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.

所有這些想法都會在我們腦海中閃過，因為，就像我說過的，我們中的大多數人都有家人、朋友或熟人經歷過化療，或者我們在電視上看到過。

So we have so many myths and misconceptions.

是以，我們有太多的神話和誤解。

And it's not your fault.

這不是你的錯。

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

我只是想消除這些神話和誤解，給你們關於寵物化療的事實和希望。

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.

今天，我們要討論化療副作用，我之所以要做這個視頻，是因為你們已經按照我的要求做了。

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

你發表了評論，我有點不好意思。

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

你能相信我們已經寫了第 93 期微博了，但我還沒有專門寫過關於化療副作用的微博。

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.

在化療播放列表中，我確實還有很多其他視頻，都是關於化療副作用的，但我沒有一個完全專門的視頻。

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

所以，這一次就會是這樣。

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

下面我們就來談談我認為你需要了解的化療副作用的五件事。

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.

下面我將回答您擔心的副作用，以及您真的不需要擔心的貓狗副作用。

So let's do it.

那就開始吧

Let's break it down.

讓我們來分析一下。

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

讓我們來談談貓狗化療的副作用。

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.

不幸的是，我們中的大多數人可能都認識一位接受過化療的人，你可能聽我說過，但也可能沒有。

And I think it's worth repeating.

我認為這一點值得反覆強調。

Chemotherapy in dogs and cats is not chemotherapy in people.

對貓狗的化療不同於對人的化療。

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

幸運的是，貓狗對化療的耐受性比人要好得多。

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.

是以，如果您有另一隻寵物在 10 年或 15 年前接受了淋巴瘤治療，請意識到這種經歷可能並不相同，因為每隻寵物都是一個獨立的個體。

We have a much more preventative approach.

我們採取的是預防性更強的方法。

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

是以，我再次鼓勵您儘可能去看癌症專科醫生。

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

您將獲得如何看專家的鏈接。

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

我認為抓住這個機會非常重要。

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

請記住，看專科醫生並不意味著要接受化療。

Just get the information and make an educated decision.

瞭解相關資訊，做出明智的決定。

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

關於貓狗化療，我想告訴大家五件事。

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

第一，我在介紹中已經提到過，貓狗對化療的耐受性比人要好得多。

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

是以，據估計，大約 80% 的貓狗在接受化療後不會出現副作用。

That's amazing.

太神奇了

It is much lower than what we see in people.

它比我們在人身上看到的要低得多。

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

即使有副作用，也多為輕度至中度，且有自限性。

What do I mean by that?

我這麼說是什麼意思？

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

是以，輕度到中度意味著它們沒那麼糟糕。

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

自我限制意味著，如果我們什麼都不做，他們就會自己好起來。

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

但這並不意味著我不想讓我們做任何事。

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

是以，作為癌症專家，我將在第一次化療時開藥。

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

是以，我希望你們能帶著這些頂級藥物回家。

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

是以，我讓所有化療病人在第一次就診時帶著這些藥回家。

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

這就是第 38 期視頻錄像，我的五大藥物。

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

是以，我的所有病人回家時都會帶上一個禮品袋。

And you can watch that video.

你可以觀看這段視頻。

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

但每個人回家時都會帶上噁心藥、腹瀉藥和益生菌。

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.

最近幾年，市場上出現了兩種刺激食慾的藥物，狗用的 Entice 和貓用的 Mirataz。

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

是以，這些就像是你第一天自動帶回家的禮品袋。

So we take a very preventative approach.

是以，我們採取了非常預防性的方法。

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.

是以，儘管它們會自己好起來，我們還是希望您能帶著藥物回家，以便隨身攜帶，因為我們希望幫助我們的寵物克服這些副作用（如果有的話）。

So chemotherapy is very well tolerated.

是以，化療的耐受性非常好。

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

貓狗住院的風險極低。

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.

據估計，約有 5%的狗狗會因化療相關的副作用而住院，無論是嚴重的嘔吐或腹瀉（我們將再次討論這些副作用），還是嚴重的白細胞計數過低導致感染（即敗血症）。

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

是以，接受化療的患者並不佔半數，不到 5%，貓的比例甚至更低。

Cats tolerate chemo better than dogs.

貓比狗更耐受化療。

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

我通常會鼓勵那些考慮使用化療藥物的寵物主人，讓我給她用一兩次藥。

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

很多主人都很驚訝自己的寵物在化療後的表現，他們會不斷地回來，因為他們太驚訝了。

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.

