Need Chemo Help. Girl Having Rough Time.

[Guest beetle_slayer]

My girl had her first chemo (carboplatin) last Thursday. She was fine until Tuesday as the oncologist said would happen (4-5 days after). I came home and found loosely formed poop and a couple small vomit spots on the rug. As the night progressed, she pooped liquid and vomited all night which by that point was mostly grass she would eat. My wife and I took turns sleeping on the back patio while she would try to poop (nothing left in her) and vomit what she had just eaten. In the morning, she had clear brown diarrhea with red droplets in it. Called the oncologist and said it was most likely from straining to poop. The ordered immodium for diarrhea and Cerenium for the vomiting. She hasn't vomited since the first night, but the diarrhea is still there. The consistency is like Hershey's syrup-no blood. Another call into the oncologist. She is scheduled for a cbc tomorrow morning with her regular vet who is off today.

 

She hasn't eaten since Tuesday morning.

She hasn't vomited since Wednesday morning.

She drinks plenty of water on her own and maybe a bit more than usual but not excessive. (gets up and walk over to her bowl)

Is not lethargic but not necessarily jumping for joy.

Urinates a normal amount and frequency and normal color/odor.

Poops diarrhea stream 3-4 times a day. Note that she hasn't eaten anything for it to be solid.

Only on 1 immodium in morn and 1 at night. No other medication.

Turns nose up at food.

Gums are pink, white with touch and back to pink within a second.

Nose is cold and wet.

 

It's obvious the chemo has taken a hit on her. Is this normal behavior? Any tips or tricks? I don't think she is going to starve today or tomorrow but know things can go downhill quickly. I have tried several different special junk food and bland foods. I am worried as the weekend is upon us. I also don't think she is dehydrated, at least not very much.

 

Any help would be appreciated.

[a_daerr]

Poor baby.

 

What post-chemo meds is she on? We always did Flagyl, Cerenia, and Pepcid after chemo. And by that time, Henry was completely weaned off pain meds (prior to chemo, he had stomach issues with NSAIDs specifically Rimadyl). He went through five rounds of Doxorubicin, and didn't have any issues until the fourth one. But even then, it was nothing like you're describing. Just a bit of inappetence and diarrhea.

[Time4ANap]

No chemo experience here, but when we've dealt with tummy issues, scrambled eggs, cottage cheese or vanilla ice cream have worked when nothing else will. Worth a try just to get some food in her. You might also try ginger snaps for the nausea. Hope all goes well for her.

[RaineysMom]

I know some have used Mirtazapine to help stimulate appetite. I don't know how well it works personally since when Nube stopped eating (osteo too) he only got one day's dose in him and then we let him go the following day.

 

sending hugs. I think you really need to reach out to your vet, this sounds pretty serious.

[Guest beetle_slayer]

Talked to other vet at oncologist office today because her oncologist is off today. They prescribed Ondansetron for nausea and Metronidazole (antibiotic) for diarrhea. I also called regular vet and the girl that answered said her symptoms sound normal. I appreciate her thoughts, but they aren't chemo experts. The oncologist office said she should clear up in a day or so with the new drugs. I told her if not that I would take Barbie in Monday morning to her regular vet to camp out for the day so they can get her healthy. I hope I don't need to take her anywhere over the weekend.

RaineysMom, Its too soon for her to have any mets to cause her to go this quick as her x-rays were clear just a few weeks ago. But that said, I realize most likely that will come to be for her at some point down the road.

The oncology vet didn't seem too concerned as far as bringing her in. I assume because she is still active and drinking.

It all boils down to me knowing my dog.

She loves her cottage cheese and turns her nose away from it. I wonder if she still has a bit of nausea.

Hopefully her new meds will help quickly. She sees her regular vet at 8am.

Poor thing.

[Rickiesmom]

I second what a_daerr has said - your oncologist should have sent you home with meds for inappetence / vomiting, as well as for diarrhea.

 

For the tummy problems you can use Cerenia and Metoclopromide - sounds like you have Cerenia now. Although she isn't vomiting, if she isn't eating she probably feels nauseous and needs something to relieve that. You can give Metronidazole for diarrhea.

