are they different from dogs?

The saying “Cats are not small dogs” is quite accurate. Their metabolism, their dietary requirements, their susceptibility to certain drugs/toxins are different from dogs.

What is furosemide (Lasix)

Lasix is a diuretic, a drug that increases the rate of urine formation.

When does my cat need furosemide (Lasix)?

Lasix is most frequently given for high blood pressure or in certain cases of heart disease.

Where is it administered?

Lasix can be given orally and via injection.

Interestingly, cats very seldom get sick following CeeNu administration, so we opt to not stress them with daily antibiotic administration unless necessary.

Why don’t they get infections following lomustine (CeeNu)?

Despite their white blood count dropping after CeeNU administration, most cats do not feel ill. We believe this is because they don’t get septic (an infection with secondary systemic severe inflammatory response) due to bacteria from the gastrointestinal tract crossing into the blood stream very frequently.

How does giving antibiotics stress my cat?

Any oral medication can cause a cat some stress. Most cats are more difficult than dogs to give oral medication to. In addition, it has been our experience that a higher proportion of dogs will eat Pill Pockets®.

What medications do cats need with CeeNu?

Cats unlike dogs do not need any medications with CeeNU.

When does my cat need antibiotics?

There are various conditions where cats need antibiotics—abscesses, pyothorax (severe infection of the chest cavity), bacterial infections of the mouth, and many others.

Where do I call if I think my cat does have an infection?

If your cat is currently undergoing chemotherapy, please call our office, as we are available 24 hours a day, seven days a week by phone. If your pet is not on chemotherapy, or you think the infection is not related to the cancer or the treatment, please call your local veterinarian.

Blood work is done to monitor the effects of the chemotherapy, not necessarily monitoring the cancer (with a few exceptions such as leukemias). Blood work being normal does not mean that the cancer is gone, only that the treatment is not harming the body.

 

For most patients, as long as they start antibiotics within 24 hours of getting the chemotherapy, it should not make a difference.

Why is this important?
Chemotherapy kills the rapidly dividing cells in the body. There are 3 groups of rapidly dividing cells in the body--the cancer cells, the bone marrow cells and the cells lining the gastrointestinal tract. When chemotherapy kills some of the bone marrow cells, they tend to kill the cells that make white blood cells (WBC). These WBCs are the cells that protect pets from infection. If the WBC count gets too low, infections can occur. We therefore recommend antibiotics to try and prevent infections from taking hold and therefore preventing your pet from feeling ill due to the low WBC/infection.

How do doctors check for low WBC counts?
A simple blood test, either run in the hospital or sent to a lab is a complete blood count (CBC). This blood test indicates the number of red blood cells, white blood cells and platelets that your pet has. These tests are very routine and are run before each and every time your pet receives chemotherapy.

What are the signs of infection?
The most common signs of infection are fever (high temperature--in dogs and cats the normal temperature is 100-102.5). The other common signs are lethargy (loss of activity level), anorexia (loss of appetite) and sometimes diarrhea and nausea.

When will my pets WBC count drop?
This low WBC counts may occur anytime from 1 to 14 days after chemotherapy, depending on the drug.

Where should I go if my pet shows greater than mild signs of infection?
If your pet is showing any of the above signs and they seem more than just mild to you, please contact The VCC, your local veterinarian or the closest 24 hour emergency center.

It is common in cancer patients receiving IV treatment to see scarring of the veins due to repeated injections. In order to preserve the integrity of the veins of the legs for chemo injections, blood draws should ideally be pulled from the jugular vein in the neck.

Benadryl and Pepcid should be given for as long as your doctor instructs. This may be for a week, 6 months, 1 year, or indefinitely. These drugs rarely cause side effects. If you have questions or concerns about this, please discuss it with your oncologist.

Why do I need to give it?

Benadryl (diphenhydramine) and Pepcid (famotidine) are both anti-histamines. They block the action of histamines in the stomach—Pepcid, and systemically—Benadryl. Mast cell tumors have granules in them and these granules contain histamine amongst other chemicals. These medications are given to try to prevent side effects from excessive histamine release from the mast cell tumors.

