FAQ-Cancer Resource Center-General

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.