Author: leah_wiebe

Today is both sad and exciting – being the last day, I’m going to miss seeing so many sweet dogs, but I’ve also learned so much over these last 2 weeks about veterinary medicine and oncology.

After the normal morning rounds and patient physical exams, I went over to the radiology department to watch Maggie the boxer receive a CT (computed tomography) scan. Maggie (who was here last week) was wearing a little doggie diaper with bananas on it today. Maggie had previously had a cancerous mass in her lungs surgically removed, but the CT scan showed multiple new metastatic masses in the lungs as well as some in the abdomen area. Based on the CT scan, there are approximately 8 nodules, which is too many for radiation therapy (radiating 3 masses is the approximate maximum that’s safe for the lungs). So, Maggie will likely be put on a chemotherapy treatment plan.

I also met the sweetest blind dog named Raini, as well as a tripawd Golden Retriever. Finally, I petted Roo the (very gentle) Doberman Pinscher. I will miss seeing so many good dogs every day, but on the bright side I’ll get to see my Goldens at home all day instead 🙂

Example of a CT scan of the lungs with a nodule (yellow arrow).

I also learned how to check for retinal hemorrhage and retinal ulcers in dog eyes.

To check for a retinal hemorrhage, a light is shined through a special lens (sort of like a magnifying glass). If red is visible in the retina when looking through the lens, that means there could be a hemorrhage.

Left: Normal dog retina. Right: Retinal hemorrhage

To check for a corneal ulcer (the outer layer, the cornea, wears away and forms a dent), a special green fluorescent stain is used. If there is no ulcer, the liquid will slip right off the cornea. If there is an ulcer, the liquid will pass through the break in the cornea and enter the eye, causing it to fluoresce green. This allows the presence and location of an ulcer to be determined. It’s also easier to see an ulcer using this method when the room is darkened.

The green splotch at the bottom of this dog’s eye indicates that an ulcer is located there. The green liquid rimming the bottom eyelid is excess stain that has slipped off the cornea.

Today, I finally started to get the hang of the daily schedule.

In the mornings, rounds are at 9am. This is a quick review of all the patients with appointments that day, as well as what their diagnoses are and what treatments or diagnostics they are scheduled for.

Then, the vets perform physical exams to look for anything abnormal in the patients and take necessary measurements.

Then, while the vets work on paperwork, I typically do some research on the specific types of cancer that the day’s patients have. This week, I’ve been looking at a vet textbook that includes diseases/disorders, procedures/treatment, diagnosis, laboratory tests, etc.

In the afternoon, the patients that are up for their next round of chemo receive their chemo treatment. Afterwards, rounds are at 2:30pm every afternoon, where the more complicated cases or new cases are discussed amongst the whole team. This is also sometimes where decisions are made for diagnosis or treatment based on the discussion of the team.

Naturally, I petted the dogs the whole day too 🙂 Today I petted Winston the lab mix (who has stage 5 multicentric B-cell lymphoma) and Pollock the Beagle.

This is the textbook I’ve been flipping through this week.

Today, Tanner the Samoyed came to visit because he was due for another chemo treatment, but his owner had also noticed that Tanner was experiencing fainting spells (particularly after exercise) and was concerned about what might be causing the fainting spells.

Tanner is receiving chemotherapy to treat his cancer. One chemotherapy drug that’s administered intravenously, doxorubicin, can result in heart toxicity, which can eventually lead to Dilated Cardiomyopathy (DCM – muscle fibers are weakened and stretched). However, Tanner receives a different type of chemo that does not cause heart toxicity. Tanner also received an echocardiogram, which confirmed that his heart is pumping weakly. The echocardiogram also showed that his DCM is not due to some other heart-related factor. Also, grain-free diets can also lead to a DCM; however, Tanner has a normal diet, so this is also unlikely to be the cause of his DCM. So, it is possible that Tanner’s DCM is due to a genetic predisposition, which some breeds in particular have.

So, medication has been recommended for Tanner that can help improve the beating of his heart. However, the weak condition of the heart muscle itself cannot be strengthened; the medication is more important for preventing further complications such as heart failure, arrhythmia, etc. that can potentially result from a DCM, as well as improving his quality of life.

My other important petting job of the day was Finley, who was a super sweet dog with a really long nose 🙂

Diagram of a normal heart and a heart with DCM – note the stretched and thinned muscle walls.

Today I visited the Radiation Oncology branch, which is where localized tumors in animals are treated with radiation therapy.

First, there was an owl that came over from the Exotics Department and received radiation therapy. Then, I traveled to the Equine & Farm Animal Clinic to watch a horse receive beta-radiation using a special tool that was essentially a radioactive wand because it had a piece of a radioactive isotope ore on one end. I learned about the difference between various types of radiation, some more complex than others (ex. electrons vs. protons vs. neutrons, surface-level vs. deeply penetrating, etc.).

