Whiskers, Wags, and White Blood Cells - Oncology Edition 🐾🩺🎗️❤️

September 17, 2025, 9 AM, I started my internship shift at VMCLI in Oncology.

Today, I was paired with Dee, an incredible oncology LVT, who guided me through the fascinating (and humbling) world of veterinary oncology. She started by showing me the chemo hood, a special workspace with negative pressure that keeps staff safe while chemo drugs are drawn up. From there, I learned about how chemo is actually given to patients - either via a 22G butterfly catheter (for shorter infusions) or an IV catheter if the medication needs more time to administer. Some drugs are administered slowly over a 15-minute duration, even with the butterfly.

Another important aspect of oncology treatments is the use of closed system transfer devices (CSTDs). These are specialized syringes designed with safety in mind. Instead of having an open needle that could expose staff to hazardous drugs, the needle is contained within a closed circuit. To administer the drug, the syringe must connect to an adapter, keeping the medication completely contained. At VMCLI, the CSTDs are used for all infused chemo drugs - whether it's chemo itself, saline, or diphenhydramine - protecting both the staff and patients while guaranteeing safe, precise drug administration.

Closed System Transfer Devices (CSTDs)

Our first patient of the day was Pebbles, the sweet little Pug. Pebbles has been diagnosed with lymphoma, but sadly, by her 4th round of chemo, her lymph nodes still haven't shrunk like they should have. She's also been showing clinical signs like coughing and lethargy. Because she hasn't been responding well, the oncologist, Dr. Edwin Brodsky recommended starting her on a rescue protocol drug called Lomustine aka CCNU.

I learned that while CCNU can be beneficial, it also carries risks to our patients. In dogs, it can cause liver toxicity, so the vet team always runs an in-house Chemistry panel and a CBC before proceeding. They pay close attention to ALP levels, WBCs, and neutrophils. If the WBC count is too low, they often delay treatment by a week to keep the patients safe. For cats, CCNU poses risks to the kidneys, so an in-house kidney panel is run instead.

Unfortunately, if Pebbles doesn't respond to CCNU, her options are limited. The focus would then shift to palliative care, making her comfortable with medications like Prednisone, a steroid, to manage symptoms so she can continue to enjoy her days surrounded by love at home with her family.

Our next patient was Bella, a beautiful but nervous young Belgian Malinois who had also been diagnosed with lymphoma, but just recently. Since Bella is still relatively new to the oncology department at VMCLI, the team was extra mindful of her anxiety. To keep her calm and comfortable, only a select few were allowed in the room during her treatment - a thoughtful step to make the experience as stress-free as possible.

Bella's chemo protocol involved Adriamycin (aka Doxorubicin), a stronger drug that's given slowly over 15 minutes via a butterfly. This slow pace is essential because if Adria is pushed too quickly, it can trigger some concerning side effects like facial twitching and even premature ventricular contractions (VPCs) - a type of arrhythmia.

To minimize risks, the oncology team always premedicates dogs with Diphenhydramine (Benadryl) before treatment. Felines, on the other hand, are given dexamethasone to reduce the chance of adverse reactions. During the infusion, patients are carefully monitored on an EKG, making sure their heart rhythm stays steady.

With the gentle handling of her LVT and assistant, Bella did wonderfully during her round of chemo and was happily reunited with her mom afterwards.

The next patient we saw was Melanie, who was diagnosed with thyroid carcinoma 4 years ago. Melanie, a sweet Collie mix, came in today for a recheck. Unfortunately, a new mass was found in her lungs, and Dr. Brodsky expressed concern that her cancer may have metastasized. To guide treatment, the team wants to run an in-house CBC/Chem panel, for which Dee allowed me to draw the blood from the left front Cephalic vein. I used a butterfly and I managed to obtain 3ccs of the blood sample. Melanie was then sent home with an oral chemotherapy drug to continue her care. The interesting thing about thyroid carcinoma in dogs vs cats: in canines, the T4 hormones are usually non-functional, while in felines, thyroid tumors actually affect their T4 levels. When possible, surgical excision of the mass is pursued, followed by a biopsy to determine which chemotherapy drugs might be most effective.

The next case was Buddy, an elderly Poodle mix with lymphoma. He came in today for his scheduled round of the chemo drug, Vincristine, the next step in his chemo protocol. Unlike some other chemotherapy drugs, Vincristine can be administered fairly quickly and is usually well tolerated with minimal side effects. Dee prepared him carefully, first flushing his vein, then administering the Vincristine through a butterfly. Buddy was calm throughout his visit and handled his treatment beautifully - a gentle reminder that not every chemo day has to be overwhelming, and sometimes it's just about steady progress one dose at a time. Our second-to-last patient of the day was Remi, a beautiful elderly Pittie mix with a diagnosis of hemangiosarcoma. Her journey has been a difficult one. A month ago, her mom found her in distress one morning - she had labored breathing, lying in a pool of her own vomit, and was rushed to VMCLI. Imaging revealed a splenic mass that ruptured, causing a dangerous hemoabdomen. The surgeons acted quickly, performing a splenectomy to stabilize and save her life.

Yesterday, Remi was officially cleared, two weeks post-op, and could finally begin her chemotherapy. She returned today for her first round - an Adriamycin infusion, administered slowly over 15 minutes. As with Bella's case, Dee premedicated her with Diphenhydramine to reduce the risk of reactions and carefully monitored her heart rhythm with an EKG monitor.

Remi is receiving Adriamycin via the CSTD in a Butterfly.

Our last case of the day was Milly, who came in for a consultation. She had enlarged lymph nodes, so Dr. Brodsky performed an aspiration and sent the sample to North Carolina for flow cytometry, a diagnostic test that helps determine which type of lymphoma she has. This process, known as immunophenotyping, is essential for tailoring the most effective treatment plan.

Alongside this, Dee and her team ran an in-house CBC and chemistry panel to check Milly's overall health status. Her first chemo drug will be what's called an induction - a protein-based drug used to kickstart treatment. These induction drugs can sometimes cause adverse reactions after a few doses. For the very first dose, the team often skips premedicating with Diphenhydramine, but in subsequent treatments, premedication is usually given to reduce the risk of side effects.

Ending my shift at 5 PM, I reflected on today, and I realized that oncology is as much about compassion and comfort as it is about medicine and science. Each patient - from Pebbles and Bella to Melanie, Remi, Milly, and Buddy - had their own story, their own challenges, and their own brave way of facing treatment. I witnessed how carefully the team balanced protocols, diagnostics, and safety measures with gentleness, patience, and love. While some cases carried heavy realities, every patient walked out surrounded by care and hope, reminding me that in veterinary oncology, the goal isn't just to add days to their lives, but to make each day they have as full of love, dignity, and tail wags as possible. 💜

Remi, after her chemotherapy. Drowsy from her diphenhydramine.