How is it given?

Both medications are given orally.

What happens if I don't give it?

In most cases, your pet will be fine, but if you forget to give it for an extended period of time, please contact your veterinarian.

When does the drug start to work?

Both of these drugs start working immediately.

Where can I get these medications?

Both of these drugs can be purchased over the counter, meaning you do not need a prescription for them. Your veterinarian will write down the dosage for you and you can purchase these drugs at your local drug store (CVS, Walgreens, Wal-Mart, Costco, Rite-Aid, etc.)

Some medications need to be given before or after others. In addition, some drugs are never given with other drugs. In most cases, it is fine to give all the prescribed medications together. If certain medications need to be given at certain times, we will alert you and write it on the label of the prescribed medication.

Why is this important?

Some medications can interact with each other making them either more or less effective.

 

How do I remember when to give what drug?

It is best to write down what drug you are giving and what time you are giving it—the calendar we provide you with serves this purpose well. Weekly pill containers sold at most drug stores can also help.

What should I do if I give the wrong drug at the wrong time?

Please call us or your local veterinarian for advice. In most cases, we will have you re-start the correct medication at the correct time the following day.

When will my pet begin to show signs from a drug interaction?

Hopefully, this will never happen, but drug interactions can begin within hours. Again, if your pet is given medications together that were not meant to be given at the same time, please call us immediately.

Where should I take my pet if he/she does show signs?

Please take your pet the closest veterinary facility that is open.

Giving your pet metronidazole is the most effective for diarrhea but there are other options that may work. You can try mixing some canned pumpkin with your dog’s food. Plain Metamucil (1/2 of the human dose by weight- a 50lb dog would get about  1 teaspoon and small dog ½ teaspoon). If the diarrhea persists you should call our office and speak with a doctor.

Cyclophosphamide (Cytoxan) can cause irritation to the bladder wall, resulting in bloody urine. If you notice this, please contact our office as soon as possible.

Why is this important? Cyclophosphamide can cause a chemical irritation to the bladder that can cause the urine to become bloody (hemorrhagic cystitis) and the bladder to be painful. However, there are a number of causes for blood to be present in urine, such as the possibility of infection -- Therefore, if you notice blood in your pets’ urine we urge you to contact our office as soon as possible, so that one of our oncologists may better assess the situation.

What can be done to prevent this? The risk of developing cyclophosphamide-induced cystitis (bloody urine) can be reduced by giving cyclophosphamide in combination with prednisone or with a diuretic (i.e. Furosemide/Lasix), which may cause your pet to drink and/or urinate more often. As you will be informed both during and after your visit; it’s very important to offer plenty of drinking water and allow for more frequent urination. This will allow for the drug to be appropriately expelled from the bladder, hopefully preventing any such complications.

How can we fix this problem? If Cyclophosphamide is determined to be the cause of the bloody urine, treatment with this drug may be stopped and another drug may be used in its place. As previously stated, if you see blood in your pets’ urine we urge you to call our office as soon as possible so that any such decisions to alter treatment may be made by one of our oncologists.

When would I see these effects? Adverse reactions to chemotherapy normally do not occur directly after treatment. Side effects such as bloody urine may appear 2-3 days after treatment; however every patient will have an individualized response to chemotherapy.

These medications are safe for use, and are sent home with you so that if your pet is experiencing any side effects you can go ahead and start these medications instead of waiting for a prescription to be filled. As each pet is different and each chemotherapy protocol is different, the recommendations may vary. Always call if you have any questions about side effects or medications.

Why do you prescribe these drugs right away?

At The VCC we believe in trying to prevent side effects because your pet’s well-being is always at the forefront of every decision we make. We want them to have a high quality of life at all times.

How do I get the drug if need more and you are closed?