 

I was also advised to take Jaynie's temperature every day, ideally twice per day, and call if it went above normal.

 

FWIW given how long it has been since she has eaten, good she is being seen.

 

Jaynie did fine until her 3rd treatment, and we got through that with Metoclopromide and Metronidazole. Given that happened though, I was advised here, and followed through, to start Cerenia the day of her treatment and continue for the standard 5 days. Did that and she sailed through the last treatment. It might be worth considering that for the next treatments for your girl.

 

ETA - given how long it has been since your girl has eaten, and the diarrhea, even though she has been drinking, it might be worth asking for full blood chemistry so they also have her current values for kidney, liver and electrolytes.

Edited August 29, 2014 by Rickiesmom

[tbhounds]

Agreed with the others --they should have sent you home with medications --metronidazole (flagyl), cerenia, zofran (ondasatron), sulfasalazine are all potential medications that may be helpful in the future. One thing your oncologist may consider with future treatments is adjusting her dosage. Often, the dosage may need to be tweaked down to prevent the known side effects.

[Riverhound]

Agreed with the others --they should have sent you home with medications --metronidazole (flagyl), cerenia, zofran (ondasatron), sulfasalazine are all potential medications that may be helpful in the future. One thing your oncologist may consider with future treatments is adjusting her dosage. Often, the dosage may need to be tweaked down to prevent the known side effects.

I'm not a dog, and I've never had chemo, but when I'm puking from migraines Zofran (odanestron) shuts it down fairly quickly. I feel pretty bleh for about 5 hours, then need protein. I coud eat a raw cow as I come off it. Anything that isn't MEAT is disgusting. Just a thought.

[Guest beetle_slayer]

My wife to the Zofran when she was pregnant. Very good stuff. They did mention they were going to adjust her dosage. Since she is getting a CBC tomorrow morning, I'll ask about the full work-up. I know she has a couple recent tests to compare too as these dogs are all different. Her vet is pretty greyhound savvy. Oh the things these dogs have to go through. She is a lazy girl and has never been a big eater. I'll try a few yummy treats off an on through out the night and in the morning.

[EllenEveBaz]

[Guest beetle_slayer]

OK, just a while ago she ate a little bit of boiled chicken boob. I gave her about a 1/2 cup for now. She has been fine for now. I will gradually increase it over the next day so she doesn't get sick.

[Charlies_Dad]

Hope she is starting to feel better. Chemo can affect pups different ways and definitely stomach meds are in order as that is what we had for Charlie. Also what Tracy (tbhounds) wrote about adjusting her dosage is a good idea.

[a_daerr]

You guys are right. Henry was on Reglan too. It was Reglan, Cerenia, Pepcid, and Flagyl. He also got a shot of Benedryl during every chemo to help with any possible allergic reaction.

[FiveRoooooers]

I hope your girl is feeling better. A friend whose greyhound was going through chemo sent me this as a PDF about feeding a pet during chemo. I don't know how to post a PDF and it's a lot of info but here it is. Hang in there.

 

Feeding a Pet during Chemotherapy: An Owner’s Guide
ALLISON L. MARTIN
School of Psychology • Georgia Institute of Technology • appliedanimalbehavior@gmail.com
A little about me: I am a PhD candidate in animal behavior and work with and train animals ranging from dogs to chimpanzees. Before returning to graduate school, I worked in the field of applied behavior analysis treating children with pediatric feeding disorders, including severe food aversions. I am also a doggie-mom to two wonderful dogs, one of whom is currently battling nasal lymphoma. So, I am drawing from all of these experiences as I write this, in the hopes of helping those of you whose beloved companions are undergoing chemotherapy.

