All these thoughts start racing through our head because, like I said, most of us have had a family member or a friend or an acquaintance gone through chemotherapy or we've seen something on TV.

So we have so many myths and misconceptions.

And it's not your fault.

It's just, I want to, you know, erase those myths and misconceptions and give you facts and hope about pets going through chemotherapy.

Today, we are talking about chemotherapy side effects and I'm doing this vlog because you guys have done what I've asked you to do.

You have commented and I'm a little bit embarrassed.

Can you believe we're at vlog number 93 and I haven't done a vlog dedicated to chemotherapy side effects.

I do have lots of other videos in the chemotherapy playlist where I address chemotherapy side effects, but I don't have one that is completely dedicated.

So that's what this one's going to be.

We're going to talk about five things that I think that you need to know about chemotherapy side effects.

I'm going to answer the side effects that you're worried about and the ones that you really don't need to worry about in dogs and cats.

So let's do it.

Let's break it down.

Let's talk about chemotherapy side effects in dogs and cats.

So most of us have, unfortunately, probably known a human that has gone through chemotherapy and you may have heard me say this before, but you may not have.

And I think it's worth repeating.

Chemotherapy in dogs and cats is not chemotherapy in people.

Luckily, dogs and cats tolerate chemotherapy so much better than people.

So maybe if you had another pet that was treated for lymphoma 10 or 15 years ago, just realize that the experience may not be the same because every pet is an individual.

We have a much more preventative approach.

So again, I always encourage you to see a cancer specialist if possible.

You will have the link on how to see a specialist.

And I think it's really important to take that opportunity.

And just remember, just because you see a specialist is not signing you up to see chemotherapy.

Just get the information and make an educated decision.

And I want to go through five things that I want you to know about chemotherapy in dogs and cats.

Number one, which I already mentioned in the intro, is dogs and cats tolerate chemotherapy so much better than people.

So it's estimated that about 80% of dogs and cats won't have side effects going through chemotherapy.

That's amazing.

It is much lower than what we see in people.

And if they do have side effects, they tend to be mild to moderate and self-limiting.

What do I mean by that?

So mild to moderate means they're not that bad.

And self-limiting means if we don't do anything about it, they're going to get better on their own.

But that doesn't mean I don't want us to do anything.

So I as a cancer specialist am going to prescribe medications at that first chemotherapy appointment.

And so I do have another vlog of the top medications that I want you to go home with.

And so I send all of my chemotherapy patients home with these on the first appointment.

So that's vlog number 38 are my top five medications.

So there's a goody bag that all of my patients go home with.

And you can watch that video.

But everybody goes home with a nausea medication, a diarrhea medication, a probiotic.

And now there's two appetite stimulants that have come onto the market in the last couple of years, Entice for dogs and Mirataz for cats.

So those are like the goody bag that you're going to go home with automatically on day one.

So we take a very preventative approach.

So even though they're going to get better on their own, we want to send you home with medications so you have them on hand because we want to help our pets get over those side effects if they have it.

So chemotherapy is very well tolerated.

The risk of hospitalization is extremely low in dogs and cats.

It's estimated that about 5% of dogs will get hospitalized from chemotherapy related side effects, whether that's severe vomiting or diarrhea, again we're going to talk about those side effects, or severe low white blood cell count which leads to an infection which is called sepsis.

So it's not half of the patients that were given chemo, less than 5%, even lower in cats.

Cats tolerate chemo better than dogs.

What I usually encourage pet owners that are thinking about giving chemotherapies, let me give her a dose or two.

And so many owners are so surprised how well their pets are doing on chemotherapy, they keep coming back because they're so surprised.

So you can watch my other videos, you can see we still have dogs that still go on hikes, still do agility, still lead a very normal life as they're going through chemo.

Every day is not going to be perfect.

You may have to cook some days for them and encourage them, and you may have to medicate them with the medications that I talked about, but owners look back and tell me time after time after time, thank you so much Dr. Sue, I feel like the time that I got was such quality time and I got so much more time.

And that's what helps me help you to think, to recommend, think about it.

Again it is so well tolerated in the majority of pets.

And the other thing is, it's not a contract.

You can always stop giving chemotherapy if you change your mind.

Just because you give one or two doses of chemotherapy does not mean that you sign up for the entire protocol.

You can stop if you change your mind, or if your pet is in that small percentage of pets that's not tolerating.

The other thing with that is if they are having side effects, we can adjust chemotherapy, lower dose, use more preventative medication, so we can tweak things and adjust things and that's really one of the advantages of working with a specialist or someone who gives a lot of chemotherapy.

