A necropsy and animal welfare breach

I poked into the pathology department at the other day, to see if there was anything interesting ex-animal coming in, so that I could excuse myself from studying and get some action. Fortunately for me, there was a 9 yo female dog with maxillary mass extending towards the level of the eye and ventral (towards the abdomen ie. lower) aspect of the maxilla, infiltrating the gum and extending caudally two third of the oral maxilla. The mass height was 10cm, so basically, the head just looked grossly abnormal that even kids can tell.

Let's see what is there.

History: the animal was seized by an animal welfare organisation, and was euthanised on humane ground. A full post-mortem/PM (after death) examination is requested.

Every now and then, there is a case related to animal cruelty comes through the department. A full necropsy (exmination of corpse, in particular non-human bodies: I tend to use PM and necropsy interchangeably, while refer an autopsy to human bodies) is required for the purpose of lawsuit against the suspected offender, therefore professional opinion and comments from a veterinary pathologist is sought in regard to the nature, manner of lesions (abnormal tissue, change of tissue) and/or death.

In general sense, a mass lesion could be anything ranging from a cyst, abscess, naevus to neoplasm (abonormal growth eg tumour). However, some sort of a tumour was very likely given the extension and distribution of the mass. Soft tissue sarcoma (cancer of connective tissue) came to my head as I palpated the structure, so the differentials goes a long way as there are several types, but I had fibrosarcoma (malignant tumour of collagen-producing cell) on the top of differentials.

We did a fine needle aspirate/FNA which is sticking a needle into the mass and retrieving a sample for microscopic examinations. When the sample staining was done a few hours later, I was quite content that I am right. The cells on the slide looked crazy, which is a typical appearance of neoplastic (abnormal and out of control) fibrocytes. It is now likely that the dog was neglected, and left to suffer from the tumour. A necropsy report is written to be provided to court as evidence and a source of expert opinion.

And I was left thinking: how and why on earth people can be be so retarded and ignorant, and leave animals to suffer? The cost of euthania is definitely not a valid excuse, since it will only cost like AUD$20 in animal welfare hospitals and some even put animals down without cost. Or even just surrender them to any animal shelter.

Let's have a look at some art

At the moment I'm digging through my overworked little laptop, searching for notes on tumours, for the purpose of exam preparation. These are interesting images from lecture materials that I come across. During high school, I did IB Fine Arts HL, and learnt to critic artworks. Guess what, that is what I like to do while looking down a microscope.

This is why we Ozzies carry sunscreens around - malignant melanoma (nasty melanin-pigment producing tumour).

 

Malignant osteoblastic osteosarcoma (nasty bone producing tumour of a bone cell lineage)

Plasma cell myeloma aka. Multiple myeloma (nasty antibody-producing white blood cell tumour)

Mast cell tumour (nasty tumour of white blood cells with histamine granules)

The purpose of microscopic examinations is to determine the type of tumour, which we are fighting against, and to grade whether the tumour so that we can decide what is the best treatment option. Some of you may have realised that I put nasty in all of the description. Yes, we usually say "O'oh" when we see this since they are likely to have seeded to several body system, hence the prognosis is usually poor.

Personality test

I don't think I ever mention here that GB's blog is actually the aspiration for this blog, and I have been reading his blog for ages. There is a post about a persionaliy test; these sort of tests are quite interesting as it can give another perspective of looking at myself. A few years ago, there was a personal development workshop, and everyone got to take a similar test at uni. The whole point was to raise an awareness that each of us has strengths and weaknesses, we need to work together as a team to bring out all the strengths. Advanced Global Personality Test can assessed here if you want to take it.

My result is as followed:

Extraversion	||||||||||||||	56%
Stability	||||||||||||||||||	76%
Orderliness	||||||||||||||||||	76%
Accommodation	||||	16%
Intellectual	||||||||||||||||	70%
Interdependence	||||||||||||||||||||	90%
Mystical	||||	20%
Materialism	||||||||||||||||	70%
Narcissism	||||||||||	40%
Adventurousness	||||||||||||||||||	80%
Work ethic	||||||||||||||	60%
Conflict seeking	||	10%
Need to dominate	||||||||||||||	60%
Romantic	||||||||||||||	60%
Avoidant	||||	20%
Anti-authority	||||||||||	40%

Wealth	||||||||||||||||||	80%
Dependency	||||||||||	40%
Change averse	||	10%
Cautiousness	||||||||||||||||||||	90%
Individuality	||||||||||||||||	70%
Sexuality	||||||||||||||||||||	90%
Peter pan complex	||	10%
Histrionic	||	10%
Vanity	||||||||||||||	60%
Artistic	||||||||||||||||	70%
Hedonism	||||||||||	40%
Physical fitness	||||||||||||||||||||	90%
Religious	||	10%
Paranoia	||	10%
Hypersensitivity	||||||||||||||||||	76%
Indie	||||||||||||	50%

Stability results were high which suggests you are very relaxed, calm, secure, and optimistic.

