This is a response of mine to a VIN colleague that is having difficulty dealing with the new found pathology and badness she continually finds during her new ultrasound curve. Getting a faster dx means also finding badness faster and she was having trouble with the adjustment. I cannot quote her because its off of VIN but i though it would start an interesting discussion posting my response.

 

EL:

 

Fellow colleague, a colleague of mine sent me this link as she thought I could have some input into your post.

This is a response of mine to a VIN colleague that is having difficulty dealing with the new found pathology and badness she continually finds during her new ultrasound curve. Getting a faster dx means also finding badness faster and she was having trouble with the adjustment. I cannot quote her because its off of VIN but i though it would start an interesting discussion posting my response.

 

EL:

 

Fellow colleague, a colleague of mine sent me this link as she thought I could have some input into your post.

 

It sounds like you are on the right path even if it doesn’t feel that way from an emotional standpoint. I have been doing only US and a very high volume since 2001 and that’s all I do now after being a GP for 4 years and a tech for many summers before that so I am no foreigner to the clinic bereavement and have shed a tear for pet owners many times as have all of us. When I made the transition from GP clinical sonographer to pure mobile sonography/clinical consultant and an average of 20 sonograms/day in 2001 I felt exactly how you do right now. I do what I do now in a certain sense to escape the bereavement I would have to deal with in the clinic ironically seeing hundreds of sonograms a month directly and remotely now, about 30% of which have cancer, none of which I have to tell the owners about because I’m a consultant. Ok, yes bear my soul but its a bit of an escape working behind the scenes though the back door of the hospital and behind a computer screen while my esteemed clients deal with spilling the news. But its better this way now because there are lots of good folks out there that can help an owner bereave better than I can having been somewhat numbed in a self protective manner from such a high volume of badness on the screen and under the probe.

 

That being said, there are two things that I have learned living by the probe.

1) What looks like cancer sonographically is only truly cancer about 70-80% of the time no matter how bad it looks and there is local cut-em out cancer and multicentric badness which are technically both cancer but the former is very rectifiable with similar effort to any other surgery (localized lobar hepatocellular carcinoma) and the other takes more effort if fruitful at all (multicentric malignant histocytosis/histocytic sarcoma). This is why we have a needle and a probe (which you are doing and I praise you for it because more probe holders need needles in the other hand) and why we always give the patient the benefit of the doubt especially you folks that live in fungal regions because fungal infections often look like cancer.

 

2) There is no better instrument than “clinical sonography” (not just ultrasound because the concepts are different) to promote and live diagnostic efficiency (TM) to get the definitive answer with a probe and a needle and give the owner the most rapid information to make an honest informed decision in the least amount of time. I have built my career and the SonoPath community on this concept. Honestly number 2 is what the pet owner is truly looking to us for with a passionate twist when you peel it all down to defining what we do. My nuts and bolts Q/A of clinical sonography: Is the case surgical? Get it under a scalpel. Is it medical? get a needle in it and treat it specifically? Does it look neoplastic? get a needle in it and confirm it so the owner can decide with definitive results and not just guess work on the part of the veterinarian that they trust. Owner can’t afford more than the sonogram? Have a needle fund as you will learn as much from videoclipping the needle into the lesion and reading the path description along with watching the echotexture of the lesion being sampled while the owner will have more information to make the informed decision. No needle fund? eat the cytology fee or work from an enhanced gut feeling because that’s all you have but your gut feeling will be enhanced by answering as many of the prior questions as you can. Or just incorporate your needle fund in other pricing in the hospital…its all a numbers game and numbers are just the vehicle to allow us to do what we do with a conscience.

 

Yes badness is out there but, honestly, it always has been. I see just as much % of badness with the probe now as I did in 1999 but I just see a ton more of it now because my volume is high but the % are roughly the same. Its only now the more clinical sonography is employed the faster we find it and the less patients are dying without a dx or sitting in a cage not improving when utilized correctly or we are getting the dx earlier in a more treatable state (i.e. splenic lsa as opposed to splenic and hepatic lsa moving from spleen to portal system….prognoses are very different under chemo or sx and chemo).

 

So the flip side of your discussion is that we are providing a more informed presentation than we could in the past and we are overwhelmed because we didn’t think there was this much bad pathology out there that could come in front of our dx so rapidly. But now we see it because we are “cheating:” with clinical sonography and all the technology advances that have happened in recent years. But honestly nothing has changed regarding the path as it has always been there unless of course you practice near a superfund site which is a whole other discussion. We just approach the art of vet med more efficiently and the more you put a probe on anything sick the more you will confirm what I am saying here. I guarantee it.

 

But just sleep better at night because we are doing our jobs more efficiently and providing our clients a better service as long as we are giving the patient the benefit of the doubt and getting as many cytology and histopath samples as humanly possible to find those 2-3/10 that look like neoplasia but aren’t, or we get an earlier dx than we would have in order to treat more effectively. As our long term service should be aimed toward those we can help as well as inform the owners of those we can’t as efficiently and as accurately as possible, we are doing our jobs to the best of our abilities.

 

If we do this the career, the business and our conscience can only be solid and stable and grow accordingly. I commend you on your curve and believe me there is an odd but solid peace that comes along the way…..you just have to let the dust settle a bit and keep the curve vertical.

 

BTW this isn’t a “pity party” at all but a thought process that each of us has gone through whether the colleagues admit it or not. If they don’t they should change profession. Its all part of the passion mixed with the art of veterinary medicine. Its is what we do.

 

Keep the faith. It gets easier.