Gap Year Job

[Tech_Penguin]

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My plan for my gap year was to work part time as a research assistant and part time as a vet assistant. I already got an RA job in a lab I’m really interested in and am trying to figure out my VA job.

I got two VA jobs offers in the same city. The first is at a community shelter. Although it’s a shelter, they have a CT machine, administer chemo with virtual oncologists, and do complex soft tissue/ortho surgeries from time to time. They also occasionally work with horses, exotics, zoo animals, and law enforcement which is interesting but not entirely related to my career interests. Vet students commonly rotate through here so it would be nice to hear their experiences.

The second is an overnight assistant at a specialty hospital which only has ECC and surgery specialists. I do have a mild sleep disorder so I’m not sure if working night shifts is a great idea, but I have an ENT appointment soon so it may get better. One of the doctors is actually a surgical oncologist professor at the nearby vet school which may be interesting.

Both jobs have similar flexibilities to accommodate my RA position and potential interviews, so if my goal is to be an oncologist and professor, which one seems better aligned? Also, some schools I'm applying to may ask for updated mid-cycle, so which one looks better on an application?

 

[pp9]

My plan for my gap year was to work part time as a research assistant and part time as a vet assistant. I already got an RA job in a lab I’m really interested in and am trying to figure out my VA job.

I got two VA jobs offers in the same city. The first is at a community shelter. Although it’s a shelter, they have a CT machine, administer chemo with virtual oncologists, and do complex soft tissue/ortho surgeries from time to time. They also occasionally work with horses, exotics, zoo animals, and law enforcement which is interesting but not entirely related to my career interests. Vet students commonly rotate through here so it would be nice to hear their experiences.

The second is an overnight assistant at a specialty hospital which only has ECC and surgery specialists. I do have a mild sleep disorder so I’m not sure if working night shifts is a great idea, but I have an ENT appointment soon so it may get better. One of the doctors is actually a surgical oncologist professor at the nearby vet school which may be interesting.

Both jobs have similar flexibilities to accommodate my RA position and potential interviews, so if my goal is to be an oncologist and professor, which one seems better aligned? Also, some schools I'm applying to may ask for updated mid-cycle, so which one looks better on an application?

Idk, this might be a more complicated/nuanced answer that is hard to put into writing succinctly, but I don't know that you need to be thinking "which VA job will make me an oncologist?' Oncology is not a field that you need to start out early in imo. Most fields aren't that way, there are a few I can think of where connections truly matter...oncology is not one. Someone can jump in and correct me if they know more about the field, but what probably matters for you most right now is just backing up the desire for a DVM degree. The shelter job sounds like it would offer you a lot of breadth that you're lacking iirc.

I know we've talked about not outright saying 'I want to be xyz' without having experience to back it up, but that doesn't mean you need to seek out oncology specifically right now. Does that make sense? From what I remember, the biggest question was whether or not you needed a DVM degree and how to prove that in the admissions process. Your goal is to prove you know what you're getting into DVM-wise/that it's right for you, not prove that you know you want to be an oncologist.

In shorter words: Seek out the experience that you think will give you a really good idea of what it's like to be a vet to be sure that's still what you want to do. Use the experience to grow and improve your application (PS, LORs, interviews). I might lean community shelter but that's because it sounds like a cool job.

 

[JaynaAli]

I agree with pp. Also, if you’re working overnights as an assistant, will you even interface with the referenced surgical oncologist? They aren’t exactly known for overnight working hours, lol. I would find it difficult to balance a night job AND a day job. Even if they’re flexible, it’s hard to be constantly flipping between being a daywalker and a nightwalker. If this was your only position that would be one thing, but working all night then having to go be a research assistant in the day (or vice versa) seems like a recipe for burnout to me.

Also, I went to school with someone who was dead set on being an oncologist from day 1. Then she realized fourth year that it was actually the cancer workup process she enjoyed, and as a referral oncologist, her duties would more commonly be treatment and not as much of the diagnostic process she loved. So she made a switch to IM…still gets a lot of cancer but now she gets more workup. Just saying to keep your mind open.

 

[supershorty]

The second is an overnight assistant at a specialty hospital which only has ECC and surgery specialists. I do have a mild sleep disorder so I’m not sure if working night shifts is a great idea, but I have an ENT appointment soon so it may get better. One of the doctors is actually a surgical oncologist professor at the nearby vet school which may be interesting.

Couple of things:

1 - working overnights and days is setting yourself up for failure. Do not wreck your sleep schedule and sleep hygiene like that if you don't absolutely have to. It's extremely detrimental to your physical and mental health (I just did this for a year. I would not wish it on anyone), and it will negatively impact the quality of work you do at both jobs.

2 - no surgical oncologist is going to be cutting things during overnight hours, so your chances of interacting with them as an overnight person are essentially nil.

A VA job right now is not going to make you an oncologist, so I wouldn't approach getting experiences that way. Yes, if you're going to write in your applications that you want to be an oncologist, you need to make sure you have experiences to back that up - but neither of these positions sound like they will be that, and I don't think that's the most important thing for you right now. I would lean toward the shelter job, based on logistics if nothing else.

 

[pp9]

Even if they’re flexible, it’s hard to be constantly flipping between being a daywalker and a nightwalker. If this was your only position that would be one thing, but working all night then having to go be a research assistant in the day (or vice versa) seems like a recipe for burnout to me.

Such a good point. Having done the flip flopping for years, it seems entirely feasible on paper, and might even be fine for the first few weeks when you're fresh and sparkly on a new job. With time it becomes extremely difficult and at the risk of being dramatic, you might feel like you're actually dying.

The average person probably needs a minimum of 2-3 days to 'safely' transition from night to day/day to night to avoid ending up being awake for 24+ hours on accident, or only getting a few hours of total sleep over a 3-4 day period. Ask me how fun it is to drive home with that little sleep, I'm sure any person who has been in the ER trenches could tell you all about that.

There's a reason that night shifts are associated with an increase in mortality. And that study looked at people that worked night shift only.

ETA: Also if you already have a sleeping disorder, it will only be worse for you. I have sleep apnea and honestly can say I felt like my body was literally dying when I was flip flopping. Swing shift is another special kind of hell because your body literally doesn't know what to do. To this day, my sleep is still affected by my ER work. If I don't let my head hit the pillow with eyes closed the second I feel tired, I catch that second wind within minutes and won't be able to fall asleep until 3-4 am, if at all.

 

[pp9]

Couple of things:

1 - working overnights and days is setting yourself up for failure. Do not wreck your sleep schedule and sleep hygiene like that if you don't absolutely have to. It's extremely detrimental to your physical and mental health (I just did this for a year. I would not wish it on anyone), and it will negatively impact the quality of work you do at both jobs.

2 - no surgical oncologist is going to be cutting things during overnight hours, so your chances of interacting with them as an overnight person are essentially nil.

A VA job right now is not going to make you an oncologist, so I wouldn't approach getting experiences that way. Yes, if you're going to write in your applications that you want to be an oncologist, you need to make sure you have experiences to back that up - but neither of these positions sound like they will be that, and I don't think that's the most important thing for you right now. I would lean toward the shelter job, based on logistics if nothing else.

Jinx on #1, emphasis on #2.

