So you want to be a Veterinarian?

I’ve wanted to be a veterinarian from the time I was a tiny child and could comprehend what it was those amazing doctors did. I’m not unique in this capacity — many of my peers would tell you the same story.

Veterinarians are lovers of animals and science, blessed with the ability to heal patients who rarely comprehend our intentions. Most of us have known pretty much since forever that this is what we were born to do.

I frequently encounter young people looking for advice on how to succeed in veterinary medicine. I am by no means an expert in career counseling, but with the 10-year anniversary of my graduation from vet school on the horizon, I feel qualified to offer some insight to those of you considering veterinary medicine as your career choice.

Here are some of the harder things I’ve learned:

Prepare yourself for debt. The cost of education is rising and veterinary schools are no exception. Students are graduating with higher and higher levels of debt, and there’s concern for oversaturation of the market with new doctors unable to secure employment. Starting salaries can be so low the average person’s student loans exceed their income by ratios considered substantial enough to inflict “economic pain”.

I recall hearing information alluding to the financial difficulties I would face pursuing veterinary medicine as a career path. I, along with my peers, typically countered those statements with the noblest of intentions, stating I didn’t care about money and vet med was my passion.

Unfortunately, student loan officers care little about my passion when it comes to repaying my debt. Not surprisingly, neither does my mortgage lender, my electric company, or the person who owns the gas station where I fill up my car. Reality is the debt matters and can detract from job satisfaction because of the pressure to perform.

I’m not suggesting only the wealthy become veterinarians, but you need to consider what incurring hundreds of thousands of dollars of debt will do for your future goals outside of those related to your professional career.

Veterinary medicine is extremely hard work. This is true not only in the sense of the academics required to obtain admission to school or the brains required to keep you there, but also in the physical demands of the job.

Long days spent on your feet, hours spent performing complicated surgeries, wrestling fractious patients, performing exams on floors, enduring bites and scratches — each of these contribute to stress and strain beyond those related to emotion.

Depending on where you live, you may need to tolerate a long commute, work overnights; be on call for emergencies, or work at multiple clinics (or all of those things at once.)

This is not a 9-5 profession and you won’t be spending a lot of time at your desk. You will be physically challenged each day and the toll can be exhausting. What seems plausible at 25 years of age might be impossible at 50.

You can only sustain the lifestyle if you keep yourself physically and mentally healthy.

Euthanasia is a part of the job. Many times I meet people who say they wanted to pursue veterinary medicine as their career choice, but couldn’t deal with putting animals to sleep. Even after enduring this conversation so many times in my life, I still find it a strange commentary on my profession. I certainly didn’t become a veterinarian because I enjoy euthanizing animals.

Alleviating suffering associated with disease or debilitating conditions is something veterinarians view as an acceptable and necessary “evil”. No veterinarian relishes the idea of killing an animal. However, we know euthanasia is a tremendous responsibility we are entrusted to.

You need to view euthanasia as importantly as you do all other aspects of your job and embrace it for its benefits rather than shy away from it because it’s difficult.

Not everyone thinks your work is important. Many people love animals. However not everyone “agrees” with the idea of spending money on pets, whether for preventative measures or to treat disease.

Many people view veterinary oncology as a depressing, torturous, and unnecessary career path. It may sound harsh, but I’m uninterested in their opinion. I know my work is important to the owners who seek my care and expertise.

You need to be prepared for every person you meet who truly treats their pet as their child; there may be dozens who view them as replaceable property. And they will not hesitate to tell you your job has no meaning in their opinion.

You will rarely receive praise for your time and effort, but when you do, it can be the best feeling in the world. Again, this isn’t unique to veterinary medicine. Few professions are truly outwardly rewarding on a daily basis. However, when you know deep down that you have helped an animal get well, or prevented them from contracting disease, or even when you relieve their suffering through euthanasia, you are given a sense of purpose. All too often, this needs to come from within, and if you are the type of person who thrives on praise and expressions of gratitude, this isn’t the field for you.

Like all professions, veterinary medicine has its fair share of frustrations, grief, and difficulties. There are equally as many astonishing moments guaranteed to leave you speechless and saddened as there are those that will leave you comforted and happy.