所以，你可以觀看我的其他視頻，你可以看到我們的狗狗仍然在遠足，仍然在參加敏捷運動，仍然在化療期間過著非常正常的生活。

Every day is not going to be perfect.

每一天都不會完美。

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.

也許有些時候你必須為他們做飯，鼓勵他們，也許你必須用我說過的藥物來治療他們，但業主們回過頭來一次又一次地告訴我，非常感謝蘇醫生，我覺得我得到的時間是如此有品質，我得到了更多的時間。

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

這就是我幫助你們思考、推薦、思考的原因。

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

大多數寵物對它的耐受性也很好。

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

還有一點，這不是合同。

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

如果您改變主意，可以隨時停止化療。

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

只進行一到兩次化療並不意味著您簽署了整個方案。

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

如果您改變了主意，或者您的寵物屬於無法忍受的那一小部分寵物，您可以停止使用。

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.

還有一點是，如果他們出現副作用，我們可以調整化療方案，降低劑量，使用更多預防性藥物，是以我們可以調整治療方案。

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

我們對這些藥物和副作用之類的東西有很多經驗。

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.

同樣，化療的耐受性也很好，但就在這周，我正在處理黛西的問題，她不喜歡其中一種藥物長春新鹼，所以我不得不降低劑量，不僅添加了賽寧，還添加了恩替卡韋，現在她的副作用小多了。

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

我們可以調整化療方案，但同樣，大多數貓狗對化療的耐受性都非常好。

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

是以，我們正在討論化療的最大副作用。

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

關於第二、第三和第四部分，我想談談化療的主要副作用。

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.

但在此之前，我必須先了解化療的原理，因為如果我們瞭解了化療的原理，就能理解為什麼我們會看到這樣的副作用。

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

是以，化療的目的是殺死快速分裂的癌細胞。

That makes sense, right?

有道理，對吧？

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

這些癌細胞正在不受控制地快速分裂。

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.

我們體內的某些細胞翻轉和分裂得更快，這些細胞就是我所說的 "無辜的旁觀者"。

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.

是以，人體中分裂速度相當快的三大細胞是毛囊細胞，這也是人們在接受化療時會脫髮的原因；胃腸道細胞，這些隱窩細胞，是胃腸道中的某些細胞；以及骨髓中的一些細胞，因為它們的更替率很高，而更替速度最快的是白細胞，這些細胞被稱為中性粒細胞，是抗感染細胞。

So those are the ones that are damaged from chemotherapy.

這些就是化療造成的損傷。

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

是以，當我們考慮到化療的副作用時，這就說得通了。

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

人和某些犬種的毛髮會不斷生長，這就是它們脫髮的原因。

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

幸運的是，大多數狗狗都不會掉毛，因為它們的毛髮不會持續生長。

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

這就是為什麼大多數接受化療的狗狗看起來都和以前一樣正常。

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

您的獸醫或腫瘤學家可以通過一些品種來了解。

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

我認為最受歡迎的犬種是一些梗類犬種，如西施犬和貴賓犬、

Scottish Terriers, Old English Sheepdogs.

蘇格蘭梗犬、英國牧羊犬

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

哈瓦那犬等一些品種的毛髮會變得稀疏。

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

在化療過程中，他們會有一些斑禿的地方，但他們的毛髮會重新長出來。

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

如果您的狗狗有貴賓犬的血統，比如金毛狗，那麼它們在接受化療的過程中很可能會變得很瘦。

Kitty cats, they do not lose their hair.

小貓不會掉毛。

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

它們可能會掉鬍鬚，但同樣會重新長出來，或者鬍鬚會變得稀疏。

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

有些長期接受化療的貓咪身上的被毛非常柔軟，我們稱之為 "化療被毛"，非常非常柔軟。

So that was number two, was hair.

所以，第二件事就是頭髮。

Again, rapidly dividing cells.

同樣是快速分裂的細胞。

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.

第三種是胃腸道細胞，這也是我們看到 GI 或胃腸道症狀的原因之一，這些症狀可能表現為嘔吐、腹瀉、食慾不振，然後可能導致體重下降。

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.

化療也會通過大腦引起噁心和嘔吐，因為化療也會影響大腦中的一些受體，但同樣，因為化療會殺死快速分裂的胃腸道細胞，這也是我們能看到這些消化道症狀的原因之一。

When do we see GI signs after chemotherapy?

化療後何時會出現消化道症狀？

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.

通常情況下，如果是胃腸道細胞受損，化療後大約一到五天就會出現這種情況，一般來說，這種情況會持續三到五天，因為這是人體補充這些細胞所需的時間。

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

所以，既然我們瞭解了化療的原理，我們也就明白了為什麼我們會看到這些跡象。

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.

