These professionals play a bigger role than many may realize in helping care for patients
Utilizing veterinary technician skills to the fullest boosts revenue, improves efficiency, promotes motivation and job satisfaction, and advances the standard of care. Especially in pet cancer care, all the help these professionals can offer is valuable to the patient and team.
Jenny Cassibry Fisher, RVT, VTS (Oncology), with Pet Cancer Care Consulting in Scottsdale, Arizona, described skills technicians can harness to care for patients with suspected or diagnosed cancer, during a lecture at the Directions in Veterinary Medicine conference in Nashville, Tennessee.1 “There are things as technicians, we will never do,” she said to attendees, “But there are a lot of things that we can do, that we don't do enough of.”
A physical exam is an excellent opportunity to use technician knowledge—and intuition—to complement the veterinarian. Technicians often help restrain the patient in a Fear-Free manner. Cassibry Fisher noted that because their hands are directly on the patient in these scenarios, technicians may pick up on an abnormality. “How many times do you feel something and [the veterinarian] missed it? Your hands are there, so you can say, ‘Hey, doc, what is this? I feel this.’”
Additionally, she advised technicians to familiarize themselves with lymph node palpation. According to the American Kennel Club, it is common for dogs with lymphoma to have lymph nodes that are enlarged between 3 to 10 times larger than normal.2 “So getting comfortable palpating those lymph nodes is only going to help increase your knowledge [but you may also] potentially catch something on a patient,” said Cassibry Fisher.
She suggested practicing feeling a pet dog’s submandibular, mandibular, and prescapular lymph nodes when relaxing at home to master this skill. “This is where you need to get comfortable, not when you're in the hospital, and [the patient] is stressed,” she said.
According to Cassibry Fisher, catheter placement is a skill that technicians in oncology are often exposed to, so they are likely good at it. Despite this, there will be good and bad days. “One of the best assets I see in a technician, whether they've been doing it for 5 days or 5 years, is when they go, ‘Hey, I tried, it’s not my day. I need somebody else to step up.’ When you can't walk away, that's a problem,” she said. Asking for help is sometimes necessary and, in this case, spares the patient from being uncomfortable from fruitless attempts to insert the catheter.
Also, because cancer patients come in regularly, about once a week for 4 to 6 months, inserting a catheter can cause trauma. Cassibry Fisher recommended using smaller gauge catheters that provide more benefit and cause less damage down the line. “We're trying to preserve these veins for as long as possible,” she emphasized to attendees.
Body mapping and measuring
Cassibry Fisher recommended that every patient with a lump or bump should have a body map in their chart. She shared with attendees that Sue Ettinger, DVM, DACVIM (Oncology) has an invaluable resource you can use for body mapping on her website, drsuecancervet.com.3
Technicians should have a pair of calipers to document the measurement of the masses in the body map. “I can look at [the mass] and say, ‘Well, I think the dimensions are [x,y, and z]…no, we have to have some concrete evidence or some data to monitor that. How we do it is with our calibers,” said Cassibry Fisher. She added that when writing down information on the body map to date it. “Because if you don't have a date on that body map and you're trying to watch for progression or regression, it's really hard to tell.”
Pet parent education and support
Although Cassibry Fisher argues that in veterinary school there should have been more required business classes, in technician school, she said, there should have been more psychology classes. Many times, when veterinarians deliver bad news to clients, the technician steps in to comfort the pet owner. She spoke of a phenomenon called cancer shock that occurs in humans.4 “It is proven that when people hear the diagnosis of cancer, they completely shut down,” she said. “Perception is reality. So, if your perception [of cancer] is you watched your mother go through treatment, or you went through treatment, whatever your experience was, it becomes very real to you.”
However, clients often don’t know that veterinary oncology is very different than human oncology. She stressed the importance of educating them on how pets handle chemotherapy, radiation, and other treatments. “But to do that, you have to understand that and know that information,” she said.
Fisher Cassibry highlighted an important point that although human cancer treatment is typically associated with severe adverse effects, adverse effects in dogs often last for shorter periods and are milder, with 75 to 80% of canines experiencing no adverse effects at all,5 because they receive less aggressive treatment. “The doses that we are using are not the same,” explained Cassibry Fisher. “We don't need Fido to live 30 years to walk his daughter down the aisle, so we can focus on that quality and not quantity. While in human medicine, we're trying to get longevity.”