24 Hours in the Life of a Veterinary Oncologist
Published on June 21, 2012
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It can be an incredibly rewarding — and, at times, emotional — profession, which is why I’m combining my love of writing and doctoring to give you a glimpse at what 24 hours is like in the life of a veterinary oncologist.
Whether it’s a Bulldog with a faulty ticker or a true canine fighter (who happens to bear the same name as a tough-as-nails champion boxer), it’s never a dull day at my cancer clinic.
New Patient, Numerous Problems
Senior cats often have more than one disease, and my first patient of the day, a 12-year-old kitty named Sasha, is no exception.At one time she had been very overweight, which led to diabetes. Recently, she had surgery to remove a benign uterine tumor — which is extremely uncommon, since most cats are spayed as youngsters — and it was discovered during this surgery that she also had a common type of feline cancer called lymphoma in her intestine, lymph nodes and liver.
Lymphoma is the most common type of cancer we see in cats, affecting mostly older kitties, but we occasionally diagnose it in younger felines as well. This form of cancer typically responds well to chemotherapy for a while, but it’s rare that we can cure a cat of the disease.
The lymphoma had left her deficient in a B vitamin known as cobalamin. Following surgery, her pancreas became inflamed and she refused to eat, complicating the management of her diabetes.
To help remedy this complex yet common situation, we placed a feeding tube in order to provide Sasha with adequate nutrition. We also tackled the issue of the cobalamin deficiency with a small volume of weekly vitamin injections — a solution that worked well since her family was already giving her insulin injections.
Today’s big discussion centers on how best to treat Sasha’s cancer, given her multiple problems. Since she has shown significant improvement, thanks to the feeding tube and the vitamin supplements, we talk about two chemotherapy options for the owner to consider over the next few days: pills given at home, with monthly rechecks, or intravenous chemotherapy given at the hospital by the oncology staff. Cat owners tend to like the first option, but not all cats respond to this treatment, and oncologists (me included) never like to risk undertreating a patient.
My Chemo Champ
My next patient of the day, Tyson, a black-and-white dog of no particular breed, has been performing just like the champion boxer he’s named after while on chemotherapy. Like Sasha, the 10-year-old has the canine form of lymphoma — but unlike Sasha, lymphoma is this pup’s only problem.Six months ago, he started what is considered to be the gold standard for the treatment of canine lymphoma: weekly intravenous injections of the same type of chemotherapy drug that’s given to humans with lymphoma.
About 85 percent of dogs treated with this protocol will experience a remission. Although we wish the response rate was 100 percent, it’s still pretty good when you’re dealing with a tough cancer like lymphoma.
Not only did Tyson go into complete remission, and finish every treatment on schedule, he did so without missing any of his favorite activities, such as his annual trip to the beach, where he romped in the sand and barked at horseshoe crabs. Most dogs on chemotherapy have an experience that’s similar to Tyson, partly due to better medications for controlling chemotherapy-associated side effects, like vomiting.
Although his family — not to mention his veterinarians — already think that he now has a great quality of life, it’s about to get a whole lot better because he only has one more treatment to go. Then he’ll only need to see me for monthly checkups for as long as his cancer is in remission!
Mending a Broken Bulldog Heart
Simon, a 12-year-old English Bulldog, has a heart problem — except it’s not heart failure, which can strike both dogs and cats.This poor guy has a rare tumor on his heart. One study of heart tumors in dogs found that this specific type of mass occurs less than 5 percent of the time.
During a routine annual examination with his regular veterinarian, a chest X-ray showed an enlarged heart. An evaluation by a board-certified veterinary cardiologist identified the tumor as the cause for the enlargement.
Treatment with a relatively new oral anti-cancer agent has agreed with Simon. We usually adapt human drugs for use in animal patients, but this high-tech drug is one of the first anti-cancer agents approved for dogs that targets a mutation in tumor cells and blocks their growth.
Today Simon is back for a visit because he’s suddenly stopped eating. This loss of appetite was perplexing to me — until I notice that his face is swollen. The culprit: a tooth abscess.
We’ve since fixed the little problem, and Simon has not only regained his appetite but he’s also gained three quarters of a pound. In two months, he’s due for a consultation with his cardiologist, who will use echocardiography to measure the tumor and determine his response to treatment. So far, the tumor has not grown in six months.
The Youngster With Skin Cancer
Louise, a petite French Bulldog, is what I consider the baby of today’s patients.Although she’s only 4 years old, she’s receiving treatment for the most common form of canine skin cancer — a mast cell tumor. There is no human tumor equivalent to a canine mast cell tumor, and most pet owners are unfamiliar with the disease.
Some mast cell tumors can be treated simply with surgical excision, but this hasn’t been the case for Louise.
We surgically removed the tumor, but a biopsy of the mass told us that her tumor was likely to spread more than the average mast cell tumor. So Louise is currently two thirds of the way through a six-month treatment protocol. If mast cell tumors recur, they typically do so within six months of surgery, so right now the family sits on pins and needles, waiting for the six-month mark.
At first, Louise received weekly chemotherapy injections, but she’s now receiving the same oral medication that Simon is taking. Since chemotherapy can depress a pet’s infection-fighting white blood cells, we check Louise’s (along with all of my other cancer patients) blood count before each treatment.
Today, she has a low white blood cell count, so we’ve decided to delay treatment until next week. Of course, you wouldn’t even know that Louise has a problem, given how she took to the treat jar in the waiting room!
All in a Day’s Work
Today was pretty easy, but not all days feature pets who are in remission, without bad side effects to manage. Days like today make the oncology waiting room a happy place.Of course, to you, a happy oncology waiting room may seem like an oxymoron. But I think that this is what veterinary oncology is all about — keeping pets and their families together, one cancer treatment at a time.
Dr. Ann Hohenhaus, a practicing veterinarian for 25 years, is board-certified in both oncology and internal medicine. She maintains her clinical practice at The Animal Medical Center in New York City, providing primary care to her long-term patients and specialty care to pets with cancer and blood disorders.