是以，我們談到了頭髮，談到了消化道，然後我告訴你們的第三組細胞是白細胞、中性粒細胞，即我們在骨髓中製造的抗感染細胞。

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

大多數化療藥物，如果要損傷這些細胞，通常是在化療後的第七天。

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.

這就是為什麼我的化療病人經常被告知，你要在化療後七天再來，這樣我就可以檢查白細胞，看看中性粒細胞計數是否變低了。

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,

如果是一種很可能導致白細胞計數偏低的藥物，因為它是一種強效藥物，我們稱之為高度骨髓抑制劑，我可能會在化療後檢查第一次白細胞計數時讓他們服用預防性抗生素，然後在我預計白細胞計數偏低時讓他們再來檢查，這就是所謂的 NADR、

N-A-D-R.

N-A-D-R。

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

這就是 NADR 預約的目的，我們要檢查白細胞計數是否偏低。

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.

我們還要確保病人沒有發燒，因為如果他們的白細胞計數很低，而且還發燒，這實際上就是腫瘤急症，因為他們可能會出現敗血症。

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.

而這 5%的患者需要住院接受幾天的靜脈點滴和抗生素支持治療。

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.

請記住，這種情況真的非常不常見，但這並不意味著如果沒有發生這種情況，我們就不需要趕緊讓他們入院，因為這可能會危及生命。

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.

是以，這種情況並不常見，但化療確實會產生一些副作用，所以我不想把化療說成是 "哦，沒什麼好擔心的"，因為儘管化療的耐受性很好，但每年還是會有一兩次化療病人的白細胞計數很低，需要住院治療、或者嚴重的，他們在化療後一天或兩天嘔吐五到七次，而病人在家裡無法服用任何口服噁心、嘔吐藥物，所以他們需要來醫院，因為他們脫水太嚴重了。

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.

我們會讓他們入院，給他們插上靜脈導管，靜脈補充液體，給他們注射噁心藥物，通常一兩天內他們就能回家了。

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

是以，我們可以通過積極的點滴治療和住院治療來糾正這些異常現象。

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?

大多數情況下，當你的貓狗出現白細胞計數低的情況時，它們通常感覺良好，只是我們想確保它們的白細胞計數不會過低，如果它們沒有服用抗生素的話，它們可能需要服用抗生素，因為有時在服藥後會出現白細胞計數低的情況，這是我們始料未及的，所以如果它們來的時候白細胞計數很低，我們可能需要延後它們的下一次化療，可能需要讓它們服用抗生素、我們可能需要延後他們的下一次化療，我們可能需要讓他們服用抗生素，所以這可能是一個好時機，讓我提醒你，化療，其中一個惱人的部分，我會說實話，是對我來說，癌症專家誰試圖指導治療的家庭和家庭經歷的是

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

一般來說，我們不會使用常規藥物來恢復白細胞數量。

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.

通常，大多數貓狗都會在幾天內自行恢復，所以我們很少會使用這種名為 Neupogen 的產品，它是一種刺激白細胞數量的人類產品。

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.

我真正使用這種產品或藥物的唯一一次，是在狗身上，通常是在醫院裡，它們的白細胞計數非常非常低，而且它們已經在醫院裡待了 48 小時，我們還沒有看到狗的中性白細胞計數有任何改善。

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.

但如果你的白細胞計數、中性粒細胞計數太低，不適合化療，你可能會得到一些抗生素，即使是輕微的低，你可能不需要抗生素，你可能只需要一兩天，或者他們可能會告訴你五天後再來，你知道，這取決於，你知道，時間安排和諸如此類的事情，但你可能會也可能不會得到抗生素，你可能只是被告知我們會延後治療。

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.

這真的取決於癌症，你知道，骨肉瘤的情況會不同，我可能會比淋巴瘤推薦什麼，以及你在你寵物的方案中處於什麼位置，但同樣，大多數情況下，如果白細胞計數低，我們就不能進行化療，所以我們通常會延後化療。

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

當我考慮化療副作用時，我想讓你思考的第五件事，同樣是非常預防性的方法，多年來，我一直是一名腫瘤學家，你知道，現在已經快20年了，你知道，甚至我已經改變了我做事的方式，預防性的方法是如此重要，所以再次強調，在化療的第一天，每個人都會帶著裝有噁心藥物的大禮包回家，所以目前我使用的是

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.

Serenia是一種腹瀉藥，甲硝唑是一種益生菌，我有一個關於益生菌的獨立視頻，以及為什麼我認為益生菌如此重要，我們也會把鏈接放進去。

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?