A member of our staff is available 24 hours a day, seven days a week by calling our main number. If you need more drugs immediately, we will call a local pharmacy to fill the prescription. If you do not need the medication immediately, you can leave us a message on our answering machine and we will fill the prescription the next business day.

What if my pet is only showing signs of either vomiting or diarrhea but not both?

Your veterinarian may direct you to only give one of the medications or they may have you give both to try and prevent further side effects. Each situation is unique and if there are any questions, please call one of our staff.

When do these drugs take effect?

These medications typically work within 24-48 hours.

Where do I go if these medications do not help my pet?

If these medications do not help, please call your veterinary oncologist and he or she will come up with a plan that is best for you and your pet. It may involve you bringing your pet into our hospital, taking your pet to your local veterinarian, to the closest 24-hour facility, or trying other medications at home.

Yes, both medications should be started the same day the injectable chemotherapy is given.

Why is this important?

The reason that both medications are to be given on the same day is that this particular protocol works best with a combination of chemotherapy agents.

How do you administer the drug?

Both prednisone and procarbazine are to be given orally. We also suggest handling the procabazine with gloves as it is chemotherapy, and we want to minimize exposure to you.

What are the side effects?

Side effects of prednisone are excessive panting, increased appetite, increased thirst, and increased urination (more frequent and larger amounts). The side effects of procarbazine can be loss of appetite, nausea or vomiting, diarrhea and loss of energy level. These side effects are uncommon and if they do occur are typically mild. If you have any questions about side effects, contact your veterinary oncologist.

When should I give these medications; the morning or evening?

Medically it does not matter, but some pets handle these drugs better in the morning and some better in the evening. Whatever you decide to do regarding the time of administration, please try to be consistent.

Where should I store the procarbazine?

Procarbazine can be stored at room temperature and should be out of reach of any children in the household. 

Yes, you can give the Cerenia; remember it is given once daily. If your pet continues to vomit or vomits up the medication, please contact us or your referring veterinarian.  We may suggest he/she come in for an injection to control the vomiting, or in more severe cases, to supplement with some fluids to avoid dehydration.

If your pet vomits after receiving medication, please check to see if the medication is in the vomitus and note how long after the medication was given the vomiting occurred. Please call our office for recommendations. Please do not just administer another dose.

Why is this important?
It is important to know how long after receiving a medication or what medication it is that was so we may better assist you into taking the next best step.

How do I know if they got any of their medication into their system?
If you are unable to find the pill or capsule within the vomitus, it would probably be safe to assume that the pill remained within the pet. Please call our office if you have any questions in regards to this.

What should I do if this happens?
If your pet happens to vomit after getting an oral medication we have no way of determining how much of that drug was absorbed during that period of time so it is best to consult with the prescribing veterinarian.

Misoprostol is used to protect the stomach when piroxicam is given (piroxicam is an NSAID – non-steroidal anti-inflammatory drug).

Why is this important?
Piroxicam can cause ulcers in the stomach if misoprostol is not given. You should start it when you get the piroxicam. Women who are or may become pregnant should not handle misoprostal without gloves.

How do I administer it?
Misoprostol is a pill that should be taken with food to decrease any possible side effects. Diarrhea is a possible, but very uncommon side effect. As with any medication take misoprostol exactly as directed by your doctor.

What happens if I forget to give it or miss a day?
If you miss a dose never double the dosage the following day; just restart the medication as it was prescribed by your doctor. Always consult your doctor if you have any questions or concerns.

When should I start the misoprostol?
Our doctors will prescribe misoprostol when piroxicam is used to help prevent gastrointestinal ulcers and kidney damage. You should start the misoprostol and the piroxicam together.

Where should I store the misoprostol?
Misoprostol can be stored at room temperature out of the reach of children, like all medications.

Zeniquin is a broad-spectrum antibiotic that we preferentially use based on the success of similar drugs (fluoroquinolones) in minimizing episodes of sepsis (infection) after chemotherapy in animals.

