Pet Owners

FAQs

Below are answers to some of the most frequently asked questions. If you need any additional information, please don’t hesitate to contact us.

1. Basic Veterinary Oncology

Nearly all pets diagnosed with cancer have the potential of receiving treatments aimed at addressing the cancer condition and/or improving and maintaining their quality of life. The extent and duration of a treatment benefit is dependent on many factors including the type of the cancer, the stage of the cancer (i.e. the extent of disease), the available therapies used to treat the cancer, and the individual features of the patient.

To learn what course of treatment is best for your pet, we suggest that you schedule a consultation with a medical oncologist. He or she will evaluate your pet, perform staging diagnostics if appropriate, and develop a list of options to best treat your pet. This involves a discussion of the unique characteristics of your pet’s condition, your goals, and the effectiveness, side effects, and costs of each option.

An important responsibility of our team is to develop a list of treatment options that can be financially acceptable to a family. Some forms of cancer therapy for pet animals are expensive. Having said this, there are often alternatives to these conventional options. For instance, clinical trials and compassionate use programs, available through our practice, involve novel anti-cancer therapies that may be provided at no cost. In some instances, these programs may also provide support towards the costs of some if not all care related to a patient. Our unique relationships with Animal Clinical Investigation, LLC and academic veterinary oncology groups facilitate access to many of these trial opportunities.

Cancer typically affects geriatric/senior companion animals; therefore, most of the information that we have regarding the efficacy and tolerability of the chemotherapy/radiation therapy protocols already takes into account the use of these treatments in older populations of animals. Concurrent illnesses (i.e. kidney, heart, liver disease) have to be assessed and considered by our team as we develop and discuss the treatment options for your pet.

2. Appointments, Return Visits, Lab Tests, and Emergencies

The Oncology Service, LLC has expanded its services to three locations in the Greater Washington Metropolitan area and Virginia. These include Washington DC, Leesburg VA and Richmond VA. New patient appointments are available as drop-off consultations or as face-face consultations (see below). All of our locations are affiliated with hospitals that provide 24-hour care, so you may drop off your pet as early as you like, and pick them up as late as necessary. Clinic hours vary per location, but you may call and speak with one of our Client Service Representatives at the location most convenient to you to schedule an appointment.

When you schedule your consultation, you will be asked who your primary and/or referring veterinarians are. Those offices will then be contacted by our staff to ensure that all of your pertinent records are faxed or emailed to us prior to your appointment.

These records will then be reviewed prior to your pet's visit in order to assess the need for additional diagnostics and to formulate treatment options. You are asked to bring in copies of imaging studies (i.e. radiographs, ultrasounds, MRIs) as these are typically not obtained when requesting your records. If these are not available and are necessary or out of date, we may discuss repeating these diagnostics at our office during your visit.

Drop off consultations: If you are unable to come to the clinic during one of our scheduled appointment times or there is no available face-to-face consultation times that day, we offer the option of a drop-off consultation. For drop-off appointments, you will drop your pet off at a designated time in the morning, and one of the oncology doctors will call you after he/she has reviewed your pet’s medical history and performed a thorough physical examination. During this initial conversation, the oncology doctor will review your pet’s pertinent medical history and will go over diagnostic and/or treatment options recommended based on your pet’s needs. Once a plan has been established, additional diagnostics and/or treatments can be accomplished during that same day. A face-to-face meeting can usually be arranged at the end of the evaluation or at discharge to answer any remaining questions and to review any additional pertinent information.

Face-to-face consultations: Face-to-face consultations provide you and your pet the opportunity to interact with our staff. During your consultation, the oncology staff will provide you with basic information about your pet’s specific diagnosis based on the medical records that we have reviewed. We will then discuss the diagnostic tests needed and/or treatment plan that has been customized to your pet. This discussion and evaluation is estimated to take 30-60 minutes, depending on case complexity and availability of medical records. Basic diagnostics (i.e. bloodwork, urinalysis, radiographs, fine needle aspirates) can be performed while you wait. If a more complex procedure is needed, the estimated time needed will be communicated to you so that you may decide on dropping your pet off, waiting, or returning on a different day for the diagnostics tests to be performed. Once all diagnostics are completed, we will reconvene with you to discuss findings and recommendations for therapy. If you are comfortable with the information presented and have made a decision about therapy, treatment can often be initiated that same day. The average time for a consultation is variable, but please allocate a minimum of two hours for your visit to the clinic.

Our client service representatives Tracey Baxter (Washington, DC), Jaime Finkelstein(Leesburg, VA) and Crystal Cruz (Richmond, VA) can discuss the scheduling options in more detail when you call for your initial consultation, and help you to determine which type of appointment would best suit you and your pet.

There is no price difference for a Drop off or a Face-to-Face consultation. This includes our time to review your pet’s medical record, a thorough physical examination, and a discussion about your pet’s condition and treatment options that can be considered. Any diagnostics and/or treatments performed at the time of your pet’s consultation are not included with the initial referral fee and an estimate will be provided for these additional costs.