I am not sure I can even count on both hands the number of prevets I know that have taken a job thinking they'd get experience under someone specific, only to never interact with them at all. If it was a VA for the oncology service specifically, that's a different story. You could clarify how often you'd work with this person, I'd wonder if they are only there on a pick-up basis if they are a clinician at a local school though

 

[supershorty]

If I don't let my head hit the pillow with eyes closed the second I feel tired, I catch that second wind within minutes and won't be able to fall asleep until 3-4 am, if at all.

I also have this experience and have never been able to make the window of sleeportunity make sense to people who haven't experienced working a broken schedule like that. I'm so glad to see someone else know what it's like lol

 

[indysadventures]

Jinx on #1, emphasis on #2.

I am not sure I can even count on both hands the number of prevets I know that have taken a job thinking they'd get experience under someone specific, only to never interact with them at all. If it was a VA for the oncology service specifically, that's a different story. You could clarify how often you'd work with this person, I'd wonder if they are only there on a pick-up basis if they are a clinician at a local school though

Second this- At my old clinic, I was hired as a VA specifically for the oncology service, and even in such a “black-and-white” situation, oncology had to fight for me to not be pulled to other specialties and it took months of effort until 100% of my time was in oncology. At first, about 75% of my time was in IM, ICU, and ER, and it took a doctor reminding them (and backing me up) that I was hired specifically for oncology.

And once I was in my niche, I stayed there. So while there were many specialists at my clinic, I BARELY talked to anyone other than those in oncology and our radiologist, as well as occasional discussions with ER for referrals, IM, and surgery, but these were not “quality time” with these specialists. All that to say that I don’t think OP will get much quality time with anyone outside what they’re hired to do, especially since they’re being hired for overnights. No surg onc I’ve known is coming in overnight (especially since they also teach), and attempts to “connect” with them outside of your working hours will be entirely dependent on their schedule and could backfire and cause stress (ESPECIALLY with that potential work schedule!).

OP - Considering the potential toll on your health, the rescue clinic job during the AM seems like a safer bet - it sounds like it will still teach you a lot of softer skills that will be crucial to help you understand what kind of doctor you want to be. As you know from our talks, I also built my application around oncology, but it was centered in my passion for its clinical work - how I can help guide patients and their people through staging, treatment, and often, end-of-life care. My time in clinics before going to oncology, I felt like I was really passionate about end-of-life care, and coupled with my love of cancer biology and oncology, I figured I might love the everyday of oncology. But I started out in GP first, and then found my way there, through discovering what I enjoyed about medicine.

So, what Jayna said about figuring out your passions is important - without a firm idea of WHAT you love about clinical work, you can’t know with 100% certainty that clinical oncology is what you love - because there’s so many doctors that contribute to oncology - obviously - researchers (many just with PhDs) directing critical clinical trials and discovering new treatment modalities and oncologists guiding clinical care and contributing to research, but ALSO GPs, radiologists, clinical pathologists, and internists contributing to diagnostics, initial dx, and staging (and of course general surgeons, surg oncs I’m including with oncologists). Getting some stronger clinical experience alone will help you start to narrow down WHY clinical work, and I think that’s the critical piece missing for you.

Plus, I’d argue that oncology is such an integrative field with complicated paraneoplastic conditions and patient QOL considerations, that it’s hard to say that anything in medicine is truly unrelated to it. So, any clinical experience - even if it feels less connected to your future goals - will be likely to help add nuance to your understanding of your future career and goals, as long as you approach it with respect and an open mind! Also, let the people at your clinic know that you’re interested in oncology - I did this at my first GP clinic and was soon being pulled in to discuss cases, which was really cool.

Just a thought, if you can get experience with end-of-life care (which it seems like you would at the rescue clinic), I think that would be really helpful. In oncology, I helped daily with tough conversations and hospice discussions. I had to regularly say goodbye to patients and hold a pet parent’s hand while they say goodbye. The specialty (at least medical oncology) consists of a lot of treatment plans, client relationships, preservation of quality of life, and making meaningful treatment suggestions for pets and their families. Many clinics say more GOOD days, not more days. If you want to work in oncology, you have to be comfortable around treatment failure and loss, you have to find meaning in being a helper. Just my two cents, and just my way of saying again that just about any area of experience you’ll get in-clinic will help you understand what you want to do. 🙂

ETA: I forgot to mention as someone who also has a sleep disorder, I would never set myself up for burnout and symptom exacerbation by taking a night shift and day shift job. That will make you sick, OP. ❤️❤️

ETA 2: Sorry this is a literal book, OP, but I can write forever when it comes to oncology. 🙂 You’ll get excellent experience that’s relevant at either job, so choose what will be better for your health.

 

[pp9]

I also have this experience and have never been able to make the window of sleeportunity make sense to people who haven't experienced working a broken schedule like that. I'm so glad to see someone else know what it's like lol

Wait I love this. But also hate it. No one else has understood me either. My husband will often roll over at 3am and be like 'wtf? you were tired when we went to bed?' and yeah I *WAS* TIRED, it went away by the time I was done brushing my teeth dude and now I could probably hop on my Peloton and ride for an hour if I wanted to (and I have done that, lol).

Second this- At my old clinic, I was hired as a VA specifically for the oncology service, and even in such a “black-and-white” situation, oncology had to fight for me to not be pulled to other specialties and it took months of effort until 100% of my time was in oncology. At first, about 75% of my time was in IM, ICU, and ER, and it took a doctor reminding them (and backing me up) that I was hired specifically for oncology.

Ooooh...yeah...if you are hired for ER/CC, very slim chance you will get to go wander to other services. If you were hired for a specialty service, very high change you will be getting pulled to ER/CC routinely lol

 

[indysadventures]

Wait I love this. But also hate it. No one else has understood me either. My husband will often roll over at 3am and be like 'wtf? you were tired when we went to bed?' and yeah I *WAS* TIRED, it went away by the time I was done brushing my teeth dude and now I could probably hop on my Peloton and ride for an hour if I wanted to (and I have done that, lol).


Ooooh...yeah...if you are hired for ER/CC, very slim chance you will get to go wander to other services. If you were hired for a specialty service, very high change you will be getting pulled to ER/CC routinely lol

I HAVE A 30 MINUTE WINDOW TO SLEEP ONCE I’M TIRED.

Exceed that, and I might as well get up, I’m not falling asleep. Actually, speaking of cancer and insomnia, once I decided to take my entire biology of cancer midterm at 2 am because well, I was thinking about it anyway.

 

[JaynaAli]

I do want to reiterate to OP that I don’t think the overnight assistant job is bad in and of itself. Both sound like decent pre-vet experiences, even if they are not specifically pointed toward oncology. But because you’ve already committed to a day-time job somewhere else, I think the other day position makes way more sense over a night position. If you were only having one position it may be a tougher discussion/decision.

And also…most night assistant spots have notorious constant turnover. Should you try the shelter day position and hate it, it’s very likely another night assistant position would come open, if these clinics are anything like the 24/7 clinics I’ve worked at before.

 

[indysadventures]

I do want to reiterate to OP that I don’t think the overnight assistant job is bad in and of itself. Both sound like decent pre-vet experiences, even if they are not specifically pointed toward oncology. But because you’ve already committed to a day-time job somewhere else, I think the other day position makes way more sense over a night position. If you were only having one position it may be a tougher discussion/decision.