If you can keep your ideals realistic, thicken your skin a bit, and smile brightly despite the negatives, you’ll be able to endure this career for the long haul.

Or, at least for 10 years, as I have.

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Holy responsibility, Batman!

In a previous article, I discussed how I felt advances in technology lead to unrealistic expectations of healthcare professionals being constantly accessible to clients.

 

The reviews of the article were mixed, with most people leaning towards understanding how emotionally taxing a life of continuously being plugged in can be, but a few individuals expressed their sentiment that as a doctor, I’m essentially obligated to be on call for others at all times.

 

I found one reader’s response particularly intriguing, as they theorized some owners could possess lofty expectations of my time and expertise because, quite simply, “With great power comes great responsibility.”

 

The quote was borrowed from the movie “Spiderman”, a film I’ve never seen (I’m much more partial to the Batman series myself.) However, I am fascinated by linguistics, and the phrase intrigued me to the point where I felt compelled to further investigate its origin.

 

Turns out (if you believe everything you read on the internet…) you can find references to the idiom many times over the course of history.
In a speech Franklin D Roosevelt was scheduled to deliver at the Jefferson Day Dinner in 1945, one day before he died, “Today we have learned in the agony of war that great power involves great responsibility.”

 

Winston Churchill, upon receiving an honorary degree from Harvard University in 1943, stated: “The price of greatness, is responsibility.”

 

In 1832, Francois-Marie Arouet (aka Voltaire), in Oeuvres de Voltaire, Volume 48 wrote: “un grand pouvoir impose une lourde responsabilité.”, translating roughly to “great power imposes a heavy responsibility.”

 

We can even travel way back to the new testament of the Bible, where in Luke 12:48, Jesus teaches, “from the one who has been entrusted with much, much more will be asked”

 

So if I’m interpreting this information correctly, political leaders, great thinkers, and the Holy Spirit, all recognized the pressures of constant accessibility, well before the invention of iPhones, the Internet, or Facebook?

 

This means technology isn’t to blame for the emotional toll of being constantly “on call”, rather the pressure arises from factors inherent to being leader and/or expert in a particular discipline or field. In other words, being good at something today means you’re expected to strive to be better at it tomorrow, and so on, and so on.

 

But here’s the counter-argument I would put forth: I’m not Spiderman. I’m not a leader of a country or a powerful thinker. And I’m not Jesus. I’m simply a human being trained in a very specific discipline and deemed “good” at what I do, but at the end of the day I’m imperfect and flawed, and I’m going to make mistakes from time to time. The philosophy of “more, more, more” is unrealistic, unsustainable, and, at times, utterly overwhelming.

 

Would I better equipped to accept my duties if I wore a cape and tights, or possessed a tiara and a magic wand I could use to fix everything?   If I were somehow “less” human, would I be more successful in my “responsibilities?”

 

Truthfully, I’m confident I wouldn’t.

 

The issue I have with not quite buying into the “power equals responsibility” as a doctor theory comes from my observation that no matter how much I give of myself and my time 1) it will never be enough for some people and 2) some people will never respect me enough to understand I am a person in addition to being their pet’s oncologist .

 

I accept and understand how my expertise and training places me in a unique position where I literally am making life and death decisions multiple times a day. Surely I’ve got the responsibility thing down, but I’ll argue the power portion ultimately doesn’t lie in my hands, but rather in the hands of my owners. It seems a better descriptor for my profession might be “With great responsibility comes more responsibility.”

 

In keeping with the superhero theme, I think Batman summed up my feelings pretty well when he said:

 

“People think it’s an obsession. A compulsion. As if there were an irresistible impulse to act. It’s never been like that. I chose this life. I know what I’m doing. And on any given day, I could stop doing it. Today, however, isn’t that day. And tomorrow won’t be either.”

 

What are the most important questions to ask your pet’s oncologist?

I spend a great deal of time asking owners questions about their pet.

What did you notice about your pet’s behavior that made you bring him to the vet?

When did you first notice the mass?

