The Dog Cancer Survival Guide (41 page)

Luckily, we can now test for this mutated gene through Washington State University College of Veterinary Medicine. If the results are positive for the mutation, we can significantly lower the dose of chemotherapy drugs to avoid severe toxicity. There are certain breeds at risk for this genetic mutation, so if your dog is an Australian Shepherd, Collie, Long-haired Whippet or Silken Wind hound, I recommend getting her tested for this mutation, before starting chemotherapy. For more information, you can go online to
www.vetmed.wsu.edu/depts-VCPL
.

Most chemotherapy agents must be administered directly into the vein at the clinic, requiring a trip to the office for each dose. Depending upon the protocol, this could mean anywhere from six to twenty trips (or more). Chemotherapy treatments rarely require hospitalization overnight and most office visits last about 60 to 90 minutes. There are even some drugs in pill form, which can be given at home.

Chemotherapy doses are based on surface area, which is calculated using weight, so your dog will be weighed at each appointment. The oncologist will also do a complete physical exam, including a complete blood count (CBC). This blood test reveals, among other things, how many and what kind of white blood cells are in your dog’s blood. Immune suppression is an inherent side effect of cancer, but it is also a side effect of chemotherapy (see below); monitoring your dog’s white blood cell count at every appointment can help the oncologist see if the immune system is holding up under the strain.

The oncologist will ask you how your dog is feeling and what side effects may have occurred since your last appointment. Your answers, along with your dog’s weight, her CBC results, and her other medical problems, if any, will be factored into the oncologist’s decision about that day’s dose of chemotherapy. The dose may be different from that on the last visit, for example, if the dog’s weight has changed. In other cases, if there were a lot of side effects (vomiting, diarrhea, etc.) after the last treatment, the dose may be lowered.

This decision is never taken lightly, however, because lower doses can radically alter the treatment’s effectiveness. For example, studies in people have shown that a 20% dose reduction can make the treatment 50% less effective: a huge drop in efficacy, compared to the drop in dosage.

There is another recent study that showed chemotherapy doses high enough to cause low white blood cell levels (neutropenia, see below) – which we typically try to avoid – were associated with longer remissions. This outcome makes oncologists even more inclined to keep doses as high as possible, while using antibiotics and other medications to keep the immune system stimulated.

Chemotherapy agents are, in general, extremely toxic, so, oncologists make safe handling a high priority. For this reason, you will likely not be allowed into the treatment rooms. Your dog will sit or lie down to receive her treatment, which is usually given intravenously, through a catheter in her forearm, or rarely into the chest or abdomen cavities. Most dogs do not need sedation to receive treatments and there is often a chemotherapy nurse and an assistant present during the entire time. Several chemotherapy agents must be delivered directly into the vein – if not, they can severely injure tissues. This is why I so strongly recommend using an experienced practitioner, or an oncologist, if you are considering chemotherapy for your dog.

Once the treatment is complete, most dogs can go home right away. Because anesthetics are not used during chemotherapy, there is usually no need to stay in the hospital for observation.

Some chemotherapy drugs are given by mouth at the hospital, or even at home. If your oncologist prescribes a home-based protocol, it’s important to remember to report all the side effects, so that she isn’t flying blind. To protect yourself and keep your family safe from the chemotherapy drugs, make sure to wear gloves while handling them. Keep them on until you are sure that your dog has swallowed the pill – that way if she spits it out, you can pick it up quickly and safely. When you’re finished, dispose of those gloves and wash your hands well.

If the pill can be given with a small amount of food, many dogs will happily swallow pills disguised in a piece of cheese, a scoop of peanut butter or a pill pocket (a treat designed with a hollow middle, available in most pet stores, at most vet offices, and at
www.DogCancerShop.com
). Some dogs become suspicious of these foods, so you might give a piece without medication, before you give the loaded version.

If the pill can be given with food, you can also try hiding it in your dog’s dinner. If you do this, make absolutely sure that the pill is gone, after your dog has finished eating.

If your dog is on to these tricks, or if the pill has to be given on an empty stomach, you’ll need to get him to swallow the pill whole. This can get a little tricky, and it is easiest if you have an assistant. Here’s how I approach it:

1. Get the pill ready.
   
2. Call your dog, with a super happy voice, so that he won’t be suspicious. It seems like dogs can read our minds, so you might try thinking about something he likes – throwing a ball, eating dinner, taking a walk – rather than the pill, when you call him.
   
3. Once your dog is present, you’ll need to find a way to hold him still. If he’s small enough. and you have an assistant, you can put him up on a counter or a couch. If he’s larger, lead him to a corner or some other place sometimes where you can put his hind end against something firm, so he can’t back away. You can also have your assistant hold him from behind, with her hands and arms firmly holding his shoulders and chest
   
4. If you’re right-handed, hold the pill between your thumb and index finger in your right hand (in your left, if you’re a southpaw)
   
5. Use your other hand to gently hold your dog’s muzzle from above, with your thumb on one side and your fingers on the other.
   