And also…most night assistant spots have notorious constant turnover. Should you try the shelter day position and hate it, it’s very likely another night assistant position would come open, if these clinics are anything like the 24/7 clinics I’ve worked at before.

Absolutely agree with this from my own personal experience, we were always hiring for overnight VAs, unfortunately it’s really tough and taxing emotional work even when it’s your only job. They’d often deal with heartbreaking emergencies while also being understaffed. They also were leaned on quite a bit - at least in my clinic - to fill gaps of coverage into the morning, and I swear they’d stay late almost every morning. Not to say that OP’s potential new clinic would do this, but I do think that with another day job, the possible mental and physical health concerns steer me away from recommending OP pursue this job when another day job is available.

It’s definitely smart to qualify though that neither job is a poor option based on the description, but more so that the night-shift itself is the problem. I appreciate you bringing that up. So please OP, consider my response above less as pushing you towards the shelter job, and more about encouraging you that it will still give you valuable experience and is almost guaranteed to be better for your health.

 

[Tech_Penguin]

Yeah, great points! The ER position was weekends but now that I’m thinking about it working until Monday morning then leaving straight for the lab would sound like a nightmare lol. And making mistakes with patient samples in the lab and charting in the hospital would be really bad. Also, I‘ve now heard that the shelter is in the works of virtually consulting the faculty at the vet school’s cancer center so they can administer chemo, which makes it even more appealing.

I actually started working as a med onc vet assistant in the spring, so I feel like I'd have enough relevant experience to back up my interests on vet school apps. And when I say I'm interested in oncology I meant it more so as an umbrella term for any specialty involved in cancer care, like med/rad/surg onc, or even neuro, IM, OMFS, IR, diagnostic radiology, and path. Ik that my specific specialty interest in vet school may change, but I've seen/heard that many of these specialties treat cancer on a regular basis.

 

[pp9]

but now that I’m thinking about it working until Monday morning then leaving straight for the lab would sound like a nightmare

You had to think about it to realize this, lol??

And making mistakes with patient samples in the lab and charting in the hospital would be really bad.

...Or falling asleep at the wheel and getting yourself/someone else killed - my biggest concern when my schedule was all over the place

Also, I‘ve now heard that the shelter is in the works of virtually consulting the faculty at the vet school’s cancer center so they can administer chemo, which makes it even more appealing.

I still think the shelter med job sounds like the better option for multiple reasons, but I think you'll have to see how the chemo thing goes before you hang your hat on it. How often does this shelter actually administer chemo? Under what circumstances?

I guess, in short, I'm just suggesting you approach the experience as a whole with a very open mind instead of being so focused on the oncology aspect of the job...which could possibly be a very small part of what you're actually going to experience.

side comment: imo chemo is not something I would ever allow a vet assistant to handle in any capacity. Ever. idk how your shelter approaches it. Watching, sure, but the stuff is inherently dangerous and I've never handled it outside of fume hoods in dedicated spaces. I don't know if that's a facility 'requirement' that is enforced by the state or if we just were able to have that equipment because corporate (with an onc service), though. Idk what this shelter's set up is, and I may be overstepping here, but I would personally not get directly involved with chemo until you've had specific, formal training on how to handle it, no matter how excited you might be. Our oncology techs were the only ones in the building that were allowed to handle and administer chemo, save for overnight ER docs who were giving it on an emergency basis to a really spicy lymphoma case, for example

Also this is a total derail, but the idea of a shelter giving chemo is an interesting ethical topic. Along the lines of rescues asking for $10k to treat a 15y old dog covered in tumors/needs full mouth extractions/etc but then refusing to take in much healthier animals because they don't have the resources for them. Not saying anything is right or wrong or the situation needs to be black/white, it's just something I think about after having to deal with shelters and rescues so much in the context of an ER doctor trying to get strays/other placed instead of euthanized.

 

[Tech_Penguin]

I was assuming it would be like pulling an all nighter first (I usually leap before I look lol). But the part-time RA job is flexible in that I don't need to go into the lap/hospital on Mondays unless there's a patient recruited. And I can just set my schedule to get my tasks done on time.

I think the shelter gets a lot of grants/donation and see a high volume of patients, which would explain how they can afford a CT scanner or fluoroscopy equipment in the OR. Also, I've had a lot of experience working with radioactive and toxic chemicals/biohazards in a hood from research, have seen how the vet techs prep the chemo drugs, and have set up the IV lines for chemo so I don’t think I have a lack of training. I’d assume the cancer center would provide support with training

Also, from another perspective, this would provide owners with an affordable option. There’s no boarded med oncologists within one or two hours, and this is the Appalachian area so they likely couldn’t pay their prices anyways. I’ve heard from techs that chemo can be more affordable if you scale back from the gold standard

 

[_rae_]

Maybe I'm just not built for it, but I can honestly say the up all night/constant switch is way way way more exhausting than you think.

First semester of vet school I had a two week alternating part time schedule: Friday 6 pm - 2 am, Fri/Sat 6 pm - 12pm. When I had to be up at 6:30 am on Friday to get to my classes and routinely wasn't in bed until 4 am (because let's be real, when is leaving an ER at 2 am ever ACTUALLY leaving an ER at 2 am), I was wrecked. I didn't have the brain to study, I was exhausted all the time, I wasn't going out with friends, it would take me until mid week to get caught up on sleep and then I'd be back at work until 1 or 2 that next weekend. If you're not on a consistent schedule and you're not someone who already has insomnia or other sleep schedule issues, I don't recommend it. I had moments where I would be driving and had to pull over, even in the middle of the day, because I was too tired to be behind the wheel, and it was scary. I was also an RA in college and had late night rounds on weekends, overnight on calls where I got constantly woken up, etc. and it's very different. There is no rest built in.

Shelters giving chemo makes my bootyhole clench, even if an oncologist is involved. Do they have a closed system like equashield? Do they have an 800 room? How frequently are we checking nadirs? ARE we checking nadirs? Have the techs been trained on the risks? How do you ensure owner compliance? What happens when the low cost chemo turns into an expensive ER stay for septic neutropenia? I have lots of questions.

 

[_rae_]

Reading back because this is just stuck in my brain a bit.

side comment: imo chemo is not something I would ever allow a vet assistant to handle in any capacity. Ever. idk how your shelter approaches it. Watching, sure, but the stuff is inherently dangerous and I've never handled it outside of fume hoods in dedicated spaces. I don't know if that's a facility 'requirement' that is enforced by the state or if we just were able to have that equipment because corporate (with an onc service), though. Idk what this shelter's set up is, and I may be overstepping here, but I would personally not get directly involved with chemo until you've had specific, formal training on how to handle it, no matter how excited you might be. Our oncology techs were the only ones in the building that were allowed to handle and administer chemo, save for overnight ER docs who were giving it on an emergency basis to a really spicy lymphoma case, for example

This was also my experience. I was a med onc/rad one assistant for three years. I wasn't even allowed to handle the L-spar or the zoledronate, which "aren't really chemo". We also had mustargen and even just helping restrain for administration gave me the heebie jeebies with that one. We had specific people who could give chemo, and they had training to draw it up if someone was out sick or we stayed late to do something, but we had a pharmacy tech who did it for us. ER had two overnight CVT/VTSs who were trained exclusively on L-spar and vinc solely for sick LSAs and ITPs respectively.