Orderliness results were high which suggests you are overly organized, reliable, neat, and hard working at the expense too often of flexibility, efficiency, spontaneity, and fun. 

Extraversion results were moderately high which suggests you are, at times, overly talkative, outgoing, sociable and interacting at the expense of developing your own individual interests and internally based identity. 

Trait snapshot:
clean, organized, regular, self reliant, tough, positive, high self control, very good at saving money, dislikes chaos, resolute, realist, trusting, hard working, dislikes unpredictability, prefers a technical specialized career, not worrying, respects authority, enjoys leadership, finisher, normal, optimistic, controlling, prudent, modest, adventurous, does not like to be alone, intellectual, likes the unknown, very practical, high self esteem, assertive, perfectionist, busy, altruistic

Bold = some traits that are quite true
But there is one more trait to add - like to procrastinate studies towards exams. That's why I'm blogging right now!

Dream = goal with deadline

While I was having my weekend jog this morning, my mind seemed to drift and think about where I stand in my life, where I want to go and what are my current goals. When this happened, I usually just kept jogging until my train of though comes to a conclusion, which in this case took 2 hours of light-pace jogging. I have a habit of putting things boxes since there are often too many things happening in my head all the time. There seems to be three boxes so far, and the number in blanket is the deadline from now.

Intellectual
Pass all of my 13 exams: 7 in a few weeks and 6 at the end of this year
Acquire a residency post and sit a board exam, and proudly call myself a veterinary pathologist (5 years)
Try a hand on teaching and tutoring at uni (5 years)
Publish articles in respected journals and present at international conferences (6 years)
Decide whether to pursue my career in academic, private practice, or government sector etc. (6 years)
Complete a MPhil and PhD (10 years) - possibly they will be something related to tumours, ocular diseases, and/or tissue graft rejection
Have a peek at the Nobel award ceremony (15 years)

Self
Get abs like this (2 months)
Try a hand on rugby (1 year)
Complete an advanced course in scuba diving (2 years)
Compete in a marathon (3 years)
Take a basic cooking course here (5 years)
Take on a spiritual journey and spend time meditate for a month (5 years)
Decide where to settle down and have a family (6 years)
Learn German and French,  and hold a basic conversation (6 years)
Snowboard in Switzerland, Japan, New Zealand, and Canada (15 years)
Travel to Bhutan and Dubai (not set)

Interpersonal
Come out to my family (2 years)
Maintain to stay out in workplace (2 years)
Have fun with a British guy (not set)


Of course, there are several goals that appear quite impossible, but I never know unless I try. For me, it's ok to take a bit of detours, extend the deadline further, and change them. I'm looking forwards to one year from now, reflect back, and review what will be crossed off and what will be added :)

Pathologists' dark sense of humour

A lot of my mates perceive veterinary pathologists as being laid back in general, which I think it's quite true after having spent some time with many. But, I have to add our humour is rather odd and morbid as well. It may be due having to deal with cardinal humours on a day basis, perhaps? There is a few examples (of many) that I have in my head:

You all must have heard people saying "Do as I said, not as I do", and many veterinary pathologists are like that (I'm included even though not a pathologist just yet). We preach veterinary students not to use food to describe lesions. But then, we describe a suppurative (pus-sy) lesion as cottage cheese or compare chylothorax (white fluid in the chest) to a thick milkshake. Worse than that, with a bit of blood contamination, the milkshake is said to have a strawberry flavour. Ewwwwww~

I was helping out a pathologist and a lab technician with a necropsy then we started chatting about cold Melbourne weather and somehow animal body cremation - turning 20kg mass into less than half a kg ash. The pathologist mentioned how her partner is having a holiday, and enjoying summer overseas while she is working and suffering this cold miserable weather. The technician asked if her partner was being naughty and she needs to use the cremation facility. She responded laughingly that she will let him know if her partner is planning to travel without her again. I can see a perfect crime there, nah?

Once we were looking at a tissue slide of a feline kidney during one of the weekly histopathology round. After looking down a microscope, I proceeded to ask about these big bubbles in the tissue, and I was told that they were fat. "Well, you are what you eat, isn't it?" quickly added someone in the room.