Why is this important?
Being a broad spectrum oral antibiotic we are able to start our patients on this antibiotic right away instead of waiting for further testing.

How does it work?
Zeniquin kills susceptible bacteria through its action on the bacteria's DNA.

What are the side effects?
Some side effects your pet may experience are loss of appetite, vomiting and decreased activity level. Please consult your oncologist if any of these side effects occur.

When should I start giving it?
Like any medication you should start giving it when your veterinarian instructs you to. Usually we will have you start it the same day it is prescribed and we will tell you otherwise if that is not the case.

Where can I have this prescription filled?
Zeniquin is a medication only carried by a licensed veterinarian; it cannot be filled at your local family pharmacy.

For most patients, as long as they start antibiotics within 24 hours of getting the chemotherapy, it should not make a difference.

Why is this important?
Chemotherapy kills the rapidly dividing cells in the body. There are 3 groups of rapidly dividing cells in the body--the cancer cells, the bone marrow cells and the cells lining the gastrointestinal tract. When chemotherapy kills some of the bone marrow cells, they tend to kill the cells that make white blood cells (WBC). These WBCs are the cells that protect pets from infection. If the WBC count gets too low, infections can occur. We therefore recommend antibiotics to try and prevent infections from taking hold and therefore preventing your pet from feeling ill due to the low WBC/infection.

How do doctors check for low WBC counts?
A simple blood test, either run in the hospital or sent to a lab is a complete blood count (CBC). This blood test indicates the number of red blood cells, white blood cells and platelets that your pet has. These tests are very routine and are run before each and every time your pet receives chemotherapy.

What are the signs of infection?
The most common signs of infection are fever (high temperature--in dogs and cats the normal temperature is 100-102.5). The other common signs are lethargy (loss of activity level), anorexia (loss of appetite) and sometimes diarrhea and nausea.

When will my pets WBC count drop?
This low WBC counts may occur anytime from 1 to 14 days after chemotherapy, depending on the drug.

Where should I go if my pet shows greater than mild signs of infection?
If your pet is showing any of the above signs and they seem more than just mild to you, please contact The VCC, your local veterinarian or the closest 24 hour emergency center.

These medications are used to treat and /or prevent the side effects of chemotherapy. If there is any question whether to start these drugs, please call and speak to one of our staff members.

Cerenia (an anti-nausea/vomiting medication) – When your pet has had no vomiting episodes for at least 24 hours and his/her appetite has returned to normal, it is typically all right to skip a dose or stop giving the Cerenia. Your veterinarian may also tell you to give the Cerenia for a set number of days, then stop for a day or two and then re-start the medication.  

Metronidazole (an anti-diarrhea medication)– We recommend continuing this medication for at least three days once started. It may be used for longer periods and may be prescribed intermittently.

Why is this important to give these drugs?

It is always easier to prevent side effects from occurring than waiting for them to start and treating them. We are as concerned about your pet’s quality of life as you are. We therefore want to do everything we can to prevent chemotherapy side effects from occurring.

How do I give these drugs if my dog is vomiting?

If your pet is vomiting, please call your local veterinarian or us as Cerenia can be given by an injection subcutaneously (under the skin).

What should I do if they vomit the drug up?

Do not just give another dose. Please call your local veterinarian or us to advise you. We may recommend waiting and trying to give another oral dose or we may recommend bringing your pet in for an injection of the medication.

When should I be concerned about my dog’s health if he is showing these signs?

If the nausea, vomiting, or diarrhea is more than mild (small amounts, 1-2 times per day, 1-2 days in duration) or if you are unsure they are mild, please call our staff and we will advise you.

Where should I call or take my pet if I feel he/she is getting worse?

You can always reach a member of our staff 24 hours a day/seven days a week if you are a client of ours. If not, please call your local veterinarian or local veterinary oncologist. If your pet is critical or having an emergency, please take your pet to the closest veterinary hospital that is open.

In most cases, antibiotics should be stopped when instructed by the doctor. If you think you need to stop antibiotics before the prescribed time, please call our office.