Eating as a behavior: Eating is a behavior - just like retrieving a ball or barking at the UPS man. Sometimes, especially when our pets are sick, we come to think of it as simply a biological process (which it certainly is) or a medical issue (which it is as well). We forget the behavioral aspect of eating though. As a behavior, it is subject to reinforcement and punishment and other behavioral principles. We eat more when we are around certain stimuli (such as the Thanksgiving table with our family), and we eat less when in other contexts (say, a first date). If you’ve had a recent stomach virus, you probably remember the last thing you ate before it struck…and you probably avoided it for several days or weeks afterward. Our pets are the same way, and this is something to keep in mind during chemotherapy.
Food aversion: Whereas learning most things involves many tries or “trials,” food aversion training (or learning to avoid or “dislike” certain foods) can happen very quickly (so called “one-trial learning”). This helps species survive. If you are in the wild and eat a poisonous berry that makes you sick, it is best to avoid those berries in the future. If your pet eats his normal dinner and then experiences nausea or stomach pain from the chemotherapy or from the cancer itself, he may quickly develop an aversion to the taste of his regular dinner. He may also begin to associate his nausea or pain with the bowl he eats from, the room he eats in, etc. So, what should you do?

1. Change your pet’s diet. Work with your veterinarian to determine appropriate foods and diets for your pet. If your pet refuses one food, offer a different one.
2. Vary the stimulus properties of the food. This includes things like:
a. Feed your pet in a different dish – use a paper plate or a different bowl. Hand-feeding or having your pet lick items off of a spoon might work as well.
b. Feed your pet in a different room.
c. Change the texture of your pet’s food. Puree their food (even if it is already canned) to a very smooth texture…or go the opposite route and give table-textured foods or hard biscuits.
d. Change the temperature of your pet’s food. Sometimes the smell of warm food will entice your pet. However, if your pet is nauseated, he may prefer cold food.
e. Have someone else feed your pet…or, if desperate, take your pet to a friend’s house to have dinner

Medications for nausea/appetite: Your veterinarian may prescribe medications to help control nausea or increase appetite in your pet during chemotherapy. These medications can be life savers, and I highly suggest that you discuss having an “emergency kit” of these medications for home use. However, keep the interaction between these medications and food aversion development in mind. If your pet is actively nauseous, giving an appetite stimulant may entice him to try to eat. However, if the food doesn’t stay down or results in further nausea, you may just be “burning” foods that you slaved over to prepare (or spent a fortune on). It can be a tough balance to achieve, because I know that you want to get calories in your pet, but try not to push food on an actively nauseous pet. It will likely only increase food aversion. You may want to stick with the current diet until the nausea is under control and then change diets (and perhaps consider the appetite stimulant at that time to help encourage your pet to try the new foods).

Delivering medications: Your cancer patient has likely been prescribed medications that need to be given at home. In addition, you may have herbs or supplements that you and your veterinarian have chosen to balance your pet’s diet or improve his overall health. Medications can be hard enough to give a healthy pet. Add in nausea and loss of appetite, and it can be a real problem. I would talk with your veterinarian about which medications/supplements are absolutely essential on a daily basis. Then, I would make a hierarchy of the importance of the other supplements or medications. On good day, when your pet is eating well, you can go through the whole list. However, on the worst days, it will be good to know which pills may need to be forced down and which you can skip. For medications or supplements that are sprinkled or added directly into food, I would suggest putting them in some sort of a special treat rather than adding them to your pet’s main diet…especially if the medication has a distinct flavor. I use things like almond butter, pureed canned chicken, liverwurst, baby food, etc. That way, if the taste of the supplements “puts him off,” you’ll just have to find a new treat – not a whole new diet. For tablets that you are hiding in Pill Pockets or pieces of cheese or chicken, my suggestion is to give “dummy” treats before and after the tablet. So, a plain piece of cheese or two, then the one containing the tablet, then a quick chaser of a plan piece of cheese again. (This works off of the principle of behavioral momentum, but that isn’t important…).

