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What to Expect 2: Chemo and After

This is a companion page to our “What to Expect with a Leg Amputation” page. Another aspect of osteosarcoma that many people fear is putting the hound through chemotherapy. Here I’ll talk about our experiences with doxorubicin chemo, since that is what Ohio State University provides for free to greyhounds, and what I have used on my personal dogs Whitey and Apollo.

A lot of people are reluctant to do chemo because they have known someone (human) who has been through chemo before and have seen how hard it was on the person. Dog chemo is not like human chemo. With human chemo, the goal is to completely annihilate every cancer cell so that it never, ever returns. Therefore, they give a huge dose and the person gets really sick. With dogs, the aim of chemo is to prolong quality time as much as possible. So they balance side effects against effective dosage, and they give a dose that most dogs can tolerate.

Dogs don’t lose their hair when on chemo. The most common side-effects are some nausea or diarrhea, but there are drugs such as Cerenia that can help this pretty effectively. The chemo process itself is minimally stressful for the hound; in fact, many sleep through it.

Before you start doxorubicin (Adriamycin) chemo, your dog will need to have a thoracic ultrasound. You will probably need to go to a specialist or vet school to have this done. One of the potential dangers of doxo is damage to the heart, so the vets want to make sure that your dog has a healthy heart to start off with.

The ultrasound is no big deal. It’s just like an ultrasound on a pregnant woman. The dog lies on his side; they smear on some gel goo; and they view the dog’s heart on the ultrasound machine. If all looks good, you will be cleared for doxo. If not, you will need to look into other chemo options (which are not free) such as carboplatin or cisplatin. The ultrasound will need to be repeated between your 2nd and 3rd doxo treatment to make sure that no damage to the heart is occurring.

OSU will probably recommend 5-6 doxo treatments for your hound, one treatment every 2 weeks, and will send your vet instructions for how to administer it. The process at each treatment is the same:

When you arrive at the vet, the first thing they do is take a blood sample for a CBC, to check the number of white blood cells your dog has. If the number is too low, you cannot do chemo that week. Chemo causes a drop in white blood cells counts (it suppresses the immune system) and you can’t let them drop too low. Running the CBC takes around 20 minutes. If everything is good, then your dog will get a shot of Benadryl. While that is kicking in, the vet will place the IV catheter for the doxo.

The IV insertion is probably the only mildly stressful part of the process, and it’s over in about 30 seconds. That’s the last “poke” of the day. The vet will hook up the syringe of chemo drug to the IV line, and the infusion takes around 45 minutes. The vet may do it by hand, or via a machine that gradually infuses over a set period of time. During this, the hound won’t feel anything and may even doze off.

Some people will need to drop off the dog for this before work and pick up again after work. But if you are able, many vets will allow you to sit with your dog in an exam room while the entire process is taking place.

(As you can see, the doxorubicin is bright red! That’s not Apollo’s blood in the line.)

On your first treatment, they’ll ask you to stay around for 30-60 minutes after it is over to make sure your dog does not have an adverse reaction and need care. Then you’re done! They should send you home with an anti-emetic such as Cerenia in case your dog does have vomiting or diarrhea. If you’re comfortable giving a subcutaneous injection, you might ask for the injectable form because it seems to work a little faster and better than the oral pills.

Every dog will react differently, and the reaction might be different on different weeks. The most common pattern for my boys was to be fine the day of treatment and the next day, but on the 2nd day after treatment to feel a little nauseous and not want to eat. They would miss a meal or two and then get back on track. On the day that they were off their food, I would do a Cerenia injection. Neither lost weight due to chemo.

While on chemo, you need to be more careful than usual about infection. Your dog’s immune system is suppressed, and he cannot fight off infection the way he usually can. If he gets a cut or scrape that might normally be no big deal, you’ll want to make sure to clean it out very well, and potentially get some antibiotics from your vet. If you generally raw feed, most vets will recommend that you stop that during chemo. Any bacteria that might give your dog no problem at other times could now prove much more serious.

In our experience, Whitey did contract an infection at one point during treatment. We don’t know what caused it, but he presented with a high fever, lethargy, and a rapid pulse. We took him to the emergency vet (and yes, when they are on chemo, a high fever is an emergency) who found that his white blood cell count was off. After some sub-q fluids he started to feel much better. We started him on some antibiotics and he was back to himself by the end of the next day.

The chemo process for us has generally been very easy. Some dogs will get sicker than ours have, but there are good anti-emetic and anti-diarrheal drugs available, so don’t be shy about asking your vet to prescribe them.

The statistics that OSU gives for life after osteo are as follows…. With no treatment other than pain management alone, the average life expectancy is 2-3 months after diagnosis. With amputation alone (no chemo), the average is 4-6 months. With amputation plus chemo, the average is 12-18 months.

We sadly only got 5.5 months with our Small White Dog, but they were great months free of pain, and we know we made the right decision for him.

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