FAQ-Cancer Resource Center-Side Effects

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.