Calories: Weight loss can result in poorer outcomes for pets battling cancer. So, it is important to try your best to keep your pet at a healthy weight. Ask your veterinarian approximately how many calories your pet needs to maintain his weight. Then, keep a log of what your pet eats in a given day. If you are using commercial diets, you will likely have to go to the manufacturer’s website or call the manufacturer to determine calories (they are often not listed on the bag or can). For homemade foods, you can use online calorie counters or look at the packaging. I wouldn’t suggest doing a detailed log each day – you may go insane. However, I would use this as a periodic check to see how close you are to your pet’s caloric goal. It willl help you know if you are falling far short or may reassure you that you are doing better than you think you are (you’d be surprised how quickly some cheese and bacon will get you to your caloric goal).
Hydration: There may be some days when your pet simply will not eat. I know I panicked the first time that happened, so I won’t tell you not to. It really is a marathon though, so try your best to look at the big picture. If he doesn’t eat today, he will be ok. However, if he isn’t drinking enough, that will become an emergency very quickly…and dehydration will only make your pet feel worse. Talk to your veterinarian about learning how to administer subcutaneous fluids at home. Also have her teach you how to check for dehydration. It was very reassuring to me to be able to give my dog the fluids that he needed, and it often helped his appetite as well.

Reinforcement: I believe that pets are fairly honest when it comes to eating. Barring an aversion to that food or the fact that they currently aren’t feeling well, they will generally eat most anything edible. I also do not think that pets are manipulative. I wouldn’t worry that, if you give your pet steak, they will “hold out” for steak and refuse to ever eat kibble again. However, you can accidentally reinforce food refusal behavior. If refusing one food results in the immediate presentation of “something better,” why not make a habit of refusing the food in front of you to see what comes next? I got around this by offering several things simultaneously and then providing more of whatever my dog chose. This gives the pet choice (which we all like to have) without setting up a behavior chain of food refusal. In fact, it helps to reinforce his eating behavior. Another thing to keep in mind is how much attention you give your pet when he is refusing food versus when he is eating well. Remember to praise your pet when he is eating well. Don’t make a big fuss over him when he refuses food (as much as you want to). Be matter-of-fact about it and offer something else an hour or so later.

Timing: If your pet isn’t eating well, try offering food several times a day. My dog went through a period where he ate best at midnight. He’d wake up to go outside, but then he’d feel like eating. So, that is when we ate. Also, if your pet refuses a food for breakfast, don’t rule it out for dinner. The next meal may be completely different.

A safe place: If you are nauseous, the last thing that you want is people poking food in your face. At some point, I realized that I was traumatizing my dog by following him around shoving food in his face. I decided to give him a “safe place.” He has a cool mat that he loves to lie on. When he was in his spot, I never offered him any food or pilled him. I tried to only offer food when he came in the kitchen, but I found myself breaking that rule on his bad days and would offer him food in other rooms. However, I do think it is important that your pet has a “home base” where he won’t be pilled and food won’t be shoved in his face.

My own experience: I started out with a balanced (by my veterinarian), healthy, homemade cancer diet. My veterinarian helped me determine the amount my dog would need to put a little weight on him (I kept him slim for agility and general health). Everything went well for a couple weeks, and I was patting myself on the back for being such a good dog owner. Hopefully, you and your pet will stay in this happy place for a long time…some animals take chemotherapy like it is water. My dog did not. The loss of appetite and nausea came after about two weeks and lasted (in varying degrees) for the next 7 months of chemotherapy. At one point, I figured out that I was spending 4 hours a day cooking for and feeding my dog (and, yes, this was in addition to being a full time graduate student and working two part-time jobs). I learned to have a large variety of foods on ready. Although no two days were the same, I’d say that a typical meal would start with some pills hidden in almond butter or pill pockets. Then, I’d put down a plate with 4 – 5 things on it. Typical items might be steak, chicken thighs, pork chops, hot dogs, goat cheese, broccoli, asparagus, cold pasta, canned food, dry food, etc. I’d figure out what he was eating at that meal and then offer more of that item. If he wasn’t eating much of anything, his go-to foods included bacon, goat cheese, and chicken and rice baby food. I probably tried 10 types of baby food before I found one he would eat. Freeze-dried chicken or freeze-dried beef liver were two other go-to foods when nothing else would work. I had one day when all he ate was broccoli and another when all he ate was watermelon and some tortilla chips from Moe’s. His special treat was baby food rice cereal with whole goat milk (that was good for getting calories in him too). While I still tried to prioritize high protein/moderate fat foods and get in as many supplements in as I could, there were many days when I would offer him anything he would eat (that wasn’t toxic or that he wasn’t allergic to). I’d wonder the aisles at the grocery store…Spaghetti O’s? Sure! Spam? Worth a try! The dog that I taught not to beg was suddenly eating French fries beside me on the couch. At our lowest, we were seriously considering placing a feeding tube. In the end though, my dog actually ended up gaining weight throughout his chemotherapy treatment.