 

[indysadventures]

Reading back because this is just stuck in my brain a bit.

This was also my experience. I was a med onc/rad one assistant for three years. I wasn't even allowed to handle the L-spar or the zoledronate, which "aren't really chemo". We also had mustargen and even just helping restrain for administration gave me the heebie jeebies with that one. We had specific people who could give chemo, and they had training to draw it up if someone was out sick or we stayed late to do something, but we had a pharmacy tech who did it for us. ER had two overnight CVT/VTSs who were trained exclusively on L-spar and vinc solely for sick LSAs and ITPs respectively.

Jumping on this train as an med onc VA. I was allowed to give El-spar and zoledronate after extensive training and I helped with chemo administration (holding while gloved, etc), but I was only beginning to train on administration myself. If I hadn’t gotten in this year they were going to train me, but I’m from Jersey so they were going to “promote” me first because we had rules that only techs could handle chemo. I agree with Rae, I would also heavily side eye any place giving IV chemotherapy without an oncologist present at least some of the time, it makes me really nervous TBH. But I’d hope they’d make up for that with really strict safety protocols.

OP, nobody’s saying you’re not competent enough to help, just to be prepared that legal limitations will likely prevent you from administering chemo without advanced training. And I’d make sure that they’re doing proper safety protocols before I EVER was willing to do it - I’d want to see proper hood ventilation, PPE, equashield, specialized gear/trays, spill protocol. Like Rae, I also worry how are they adequately monitoring dosage response (eg tracking nadirs), tracking remission status, and patient side effects. And are they properly following up with owners and addressing safety issues for at-home care?

Not saying it can’t be done, but I think PP, Rae, and I are all a little worried for a reason - just make sure you’re staying safe. It’s one thing to handle dangerous compounds in a lab - it’s a controlled environment……it’s a whole different ball game in a clinic. Things are chaotic, a dog can spit Cytoxan out into your face, ya know, fun stuff. Heck, doxorubicin sometimes required three of us, all gowned up, to be assisting and it’s such a delicate, careful process because of fear of extravasation.

 

[_rae_]

Heck, doxorubicin sometimes required three of us, all gowned up, to be assisting and it’s such a delicate, careful process because of fear of extravasation.

Three techs (two holding, one administering) vs. cat getting doxo. Cat gets loose, starts biting restrainer and person administering, ends up flying off the table and on the floor, bit clean through my coworker's sneaker into her foot. Cat kept her leg because despite the chaos, the person administering and the person holding the back end held onto that leg through the whole rodeo and we never lost the catheter.

 

[pp9]

Also, from another perspective, this would provide owners with an affordable option. There’s no boarded med oncologists within one or two hours, and this is the Appalachian area so they likely couldn’t pay their prices anyways. I’ve heard from techs that chemo can be more affordable if you scale back from the gold standard

Fair, I was assuming this was for an in-house clinic for surrenders/animals up for adoption, not a public clinic. I'm not sure what you have in mind when you are saying gold standard, though. Affordable care =/= unsafe care =/= low cost care. If they have dedicated space and equipment for this great, if not...

If we're talking Appalachia, one of the more chronically poverty-stricken areas in this country (depending on the specific location I guess), how many people are really paying to get chemo though? Genuine question, especially since you've described what might be a low-cost/subsidized clinic.

And just to share some life experience, it's rarely the cost specifically that keeps an owner from pursuing chemo, especially when palliative courses can be fairly affordable. The reason people don't get chemo is because chemo treatment evokes a very specific image/sequence of events for the average person and it's an instant no before cost is even brought up. Pets usually tolerate chemo very differently than humans, but explaining that does little to change a person's mind. I am not even sure how many times I've diagnosed cancer in someone's pet and offered to schedule them an onc appt - it was never the cost of chemo or radiation that stopped them. Most people won't even schedule the oncology consult. Kind of goes into the post I wrote on another thread about I think why vet onc is not a rapidly growing field, compared to almost every other specialty out there.

I know this is a giant derail, but you've gotten your answer on which job might be the better choice. I just caution you again to have realistic expectations both about this job, but also what you are actually going to be doing at this job (which does not always coincide with what you think you should be doing).

It’s one thing to handle dangerous compounds in a lab - it’s a controlled environment……it’s a whole different ball game in a clinic. Things are chaotic, a dog can spit Cytoxan out into your face, ya know, fun stuff. Heck, doxorubicin sometimes required three of us, all gowned up, to be assisting and it’s such a delicate, careful process because of fear of extravasation.

Basically this. It's a bit arrogant to think otherwise.

legal limitations will likely prevent you from administering chemo without advanced training.

Or potentially at all. Some state practice acts to specify that assistants cannot administer (+/- handle, depending on interpretation) chemo

 

[indysadventures]

And just to share some life experience, it's rarely the cost specifically that keeps an owner from pursuing chemo, especially when palliative courses can be fairly affordable. The reason people don't get chemo is because chemo treatment evokes a very specific image/sequence of events for the average person and it's an instant no before cost is even brought up. Pets usually tolerate chemo very differently than humans, but explaining that does little to change a person's mind. I am not even sure how many times I've diagnosed cancer in someone's pet and offered to schedule them an onc appt - it was never the cost of chemo or radiation that stopped them. Most people won't even schedule the oncology consult. Kind of goes into the post I wrote on another thread about I think why vet onc is not a rapidly growing field, compared to almost every other specialty out there.

YES.

I have several friends/family members who wouldn’t have treated their pets’ cancers without me actually working in oncology. It wasn’t money - they legitimately didn’t want to put them through what they reasonably imagined would be a similar ordeal to what humans go through. All have told me they’re happy I discussed it with them, but they wouldn’t have trusted if someone else told them and then they wouldn’t have treated. They’re all actually very satisfied with their pet’s QOL, but getting over that initial (and reasonable) worry about harming their pet’s QOL is a huge roadblock.

It’s actually something I really love about oncology, how many clients come back smiling, realizing that their pet really does feel okay on chemo.

 

[pp9]

YES.

I have several friends/family members who wouldn’t have treated their pets’ cancers without me actually working in oncology. It wasn’t money - they legitimately didn’t want to put them through what they reasonably imagined would be a similar ordeal to what humans go through. All have told me they’re happy I discussed it with them, but they wouldn’t have trusted if someone else told them and then they wouldn’t have treated. They’re all actually very satisfied with their pet’s QOL, but getting over that initial (and reasonable) worry about harming their pet’s QOL is a huge roadblock.

It’s actually something I really love about oncology, how many clients come back smiling, realizing that their pet really does feel okay on chemo.

My memorized ramble I had was 'The goal of chemo for pets is not to get them to live forever or eliminate the cancer like we aim for in people, it's to get them to be able to live comfortably alongside the cancer for as long as possible. Some pets end up in remission, many don't but have a good QOL. There can be side effects that warrant vet visits/hospitalizations, but your dog/cat won't lose its hair, won't be vomiting uncontrollably, won't be a walking skeleton, etc. And you can always stop if you want to.'