Is she vomiting or having diarrhea?

What do you know about your pet’s diagnosis?

I ask questions to gain a better understanding of the animal’s disease and how afflicted they are by their condition. I want to make sure owners comprehend my recommendations and the options I’m presenting them with. I need to know we are all on the same page regarding our expectations. But this inquisitive dialogue is rarely one-sided.

Owners ask me a tremendous amount of questions, too. Some are predictable and some are more specific, while others can be remarkably probing.

One question I am routinely asked is, “What else should I be asking you?”

I used to find that particular inquiry rather peculiar, but I’ve grown to embrace it for what it represents in terms of ensuring good communication between my clients and myself.

The following are examples of the types of questions I try to ensure are addressed for my patients, even if the owners do not think to ask them in the first place.

1. “How long will my pet live if I do everything you are telling me to do, and how long will they live if I don’t?”

This is the most reasonable question to ask a veterinary oncologist, and also the most difficult to answer. As an evidence based doctor, I use the results of previously published research to help guide my treatment recommendations. Data from the studies offers information regarding what patients would potentially benefit from a particular treatment plan and what their expected prognosis would be.

However, veterinary research studies, in particular those associated with oncology, are notoriously weak in that they tend to enroll low numbers of patients, lack standardization of methodology, and are absent of untreated control groups with which to accurately compare outcome.
Juxtaposed against research studies are my personal clinical experiences, which often influence how I think a patient could respond to treatment. Though reasonable to consider, if I practiced medicine solely on the basis of experience, I’d be subjecting my owners and their pets to an incredible amount of bias.

The question I can answer is, “What do you think is a reasonable outcome for my pet if we do the treatment you’ve outlined?”

2. “How will I know when it’s time?”

When owners ask me this, I always take a few seconds to pause before starting to respond. Veterinary patients are blessed with the option of euthanasia to relieve suffering. We alleviate the pain and debilitation associated with fatal diseases so death can occur with dignity and peace. Because we make this decision for our pets, it is nearly impossible to quantitate when “enough is enough” from the outside.

Most owners assume quality of life is a discreetly calculable parameter. In many ways we can measure a patient’s quality of life, but it does not exist as a line in the sand that is crossed at a specific moment. A pet’s quality of life exists on a continuum from excellent to poor; a virtual sliding scale of what is acceptable versus not.
I am trained to make sure that pets do not suffer. But even that barometer is different for each veterinarian. There are many who would state that administering chemotherapy to an animal is akin to torture and will equate it to a poor quality of life. I, obviously, vehemently disagree.

The question I can answer is, “Can you help me understand what signs to look for that indicate my pet’s disease is progressing?”

3. Will my pet become sick from chemotherapy?

Though I know 75% of my patients experience no adverse signs from their treatments, the converse of this statement means that 25% will. And 5% will experience severe toxicities that could be life threatening.

When all things are otherwise equal, and patients are in good health other than their cancer, I have a very hard time predicting which ones will fall into the latter category.

It’s easier to foretell a poor reaction to treatment when lab work tells me a patient’s liver or kidneys are failing, or when a pet is showing significant adverse clinical signs prior to starting treatment. Those pets are more likely to become ill from treatment because they are already unwell. For the average pet with cancer, I can’t discern who might not fare well with chemotherapy.

The question I can answer is, “Do you have any specific concerns about my pet’s ability to withstand the treatment you’re offering?”

*
I realize I’m being idealistic when I ask for alternative phrasing of those particular questions. Likewise, it’s just as easy for me to answer the original question by saying “I can’t answer your question directly, but here’s what I can tell you…” to ensure expectations are met.

The take home message is, don’t be afraid to query your vet with “What other questions should I be asking you?”

They probably have an excellent idea of what it is you didn’t even know you were thinking about in the first place.

Plug in, Plug out…

As I sat down to write an article for this blog on my day off from my ‘regular’ job, I paused to take stock of my immediate environment.