This last one really got me laughing; there was a dog skull transceted in halves. One of the senior pathologists looked the skull and said "Hmm, I'm amused that the cranial cavity (hole in the skull that the brain sits in) is tiny. Look at the dog, it's massive! The brain is also tiny. I really to see the owner of this dog". Comparing people and their pet for similarities is always a good fun, don't you think?

Laughter is always good, isn't it?

What is veterinary pathology and who are veterinary pathologists?

These two are the questions some of you might be wondering since I have yet to proper explain.

pathos = suffering
logos = study

In a nutshell, veterinary pathology is a branch of science dedicates to the study of animal diseases. It is one of the many core subjects, taught in veterinary medicine. We learn about pathogenesis of diseases (how and why a disease occurs, and what are the consequences eg. how does a tumour occur) and lesions (what happened to the body eg. inflammation).
 

To be a veterinary pathologist, one needs to have a Doctor of Veterinary Medicine degree or equivalent, spends at least three years in a post-grad training eg. residency, and then sits the American or European board exam becoming a diplomate of the college - total of 8 or 11 years in uni minimum. That sounds rather excruciating but I'm almost half way there, yeah! Furthermore, there are two branches in the field, namely clinical and and anatomical. Clinical pathologists basically read blood and biochemistry profiles, and deal with samples of live tissues while anatomical pathologists examine fixed tissued and perform necropsies. I have spent a quite considerable amount in both, but aim to speciliase and become the latter.

Now, what do veterinary pathologists do? They seek to gain understandings of pathogenesis and lesions. The roles of veterinary pathologists are thoroughly described in the following excerpt from American College of Veterinary Pathologists:


"....... Why Are Veterinary Pathologists Important?
Veterinary pathologists improve and protect human and animal health by:

• Diagnosing disease in companion and zoo animals, and wildlife. Veterinary pathologists examine animal tissue and body fluids to diagnose disease and predict outcomes.
• Diagnosing disease in food-producing animals. By determining causes of disease, veterinary pathologists help maintain herd health and establish if there is a risk to humans handling or consuming the meat or milk of food animals.
• Contributing to drug discovery and safety. Because of their broad-based biomedical training, veterinary pathologists serve as key members of pharmaceutical research and development teams.
• Conducting research. With experience in diseases of multiple species, veterinary pathologists are uniquely qualified to perform studies to advance our understanding of the cause and methods to prevent disease in animals and humans......."

Lastly, the reason for having an image of Contagion (2011) in the post. It has a lot to do with veterinary profession, and one of the Diplomates of ACVP was the scientific consultant during the production, here! I have got to see the film that some point :)

Roles and responsibilities of veterinarians

I'm sitting in my room, drinking a long macchiato, and wondering about what is beyond my to-come graduation and so on. But, there is usually one thing that I usually keep thinking when I have time for my mind drift philosophically: what are my roles and responsibilities as a veterinarian apart from the stuff that set up by the AVMA and AVA?

Hmmm... I can't hear my heart

The answer in response has always been changing through my yet-to-end veterinary training, and it will continue to be so. When I first entered the vet school, it was just simply treating the patients. Be it dogs, cats, horses, cattle, sheep, rats, mice snakes, spiders! etc. Over the years, I have added, tweaked and formulated a long response, which now becomes more like an equation and includes:

1. Consult with clients in regard to their concern with their pet, and provide up-to-date information so that a well informed decision can be made in the best interest of the patient.
2. Utilise the knowledge to approach the problem, on ethical and compassionate grounds.
3. Understand, value and endearvour to cherish the bond between human and animal.
4. Provide sound and well informed opinion to the general public in regard to issues related to the profession, in addition to educate pet owners.
5. Contribute, where possible, to the advancement of scientific knowledge and research, as well as the training of future veterinarians.
6. Participate in continued education and pursue one's interest in veterinary discipline and expertise.

With those said, I strongly view myself as a source of information for clients. However, clients facing with a dilemma frequently turns to veterinarians and ask this particular question that I'm really reluctant to answer in a consult, especially when dealing with a potential euthanasia: What would you do if he/she (the animal) is your pet?

"Damn, she/he is definitely not my pet. I'm not the one paying for the treatment bill. Can't you use your brain and make up your mind?" I say in my head before respond with a blurb I have for this situation in an auto-pilot mode.

"I'm afraid that it's not my responsibility to make a decision about Insert the animal's name. There is no right or wrong choice, so what you believe is the right decision is right, and I'm not here to judge." I say in a matter of fact tone but with sympathy, while looking at the client.

Nowsdays, pets are in general as part of the family in the western society. Many people consider their pet as their child. Therefore, I do not see myself morally and legally proper to be making such decision for someone else under the above circumstance.