The night before my dog Cardiff was slated to start his first chemotherapy treatment was a rather sleepless one for me. My mind was racing about what his overall response would be. Would Cardiff suffer side-effects? Would I repeatedly wake up each night to find him needing to go out to have diarrhea or heaving to produce vomit?
I ultimately had to medicate myself to get to sleep at a reasonable hour, as I had to be semi-fresh and functional to effectively oversee Cardiff’s chemotherapy administration process.
Fortunately, I work on a weekly basis at the largest cancer treatment facility in the country (between multiple facilities), the Veterinary Cancer Group, so I have the expert guidance of experienced veterinary oncologists (like Dr. Mary Davis) to support me through Cardiff’s chemotherapy, and proficient technicians to administer his treatments.
As Cardiff’s appetite has not been as good post surgery as it was in the four weeks leading up to his diagnosis and surgical removal of an intestinal mass, I have concerns for how he will eat once we get going on his weekly chemotherapy treatments.
Cardiff will be undergoing 24 weeks of treatment (approximately six months) with a specific protocol for lymphoma called the University of Wisconsin Canine Lymphoma Protocol (CHOP). Every week is different on the CHOP protocol, and Cardiff even gets two weeks off during the first ten weeks of treatment. Blood testing to evaluate his baseline internal organ function and red/white blood cell and platelet levels are performed every week before he gets his chemotherapy, or during a week off from treatment.
There’s a likelihood that Cardiff’s appetite will be diminished on chemotherapy and cause him to utilize his body’s reserves for energy and lose weight. To ensure Cardiff will have the best response to treatment, I have been striving to increase his calorie consumption by feeding him larger and more frequent meals. Additionally, he’s eating more calories from protein and fat.
His appetite still has not returned to it’s reliably normal levels as it was pre-cancer, as it takes weeks to months for his intestines to fully heal from the trauma of surgery and for normal nerve conduction to be reestablished. Fortunately, he's very cooperative for syringe feedings of Honest Kitchen Pro Bloom, a dehydrated, goat milk-based probiotic and digestive enzyme supplement that helped to jump start his digestive tract during his post-surgical recovery.
Fortunately, one of the drugs used during his chemotherapy treatment is Prednisone. Prednisone is a steroidal anti-inflammatory drug that helps to promote better appetite and increased water consumption, and generally makes a pet suffering from cancer or other appetite-zapping illness feel better. Cardiff has received Prednisone on three prior occasions during his bouts of immune mediated hemolytic anemia (IMHA). Yet, the doses Cardiff will be receiving during his chemo protocol are lower than the high doses used during his IMHA treatment to suppress the immune system from destroying its own issues (red blood cells).
Cardiff will be on Prednisone for the first four weeks of his treatment with the dose and frequency sequentially tapering. As Prednisone has previously helped his appetite to stay good during his IMHA treatment, I hope it will have the same effect during his chemotherapy.
Besides the Honest Kitchen Pro Bloom, I have some other tricks to help to promote his better appetite and digestive tract health, including:
Rx Vitamins for Pets Nutrigest — probiotic, anti-inflammatory, and intestinal cell supporting supplement
Mirtazapine (Remeron) — tricyclic antidepressant medication which increases neurotransmitter (norepinephrine and serotonin) levels in the brain
Famotidine (Pepcid) — Histamine-2 blocker which reduces stomach acid production, commonly used with patients taking steroidal (Prednisone) or non-steroidal (Rimadyl, Metacam, etc.) anti-inflammatory medication to reduce medication-associated digestive tract inflammation
Acupuncture and Acupressure — promotes improved energetic movement around the body, breaks up areas of qi stagnation (energetic restriction), and permits better blood circulation and lymphatic drainage
Vitamin Injections — Vitamin B12 helps animals suffering from intestinal inflammation or bacterial overgrowth, which can prevent proper absorption of the vitamin and other nutrients
Fluid Therapy — reduced appetite often pairs with diminished liquid consumption to maintain normal hydration. Fluid therapy, given under the skin (subcutaneously) in Cardiff’s case, maintains normal cellular function, electrolyte levels, and aids in the detoxification of the body through the liver and kidneys (permitting toxins and metabolic by-products to be excreted in the feces and urine)
Hopefully, Cardiff will sail through his chemotherapy treatments with minimal side effects. Considering how well he tolerated his treatment during his three bouts of IMHA, I feel hopeful that he will respond similarly to his cancer treatments.
Dr. Patrick Mahaney