 

A cursory glance would probably lend one to assume I was incredibly relaxed. I’m dorsally recumbent on my couch, with fresh coffee just a short reach away. Wrapped in a warm fleece blanket, with an adorable tabby cat curled at my toes, an unsuspected observer would conclude I was experiencing the true meaning of leisure. Closer inspection would reveal details suggesting otherwise.

 

Perched on my extended legs was my ergonomic, yet stylish, lap desk. Sitting atop the desk was my state of the art computer. The high-resolution screen was cluttered with a variety of open windows including my mail application where 6 (yes 6!) different personal e-mail accounts were linked and pinging with distinct regularity. In a separate window, I was connected to the e-mail account for our oncology service at work.

 

My professional Facebook and Twitter pages were open as well. My iPad mini was plugged into the USB port on the left. Extending from the USB port on the right was my iPhone. My Kindle sat a mere 3 feet away on my coffee table. My TV was tuned to the morning news.

 

It was barely eight o’clock in the morning on a chilly, but otherwise brilliant Spring day, yet I was completely numb to anything not instantaneously attached to a virtual world located well beyond my immediate surroundings.

 

Reflecting on my awareness of the moment, I realized, for a day ‘off from work’, I was anything but ‘off’.

 

We live in a plugged in world. There’s no way around it. Accessibility is a part of our daily lives.   We are compelled to check e-mails and voicemails and text messages the moment they chime through our mobile phones, tablets, and computers.

 

My point is nothing novel – we all recognize our attachment to ‘gadgets’. As many times as we’ve surreptitiously checked our e-mails or Twitter feeds in a public forum, we’ve likely equally ignored phone calls and text messages in times of self-declared preservation.

 

As a veterinarian, I’ve noticed how accessibility is a particularly challenging and disturbing part of our occupation.

 

Technology affords us the benefit of immediate access to results for the majority of lab tests that used to require days of turn around time.  We have digital radiography, CT, and MRI scans, where professionals, located thousands of miles away from the patient, interpret results on a moments notice. We can now provide standards of care on par with those found in human medicine, and owners are becoming more demanding of these standards.

 

There is a dark side to this accessibility. It means I’m now compelled to search for test results expected to arrive on my days off. It means I routinely answer emails and phone calls after hours and on weekends. It means I open my life to the public on social media so I can continue to put forth accurate information about my profession.

 

The counterpart to this perspective is the impact it has on the expectations of owners when it comes to their pet’s healthcare. Results are commanded immediately. Phone calls must be answered right away. Doctors must be interrupted at home when they are not in the hospital because of perceived urgency.

 

I’ve experienced many instances of ‘over the top’ behavior from owners in terms of expectations for my time and emotional capacity. I’m not speaking of the occasional email or call or question on Facebook. I’m not concerned about those asking whether their pets’ reaction to treatment should be expected or not or needing me to clarify treatment options for their pet after a complicated consult. I’m happy to provide information for people who have genuine and sensitive motivations. We all ultimately have the same goal in such cases.

 

However, a fitting example would be how during the 2 (yes 2!) days off I had for my ‘honeymoon’ a while back, I found myself hiding in a hotel bathroom with my iPhone, covertly responding to emails and calls from work, so my husband would not find out. I’ve dealt with severe complaints from owners who elect to communicate their urgent concerns via email on a weekend, who received an “away message” indicating their email would not be opened or responded to until we were back in the office days later. There are countless other examples of the downside to being accessible 24/7.

 

I feel guilty admitting I would relish a day without my electronic tethers.   Even while typing the words, I’m immediately stricken with a sense of selfishness.

 

Why shouldn’t I remain on call for my patients at all times? Am I not obligated to make sure I am able to answer to owners or co-workers whenever they need me? How do I decide when it’s time to tune out when I clearly have an obligation to my work? Why don’t I want to be accessible all the time?

 

Our world may be plugged in and pushed to the realm of technological advancement, but is this really to anyone’s advantage? And when we have so many ‘things’ to answer to, rather than taking the time to preserve ourselves and ‘take a proverbial breath’, are we really providing better patient care?

 

I would love to answer the question, but right now I just can’t seem to surface from my pile of electronics to give it significant consideration.

 

And perhaps, therein, lies the answer.

 

What do you think about grief?