Having a pet with cancer really is an emotional roller coaster. Be kind to yourself. I hope my experiences / recommendations will help you on your ride.
ALM

[Guest beetle_slayer]

_{She is on the Flagyl for diarreah. She ate a few handfuls of boiled chicken breast last night and picked through her kibble this morning to get the chicken out. I am having a difficult time hand feeding because my 85lb boy has to butt in.}

_{Her red blood counts were elevated and everything else looked good this morning. This was because she's a greyhound and she's a bit dehydrated. He wasn't worried as long as she is eating and drinking and not vomiting. Her weight was pretty scary to me. Pre-amp she was 65lb. Last Thursday she was 59.5lb when she went in for chemo. This morning she was a fragile 49lbs. Hopefully she will continue to eat throughout the weekend. I feel she is on the mend. The long post has some good points. I am at work today and will read it more in detail this evening. Thanks everyone.}

_{By the way, she has a homemade food I give her 50/50 with her kibble made of grnd tky, eggs, broccoli, and kale. I don't want to force anymore than she wants. Multiple small meals are probably better than 2 big meals.}

[Guest hlpnhounds]

That is an excellent article posted by Roooooers with very sound advice.

It is also important to know how many calories your dog needs to get into him in order to do well. The bland diet that may be recommended when diarrhea hits (boiled lean protein and white whole grain rice), while getting easily processed nutrients into our ailing pets, are not a balanced diet to be used long term but should be used to get them eating again.

 

Logan has gone "off feed" for the past few weeks. It has been a bit of a struggle to get enough food into him. For years, we have given all of our dogs a tablespoon on home made chicken mash on their kibble in the morning. In the past month or so, Logan has refused to touch the mash. He has gone so far as to snub his food if it was stirred with the same spoon as the other dogs' food. He has had a meal or 2 that consisted of primarily hot dogs and cheese as that is ALL he would eat. Not ideal by any means. Some days, he will refuse his morning meal initially but will then either nibble on it throughout the morning when it is offered again or he will eat it all at one time when it is offered. Most evenings he will eat his entire meal right away.

He had a bout of diarrhea last week ----5 days before his first chemo treatment. We had to start the bland diet and metronidazole in addition to his Rimadyl, gabapentin and tramadol. Thankfully, the stools firmed up before his chemo treatment. It's really difficult to say what is causing him to go "off feed" and become so picky. He will eat his food....just not always when we want him to eat it. We have just learned to try various things for him. He likes Hill's T/D food---we use it as treats here. The large kibbles are kept in a jar on the kitchen counter. There have been times where he has been hand fed several of those large kibbles after getting his meds just so that we are sure he has at least something in his gut with all that he is on now. I keep a separate container of the T/D on the counter with 60 of the "biscuits" counted out as that is ONE full meal for him. If he will eat nothing else on any given day, at least I can sort of keep track of how much he is taking in. Then again, each of his meds is given in a "meatball" of canned food or a slice of hot dog or something like that. His list of analgesics, antibiotics and anti nausea meds is quite long. He certainly has quite the pharmacy going at this point. It's no wonder he doesn't want to eat sometimes.

 

I wish you luck with your hound. It is not an easy road we are on---there are bound to be some bumps along the way.

[galgrey]

I hope your sweet girl continues to improve.

[Guest normaandburrell]

No advice, just hugs and best wishes.