We have a lot of experience with these medications and the side effects and things like that.

So again, chemotherapy can be very well tolerated, but just this week I'm dealing with Daisy who didn't like one of the drugs, Vincristine, so I've had to lower the dose and add not only Serenium, but Entice, and now she's having much less side effects.

There are things that we can do to adjust the chemotherapy, but again, the majority of dogs and cats, chemotherapy is extremely well tolerated.

So we're talking about the top things about the top side effects of chemotherapy.

So for two, three, and four, I want to talk about the main chemotherapy side effects.

But before I can do that, I kind of have to go through how chemotherapy works, because if we understand how chemotherapy works, we can understand why we see the side effects that we see.

So the goal of chemotherapy is to kill the rapidly dividing cancer cells.

That makes sense, right?

These are cancer cells that are dividing uncontrollably and rather quickly.

There are certain cells in our body which turn over and divide more quickly, and those are what I call the innocent bystanders, and those are the ones that get damaged from chemotherapy, and those are the ones that we tend to see side effects.

So the three main cells that divide pretty quickly in the body are the hair follicle, and that's why people will lose their hair as they're going through chemotherapy, the gastrointestinal tract cells, these crypt cells, which are certain cells in the GI tract, and some of the cells in the bone marrow, because they have high turnover, and the ones that have the quickest turnover are the white blood cells, these ones called the neutrophils, which are the infection-fighting cells.

So those are the ones that are damaged from chemotherapy.

So that makes sense when we think about the side effects of chemotherapy.

People and certain dog breeds have continuously growing hair, and that's why they lose their hair.

Luckily, most dogs do not lose their hair because they don't have a continuously growing hair coat.

That's why most dogs going through chemotherapy look as normal as ever.

There are some breeds that your veterinarian or your oncologist can go through.

The top breeds that I think about are some of the terrier breeds, like Westies, Poodles,

Scottish Terriers, Old English Sheepdogs.

Some of those breeds, Havanese, their hair coat will thin out.

They will have some patchy areas of baldness as they're going through chemotherapy, but their hair coat will grow back.

If your dog is part poodle, like a golden doodle, they are likely to thin out pretty decently as they're going through chemotherapy.

Kitty cats, they do not lose their hair.

They can lose their whiskers, and again, they will grow back, or their whiskers can thin out.

Some cats that are on chronic chemotherapy get a really soft, we call it a chemo coat, just super, super soft.

So that was number two, was hair.

Again, rapidly dividing cells.

Number three is gastrointestinal cells, and that is one of the reasons that we see GI, or gastrointestinal signs, which can manifest as vomiting, diarrhea, loss of appetite, and then can lead to weight loss.

Chemotherapy can also cause nausea and vomiting through the brain as well, because it can hit some of the receptors in the brain as well, but again, because it can kill rapidly dividing gastrointestinal cells are one of the reasons that we can see these GI signs.

When do we see GI signs after chemotherapy?

Usually, if it's from damage to the gastrointestinal cells, about one to five days after chemotherapy, and in general, it will last about three to five days, because that's how long it takes the body to replenish those cells.

So again, now that we understand how chemo works, we're understanding why we see the signs that we see.

So we talked about hair, we talked about GI, and then the third set of cells I told you are those white blood cells, those neutrophils, those infection-fighting cells that we make in the bone marrow.

Most chemotherapy drugs, if we're gonna damage those cells, it's usually day seven after the chemotherapy.

So that is why my chemotherapy patients are often told, you're gonna come back seven days after chemotherapy so I can check the white blood cell to see if the neutrophil count got low.

If it's a drug that is very likely to cause a low white blood cell count, because it's a strong drug, what we call highly myelosuppressive, I may put them on preventative antibiotics while I'm checking that first white blood cell count after chemotherapy, and then have them come back when I expect that low white blood cell count, which is called a NADR,

N-A-D-R.

So that's what the NADR appointment is, where we're checking for that low white blood cell count.

We also wanna make sure the patient doesn't have a fever, because again, if they get a very low white blood cell count and they have a fever, that's actually an oncologic, a cancer emergency because they could be getting septic.

And that would be those 5% of patients that need to get hospitalized for a couple of days of supportive care with IV fluids and antibiotics.

Remember, it's really, really uncommon, but that doesn't mean if it doesn't happen, we don't need to hop on it and get them admitted, because that can be life-threatening.