Lately, I’ve been thinking a lot about grief. I’m not sure if it’s associated with the particularly gloomy run of cases I’ve seen at the clinic or the personal stress and sadness I’ve recently faced, but something is pulling my emotional barometer towards focusing on the different ways people inwardly, and outwardly, express grief.

I’ve witnessed grief in many different forms. Grief is an emotion shared by all humans, and, if you’re a believer, animals as well. Setting aside observations incurred in my daily activities with friends, family members, and even strangers, and considering only what I see working as a veterinary oncologist, I feel qualified to contemplate this complex topic with a fair share of authority.

Death, illness, disappointment, heartache these are not unfamiliar terms or experiences for me professionally. I recognize this makes me far from unique.

What is particularly distinctive to my perspective as a veterinary oncologist is that I am entrusted to deliver news that will bring grief to other human beings.

The stereotypes of doctors being perceived as compassionate and caring are often equally juxtaposed against those suggesting we are inanimate, cold, and sterile in our delivery of information, especially when it is anything negative or complicated.

The words “bedside manner” are used to describe our ability, or inability as it may be, to perform this exact task. I’m hard-pressed to think of a time when I’ve heard the words used to describe the way we discuss the positives or present favorable news.

I received only very rudimentary grief training during vet school. I possess no formal education in counseling or psychology. I’m not someone considered overly outwardly emotional myself. Like many of my colleagues, I entered the field of veterinary medicine because I relate better to animals than people.

Despite the shortcomings of both my professional training and my personal mental outlook as it relates to grief, my job requires me to be capable of gauging human emotional responses, and to thoughtfully discuss complex topics such as death, palliative care, and hospice. For better or for worse, my education with grief has pretty much solely come from on the job experience.

To this end, I’ve been a quiet observer, watching colleagues speak with owners about issues related to illness, death, and suffering. In this capacity I’ve witnessed ineffective speech, disheartened wording, and dispassionate phrasing.

I’ve also seen colleagues show remarkable empathy, patience, and kindheartedness — even in the face of an owner who literally is taking their grief out on the individuals associated with their pet’s care.

I’ve watched pet owners comfortable with outward manifestations of their sorrow, shedding copious tears, their sadness obvious not only in their facial expressions, but also by their physical actions. Equally as often, I’ve seen those owners who are quiet, preferring to restrict communication to silent glances, nods, or short-worded answers.

When confronted with grief, some owners will ask a tremendous amount of questions, probing for details and explanations of why the terrible event is happening and what can be done to change it. Others are much more accepting, seemingly unconcerned with specifics, focusing more on the moment at hand and how to move on.

What I find the most shocking are those who express their grief through anger. When an angry owner, looking to impart blame as a means to deal with their pain, confronts me in a hostile manner, my faith in all the good aspects of my profession is completely rattled. Of all the emotions I encounter in a given day or week, it’s anger that causes me the most personal anxiety and strain.

It would be wonderful if I always knew the right words to say or the best way to console someone, or if even half the time I felt as though I did an “okay” job calming down an aggressive owner. The truth is, I simply don’t always know the right response. When anger and grief mix, I’m not the person you want playing on your team.

Though I’m a tougher person than I was when I first started working, I’ll never possess thick enough skin to let such events roll off without consideration. When I write about such cases from vet school, or about my early days as an oncology resident, my husband will ask me, “How do you remember these pets?” I answer honestly, “These are the things I can never forget.”

Despite knowing I’d certainly rest a bit better if I could dislodge those memories of angry pet owners from my brain, I’m certain I wouldn’t want to forget them. The fact that I still consider the words and actions of a few select owners this far along in my career keeps me grounded.

Even though I’m far from perfect in my ability to handle aggressive situations when they arise, I’m still capable of feeling something other than resentment towards those who are angered at the news I bring. This is, at least in part, because I can remember those who do the opposite; sharing their sorrow with me because they trust my response.

Those are the one percent we doctors do it for. Their quiet voices are heard as much as the raging ones. Their grief affects me as deeply as those who resort to anger.

My bedside manner indelibly influenced their pain and grief.