For drop off appointments, your next appointment date will be scheduled for you and included in your discharge instructions. For timed appointments, you will schedule your next appointment at each visit.

For drop-off recheck appointments with The Oncology Service, your pet will need to be dropped off in the morning of your appointment date. This drop off time may vary depending on your location. This is to ensure that we have sufficient time to submit laboratory tests (bloodwork, urinalysis) or perform other diagnostics that may be needed prior to your pet’s therapy. We also need time for the doctor to examine your pet and for administration of treatment. Most pets are ready to go home after 6:00 pm, and we will call you when the treatment is complete. For those cases where additional diagnostics are needed, the time for discharge may be later and will be discussed with you.

During the time your pet is in hospital, our support staff will make sure that your pet has food (if indicated), water, clean bedding, and the opportunity to go outside for short walks. If your pet is receiving any medications, please have these ready with instructions on times to give.

For follow-up questions relating to your pet’s care with The Oncology Service that are non-urgent in nature, you may reach us via email at any time, or by phone during business hours. Please note that a voicemail or email message left after business hours will not be returned until the next business day. We do monitor email regularly; however, for any urgent matters please do not wait for an email response. If you have an urgent question during business hours, please call us. If it is after normal business hours, please call your closest emergency facility.

Emergencies can occur at any time and can be life-threatening if not managed correctly. In the event of an emergency, please take your pet to the nearest emergency facility for initial triage and supportive care. If you are concerned that your pet is having an emergency, DO NOT EMAIL the oncology doctors.

All four of our offices are affiliated with 24-hour emergency and critical care hospitals. We work closely with the doctors at these hospitals, and it is our expectation that we are involved in the care of cases that have an emergent problem. Alternatively, we are happy to work with your primary care veterinarian or other emergency hospitals if that becomes necessary or more convenient for you.

Things that you can do to help the emergency veterinarian managing your pet’s care includes provided them with the following information:

  • Your pet’s cancer diagnosis
  • The last cancer treatment your pet received and the date of that treatment
  • All other medications that your pet is currently receiving including their doses and the last time the medications were administered

Once your pet is receiving initial medical attention, our on-call doctor can be reached by the attending veterinarian. The veterinarian taking care of your pet should call the specialty/emergency hospital associated with your pet's TOS doctor.

It is important for you and your pet to adhere to the recommended treatment and/or recheck bloodwork schedules. These schedules are created in order to maximize the benefit from therapy and to monitor for expected toxicities that can occur with treatment (i.e. low white blood cell counts post chemotherapy). If you can’t make a scheduled appointment, please contact us as soon as possible so that we can advise you on the next available appointment. If you are unable to get recheck bloodwork done on the day recommended, please discuss this with our team so that we may best advise you on alternatives.

3. Chemotherapy

While there are certain dog breeds and some cats that do show hair loss during chemotherapy, for the most part, this is not common. Hair loss is more common in non-shedding dog breeds (i.e. poodles). If hair loss occurs, re-growth will occur when chemotherapy is stopped.

The image of the human cancer patient experiencing chemotherapy related side effects is not our expectation in cats and dogs. In general chemotherapy in dogs and cats is well tolerated. This is in part related to our goal to use protocols that maximize quality of life and the resilience of our pet animals.

Most pets will experience some mild and self-limiting side effects including decreased appetite, energy, and overall demeanor for 24-48 hours after a treatment. Isolated episodes of vomiting and diarrhea can also be encountered. The risk for more significant side effects includes a 1:10 chance of vomiting and diarrhea characterized by 3 or more episodes of vomiting in a 24 hour period or diarrhea that may be profuse or occasionally bloody in nature. A 1:100 chance of life threatening complications primarily associated with white blood cell suppression (neutropenia) and secondary infection can also occur with most chemotherapy. Dogs and cats that at risk for these more severe chemotherapy side effects are typically very lethargic, not eating, dehydrated, weak, and many will have a fever. There are some less commonly used treatment protocols where this risk is higher. If you are concerned about your pet’s current clinical status, please contact us or have your pet evaluated. In addition to these more typical side effects, individual drugs may also have other side effects that are specific to that therapeutic. See our chemotherapy handout for further information on side effects.

Unless the doctor tells you otherwise, you can continue these treatments.

We do not always recommend vaccines while a patient is on chemotherapy. If your pet is due for their vaccines, please discuss this with our team. We will work with your primary care veterinarians to provide recommendations that are in your pet’s best interest.

Prednisone, a common oral steroid, is frequently given as part of several treatment protocols including those for lymphoma. Prednisone is often used as a long-term medication for many of our patients, and the dosage should not be altered or discontinued without consent from our team. Side effects including increased thirst, increased urination, increased appetite, panting, anxiety/behavior changes, or weight gain, may be seen and may warrant changing the dosage of this medication. If you are running low on this medication, please inform us at your pet’s next appointment or contact us via phone so that we may refill this medication. Please note that we do require at least 24 hours notice to fill prescriptions. Our locations have varying clinic hours, so do not wait until you are out of medication to call us.