Why is this important?

In order to kill all of the bacteria, and avoid making the bacteria resistant to a particular antibiotic, veterinarians prescribe antibiotics for particular length of time. It is very important to finish the course of antibiotics as instructed by your veterinarian.

How do I know when to stop giving antibiotics?

Please do not stop giving antibiotics unless told otherwise by your veterinarian.

What are the signs of infection?

An infection may be small and localized such as an abscess or it can be systemic and generalized as in sepsis. The most common signs are fever (typically a temperature of greater than 102.5), lethargy (loss of energy), anorexia (loss of appetite), or a painful swelling with or without discharge at a particular site.

When should I become concerned?

You know your pet. If there are any abnormal signs, and you think they are more than mild, or if you are unsure if they are mild, please call our office so that we can further instruct you.

Where can I get a refill on the antibiotics when we run out?

Antibiotics are typically not meant to be given for extended periods. Most of the antibiotics that we dispense are to be given only for 7-14 days, depending on the particular antibiotic and the reason for using them. Please consult with your veterinarian if you have any questions regarding this.

Some chemotherapy protocols will ask that the owner administer oral chemotherapy at home. It is important to wear gloves when handling these medications-as these medications are prescribed for your pet, not you—so we want to minimize your exposure. If you do not have gloves The VCC will provide them for you.

Why is this important?
It is best to act conservatively when handling chemotherapeutic medications. Although the possibility of having a serious reaction is rare, these drugs are known to be carcinogenic and mutagenic in humans. Using gloves and disposing of them properly minimizes any unnecessary exposure. Pregnant women and immuno-suppressed people should not handle chemotherapy drugs.

How do administer the chemo pill?
With the exception of wearing the gloves the administration of the chemotherapy pill is the same as any other oral medication. If you need assistance the first time one of our technicians will be happy to show you before you leave the office

What happens if I touch the pill without gloves? 
Most if not all of these types of medications are safety coated. Wearing gloves is a precaution to help minimize any possible contamination. Wash your hands if you accidentally touch the pills.

When should I put the gloves on and take them off?
The exterior container of prescription is contamination free. Put your gloves on, open the container, remove the pill and give it to your pet. Once you have completed pilling your pet, take your gloves off by pulling them inside out and then put the cap back on the container.

Where should I dispose of the gloves?
Again, these pills are safety coated and the chance of contamination is very low. The gloves can be disposed of in you every-day garbage. If you are still concerned you may bring them back to us and we will dispose of it for you.

Most non-chemo medications are dosed based on weight in kilograms; also it’s an easier conversion to metered square, which is the unit how most chemotherapy medications are dosed.

Cats don’t get Lasix-- a diuretic-- with Cytoxan because they are not prone to developing sterile hemorrhagic cystitis (a severe irritation to the bladder wall) that is sometimes seen in dogs.

Why don’t they?

The reason why cats don’t commonly get sterile hemorrhagic cystitis from cyclophosphamide is unknown, but it may have to do with a different way they metabolize the drug or a different way their kidneys excrete it or their bladder’s sensitivity to cyclophosphamide.

How are they different from dogs?

The saying “Cats are not small dogs” is quite accurate. Their metabolism, their dietary requirements, their susceptibility to certain drugs/toxins are different from dogs.

What is furosemide (Lasix)

Lasix is a diuretic, a drug that increases the rate of urine formation.

When does my cat need furosemide (Lasix)?

Lasix is most frequently given for high blood pressure or in certain cases of heart disease.

Where is it administered?

Lasix can be given orally and via injection.

Interestingly, cats very seldom get sick following CeeNu administration, so we opt to not stress them with daily antibiotic administration unless necessary.

Why don’t they get infections following lomustine (CeeNu)?

Despite their white blood count dropping after CeeNU administration, most cats do not feel ill. We believe this is because they don’t get septic (an infection with secondary systemic severe inflammatory response) due to bacteria from the gastrointestinal tract crossing into the blood stream very frequently.