When you hear hoofbeats…

The Dalmatian stood hunched in the corner of the exam room, barely lifting his head high enough to scan his surroundings. His discomfort was obvious, even from a distance.

I watched as he made several unsuccessful attempts to lie down. The sound of his anxious panting echoed the sound of the blood rushing in my ears. My eyes fixated on the tiny drops of blood-tinged urine slowly trickling from the underside of his belly that contrasted so starkly against the gleaming white of the tile floor of the hospital.

I’d examined the dog about an hour prior, a few minutes after he’d arrived, but I’d just completed telling his owner my recommendations for how to move forward.

She spoke slowly and deliberately, “To be honest, I’m extremely uncomfortable with everything you are telling me. I’m taking my dog home and I will see my regular veterinarian tomorrow when his office is open. You clearly have no idea what you’re doing. You’ve only just graduated from veterinary school. And I’m not paying for this exam.”

The words reverberated in my skull and my already flushed skin prickled and reddened to an even deeper shade of crimson. I rubbed my sweaty palms along the tops of my scrub pants, rigid with the newness of unwashed polyester. They’d only been in my possession for a few days, along with my pristine white lab coat and shiny laminated plastic name tag bearing the identification, “Dr. Joanne Intile.”

It was my first shift working on the emergency service, during the first week of my veterinary internship, and my first experience seeing a case on my own as a newly minted veterinarian.

Countless years of preparation, weeks spent toiling on the clinic floor of vet school, hours of studying and experience all led up to this moment. It was my quintessential time to shine. Yet, I found myself stumbling over what to do, what order to do it in, and what to tell the owner.

I was seeing a young male Dalmatian with signs of stranguria (straining to urinate) and hematuria (blood in the urine). Though the causes of such signs are numerous in dogs, we are taught in veterinary school that “when we hear hoof beats we are to look for horses, not zebras.”

Dalmatians, especially young males, are predisposed to forming a specific type of stone in their urinary tract called urate stones. Urethral obstruction can occur when stones that formed in the bladder or kidneys become lodged in the urethra. It is a life-threatening complication.

Obstruction can lead to severe bladder distention and eventual rupture. The blockage can also lead to buildup of toxic waste products of metabolism in the bloodstream, as the kidneys are unable to filter the blood properly from the back pressure from the stone.

The conversation with the dog’s owner should have been straightforward. I should have immediately recommended first stabilizing my patient, treating his pain, confirming the diagnosis by obtaining a radiograph (X-ray) and visualizing the stone lodged within his urinary tract, followed by an immediate effort to remove the stone by sedating him and passing a urinary catheter, and surgery to remove the stone.

Within the recesses of my mind, I knew what I should do, but under the stressful situation of being an inexperienced doctor, in the unfamiliar position of working on an emergency service, and an abrasive owner questioning my qualifications, I had zero confidence in my ability to help this dog.

Instead of doing the “right” thing, after I performed my exam I spent the next 40 minutes pouring over my textbooks and class notes, relearning the pathophysiology of urate stone formation in Dalmatians and the intricacies of their surgical removal.

I fumbled over creating an estimate of what it would cost to enact the plan I wanted to offer the owner. My voice trembled when I talked with the on-call surgeon, informing her she might need to come in to perform surgery that night. She aggressively chastised me for calling her without having a definitive diagnosis and hung up the phone.

By the time I re-entered the exam room to talk to the owner, the damage was done, not only to the dog, but also to my fragile newborn doctor ego.

I’ve come a long way since that first emergency case ten years ago, and despite possessing a great deal of confidence in my ability to treat my cancer patients accurately and ethically, there are times where I still find myself questioning my decisions about a particular recommendation or conversation with an owner.

Humility is a trait not often associated with medical professionals, but I’m certain it would be far more dangerous for me to be overconfident rather than conservative when practicing my craft.
I’m certain I’ve saved more patients by second guessing a biopsy report or lab work result. I know I’ve made more allies than enemies by calling owners and admitting I’d made a mistake rather than brush it off and pretend it didn’t happen. I’ve never regretted recommending an owner seek a second opinion when I felt I could not meet their goals.

