‘Frustration drives development’. The theory, proposed in a book on child development that I read while on maternity leave, was that babies would never learn to crawl and walk unless they were frustrated with sitting still. It is also true in my veterinary clinical and research career.
I started after graduation in a mixed veterinary practice in rural North Wales. I enjoyed the life-style, but a move back to East Anglia, where there are very few cows and sheep, combined with a growing realisation that actually I enjoyed treating dogs and cats.
My return to academia after four years in practice was also driven by frustration: I had become increasingly aware that animals (my clinical cases) might suffer or die not just because of mistakes I might make but also (more worryingly) because of things I didn’t know. So I wanted to learn as much as possible and returned to the Small Animal Medicine Department in Cambridge to train for a specialist qualification, the veterinary equivalent of medical consultant physician training. ‘Small animals’ in veterinary terms means dogs and cats.
In retrospect, I think the writing was always on the wall that I was going to be a physician and not a surgeon: I had loved physiology and pathology during the Cambridge Veterinary course. Surgeons and physicians are born and not bred – I bemuse the first-year medics and vets I supervise in physiology every year at Emmanuel by predicting which will become surgeons and which physicians – and it is often already obvious half-way through the first term. Physicians are crossword-puzzle-solvers and enjoy physiology. Surgeons prefer anatomy.
Frustration also drives my clinical research, which provides a bridge between real cases and pure science. Much veterinary and medical clinical research begins with frustration that you can’t help your patient. Difficult cases drive the desire to understand more so you can help more. For me, these cases are gastroenterological, and more specifically chronic inflammatory liver and pancreas diseases. Chronic hepatitis and chronic pancreatitis are difficult to treat in humans and even more so in small animals, where we understand even less about their causes. I am helped by some wonderful final-year students on small animal electives, veterinary residents (roughly equivalent to medical registrars) and very talented veterinary PhD students.
A particular passion is studying chronic pancreatitis. The pancreas sits in the abdomen next to the stomach and small intestine. It performs two very important functions: one is to produce insulin and other hormones, which are secreted into the blood stream and control blood glucose. The other is to secrete enzymes, which are very important for digesting food, down a duct or ducts into the small intestine. Chronic pancreatitis is an ongoing, often very painful inflammatory disease in the pancreas, which leads to scarring and progressive loss of tissue. Eventually, when about 90 per cent of the pancreas has been destroyed, the affected dog (or human) may become diabetic and require pancreatic enzyme supplements in food. The most common cause in humans is alcoholism.
Dogs don’t generally drink and chronic pancreatitis was previously believed to be rare in them. However, my clinical experience suggested that in fact many dogs were suffering in silence. To improve recognition and treatment of this disease, I embarked on a VetMD, looking at post mortem specimens from dogs from first opinion practice (equivalent to general practice in medicine). We confirmed it was very common, clinically significant and also very strongly breed-related. In some, such as Cavalier King Charles Spaniels and English Cocker Spaniels, about 25 per cent of dogs have chronic pancreatitis by the time they die, a very large number given that they don’t drink alcohol.
So what is the cause? We noticed a difference in the pathological and clinical appearance in different breeds. Pedigree dogs are very ‘in-bred’, which means that different breeds tend to suffer from different ‘typical’ diseases. English Cocker Spaniels are particularly interesting because their chronic pancreatitis appears to be very similar to a rather rare human disease, where an individual’s own immune system attacks not only the pancreas but also other ducts in the body such as tear ducts, salivary ducts and the kidneys.
In cockers, unlike in humans, this disease is very common, which means our research has the potential to help not only dogs, but also humans. Fran Coddou, my current PhD student, is investigating the immunology and genetics of the disease, hoping to increase our understanding and ultimately improve treatment of affected dogs. Frustration has taken me on a long and rewarding journey: there is still so much we don’t understand, but we are chipping away ...