How does giving antibiotics stress my cat?

Any oral medication can cause a cat some stress. Most cats are more difficult than dogs to give oral medication to. In addition, it has been our experience that a higher proportion of dogs will eat Pill Pockets®.

What medications do cats need with CeeNu?

Cats unlike dogs do not need any medications with CeeNU.

When does my cat need antibiotics?

There are various conditions where cats need antibiotics—abscesses, pyothorax (severe infection of the chest cavity), bacterial infections of the mouth, and many others.

Where do I call if I think my cat does have an infection?

If your cat is currently undergoing chemotherapy, please call our office, as we are available 24 hours a day, seven days a week by phone. If your pet is not on chemotherapy, or you think the infection is not related to the cancer or the treatment, please call your local veterinarian.

Giving your pet metronidazole is the most effective for diarrhea but there are other options that may work. You can try mixing some canned pumpkin with your dog’s food. Plain Metamucil (1/2 of the human dose by weight- a 50lb dog would get about  1 teaspoon and small dog ½ teaspoon). If the diarrhea persists you should call our office and speak with a doctor.

If your dog is on prednisone, as many cancer patients are at some point during treatment, this could be causing urinary accidents in the house as the medication makes them more thirsty than usual. If your pet is not on prednisone, please check with your oncologist as there are several causes for an increase in urination.

Our first recommendation would be to check a rectal temperature to rule out a fever which could indicate that medical attention is needed. You can go to your local drug store and purchase a rectal thermometer and take your pets temperature. Designate this thermometer for your pets use only – use a small amount of Vaseline on the end of the probe and insert about an inch into the rectum. A normal temperature for dogs and cats is 100-102.5°F. If you pets temperature is elevated, we will likely ask you to bring your pet in for evaluation either with us or your local veterinarian. You can also look at the color of your pets gums you want them to be pink – if the gums appear pale or white we will likely recommend immediate evaluation. Some pets just take a few days to get back to normal after treatments so this may be normal for them. Always call if you are concerned.

 

Dogs will very quickly learn that sometimes if they decline their regular food that you may give them some people food – cold cuts, chicken and rice, etc. If they get used to this it may be difficult to get them back to a dog-food exclusive diet.

Cats may get very finicky with what they will and will not eat, and can develop aversions if, for example, they are given medications with a particular food.

Our goal needs to be to keep your pet eating as close to a normal, balanced diet as possible. We can provide contact information for a nutritionist if there are questions.

Cyclophosphamide (Cytoxan) can cause irritation to the bladder wall, resulting in bloody urine. If you notice this, please contact our office as soon as possible.

Why is this important? Cyclophosphamide can cause a chemical irritation to the bladder that can cause the urine to become bloody (hemorrhagic cystitis) and the bladder to be painful. However, there are a number of causes for blood to be present in urine, such as the possibility of infection -- Therefore, if you notice blood in your pets’ urine we urge you to contact our office as soon as possible, so that one of our oncologists may better assess the situation.

What can be done to prevent this? The risk of developing cyclophosphamide-induced cystitis (bloody urine) can be reduced by giving cyclophosphamide in combination with prednisone or with a diuretic (i.e. Furosemide/Lasix), which may cause your pet to drink and/or urinate more often. As you will be informed both during and after your visit; it’s very important to offer plenty of drinking water and allow for more frequent urination. This will allow for the drug to be appropriately expelled from the bladder, hopefully preventing any such complications.

How can we fix this problem? If Cyclophosphamide is determined to be the cause of the bloody urine, treatment with this drug may be stopped and another drug may be used in its place. As previously stated, if you see blood in your pets’ urine we urge you to call our office as soon as possible so that any such decisions to alter treatment may be made by one of our oncologists.

When would I see these effects? Adverse reactions to chemotherapy normally do not occur directly after treatment. Side effects such as bloody urine may appear 2-3 days after treatment; however every patient will have an individualized response to chemotherapy.