Most people still absolutely would not do it, and that's completely their prerogative, but chemo is a scary word for a lot of people in this world. Understandably so.

Survey sheds light on pet owners’ perspective on cancer Here is some data on it actually. Yeah, people are worried about cost (spoiler alert, pet owners would say the same thing about vaccines) but more significantly, they are worried it is the wrong choice regardless of cost.

 

[indysadventures]

My memorized ramble I had was 'The goal of chemo for pets is not to get them to live forever or eliminate the cancer like we aim for in people, it's to get them to be able to live comfortably alongside the cancer for as long as possible. Some pets end up in remission, many don't but have a good QOL. There can be side effects that warrant vet visits/hospitalizations, but your dog/cat won't lose its hair, won't be vomiting uncontrollably, won't be a walking skeleton, etc. And you can always stop if you want to.'

Most people still absolutely would not do it, and that's completely their prerogative, but chemo is a scary word for a lot of people in this world. Understandably so.

Survey sheds light on pet owners’ perspective on cancer Here is some data on it actually. Yeah, people are worried about cost (spoiler alert, pet owners would say the same thing about vaccines) but more significantly, they are worried it is the wrong choice regardless of cost.

I mean, that’s about as good of a speech as you can give. I like the bit about living comfortably alongside cancer - may borrow that sometimes if that’s okay.

I watched several people I loved get absolutely wrecked by cancer and their chemo treatments. It’s a rational thing to not want to see anyone you love go through it, and to assume pets would have the same reaction.

When someone would ask a question about chemo’s safety/QOL during intake, a mentor I worked with would say something like, “pets can’t consent to being sick the way that people can, so we don’t use such strong doses of chemotherapy for their treatment. Our goal isn’t just more days, it’s more good days.” I’m sure I butchered it but I got the gist. 🤣

Anyway OP, sorry for the detour, but I’m sure you’ll see a lot of this stuff (or you already do if you’re working in med onc).

 

[Tech_Penguin]

I'm not sure what you have in mind when you are saying gold standard, though. Affordable care =/= unsafe care =/= low cost care. If they have dedicated space and equipment for this great, if not...

If we're talking Appalachia, one of the more chronically poverty-stricken areas in this country (depending on the specific location I guess), how many people are really paying to get chemo though? Genuine question, especially since you've described what might be a low-cost/subsidized clinic.

It's an urban hub, and the median household income is over 50k, so it's one of the better-off places in Appalachia. And by gold standard, I meant doing complete bloodwork/radiographs before each session and using name-brand drugs instead of generic ones.

I'd assume they'll get a chemo hood if they already have all that imaging equipment. I certainly wouldn't feel comfortable or willing to handle chemo drugs without all the necessary engineering controls. But what I'm suspecting is that almost all (if not all) the drugs will be oral chemo, and most will be for palliative care.

But either way, I'm excited to work in their surgery department bc they do a high volume of procedures daily, and I'd get to take CT scans. Plus, they'll be an exotic patient every once in a while

 

[pp9]

It's an urban hub, and the median household income is over 50k, so it's one of the better-off places in Appalachia. And by gold standard, I meant doing complete bloodwork/radiographs before each session and using name-brand drugs instead of generic ones.

I'd assume they'll get a chemo hood if they already have all that imaging equipment. I certainly wouldn't feel comfortable or willing to handle chemo drugs without all the necessary engineering controls. But what I'm suspecting is that almost all (if not all) the drugs will be oral chemo, and most will be for palliative care.

Idk about chest rads, but frequent labs are required for a reason (aka not killing the pet in favor of saving a couple bucks) and it's not something that should be option. I can see why some people might want frequent chest rads with doxorubicin, but generally the patient is already clinical for cardiac changes (as in, they presented to ER the night after a dose or after several doses of chemo) and you wouldn't be administering more doxo to a dog that's clinical. That's kind of why it all feels weird to those of us with clinical experience with these drugs/patients...some things you really just can't cut corners on and still say you're practicing halfway decent medicine. I'd be curious to see how it's all actually going down when you get settled into the new job and see what they're actually doing. 'Do no harm' is relevant here, but we don't know the full story.

And just fyi, last I checked, chlorambucil is the only generic oral chemo in this country (that vets reach for, anyways). Pretty sure all injectables are available as generics now. No vet hospital is intentionally ordering brand name drugs when generics are available, but maybe a 501c3 can get things slightly cheaper

 

[_rae_]

I think Palladia comes as a generic. Toceranib phosphate. That’s the only other one I know of.

 

[_rae_]

And in that vein, Palladia needs frequent BP checks as it can cause severe hypertension. We had multiple patients come in doing well cancer wise on Palladia but acting sick only to find their blood pressure was >200 on the Doppler. Even had one cat go blind from hypertensive retinopathy. And again, in that same vein, you need routine x-rays/CTs/ultrasounds for solid tumors to make sure they’re still responding/not metting. What’s the point of spending $600/mo on Palladia if it’s not working in the first place?

 

[pp9]

I think Palladia comes as a generic. Toceranib phosphate. That’s the only other one I know of.

Oooh right. Still an expensy generic, plus sometimes the dosing doesn't work with the generic iirc

 

[battie]

Gotta say, id be uncomfy as a doctor administering chemo for patients without appropriate diagnostics. Just did rounds with our baby doctors on Onco emergencies and neutropenia can be deadly in these patients. And it's a bad way to go.

Gives me the heebie jeebies to think someone would do chem without appropriate follow up

 

[SkiOtter]

And just fyi, last I checked, chlorambucil is the only generic oral chemo in this country (that vets reach for, anyways).

Cytoxan(cyclophosphamide) has a generic and can be compounded. My dog was on metronomic chemo with that for a year back in 2018/19 for a soft tissue sarcoma.

 

[indysadventures]

Gotta say, id be uncomfy as a doctor administering chemo for patients without appropriate diagnostics. Just did rounds with our baby doctors on Onco emergencies and neutropenia can be deadly in these patients. And it's a bad way to go.

Gives me the heebie jeebies to think someone would do chem without appropriate follow up

Yeah, where I worked that would never be an option and I remember my mentor saying something along the lines of, “it’s not safe medicine to administer chemo without appropriate bloodwork and follow-ups - we don’t practice unsafe medicine here.”

Under no circumstances would this ever be allowed with an oncologist present and overseeing. It breaks the codes of “do no harm” as well as “more good days” if chemo isn’t being safely administered, putting patients at risk of early death due to treatment. I’d be shocked if anywhere would be willing to do something like that - as Rae pointed out, even Palladia still requires frequent bloodwork and BP monitoring at first, followed by monthly.

I truly don’t know how it would be defensible if a patient died from neutropenia after chemo administration without bloodwork - more than likely, that would be an entirely avoidable death. And truthfully, this is common enough that such deaths wouldn’t be unlikely to happen with a heavy-hitter like dox.

Further, it opens vets up to a potential suit if the family finds out that proper protocol was broken. People facing sudden, traumatic losses will lash out. I saw it happen ALL THE TIME in oncology. They look for errors, even when there were none to be found and their pet’s treatment failure was just **** luck. Administering chemo without verifying cell counts (+\-) chemistry to check liver/renal function would open you up to a serious suit (my mentor talked about the risks with people often because they’d ask about foregoing bloodwork).

