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Chemotherapy: What to Expect

Approximately 10-20% of veterinary oncology patients experience side effect after chemotherapy including:

  • loss of appetite
  • vomiting
  • diarrhea (generally 3-5 days after therapy)
  • drop in white blood cell count (generally 7 days after therapy)

Most of the time these signs are mild and self-limiting and resolve with supportive care (bland diet, anti-nausea / anti-diarrheal medication) at home.  Less than 5% or patients require hospitalization after treatment.

Below are the instructions and possible side effects of steroids and chemotherapy that we received from our Oncologist, Dr. Risbon, at  VSEC.

Steroids

Prednisone may cause the following side effects:

  • excessive thirst
  • urination
  • panting
  • increased appetite

Other rare but possible side effects include:

  • loss of appetite
  • vomiting
  • diarrhea
  • dark/tarry or black stools

****If your dog experiences any of the above rare side effects, you should call your primary veterinarian or your oncologist immediately.

Other very important things to note:

  • Steroids cannot be given with non-steroidal anti-inflammaroty medications (NSAIDs) such as Rimadyl (Carprofen), aspirin, Deramaxx, Metacam, Piroxicam, and other drugs in this class.
  • Once started, steroids cannot be stopped suddenly as this can be detrimental to your dog.  You must speak with your primary veterinarian or your oncologist for appropriate instructions on weaning your dog from this medication.

Chemo therapy instructions

Do not give the chemo if your dog is not feeling well. For example: vomiting, diarrhea, very lethargic, not eating, etc. Contact your oncologist before you begin/continue oral medication to receive further instructions.

Handling instructions for chemo

Wear latex gloves while handling chemo drugs. Dispose of the gloves into a garbage bag, tie the bag, and wash your hands. If you come in contact with the chemo drugs wash your hands thoroughly. Children and pregnant or nursing mothers should not handle chemo. Keep chemo in an isolated place, out of the reach of children and animals, and away from where other medications or food are stored.

Waste

A small percentage of chemo may be excreted in the urine and stool for the first two days after treatment. If your dog has an accident in the home wear latex gloves and discard in a garbage bag. Clean the area thoroughly with a regular cleaner and try to cover or avoid carpeted areas for 48 hours after cleaning. For waste outside, you should try to avoid the area for 48 hours or spray the area with water. If you are walking your dog on public property, bring a bottle of water and soak the area.

Side Effects

Vomiting/nausea

If your dog is vomiting, it may be due to the side effects from the chemo therapy or the cancer itself. If you have anti-nausea medication, you should start it at the first sign of vomiting. If you do not have this medication call for a prescription. Most of these medications can be called into your local pharmacy. If your pet vomits shortly after this medication is given (for example less than 15 minutes), the medication may not have been absorbed. It may be necessary for your pet to receive an injectable anti-nausea medication. Do not give any over-the-counter medications until approved by your doctor.

  • If your dog vomits more than 3 to 4 times in a couple of hours or vomits after every meal, take up all food and water for at least four hours. It will help in emptying their stomach of any contents while reducing the catalyst to vomit.
  • If vomiting continues call your primary veterinarian, or your oncologist
  • If vomiting stops after four hours of fasting, offer small amounts of water. This will help determine if your pet can hold anything in the stomach without vomiting. If your pet does not want to drink water, consider trying alternate fluids, such as broths, Pedialyte, apple juice, etc. If vomiting continues, you should contact your primary veterinarian or your oncologist for further instructions.
  • After several hourly trials of offering water with no vomiting you can try to offer small amounts, enough for only a couple of bites, of bland food. For example baby food, chicken and rice, etc. every three hours. If there is no vomiting continue to offer food. Slowly increase the amount offered each time.

****If you notice any blood in the vomit, notify your oncologist or your primary veterinarian immediately.

Diarrhea/Constipation

If your dog has diarrhea, it may be due to certain G.I. cancers, chemotherapy given previously, the body’s malabsorption of fluids, suppressed immune system, diet, or intestinal motility changes, among other possibilities.

Temporarily switch from your dog’s normal diet to a bland diet of boiled rice/pasta/potatoes and boil chicken or boiled hamburger. Keep your dog hydrated and make sure that water is readily available.

  • Continue this diet until the diarrhea has stopped for at least two days. You will then slowly mix back in your dog’s normal diet with a bland diet.
  • If diarrhea continues for two days while on this diet please contact your oncologist or your primary veterinarian for further instructions. An anti-diarrheal medication may be prescribed, as well as fluid therapy and a chem/electrolyte panel.

For constipation, consider giving canned pumpkin or Metamucil. Be sure to call your primary veterinarian or your oncologist for the correct dosage of Metamucil for your dog. Your dog may need to be seen if there is no defecation within a period of 48 hours. Do not give any over-the-counter medications until approved by your oncologist or primary veterinarian.

****If you notice black/tarry stools or the presence of blood, notify your oncologist or your primary veterinarian immediately.

Anorexia/poor appetite

If your dog experience has a poor appetite, it may be due to nausea from the chemo, the cancer itself, picky tastes, a pre-existing poor appetite, chemo related scent changes, among other possibilities. Try introducing other food choices, such as

  • Baby food or canned dog/cat food
  • Different brand of food, boiled chicken or hamburger mixed in with regular diet, roasted chicken, steak, fish, or cooked eggs
  • Flavor stimulants such as pet gravy from pet stores, or low-sodium broth
  • Warm soft foods, or add warm water to dry foods. This can bring out the flavor and aroma
  • Cottage cheese or plain yogurt, alone or mixed in with the regular diet
  • Try hand feeding or syringe feeding. Put food into the blender if syringe feeding

If you have any anti-nausea medication start the medication since poor appetite could be due to nausea. If your dog does not eat beyond two days, or if you are concerned, contact your oncologist or your primary veterinarian for further instructions. Certain medications may be dispensed to stimulate the appetite.

Lethargy/weakness/fever

If your dog experiences lethargy, weakness, or fever it may be due to the chemotherapy given, the bodies adjustment to the new chemo drug in the system, the cancer, among other possibilities. Usually this only last for a few days. Your dog may not act like him/herself, may exhibit behaviors not noticed before, and may not be feeling well. In response to this you should keep an eye on your dog for these things and notify your oncologist and or primary veterinarian if it progresses for an extended time or if you are concerned.

In addition take your dog’s temperature rectally with a digital thermometer, and use Vaseline or KY jelly for lubrication. Normal temperature range for dogs is from 100.5° to 102.5°. A temperature above 103.5° should be reported to your oncologist and primary veterinarian.

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