Complementary and alternative (CAM; aka Holistic) medications are becoming more and more recognized and used for the management of cancer. We support the use of all effective treatments for your pet.

At The Oncology Service, we believe that there is an opportunity to include these medications in your pet’s therapy at certain times and under the guidance of a holistic veterinarian (see Comprehensive Care section). We will work with you and your holistic veterinarian to integrate treatment approaches. Our goal will be to develop a plan including both conventional and alternative treatments for your pet so as to minimize side effects and limit the risk of inhibiting the activity of chemotherapy with the use of other medications. Given the absence of formal clinical trials demonstrating the effectiveness of many CAM approaches, we will rely on the insight and expertise of the holistic veterinarians who have directed the CAM treatments for you pet.

The effect of diet on the development of cancer has been an area of ongoing interest in both people and in pets. Unfortunately, it is very difficult to isolate what potential foods or food components fuel or treat certain diseases. Although there are many claims on the types of diets best suited for cancer care (especially on the internet), very little rigorous data is available to assess the claimed benefits. This is likely the result of the complexity of the question and that each individual has distinct needs.

Some groups purport that carbohydrates should be eliminated while others feel that higher fat diets can result in increased cancer risk. The Oncology Service recommends a balanced and fortified premium dog food where the protein source remains consistent. We also prefer those diets that are AAFCO feeding trial certified (supervising agency on dog nutrition) and particularly those that are certified for that life stage (i.e. all stages, puppy, adult, senior). These diets have been formulated to ensure that necessary nutrients are available to promote health.

Raw food, or BARF diets, are also increasingly popular for dogs and cats; however, these diets can be particularly problematic for pets with cancer. Raw foods (especially meat) include pathogenic (illness producing) bacteria that can result in serious gastrointestinal infections for both your pet and for you. Some more serious examples include Salmonella, E. Coli, and Campylobacter. This concern becomes particularly important for our patients that are receiving immunosuppressive therapy (i.e. chemotherapy), as they can be at a higher risk of significant infection due to their compromised immune system. We do not recommend such diets in our patients.

If you have concerns about your pet's nutritional health, The Oncology Service does work with veterinary nutritionists that are available for phone consultations regarding diet formulations for pets with cancer.

After treatment, trace amounts of active chemotherapy can be excreted by the body through bodily secretions (i.e. saliva, urine, feces). Studies have been performed assessing some of the more common chemotherapy drugs and their metabolism, and active drug residues have been found following treatment in urine and in other body fluids. The health risk of these trace amounts of chemotherapy to you and other pets is not known but believed to be very small. Health risks that may be linked to such trace exposures are likely most significant if repeated over long periods (months or years) and are not related to short term exposures. Some populations of people should exert greater precautions (pregnant women, individuals who are otherwise immunosuppressed). We recommend that you take precautions to minimize direct contact with urine, vomit, and feces from your pet while receiving chemotherapy. We also recommend the following chemotherapy safety tips:

  • Wear gloves when handling all excrement or vomitus. Place the waste in a sealed trash bag and discard in appropriate disposal areas. Wash your hands with soap and water.
  • If you pet received a tablet formulation of chemotherapy (i.e. CCNU, Cytoxan, Leukeran) and vomiting has occurred within 4 hours of the treatment, check to see if the tablet is readily identifiable and contact The Oncology Service for further instruction. Do not pick up the tablet without wearing gloves.
  • If administering home chemotherapy (i.e. Cytoxan, Leukeran), study drugs, or small molecule inhibitors (i.e. Palladia and Kinavet), always read the dosing and handling instructions prior to administration. Wear gloves and avoid direct contact with the medication. Wash your hands thoroughly once done and place remaining prescription in an area where children/pets can’t readily access.
  • Walk your pet in areas of low traffic especially avoiding areas where children and other pets may frequent. The trace amounts of chemotherapy in urine and feces will be breakdown spontaneously in the environment and do not pose a risk to the environment.
  • It is reasonable to minimize the opportunities for your pet to excessively lick you, your children and family after treatment.
  • Allow your pet the opportunity to free access to water and frequent walks to use the restroom to minimize risk of accidents in the house.
  • You do NOT need to have separate feeding bowls, water bowls, bedding, or litter boxes for your other pets as long as these are well maintained and have not been soiled by the pet undergoing treatment.
  • Contact The Oncology Service if your pet experiences more than 3 episodes of vomiting in a 24 hour period or profuse, bloody, or mucousy diarrhea.

With these helpful tips, your risk for chemotherapy exposure is very, very low. Please do not hesitate to contact us with any questions relating to your pet’s chemotherapy and supportive care.