 

[Tech_Penguin]

still don't know all the details because it's still very much in the works, but in my mind the "gold standard" for rechecks would be like CBC + superchem + UA + US/CT/MRI + full exam + EKG/BP if on doxy/palladia. Ik it seems overboard, but I, like many owners I've seen, want the best for my (insured) pets. But if you want to do the bare minimum, maybe like a Chem 10, blood smear, quick exam, etc? From what I've heard about their prices, this would be around $60 +/- $15 for basic blood + an exam, so not too bad. But yeah, it's a gray area when you want to provide specialty care at a fraction of the price

 

[indysadventures]

still don't know all the details because it's still very much in the works, but in my mind the "gold standard" for rechecks would be like CBC + superchem + UA + US/CT/MRI + full exam + EKG/BP if on doxy/palladia. Ik it seems overboard, but I, like many owners I've seen, want the best for my (insured) pets. But if you want to do the bare minimum, maybe like a Chem 10, blood smear, quick exam, etc? From what I've heard about their prices, this would be around $60 +/- $15 for basic blood + an exam, so not too bad. But yeah, it's a gray area when you want to provide specialty care at a fraction of the price

By recheck, do you mean before every appt?

For example, if receiving dox (not doxy), the schedule is 6 doses at three week intervals, with appts the week after administration to check bloodwork to make sure they aren’t neutropenic/anemic/thrombocytopenic. So the schedule would be week 1 - bloodwork/recheck/ treatment/staging if not already done, week 2 - bloodwork/recheck, week 3 - break…. Repeat until finished, with full re-staging at treatment 3 or 4 and at 6.

Honestly, if you mean doing full re-staging diagnostics at every recheck/appointment, I personally don’t think that’s gold standard medicine because it wouldn’t be cost-effective or even reasonable for a client’s time to do that level of diagnostics at every recheck. And that’s before we even discuss that diagnostic imaging - esp CT/MRI - are not without risk. Of course I have so much more to learn, but the gold standard that I’m aware of would be histopathic confirmation followed by staging before start, then re-staging at mid-treatment (or earlier if clinical signs are suspicious) and then finally at end of treatment. For dox, echo would obviously be ideal before treatment but more often than not, it may not be indicated if you have a dog that isn’t a standard breed at risk and isn’t showing clinical signs and has a normal cardiac history and no abnormalities noted on CXR during staging. Echo wouldn’t really need to be repeated during treatment unless the patient began to show signs of cardiotoxicity. We have a pretty solid understanding of our dosage limitations regarding dox to help us avoid cardiotoxicity, but it’s always great to check if able before beginning treatment.

Gold standard has to balance risk vs reward. This applies to ideal chemo dosages and treatment plans, as well as diagnostic imaging….. more doesn’t always mean better. Many patients have significant fears of the vet and need to be sedated even for AUS or CXR. Definitely full anesthesia for something like CT or MRI. It would be unreasonable to potentially expose the patient to that much risk (and the client to such unnecessary cost and time commitments) at every recheck. Especially considering our population is more likely to be clinically sick while undergoing these diagnostic procedures. This would significantly bar many clients from treatment and skyrocket costs. Recheck should be full bloodwork at appropriate intervals for the drug being administered - this will vary depending on the treatment plan - but ALWAYS at least a CBC before administration of chemotherapy. Chemistry is necessary for some at every appointment but not all, there’s a lot of nuance there that needs an oncologist to interpret. Same with the UA, BP, etc etc.

Considering how nuanced oncology truly is, and how each patient and their cancer and treatment will be slightly different - many of us here are just saying that we have serious concerns about potentially administering any chemotherapy without an oncologist in house - chemo side effects require adequate communication and follow-up that’s a full-time job. They also require prompt response before side effects start a run away train. It can happen so easily.

That’s not saying this clinic isn’t doing things the right way - we’re just giving you some warning signs to look out for, for your safety and for the patients. I personally wouldn’t want to be involved in care that provided these drugs without appropriate monitoring and patient care. GP administration of “at-home” chemos are one thing …. though I think these drugs are too often treated as less dangerous when they should not be - e.g., palladia has a scary number of weird side effects. But, any IV chemo without standard monitoring and follow-up by an oncologist is just simply not safe for patients (and I think we all doubt anyone at this clinic is administering IV chemo, but if they are, proceed with caution). There are legitimate legal concerns regarding utilization of these drugs and for good reason.

 

[Tech_Penguin]

yeah, regarding the gold standard I meant it more as a combination of the above depending on the case and dosing schedule. Like if I owned a golden with HSA, I’d want to ultrasound it like weekly or biweekly just in case it gets a heme-abdomen or something. But if it was a slow growing oral ameloblastoma, that’d be a different story. And while I’d do a superchem for my dog, an oncologist may suggest a more basic chem for each appointment. I understand your concern, but virtual oncology consulting is becoming more and more common as there just aren’t enough medical oncologist in some parts of the country. It’s even happening at some vet schools.

Also, side note some vets in rural areas are surprisingly resourceful and creative. I went to a talk at my school one time and he talked about using ballottement in the field when there wasn’t a portable X-ray. Maybe this is the kind of things happening in shelters and other places with limited resources

 

[_rae_]

Weekly ultrasounds are impractical and quite honestly, a bit outrageous, and show me you need some more experience in this niche. It takes a long time to understand the protocols, the recommendations, and where to cut corners. Doing more isn’t always doing right.

I also really want to caution you about how you’re talking about “wanting whats’ best for your (insured) pets.” While I understand the sentiment and where I think you’re coming from, it comes across judgey, as if those who don’t have insurance don’t care about their animals. As someone who is wanting to work a job in a low/middle income area, that kind of attitude is not going to help you. I had people from all walks of life, with and without insurance, with and without financial need, who did what was best for their pet within their means. Spectrum of care is invaluable to veterinarians and applies as much to specialty as it does GP/ER.

The surgery side of this job sounds fabulous and like it will be a good fit for you. If you want onco experience though, you need to find an oncologist and work directly under them. Many of our oncologists did teleconsulting for diagnoses, prognosis, and general recommendations, but never for direct treatments. That is not what teleconsults are for.

 

[genny]

It’s even happening at some vet schools.

which school is that?

 

[indysadventures]

Weekly ultrasounds are impractical and quite honestly, a bit outrageous, and show me you need some more experience in this niche. It takes a long time to understand the protocols, the recommendations, and where to cut corners. Doing more isn’t always doing right.

I also really want to caution you about how you’re talking about “wanting whats’ best for your (insured) pets.” While I understand the sentiment and where I think you’re coming from, it comes across judgey, as if those who don’t have insurance don’t care about their animals. As someone who is wanting to work a job in a low/middle income area, that kind of attitude is not going to help you. I had people from all walks of life, with and without insurance, with and without financial need, who did what was best for their pet within their means. Spectrum of care is invaluable to veterinarians and applies as much to specialty as it does GP/ER.

The surgery side of this job sounds fabulous and like it will be a good fit for you. If you want onco experience though, you need to find an oncologist and work directly under them. Many of our oncologists did teleconsulting for diagnoses, prognosis, and general recommendations, but never for direct treatments. That is not what teleconsults are for.