Some would argue these characteristics make me a weak and self-doubting doctor. I’d argue these are the things that keep me human.

I still wonder what happened to that Dalmatian. And despite how horrible the events of the visit were, I’m still grateful for the experience. The most important lesson I learned is that a follow-up phone call after a difficult appointment can do much to ease the minds of both doctor and owner.

Even when the outcome isn’t the optimal one, in the end it’s communication and caring that matters the most.

Have you heard about the cancer sniffing dogs?

A curious headline popped up along my Twitter feed the other day: “Could Dogs Sniff Out Thyroid Cancer?” I read the words and paused a few seconds, contemplating taking the bait before opening the link.

Convinced I would be disappointed in what I was about to read, I contemplated how a dog could be able to detect cancer given the complex nature of the disease and how troubling it is to uncover even under the best of circumstances. I figured the title was just a catchy way to drive readers to an advertisement for something completely banal like air fresheners.

One the other hand, what if it were true? What if dogs were really able to pick up on the subtlest of changes in our biochemistry, leading them to distinguish those of us with disease from those without? What if doctors could somehow capitalize on a dog’s powerful sense of smell and bypass the need for invasive diagnostics? How remarkable would that be?

I clicked the link.

To my surprise, the sensational headline was completely legitimate. In early March 2015, during the 98th annual meeting of the Endocrine Society, a group from the medical school of the University of Arkansas presented a research abstract entitled “Scent-Trained Canine Prospectively Detects Thyroid Cancer in Human Urine Samples.”

As if that weren’t fascinating enough, this presentation was actually a follow up to a previous study by the same group that demonstrated that dogs could reliably discriminate between urine samples obtained from patients already diagnosed with either metastatic thyroid cancer or benign thyroid disease.

What I wouldn’t have given to be a fly on the wall during that conference just to listen to this fascinating topic!

In the study, a single dog (which an unconfirmed source reports is a German shepherd mix named “Frankie”) was trained to either lie down when he detected the presence of papillary thyroid cancer (PTC) in the urine sample, or turn away or do nothing if the sample was ‘clear.’

Urine was collected from 59 human subjects who presented for evaluation of one or more thyroid nodule(s) suspected to cancerous. In the meantime, Frankie was “imprinted with urine, blood, and thyroid tissue obtained from multiple patients with PTC, and trained over 6 months to discriminate between PTC and benign urine samples.”

During the experiments, a gloved handler, lacking information about the diagnosis of the person providing the sample, presented Frankie with the urine samples. Frankie sniffed the samples and responded with the cues above. The handler verbally communicated Frankie’s response to a blinded study coordinator. Control samples (both cancerous and benign) were interspersed with the unknown samples and Frankie was rewarded with positive reinforcement when his answer was correct.

Frankie’s diagnosis matched the final surgical pathology diagnosis in 24 out of 27 cases (92.3% correct, 2 false negatives and 1 indeterminate), yielding a sensitivity of 83.0% (10/12) and specificity of 100% (14/14). Not too shabby for a four-legged ball of fur that never graduated more than a basic puppy training class!

In all seriousness, the most fascinating aspect to me is that the researchers have no idea what the dog actually smells to trigger the response. There clearly must be a chemical present that is excreted by affected individuals. However, research thus far has failed to identify this particular biomarker.

Much energy and effort in medicine is spent on early disease detection and veterinary oncology is gaining much ground in this aspect of medical care. We routinely recommend preventive screening diagnostics in order to discover illness at an earlier stage. We model our testing algorithms off those presented to our human counterparts.

But what if the reality is that we simply need to learn how to listen to our animals in a different way to understand their capacity for communication about their health?

Veterinarians lament the lack of ability to communicate with our patients and their inability to tell us where it hurts. It seems maybe we just need to heed their warnings a little harder.

The old wives tale of a cold, wet nose indicating a healthy pet may not be as farfetched as we presume. How wonderful would it be if man’s best friend were also the best advocate for not only their health, but for that of their owner?

I suppose maybe Frankie’s nose knows the best answer to that question