6. Squeeze just behind the upper canine teeth and tilt your dog’s head back over his shoulders. As he looks at the ceiling, his jaw will drop open a bit.
   
7. Lower the bottom jaw even further by hooking a finger of your hand with the pill in it between the lower canine teeth (the long front teeth), and pushing gently down.
   
8. Place the pill as far back in your dog’s mouth as possible, and certainly over the hump of the tongue, right in the center. Do this quickly, and don’t go so far in that your dog starts to gag.
   
9. Remove your finger and press your dog’s mouth closed. Hold it and lower his head to a normal position to make swallowing easier. Gently rubbing or blowing on your dog’s nose sometimes stimulates the swallow reflex.
   
10. Give your dog lots of praise, and a treat if you can, to make the next time easier.
    
11. Watch him to be sure that he doesn’t hack the pill back up.
    

The key is calm confidence and efficiency. The more practiced and quicker you are at this, the easier it is on both of you.

If you are really having trouble, you can try filling a turkey baster or needle-less syringe with water and squirting it into your dog’s mouth after you place the pill. This can “chase the pill down” and make it easier to swallow.

If you have never seen this done, you might want to ask your vet if you can have a lesson or demonstration. Personal instruction is a good way to learn this important guardian skill.

Never break chemotherapy pills into pieces, because the medication may not be dispersed evenly throughout the entire tablet. Also, breaking a pill in two creates a puff of powder, which you could inhale (the exceptions to this rule are prednisone and prednisolone). If the label on your dog’s chemotherapy drugs instructs you to break the tablets, double check with your vet about the dosage.

Keep the medication in its original safety vial and do not store it near food or other medications (to avoid mix-ups). It’s best to avoid having any open food or drink near you when you give your dog her medication – otherwise, you might accidentally contaminate your food supply. Be sure your dog has completely swallowed the pill, if you’re hiding it in food.

If you are pregnant, nursing, or planning to become pregnant, be very, very careful when you administer chemotherapy. These drugs target rapidly dividing cells, so fetuses and babies are particularly vulnerable to their toxic effects.

Depending upon how chemotherapy was administered you may need to care for your dog at home. For example, there may be a pressure bandage on the leg where the chemotherapy was given. Remove this about an hour after you arrive home or circulation could be impaired and the paw might swell up. Once the bandage is off, check the injection site to make sure it looks normal. If your dog starts licking it excessively, contact your vet or oncologist, right away.

Rarely, chemotherapy drugs, that are intended to go directly into the vein, come in contact with other tissues, which can cause irritation, sloughing (skin falling off) or swelling. This is another reason why we recommend treatments be performed with an experienced team. The oncologist will tell you if the treatment accidentally contaminated the skin or other tissues, explain what to look for and give you medications or instructions for treating home care. Please follow this advice closely and keep an eye on the injection site.

In between appointments, monitor your dog for changes in the injection site and the side effects listed below. Be sure to record as much as you can, to report back at your next appointment. Contact your vet if severe symptoms develop as outlined below.

Drugs often continue working after the treatment is over, and residues and by-products can come out in urine, feces vomit and, potentially, even saliva. For this reason, it’s really important to take some safety precautions around these bodily fluids. I don’t want you to be scared to touch your dog – normal play and cuddling is safe and good for your dog’s mental and emotional health – but you should definitely take the following common-sense precautions:

• Avoid direct contact with urine, feces, vomit and saliva for at least five days. Wear gloves to pick up and dispose of wastes, gloves, paper towels and rags used to clean up messes, placing them in a tightly sealed plastic trash bag. If your dog goes outside, it’s wise to pick up and dispose of feces in tightly sealed plastic bags.
  
• If your dog has an accident on bedding (towels, blankets) or other washable items, use gloves to pick them up and wash them separately from other laundry. Make sure to clean any floors, countertops, or carpets with a strong detergent.
  
• If you accidentally touch your dog’s waste products or soiled items, wash your skin thoroughly, and contact your doctor if it becomes irritated.
  
• Because chemotherapy targets rapidly dividing cells, avoid all contact with both drugs and dog wastes if you are pregnant, trying to become pregnant, or are breast feeding, because the majority of your baby’s body cells are naturally dividing rapidly, and are therefore very sensitive to chemotherapy.
  
• If you have a suppressed immune system, for any reason, avoid all contact with both chemotherapy drugs and dog wastes.
  
• Because they are growing and many of their cells are rapidly dividing, children and teenagers should not handle either chemotherapy drugs or dog wastes.
  
• There is some evidence that some chemotherapy drug residues can come out in saliva. The amount from a one-time exposure is likely minuscule; still, it is wise to keep your dog from licking you or anyone else for seventy-two hours.