Thanks to all the vets and nurses who joined us last month for a very special CPD night organised by BattLab and the Warwickshire Veterinary Clinical Club (WVCC). Over 50 participants joined us for the evening as we had the honour to have as special guest, Prof. Mike Willard from the Texas A&M University (USA) and one of the most well know veterinary gastroenterologists in the world. Prof. Willard guided us through the most common diagnostics test and therapeutic trials often used to diagnose and treat gastrointestinal diseases in dogs. Below a few passages of prof Willard talk. “The major cause of therapeutic failure is misdiagnosis (either you did not correctly the diagnose the main disease, or you did not diagnose all the diseases that are present). Perhaps nowhere is this more evident than with gastrointestinal disorders. Chronic small bowel disease in particular is a very frustrating and potentially debilitating series of disorders. While dietary and bacterial antigens are typically the most common causes, resolving the problem requires a very careful, well-thought-out and methodical approach. Too often people do the “right thing” the “wrong way” and experience therapeutic failure. Patients with hypoalbuminemia due to gastrointestinal disease are typically some of the more severely affected patients, but even many of those are amendable to a well constructed therapy”.
In you are interested to know more about the career of prof Willard, don’t miss the interview we did with him.
Next evening seminar we have planned in collaboration with the Warwickshire Veterinary Clinical Club will take place on the 11th of March. Our senior clinical pathologist, Francesco Cian, will give a talk “Results are more than just a number: improving sample submission for best laboratory results”. For information do not hesitate to contact us.
(Francesco) You are considered one the fathers of modern veterinary gastroenterology. What aspect of clinical pathology inspired you to explore the subject and write a book?
(Prof Willard) Very truthfully, I do not think I am a father of gastroenterology. I learned from people who I considered the Fathers of Veterinary Gastroenterology (Neil Anderson, Don Strombeck). I suppose I got my interest in gastroenterology from reading Kirk’s Current Veterinary Therapy back in the mid 1970’s. Back then it explained how to use fat digestion tests (with and without enzymes) to distinguish maldigestion from malabsorption. I thought it was pretty neat that there was a logical, linear thought pattern to making this distinction (as opposed to having to “magically” know what was wrong just by looking at the animal. Then I had an instructor in my senior year at Texas A&M who was interested in the same. When I graduated, I took the only job I could find that would take me, which was an internship under Neil Anderson who was at that time one of the genuine experts in pancreatic disease in dogs. I did a Master’s degree under him on gastroenterology (IgM cells in the canine intestine), and from there it just grew. I think that realizing that there was a linear logic to diagnosing GI disease made it most attractive to me. Writing/editing a book was a chance occurrence. A book publishing company came to me and asked if I would do it. I was going to give them an out-right “no”, but then I thought “why not try?”. This is pretty much how it happened.
(Francesco) We all know how important the interaction between internal medicine and clinical pathology is. How do you think this relation has evolved over time? What do you think an internist needs from a clinical pathologist?
(Prof Willard) In my opinion, the internist needs to know enough clinical pathology to be able to ask very intelligent questions of the clinical pathologist, and the clinical pathologist needs to know enough internal medicine to ask very intelligent questions of the internist. These two people need to work as a team, with each having a more-than-rudimentary knowledge of what the other one does. This makes for the best team. As clinical specialization increases, it is becoming too easy to retreat into a comfortable, small, limited niche of an increasingly narrow aspect of medicine. In the US, the joke is that some people want to be a specialist of the cortex of the posterior aspect of the left kidney of domestic cats weighing more than 4 kg. In my opinion, the best medical care is given by people who have a broad knowledge of just about everything and still know that other people have a bit more knowledge in specific areas than they do, and hence consult the right people about the difficult cases. The internist can offer the clinical pathologist an insight into how the clinical pathology data affects what they do and hence what they are most interested in, while the clinical pathologist can offer the internist insight into what the many clients of the clinical pathologist are seeing.
(Francesco) And now the questions that I always ask at the end of the interviews. What are you most proud of in your long career? Is there anything you would have done differently?
(Prof Willard) I suppose that there are a lot of things that I am tempted to say I would have done differently. The truth is that you don’t really know what all would have happened if you had done something differently. So, I would not have changed much. I am pleased that I was able to be on a team that helped decrease the confusion surrounding histopathology of the small bowel.