Do not give the next dose of Palladia and contact our office for advice.

 

These medications are safe for use, and are sent home with you so that if your pet is experiencing any side effects you can go ahead and start these medications instead of waiting for a prescription to be filled. As each pet is different and each chemotherapy protocol is different, the recommendations may vary. Always call if you have any questions about side effects or medications.

Why do you prescribe these drugs right away?

At The VCC we believe in trying to prevent side effects because your pet’s well-being is always at the forefront of every decision we make. We want them to have a high quality of life at all times.

How do I get the drug if need more and you are closed?

A member of our staff is available 24 hours a day, seven days a week by calling our main number. If you need more drugs immediately, we will call a local pharmacy to fill the prescription. If you do not need the medication immediately, you can leave us a message on our answering machine and we will fill the prescription the next business day.

What if my pet is only showing signs of either vomiting or diarrhea but not both?

Your veterinarian may direct you to only give one of the medications or they may have you give both to try and prevent further side effects. Each situation is unique and if there are any questions, please call one of our staff.

When do these drugs take effect?

These medications typically work within 24-48 hours.

Where do I go if these medications do not help my pet?

If these medications do not help, please call your veterinary oncologist and he or she will come up with a plan that is best for you and your pet. It may involve you bringing your pet into our hospital, taking your pet to your local veterinarian, to the closest 24-hour facility, or trying other medications at home.

Yes, both medications should be started the same day the injectable chemotherapy is given.

Why is this important?

The reason that both medications are to be given on the same day is that this particular protocol works best with a combination of chemotherapy agents.

How do you administer the drug?

Both prednisone and procarbazine are to be given orally. We also suggest handling the procabazine with gloves as it is chemotherapy, and we want to minimize exposure to you.

What are the side effects?

Side effects of prednisone are excessive panting, increased appetite, increased thirst, and increased urination (more frequent and larger amounts). The side effects of procarbazine can be loss of appetite, nausea or vomiting, diarrhea and loss of energy level. These side effects are uncommon and if they do occur are typically mild. If you have any questions about side effects, contact your veterinary oncologist.

When should I give these medications; the morning or evening?

Medically it does not matter, but some pets handle these drugs better in the morning and some better in the evening. Whatever you decide to do regarding the time of administration, please try to be consistent.

Where should I store the procarbazine?

Procarbazine can be stored at room temperature and should be out of reach of any children in the household. 

Yes, you can give the Cerenia; remember it is given once daily. If your pet continues to vomit or vomits up the medication, please contact us or your referring veterinarian.  We may suggest he/she come in for an injection to control the vomiting, or in more severe cases, to supplement with some fluids to avoid dehydration.

Although Palladia is not a "chemotherapeutic", similar side effects may be observed. These reactions are usually mild to moderate and temporary. The most common of side effects is associated with gastrointestinal (GI) toxicity, with presenting symptoms such as: diarrhea, bloody diarrhea, loss of appetite, vomiting, and weight loss. Other less commonly reported side effects are temporary lameness (difficulty moving) and lethargy (lack of energy), but these issues will often resolve on their own. If you notice your pet is experiencing any of these side effects, please give our office a call as soon as possible.

Why is this important?

It is important to address these side effects immediately as patients left untreated for gastrointestinal toxicity may develop more serious clinical signs. GI toxicity is relatively simple to treat, as long as symptoms are detected early on. Dependent upon the severity of side effects, the veterinarian might decide to lower the dose of Palladia or to stop treatment. If you notice your pet is experiencing any side effects from Palladia, please give our office a call as soon as possible.

How can these Issues be prevented?

There are a number of commonly used drugs that one of our doctors may prescribe to your pet to be administered at home, treating prophylactically(i.e. Metronidazole and/or Cerenia). In most cases, these side effects can be treated easily with some additional medications or by adjusting the treatment schedule.

