Chemo is a scary word. We all have people close to us that have had chemotherapy and we'd all like to forget how sick and miserable it made them (or made us). Now our dog has cancer and yes, we want her to live longer, but the thought of putting her through chemotherapy...we just can't do it.
Well, as an oncologist, I wouldn't be able to do it if it were similar to a person's experience either. That's why things are very different in veterinary oncology.
In human oncology, we are choosing chemotherapy for ourselves. We accept that we will feel terrible during treatment, but we make this choice in order to live longer; that's the payoff.
In veterinary oncology, we are making these choices for our dogs. Our goal is of course to prolong life, but not by compromising the quality of life. We give dogs chemotherapy at a fraction of the dosage that they use to treat people to avoid side effects.
Chemotherapy in dogs is either oral or injectable. Most injectable chemotherapy is either a quick intravenous injection or a slow infusion over 20 minutes or less. In some cases, treatment is weekly, other times treatment is every three weeks, and in other cases, the family gives a chemotherapy pill once daily at home - it just depends on the type of cancer we're treating and the protocol that the family has chosen to pursue.
With our standard chemotherapy protocols, less than 25% of dogs experience mild nausea or soft stool during a 2-4 day window after treatment - this is usually fleeting if appropriate treatment is pursued. The good thing is that most dogs won't experience ANY side effects (you would never know these dogs were getting chemo!).
For the patients that do experience side effects, we can minimize the impact by initiating treatment at the very FIRST sign of nausea or soft stool. All of my patients are sent home with both Cerenia (maropitant) for nausea and metronidazole for soft stool; these medications typically work great.
The family is instructed to watch very closely for signs of nausea 2-4 days after treatment. It's important to know that vomiting is actually the last sign of nausea; we want to prevent this at all costs.
To keep patients feeling as good as possible, treat for nausea if ANY of the following signs are observed: walking over to the food bowl but not eating, decreased appetite, not eating, lethargy, lip-smacking, drooling more than normal. In these cases, I recommend giving Cerenia as soon as possible, then continue Cerenia for a few days. If your dog isn't feeling well, she might enjoy boiled chicken and rice for a few days. She should never be offered food if she still looks nauseous - wait at least 30-60 minutes after giving the Cerenia before offering food (you have to allow it to kick in first).
If you want to do everything you can to prevent nausea, this makes it easy. Just ask your care provider to give a Cerenia injection with chemotherapy, then continue giving oral Cerenia for the next 3-4 days at home (remember, wait 30-60 minutes before giving food after you give the Cerenia).
If your dog is very sensitive to chemo and has nausea despite prophylactic Cerenia, the chemo dosage should be lowered. Just talk to your vet or oncologist about this. An oncologist treats many patients with chemotherapy every day, we have lots of tips and tricks to help keep a dog feeling well throughout treatment.
And remember, as an oncologist, we want your dog to have a good experience with chemotherapy as much as you do. So if your dog isn't feeling well after treatment, please let us know so that we can make a change. The most important thing throughout treatment is your dog's quality of life.
Dr. Lori Cesario
Board Certified Veterinary Oncologist
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