I love how Christmas-y it is right now! It's gotten pretty cold here in Raleigh (it actually rivals Pennsylvania weather!), and we're expecting a dusting of snow tomorrow. Naturally, everyone is freaking out at the news. Plus, without classes I've had the chance to do Christmas baking, shopping, and movie-watching. It's going to be really strange (and not so fun) going back to long days and hard-core studying in January...
Now that we're done with the fall semester, I've had the chance to spend the week with the oncology department in the teaching hospital. LOVE IT! There's a senior clinician on staff each week along with five oncology residents and three fourth-year students. It's been a blast tagging along on appointments and treatments and getting some first-hand information on the whole internship/residency process from people who are currently in its midst.
Things I've learned this week...
1) On the whole, cancer medicine is NOT depressing! Sure, there is always patient death or euthanasia to contend with, but that is true of any part of veterinary medicine. "Cancer" is not necessarily an immediate death sentence. Owners that bring their pets to the oncology service are able to get answers to their questions and often get additional time (often years) with their animals that they wouldn't have otherwise.
2) You don't really cure cancer as much as treat cancer. For example, lymphoma is extremely common in dogs and cats and is one of the more common conditions that we've seen this week. Even after pursuing radiation or chemotherapy for an initial diagnosis, remission is temporary and relapse is inevitable. It's amazing to me how many owners are enthusiastic about pursuing treatment with the knowledge that a relapse will occur.
3) Golden retrievers and boxers are cancer machines. I always knew these were breeds with strong cancer predispositions, but I think half of our patients this week have been one of these breeds.
4) Oncology is an attractive field to me due to the long-term interactions that you have with the client-patient unit. Unlike some specialties where you stabilize or fix a problem without any additional follow-up, oncology gives the chance to be involved in a particular human-animal bond for years on end.
5) There are no right and wrong answers in treatment. What's right for one owner isn't right for another, and what works for one animal may have no effect on another.
6) There's a lot of guesswork and extrapolation from human medicine and veterinary studies with small sample sizes (25 dogs in a paper is a decent study). As a result, doctors in the field do the best they can with the information they have with little guarantee of efficacy. For example, this week we completed a consult for a cat who had a lung lobectomy. The owners wanted to know what they could do next to control growth of additional cancer processes. The problem is, there is no solid or collected data about lung cancer chemotherapy in cats...so we advise, explain, and suggest things but always remind clients that nothing is known for sure.
7) All of those cell surface markers I learned in immunology are pretty important and can tell us a lot about the cell populations present in lymphoma and leukemia cases!
8) One of the first things that will happen with any new cancer patient is staging of the disease - where is it located and how far has it spread? At our hospital that involves a CBC/Chemistry panel, lymph node aspirates (to check cytology in those locations), chest radiographs (to see if there is any pulmonary metastasis), and an abdominal ultrasound (to see if there is any other organ metastasis).
9) Dogs are really, really resilient!!! Just today there was a surgical removal of a fibrosarcoma from the chest of a dog who just started showing clinical signs this past week. There was a golf-ball-sized piece palpable on the outside of the ribcage...and a cantaloupe-sized continuation of it inside the ribs, smushing the lungs and surrounding the heart and aorta! The surgeons spent eight hours removing the mass and it was amazing to see this huge ugly, lumpy thing sitting in the biopsy tray after. And 14 days ago, the owners had no idea it was even present in their pet!
10) Seeing dogs and cats that are living two or three years after their initial cancer diagnosis is pretty awesome.
All in all, I'm really loving my time with the service. Can't wait for neurology in January!
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