Alistair Cox completed a residency in veterinary pathology at the University of Edinburgh. Here, he describes why he did it and what the work involves
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I QUALIFIED as a vet in 2002 from Glasgow university and worked as an equine vet for the next five years. I decided to specialise in pathology as I enjoy investigative work and finding out the underlying causes of diseases and conditions.
Edinburgh vet school just happens to be the closest university to me, and fortunately it offered the residency that I needed. I completed part one of the Royal College of Pathologists' exam during my residency and I'm studying for the second part, which I will sit next September. I will then become a Fellow of the Royal College of Pathologists.
My studies were supported by a Horse Trust scholarship, which made a huge difference, as it allowed me to leave general practice and go back into education to train in a new field. The skills I have learned allow me to have a big impact on the welfare of horses, both in terms of the health of individual horses and by carrying out research projects to help the equine population as a whole.
My residency focused on anatomical rather than clinical pathology. While clinical pathology diagnoses diseases based on analysis of body fluids, anatomical pathology diagnoses disease based on gross, microscopic and molecular examination of organs, tissues, and the whole body.
Investigating the role of bacteria in the development of equine periodontal disease
During his residency Alistair carried out research into equine periodontal disease and discovered not only that his findings could make a difference to horses' quality of life, but that he really enjoyed the experience too
Although bacteria are known to be a cause of periodontal disease in humans, cats and dogs, their significance in relation to the disease in horses is less clear. Mechanical factors, such as food becoming packed between the horse's teeth due to abnormal growth, were considered to be the primary cause.
Equine periodontal disease affects around 60 per cent of horses over the age of 15 years. The disease is painful and can have a big impact on their quality of life.
During my residency, I examined the skulls of 22 horses that had been submitted for postmortem examination and found that 16 had some form of periodontal disease, although none had been examined for or euthanased because of the disease.
I identified bacteria, including spirochaetes, that were associated with the presence of periodontal disease. Spirochaetes are known to be important in human and canine periodontal disease, but this was the first study to identify spirochaetes associated with equine periodontal disease.
It shows that bacteria may be more important than was previously thought in the development of equine periodontal disease. More research is needed to understand whether bacteria or mechanical factors are the main cause of the disease. Once we have a better understanding of why and how the disease develops, we can do more to prevent horses from developing this painful condition.
I also found a significant association between the age of the horse and periodontal disease. Skulls were examined from horses ranging from four years of age to over 20 years old. The older horses were found to be more likely to have periodontal disease and a more advanced form of the condition.
The skulls were examined under a microscope and using radiography. Various histological features appeared to be associated with equine periodontal disease, but I did not find any statistically significant radiographic features.
During my residency, my work mainly consisted of analysing tissue samples submitted by clinicians, for example, when an animal had a lump or tumour removed. I studied samples from all animals including horses, dogs and cats.
Occasionally I carried out postmortem examinations on Scottish SPCA welfare cases in conjunction with a senior pathologist. We had a rota system at the university where we spent one week on surgical biopsies, one week doing postmortem exams and the other weeks carrying out research.
I really enjoyed investigating conditions and finding more answers than you would in general practice. By trying to gain better understanding of equine diseases I can hopefully help horses in the future. I like the challenge of finding out answers – it's like putting together the pieces of a jigsaw puzzle.
The one part of the pathologist's job that can be difficult is the volume of paperwork involved – we need to write a report for every case we work on, and reports for complex cases can be very long.
When my scholarship ended, I took up a position at the Scottish Agricultural College carrying out diagnostic pathology, predominantly in farm animals.
Skills and qualifications
As a pathologist, it is important to have a basic veterinary background, experience in clinical practice, and a number of other skills are useful too:
▪ You must be ready to learn, as you learn a lot in residency, such as microscope skills, visual examination of slides and postmortem examination techniques.
▪ You need to be meticulous and thorough as it's easy to miss something crucial.
▪ You have to look at everything to form a conclusion and diagnosis.
Anatomical pathologists are employed in diagnostics, teaching, research and the pharmaceutical industry, so there is a range of different fields that you can go into.
I think it is essential to work in veterinary practice and get some experience as a vet before thinking about working in pathology, rather than going straight into it. My job requires lots of concentration, but I find it very rewarding.