So it's uncommon, but there are some real side effects of chemotherapy, so I don't wanna make it all like, oh, there's nothing to worry about, because even though chemotherapy is very well-tolerated, about once a year, maybe twice a year, I do have some chemotherapy patients that get very low white blood cell counts and need to be hospitalized, or severely, they're vomiting five to seven times a day or two after chemotherapy, and the owners can't get any of those oral nausea, vomiting medications in at home, so they do need to come to the hospital, because they're getting so dehydrated.

We're gonna admit them to the hospital, put an intravenous catheter into them, replenish their fluids intravenously, give them injectable nausea medications, and they're usually home within a day or two.

So we can correct these abnormalities with aggressive fluid therapy and hospitalizations.

Most of the time, when your dog or cat has a low white blood cell count, they're usually feeling well, it's just we wanna make sure they're not getting in that low range where they might need, if they hadn't been prescribed antibiotics, because sometimes it happens after a drug that we're not expecting for them to get low, so if they come in and they have a very low white blood cell count, we may need to delay their next chemotherapy treatment, and we may need to put them on antibiotics, and so that's probably a good time for me to remind you that chemotherapy, one of the annoying parts, I'll be honest, is for me, the cancer specialist who's trying to direct treatments for the family and the family going through is, there's a little bit of uncertainty, like sometimes, oh, we went in for treatment, it got delayed, or we needed antibiotics, so it goes back to you need to be a little bit flexible with your budget, make sure you have some room in there for extra antibiotics, extra nausea medications, and things like that, and there are maybe times where you go in and the white blood cell count was low, so maybe the oncologist had to rearrange the order or told you needed to wait a week till the white blood cell count rebounded, and that's another good question that I often get is, well, what can I do when my dog or cat's white blood cell count is low to get it back up?

In general, we don't give a routine medication to get the white blood cell count back up.

The body is really good at sensing that the white blood cell count is low, and it releases a natural substance in the body, and that's gonna stimulate the neutrophil, the white blood cell count, to rebound, and usually, most dogs and cats will rebound on their own within a couple of days, so it's very rare that we'll use this product called Neupogen, which is a human product to stimulate the white blood cell count.

The only time that I really use that product is, or that medication, is a dog, it's usually dogs that are in the hospital, their white blood cell count's really, really low, and they've been in the hospital for like 48 hours, and we haven't seen any improvement with the dog's neutrophil white blood cell count on their own.

That's when we're gonna use Neupogen, but if you go in and the white blood cell count, the neutrophil count, was too low for chemo, you may get some antibiotics, even if it's mildly low, you may not need antibiotics, you may just need a day or two, or they may tell you to come back in five days, you know, depending on, you know, the scheduling and things like that, but you may or may not get antibiotics, you may just be told that we're gonna delay treatment.

It really depends on the cancer, you know, osteosarcoma's gonna be different, what I may recommend than lymphoma, and where you are in your pet's protocol, but again, most of the time, we can't give chemotherapy if the white blood cell count's low, so we're usually gonna delay it.

The fifth thing that I want you to think about when I think about chemotherapy side effects, again, is that very preventative approach, and over the years, so I've been an oncologist, you know, going on 20 years now, you know, even I have modified the way that I do things, and a preventative approach is so important, so again, on that first day of chemotherapy, everybody's going home with their goodie bags of a nausea medication, so currently I'm using

Serenia, a diarrhea medication, metronidazole, a probiotic, I have a whole separate vlog on probiotics and why I think they're just so important, and we'll put that link in there as well.

A couple of months ago, I just went to that whole symposium in Canada on probiotics, so again, nausea vomiting medication, diarrhea medication, probiotic, and then an appetite stimulant, Entice for dogs, and Mirataz for kitty cats, so you know, you wanna go home with those, and then there are additional medications, you know, if your pet is still having diarrhea, we can use products like RX Clay and things like that, so again, we just wanna take a very preventative approach, I often give injectable nausea medication with many of the chemotherapy drugs, part of that preventative approach may be preventative antibiotics for these chemotherapy drugs that are highly likely to cause a low white blood cell count, I may use a preventative antibiotic, so not after all chemotherapy drugs, and now you're thinking, well, which ones?

So let me give you an example, doxorubicin, really common drug, it's in the lymphoma chemotherapy protocol, can be used as a single agent drug for lymphoma, it's given to dogs with emangiosarcoma, just a really common drug for cats, we often use it for mammary cancers, also in the lymphoma protocol as well, so what we know is that it is a drug that's likely to cause nausea and vomiting, and likely, highly likely to cause a low white blood cell count, so we take a very preventative approach, what do we do?