I’ve also have seen clients who could afford the gold standard treatment - CHOP for LSA for example - but they had to elect for a single-agent protocol like lomustine. They needed to do this because of physical, familial, or health limitations that prevented them from being able to adhere to a weekly protocol.

They didn’t love their pets any less.

Neither do those who opt for palliative care.

People often have to deal with near-impossible decisions and they have to do what they feel is right for their family. It’s our job to meet them without judgement - as long as their pet is comfortable, loved, and not suffering, the family is doing their job.

 

[Tech_Penguin]

yeah, I get what you mean rae and indy. I think it’s great when owners can do everything a vet recommends but I also think it’s great when they do what they can within their budget. I’m used to spectrum of care in my first hospital and the service I started in a few months ago does the same as well for chemo. And my research interests also tie into lowering the cost for cancer care

This is more me joking that I’ll go overboard with my own pets’ tests years down the road. And I have good reason - my dog was getting US around every ten days for his last month because my parents (and his vet) were worried about bleeding based on his progressing symptoms (ie melena) and the size of the tumor. And he did eventually go to the ER for a hemoabdomen. If my future dog were to get cancer after I graduate I’d probably get one of those wireless ultrasound probes that connects to your phone to use at home lol. But for actual patient, I would stick with the recommended guidelines when I start practicing.

And Virginia-Maryland is the only place I know that gives chemo with a virtual oncologist since they lost their two medical oncologists to Purdue over a year ago. I think MSU did a similar thing a few years ago when they lost their oncology team but someone correct me if I’m wrong. If a boarded oncologist agrees to a virtual setup with a rDVM, who’s to tell them they shouldn’t be helping. If this telehealth was so problematic, VM would’ve pulled the plug long ago.

Roughly half the counties in the US lack a medical oncologist, so these owners are left without many options and are forced to drive over an hour or two, several times a month which isn’t feasible for most people. I have a feeling this is going to get worse due to the economic state of this country, and specialists in rural areas and academia will move to cities for a better salary.

But you’re right, there’s still a lot for me to learn and that’s fine because I still have about a decade of school ahead of me plus residency 🙂

 

[_rae_]

A couple of things:

An ultrasound every ten days is STILL impractical! Whether it was recommended by a veterinarian or not. A US won’t stop a hemoab and it won’t make it more survivable. Those things burst how and when they want. The only sure fire way for that to NOT happen is to remove the spleen. Something you’re going to learn is that all the medicine you’ve been exposed to isn’t always good medicine.

There is a very large difference between a specialty academic center utilizing virtual specialists who probably have some connection there, and the commoditization of chemo through GPs using telehealth. That is never going to happen. What happens in care deserts is animals get euthanized or their owner makes the drive. The state of Vermont (my homestate) has a single board certified oncologist and no rad onc. You either go to her, or you drive the three and a half hours to Angell in Massachusetts, the hospital I worked at. We saw clients from NJ, ME, VT, NH, RI, NY, and even further. Many of these clients asked if we could advise their GP so they didn’t have to drive so far. The answer was always no.

I’ll debate putting this point in before I post, but I think it’s important. I want you to read back through this thread and notice how you have a retort or rebuttal for everything we say, despite the fact that two of us spent multiple years in oncology and one is a very seasoned zoo doc with a lot of ER experience. You do not have more knowledge than any one of us and you certainly don’t have more knowledge than the three of us combined. You may be reading this as a “oh we’re talking about different kinds of care!” But I know I can speak for Indy and myself when I say this has been a long thread of deep concern about patient, staff, and owner safety. Knowing when to back off instead of coming up with excuses, brushing things off as jokes, or continuing to speak on topics you realize you’re out of your depth is a really difficult skill, and one I’m still learning myself. I see a lot of the same overexcitement and big ideas I had when I was just starting out. Hopefully this whole conversation is at least a good learning tool.

And with that, imma tap out, because I cannot stress about theoreticals or patients that aren’t my own. Good luck.

 

[Tech_Penguin]

Thanks for your input Rae. And I appreciate your concern but the comments regarding my own pets seem a tad judgmental even if that wasn’t your intention. This was for a gastric adenocarcinoma so POCUS + rechecks at that frequency was what was agreed upon between the medical oncologist, GP vet (right next to my house), and my family since free fluid in the abdomen was an endpoint criteria. If owners want to take extra precautions within reason and have a better safe than sorry mentality, shouldn’t their vet support them?

Again, I’m not even sure if it’ll be IV chemo bc nothing is finalized. I’d wager it wouldn’t be the more pricey or combo chemos mentioned. And I’m sure there will be case selection. But I agree, there needs to be a certain level of diagnostics and precautions for these drugs. Also, I don’t have the expertise to answer your questions. And it’s the DVMs planning this, not me, so it’s going to happen regardless of me being there.

Medical oncologists have been doing tele-health with GP vets for years due to the access to care problem. DVM360 has a podcast about it. I’m sure these oncologists advocate for good medicine. Sure, it is not the same as going to an oncologist in person, but the alternative is euthanizing earlier.

But thanks everyone for your replies. I’ve learned some new things like red flags to look out for. At the end of the day, I want what’s best (and safe) for the patients/owners and others involved.

 

[pp9]

one is a very seasoned zoo doc with a lot of ER experience.

You're making me blush

--------

I am bored at work waiting for 4:30 so I will keep rambling. When I was a prevet I very much said things that I thought I understood, but didn't. Or maybe had a very loose grasp on, but didn't quite have a handle on the full concept. I think there's a lot of opportunity to learn and grow thanks to SDN, I know I sure did. A lot of this you just can't really understand until you're out in practice, too.

If owners want to take extra precautions within reason and have a better safe than sorry mentality, shouldn’t their vet support them?

I've talked numerous owners down from doing unnecessary things before, but I also just told them I wouldn't be doing it anyways. Could give countless examples of this. Be very cautious about allowing medicine to become a fast-food drive through of sorts - 'I'll take the ultrasound with the CBC, but I'll hold on that chem, and I want a repeat chest xray to make me feel better.' If and when you get in that position, you are the doctor and you make the recommendations. Working within the financial means of an owner is one thing, letting them dictate what you do is another.

I personally don't cater to clients in that way, ever, because why would I spend their money and my time on stuff that isn't actually needed? You're also asking for an owner to turn around and accuse you of padding bills at some point.

Medical oncologists have been doing tele-health with GP vets for years due to the access to care problem. DVM360 has a podcast about it. I’m sure these oncologists advocate for good medicine. Sure, it is not the same as going to an oncologist in person, but the alternative is euthanizing earlier.

You seem to have confusion as to what this entails, though. Using a tele-onc does not mean these places are not also checking CBC/chems or whatever pre-chemo stuff is deemed necessary. What's likely happening is the GP says 'they have this dog with this cancer, here are the labs/today's vitals, clinically dog is fine, what dose of chemo/what drug today?' Idk what others have to say, but freely administering something like chemo without making sure the patient is able to receive it safely could be considered malpractice by some. This isn't a drug a pet might have an unpredictable adverse reaction to, these are drugs that are all but guaranteed to cause very specific types of problems that will result in serious expense (if not death) if the basic pre-chemo checks are not done and that pet has a find-able problem that would preclude treatment that day.

