Oncology . . . cancer is keeping me busy

So I've been the only student on the oncology rotation this past week. Its been crazy. I've been staying mainly with the surgery side of the department for this week, next week I'll focus more on medicine. Its a great rotation, everyone is super nice and the department head, Dr. Miles, is hilarious. I walked in on him dancing to the song 'Gettin' Jiggy Wit It' the other day. I almost died of laughter. The cases are crazy. Some of these clients have been told there is no help for their pet and then they come here and we give them an option. A women came in with her dog, Tabasco, who had just been diagnosed with osteosarcomma. The dog has bad hips and stifles so the owner didn't want to do a limb amputation. We offered her stereotactic radiosurgery to treat the cancer. Turns out we're the only place in the world offering that for animals. How cool is that?

I had another crazy cat lady this week. Well, really, a crazy cat couple. The husband was scary. Dr. Fray likened him to Norman Bates. No really, he might murder us if the cat dies. The cat has a liver mass. Most likely its benign but the owners want us to take it out. Fair enough. Trying to get a history from these people though was like pulling teeth. I somehow managed to get the history of the cat's entire family. Don't even think about asking how many cats they have, they don't even know. The best part was when the wife taught me a song I had to sing to the cat when he got his asthma medicine. The entire oncology department has been trying to get me to sing it. Not going to happen. Later in the week I had to call them with the results of their ultrasound and fine needle aspirate (which the woman tried to tell me was the same thing as a biopsy . . . not so much). That was when I screwed up. She asked if we were going to do a clotting profile and cross matching on the cat prior to surgery. I said that I didn't think so but that we could do it if it would make her more comfortable. Apparently she was really upset by this and told the referring vet that she was losing confidence in us. Turns out, I found out later, that we always do a clotting profile on liver lobectomies. Luckily my clinicians weren't too upset with me because they think she's crazy anyway. I'm dreading when this cat comes in on Wednesday for surgery.

We had another dog come in, Rocky, who is a doberman with an oral sarcomma that takes up the front of his mandible. The other vets they went to see said they couldn't do anything for it. Our surgeons looked at him and told them that we could help them. Granted, he'll have to relearn how to eat but he'll be sarcomma free . . . at least for a little while. Its a very aggressive tumor and will most likely show up again in some form. It should be an awesome surgery, unfortunately I won't get to scrub in on it. Oh well, such is life I guess.

Our surgery day this week was ridiculous. We started off with Bart, who was supposed to have a liver lobectomy. Well, when we got in we realized the mass was too close to the hilus and next to some nasty large vessels. So we opted for not trying to kill the dog and tried to remove as much of the mass as possible without bleeding the dog out. Despite all our efforts he still bled a lot and needed a transfusion, he made it though. We still have him because he decided that peeing on his incision was a good idea and now has an infection. He's still having trouble with the whole peeing outside thing, which makes taking care of him kind of a pain in the ass. Plus, he won't eat for us. I think he needs to go home at this point. He'll eat there and his incision looks 100% better.

So after that surgery, which took longer than expected, and getting Bart settled into ICU, Dr. Cane told me to grab something to eat quick because we had to get started on the next surgery. I grabbed a bag of chips and was halfway through before Dr. Cane and Dr. Fray started moving into the OR. So much for lunch. So we started the next crazy surgery. Poor little Dexter had a peripheral nerve sheath tumor on his sciatic nerve that extended up to nerves L5, L6, L7, and S1. So we had to do a coxofemoral disarticulation, hemipelvectomy, and hemilaminectomy in order to remove the leg and the nerves at their origin on the spinal cord. It was such a cool surgery, they even let me use the cautery to transect the muscles of the hind leg! Dexter actually did really well after surgery. He recovered like a champ and was running around on his three little legs like nothing ever happened. It was awesome.

Not everything is so happy about oncology though. Not surprising. Molly is this sweet cat with these owners that are just the nicest people. She came in to start a new protocol to treat her GI lymphoma and hemangiosarcomma (very rare in kitties). We did an ultrasound before treatment and unfortunately found that her hemangiosarcomma grew despite the treatment we had been doing. Since HSAs are such resistant tumors we decided that it would not be in the best interest of the cat. We had to tell the owners that it was now about end of life care and providing a good quality of life while we can. It was so sad, the wife was crying and the husband was being so supportive. You could tell that he was trying to keep it together for her. It broke my heart.

There wasn't much time to be sad though because I had to wrastle Marmaduke, an ill-behaved Great Dane. It was like trying to wrestle a foal. Litterally. He was huge. We had to give him medetomidine before we could give him his chemo.

Next week should be busy since we have to fit five days of appointments into four. Stupid labor day. I still have to go in on Monday to take care of Bart, the amazing peeing wonder dog.