Upon returning to the normal radiation room, I watched 3 dogs and a cat (Maggie the fluffy white/brown dog, Bundles the Chihuahua, Mogh the Pitbull, and Mylo the cat) receive radiation therapy. Each animal was anesthetized and its vitals were monitored while it received radiation therapy.

Lastly, today’s important petting job was Mogh the Pitbull and Carter the noisy dog. Because it was Carter’s last treatment, she got to “graduate” and go home wearing a celebratory red bandana!

Example of a dog receiving radiation therapy.

Today had a particular emphasis on patients scheduled for rechecks. A recheck may occur after the patient has completed its chemo (remission) – the pet comes in about once a month afterwards to have routine checks of its vitals, bloodwork, and areas where the cancer had been present in order to monitor whether the cancer has returned. Recheck appointments can also be the days when patients receive chemo.

The vet I shadowed today had 4 patients – 3 dogs and a cat. To begin each recheck appointment, the vet performs a physical exam on the patient. This includes checking heart rate, palpating lymph nodes, looking for new/larger bumps, looking at the eyes and teeth, etc. Afterwards, the patient may have bloodwork done to monitor levels such as red and white blood cells, platelets, and chemicals in the body.

Then, if everything looks normal and the patient is in remission (no signs of cancer), it can go home. If the patient is scheduled to receive chemo, then it receives the chemo as an IV injection, and can go home afterwards.

Overall, I shadowed 4 recheck appointments today, which can be described as the sort of check-up appointments of veterinary oncology.

Example of a dog receiving a physical exam during a recheck appointment.

(Lastly, and most importantly, my petting jobs of the day were Sadie the Basset Hound and Zero the Golden Retriever!)

This morning I had the opportunity to visit the Health and Wellness Center, which is closer to a general practice clinic but where the vet students take care of the patients.

First, I watched a vet student neuter a cat. I then shadowed two appointments: the first was a dog with separation anxiety and a tooth that needed removal, and the second was a cat that ingested litter and had some stuck in his paws. At the Health and Wellness Center, I understood how most of the patients required care for general issues, as opposed to the oncology department where most of the patients had fatal diseases. I also learned what a unique clinic this is – the students that perform the operations, appointments, etc. under the supervision of the faculty are in their 4th year of vet school, where they rotate through the departments and spend ~14 days with each.

Finally, I also looked at CT scan images of a dog with cancerous tumors in his lungs. It was really neat to see another tool used to pinpoint cancers in animals.

Naturally, the most important part of my day was petting Annie, a golden retriever, while she received her chemo.

Examples of CT scans of dogs and cats with lung diseases.

Today I worked with Kona, a German Shepherd mix. Kona was diagnosed with stage 4b multicellular B-cell lymphoma. Stage 4 means the cancer’s location is in multiple lymph nodes as well as the spleen, and “b” means Kona visibly experienced symptoms; multicellular means the cancer originated in the lymph nodes; B-cells are the type of white blood cells that the cancerous cells are.

Fortunately, B-cell lymphoma is often easier to treat than T-cell lymphoma and results in a generally better prognosis. After talking with Kona’s owner and the faculty veterinarians, it was decided that Kona will be treated with the CHOP protocol. This protocol involves a combination of chemotherapy drugs that will be administered intravenously over 4 4-week cycles.

Ideally, Kona will achieve remission from the CHOP protocol (for dogs, chemotherapy is a way of managing the cancer, NOT curing it), with the median prognosis for B-cell lymphoma being 12 months.

Finally, we discussed Kona’s case in the afternoon during the oncology team rounds.

As a bonus, I got to tour the whole Terry Companion Animal Center beyond the oncology wing. 🙂

Enlarged lymph nodes are a common symptom of multicellular lymphoma.

I started my day shadowing a vet who had taken Bernie’s case – a Bichon Frise mix with Cardio Hemangiosarcoma. In other words, a very large tumor (~5cm) was attached near the right atrium of Bernie’s heart and inside the pericardial sac (sac surrounding the heart). The tumor was leaking blood into the sac, causing it to inflate significantly. The pressure of the blood on the heart combined with the size of the tumor made it difficult for Bernie’s heart to contract regularly. The result was that Bernie had reduced blood flow to other areas of his body, which was evident because of his very light-colored gums (the pressure on the heart and subsequent reduced blood flow is called cardiac tamponade).

In an attempt to alleviate some of the pressure on Bernie’s heart, I observed a procedure called a chest tap (pericardiocentesis), in which a needle is inserted between the ribs and into the pericardial sac and the excess fluid is drawn out. Throughout the procedure, we monitored Bernie’s ECG to watch out for an arrhythmia.

After the procedure, Bernie was brought to the ICU, and he should be able to return to his family tonight.

(Update 5/31: Bernie was able to go home and is still doing well!)

Left: a golden retriever receiving pericardiocentesis

Right: echocardiogram of heart with fluids inside pericardial sac

I am very excited to work with Dr. Intile at the NCSU School of Veterinary Medicine, specializing in oncology!