And then your local ER/criticalist gets to try to save the pet you septicized, but the owner now has only $5 because they were doing random $300 ultrasounds every week (kidding, kind of).

my dog was getting US around every ten days for his last month because my parents (and his vet) were worried about bleeding

And he did eventually go to the ER for a hemoabdomen..

Yeah so those ultrasounds told you that at that very exact moment in time, there was no evidence of free fluid. But your dog did end up bleeding despite all of the time/money that went to those ultrasounds, because hemoabdomens are essentially inevitable for vascular tumors.

I like what rae said - impractical. I get that some people must have the time/money to do unnecessary things, but a lot of what goes into the art of being a vet is understanding what is practically needed for an animal at any given time.

I mean, that’s about as good of a speech as you can give. I like the bit about living comfortably alongside cancer - may borrow that sometimes if that’s okay.

Borrow away!

 

[Tech_Penguin]

His case was a GI tumor, not a vascular tumor. The absence of effusion in the first two ultrasounds was clinically useful because it justified putting off a PTS appointment. The visits were also useful to go over his QOL, meds, and get a refill of hydromorphone since the GP preferred to prescribe small quantities.

And yeah, it’s my understanding that these virtual oncologists require full patient histories and labs in the referral and continual follow-ups. Like you said, these contraindications are important to double check.

From what I’ve seen, oncology and palliative care isn’t cookie cutter. The treatment plan is dynamic and depends on owner goals, patient health, hospital resources, etc. And I agree that different people have different ways of practicing.

Also, interestingly this is also happening with rad onc also because of how few specialists there are. They contour dose maps remotely with a DVM and trained techs on-site.

 

[indysadventures]

His case was a GI tumor, not a vascular tumor. The absence of effusion in the first two ultrasounds was clinically useful because it justified putting off a PTS appointment. The visits were also useful to go over his QOL, meds, and get a refill of hydromorphone since the GP preferred to prescribe small quantities.

And yeah, it’s my understanding that these virtual oncologists require full patient histories and labs in the referral and continual follow-ups. Like you said, these contraindications are important to double check.

From what I’ve seen, oncology and palliative care isn’t cookie cutter. The treatment plan is dynamic and depends on owner goals, patient health, hospital resources, etc. And I agree that different people have different ways of practicing.

Also, interestingly this is also happening with rad onc also because of how few specialists there are. They contour dose maps remotely with a DVM and trained techs on-site.

I think we are confused because you said hemoabdomen before now with regard to your dog’s AUS monitoring, not effusion/ascites.

 

[_rae_]

Also, interestingly this is also happening with rad onc also because of how few specialists there are. They contour dose maps remotely with a DVM and trained techs on-site.

No. That is super not how that works. This is a massive oversimplification.

 

[pp9]

His case was a GI tumor, not a vascular tumor. The absence of effusion in the first two ultrasounds was clinically useful because it justified putting off

I have a feeling you are missing some key pieces of info here.

My turn to tap out?

 

[Tech_Penguin]

yes, it was unclear bc the hypothetical I gave initially was HSA which I don’t know a lot about but my dog had a gastric carcinoma. And now that I’m looking, these terms aren’t interchangeable. The free fluid was likely a combo of ascites and blood, but I don’t think this necessarily makes it hemoabdomen

 

[indysadventures]

yes, it was unclear bc the hypothetical I gave initially was HSA which I don’t know a lot about but my dog had a gastric carcinoma. And now that I’m looking, these terms aren’t interchangeable. The free fluid was likely a combo of ascites and blood, but I don’t think this necessarily makes it hemoabdomen

It was not unclear because we misunderstood your example. It was unclear because you said your dog had a hemoabdomen, but then later said it wasn’t vascular cancer after we discussed how that applied re: unnecessary AUS protocols etc.

You literally said it here:

This is more me joking that I’ll go overboard with my own pets’ tests years down the road. And I have good reason - my dog was getting US around every ten days for his last month because my parents (and his vet) were worried about bleeding based on his progressing symptoms (ie melena) and the size of the tumor. And he did eventually go to the ER for a hemoabdomen.

As respectfully as I can say this, you clearly have a lot of learning to do within this specialty. But…. it is okay to not know something. You have to start somewhere and you can never know everything. Not even when you’re a doctor — especially when you’re a doctor. You will see much more success in your professional goals if you let go of the need to always appear right, or intelligent.

Because you are going into a field that requires you to be a lifetime learner. Your behavior in this thread makes me seriously question if you are seeking to enter this field to be a good doctor or to satisfy your ego. If you truly care about patients, you will learn to embrace that you don’t know something. Rushing headlong into a treatment and asking questions later will get your patients killed.

The colleagues I always trusted the most - the ones I relied on through thick and thin - were not those who always acted like they knew everything, but instead those who knew when to ask for help when they needed it.

ETA: I am not welcoming a retort to this, I will not be responding further to this post because it is unproductive at this point.

 

[genny]

Because you are going into a field that requires you to be a lifetime learner. Your behavior in this thread makes me seriously question if you are seeking to enter this field to be a good doctor or to satisfy your ego.

OK, this is a little harsh. Pretty much every prevet under the sun thinks they know what they're signing up for, and then four years of schooling makes them realize that they actually knew nothing. There are varying degrees of obnoxiousness, and some have more growth to go through than others. I think you can gently educate without calling into question their vision for their future because i can guarantee you, you're not going to change their mind. Most of what Tech_Penguin has said thus far sounds like a very eager learner who doesn't know much yet, though they do know more than your average owner.

 

[_rae_]

I hate to be a jerk, but this person has changed their username multiple times to distance themselves from things they've said that have gotten them in trouble. This isn't just someone eager to learn, this is a pattern of behavior of not being willing to do any introspection.

ETA: I will not elaborate on this, just to be clear. They know exactly what I’m talking about and I don’t want to start a witch hunt.

 

[Tech_Penguin]

Wow, this seems like a lot. I wanted to share how excited I was about my job offer and exploring access to care at first. I tried to go through your scenarios with my limited knowledge when grilled, and mentioned a couple of times how I was unsure about x or was still learning about y. I also acknowledged several points brought up. I opened up about my own story to show how the spectrum of care goes both ways - some owners want to do more for their pets. But to have the most emotional point of my life picked apart and my decisions labeled as “bad” is beyond hurtful. Also, the ER did not test the fluid since this was a PTS, which is why I expressed that I may have been wrong about the term. ‘Hemoabdomen’ was just thrown around by vets at that time.

You already know the reasons I want to be an oncologist and researcher. It’s from personal connections and genuine curiosity. I wouldn’t pursue this path unless I was 100% committed to learn throughout my life. I’ve also encountered many situations over the last few years where I’m out of my league and need to ask for help. And not that anyone asked, but I’ve done a lot of self-reflection over the past few months and will do more over the next year. I understand that there are a lot of strong opinions surrounding these topics, and I can come across as high-strung or even neurotic about oncology, but personal affronts are not necessary. If you’re getting the impression that I have a “need to be right” it’s probably my OCD worry of being misunderstood or misjudged. It’s not healthy for me to keep re-hashing this memory, especially when I recently lost my other dog to a cancer-related complication, so I’m not logging on for a while or responding