Side effects of chemo can be seen (depending on chemo) anytime from immediately after treatment to more than 1 week. Most commonly we see nausea, diarrhea, loss of appetite and loss of energy. Every animal reacts differently to the chemotherapy they are receiving. Be observant of your pet starting immediately. If side effects do occur, please let us know so that we can offer supportive care and hopefully prevent future occurrences.

For most patients, as long as they start antibiotics within 24 hours of getting the chemotherapy, it should not make a difference.

Why is this important?
Chemotherapy kills the rapidly dividing cells in the body. There are 3 groups of rapidly dividing cells in the body--the cancer cells, the bone marrow cells and the cells lining the gastrointestinal tract. When chemotherapy kills some of the bone marrow cells, they tend to kill the cells that make white blood cells (WBC). These WBCs are the cells that protect pets from infection. If the WBC count gets too low, infections can occur. We therefore recommend antibiotics to try and prevent infections from taking hold and therefore preventing your pet from feeling ill due to the low WBC/infection.

How do doctors check for low WBC counts?
A simple blood test, either run in the hospital or sent to a lab is a complete blood count (CBC). This blood test indicates the number of red blood cells, white blood cells and platelets that your pet has. These tests are very routine and are run before each and every time your pet receives chemotherapy.

What are the signs of infection?
The most common signs of infection are fever (high temperature--in dogs and cats the normal temperature is 100-102.5). The other common signs are lethargy (loss of activity level), anorexia (loss of appetite) and sometimes diarrhea and nausea.

When will my pets WBC count drop?
This low WBC counts may occur anytime from 1 to 14 days after chemotherapy, depending on the drug.

Where should I go if my pet shows greater than mild signs of infection?
If your pet is showing any of the above signs and they seem more than just mild to you, please contact The VCC, your local veterinarian or the closest 24 hour emergency center.

If you think it’s a cancer related emergency, call ER phone. If anything else, call RDVM. If there is ever a question about which to call, don’t hesitate to call us.

First, you should alert your physician that your pet is currently on chemotherapy. Second, if possible, have another member of your household clean up any pet related waste products—urine, stool or vomit. If you must handle these waste products, use gloves, pet waste bags, or wash your hands thoroughly. 

Why is this important?

It is possible that toxins the mother is exposed to during pregnancy can adversely affect the developing baby. By knowing what precautions to take, you and your child’s safety are protected.

How will exposure affect my unborn child?

New research has found that children born to mothers treated with chemotherapy during the last two trimesters of pregnancy appear to be normal, completely unaffected by the experience. It is always better to be safe and minimize any exposure to chemotherapy, especially during the first trimester of pregnancy.

What are the risks if I have to clean up after my pet if I am alone?

With the appropriate precautions—gloves, pet waste bags, thorough hand washing, and the proper disposal of contaminated materials—the risks are minimal.

When is it alright for me to clean up after my pet?

If it is possible to have someone else clean up the waste for the first 48-72 hours after each treatment, you can minimize your exposure. In addition, if you do not directly handle the medications, you will minimize the exposure to yourself and your child.

Where should I dispose of the waste from my pet?

Feces or flushable litter may be flushed down the toilet or put in a plastic bag and disposed of in the garbage. If your pet urinates or defecates in your yard, hosing the area down on a regular basis is advisable. If your pet’s bedding becomes contaminated with waste—feces, urine or vomit—it should be washed in the laundry separately.

Our first recommendation would be to check a rectal temperature to rule out a fever which could indicate that medical attention is needed. You can go to your local drug store and purchase a rectal thermometer and take your pets temperature. Designate this thermometer for your pets use only – use a small amount of Vaseline on the end of the probe and insert about an inch into the rectum. A normal temperature for dogs and cats is 100-102.5°F. If you pets temperature is elevated, we will likely ask you to bring your pet in for evaluation either with us or your local veterinarian. You can also look at the color of your pets gums you want them to be pink – if the gums appear pale or white we will likely recommend immediate evaluation. Some pets just take a few days to get back to normal after treatments so this may be normal for them. Always call if you are concerned.