[TwiggysMom]

I am sorry to hear that Barbie had such a tough time with her first chemo treatment. Twiggy had 6 rounds of carboplatin, and I never saw any side effects until after her 4th round. However, they did give her a Cerenia injection, and send her home with 4 days' worth of Cerenia tablets. I also kept her on twice-daily doses of omeprazole (generic Prilosec).

 

I was fortunate that Twiggy has always been a total food monster. I think think this must be so much more difficult with a non-food motivated hound. Even so, after rounds 4-5, she was occasionally a little slow to eat her food, and she had a very bad reaction to her last treatment.

 

She did have relatively frequent bouts of what I call "chemo poop", which is that orangey, mucousy, runny stuff that seems common with chemo. She did get metronidazole when things got icky that way, but her worst issues were mostly varied UTIs and skin infections.

 

We used topical treatments for the skin infections (colloidal silver and medicated baths), and I started her on a supplement recommended by her vet (UroMaxx) to prevent future UTIs after we got the first one under control.

 

I hope Barbie is feeling better and re-gaining her appetite!

[Guest beetle_slayer]

Twiggy is Barbie's hero. She has never been much of a food monster like my boy. He will eat ANYTHING!!! but can't. She can eat anything but won't. She snubs her nose at her homemade salmon steak, sweet potato, egg squares. I am giving her kibble and turkey/egg veggie squares she loves but will eat half and go lay down. A few hours later she will eat some more. This is a pain because I have to take it up so my boy doesn't inhale it. The one thing she loves most is a raw egg. I agree that she needs a balanced meal. Hopefully we can get there in the next day or two. I think they are a lot like us in that not every meal is balanced but a group of meals provides balance. She appears to be on the mend but is still drinking more water than normal-not a dangerous but a noticeable amount. She has had a few accidents inside. I don't think it is UTI, but more too lazy/not wanting to go outside as she usually is. The Flagyl could possibly treat that if it was unless it is a different type of bacteria. I feel she is on the mend. I think she got this way because I was ignorant about the medications and should have gotten them and given them sooner.

Thanks everyone for the help. She has been getting up on her couch the last 2 days which is a good sign of her happiness and recovery. Thank goodness for a holiday tomorrow to stay home!

[Batmom]

Glad she is eating something! Don't worry about balance over the short term (6 weeks or so). Over that period of time, any calorie is a good calorie.

[Guest beetle_slayer]

Well she is back to eating like a little pig again. It will take some for her to fill back out. I can feel quite a bit more of her spine than I want to. Its pretty scary how fast these guys can drop weight. I think she should be around 56-59lb range (min and max). 49lbs was a pretty big shock to me. The way she's eating it won't take too long for her to get back up there. She is scheduled for Sept 11 for her 2nd round. This time I know what to do different along with a dosage change.

[a_daerr]

Great news! So glad to hear she's eating again.

 

Henry finally leveled out at 64 pounds (9 pounds below his pre-amp weight). He still looks a bit skinny sometimes, but part of that is due to the way he stands. One side of his ribs looks more protruding than the other.

[Guest beetle_slayer]

I expect that of her. She was between 62 and 67lbs pre-amp. At her first chemo she was 59 (16days post-amp). Not sure how much fluid was still in her. She is a dainty girl but still had some muscle as she had 70-80 races under her belt. Her ribs are showing some by the way she stands but her backbone is definitely sticking out which I don't like.

 

On a second noted, is thirst or excessive drinking, polydipsia, something noticed with Flagyl or metronidazole? She drinks a bit more than normal. She is of the ondansetron (Zofran). I know its hot out here in Dallas, but it has been hot all summer. I'm hoping its a side effect and not a UTI. I will check in a day or two if needed.

By the way, her spirits are great. She goes outside and "hunts" as she has always loved to do. She has overwhelming confidence which I believe is helping her and me through this.

[Guest beetle_slayer]

a_daerr, I just looked at Henry's pedigree just out of curiosity. My Barbie's grandsire was Gable Dodge. Someone had mentioned a study about GD descendants having osteo. I think this is a very inconclusive study given the amount of offspring he had. Also, couldn't the efforts be put to better use? Just my .02.