An Animal Surgeon's 'Tale Of Humor, Healing' Veterinarian Nick Trout has performed CAT scans on rats and at least one ultrasound on a frog. He details the highs and lows of animal healing in his new memoir, Tell Me Where It Hurts.
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An Animal Surgeon's 'Tale Of Humor, Healing'

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An Animal Surgeon's 'Tale Of Humor, Healing'

An Animal Surgeon's 'Tale Of Humor, Healing'

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This is Fresh Air. I'm David Bianculli of Broadcasting & Cable Magazine and, sitting in for Terry Gross. Today, we're going to listen back to some of our favorite interviews of the year. Animal surgeon Nick Trout has noticed that many pet owners feel more like pet parents. The people who bring their animals to him want him to know how much they love their pets. He loves animals, too, although the cats and dogs he treats might not return the sentiment during his examinations.

We're going to hear about some of his more unusual cases and how the whole field of veterinary medicine has changed in the past few decades with interventions that once were reserved for people. Dr. Trout is a staff surgeon at the Angell Animal Medical Center, which is part of the Massachusetts Society for the Prevention of Cruelty to Animals. He's also the author of the memoir, "Tell Me Where It Hurts." Terry spoke with him earlier this year.

(Soundbite of WHYY's Fresh Air, March 20, 2008)

TERRY GROSS: Dr. Trout, welcome to Fresh Air. Now the name of your book is "Tell Me Where It Hurts," and of course, that's a great title because you can't ask your patients to tell you anything. I mean, you can ask them, but they can't speak. Of course, you can talk to the people who live with the animals. So, what are some of the things you do to diagnose a pet to compensate for the fact that you can't talk with the animal?

Dr. NICK TROUT (Angell Animal Medical Center, Massachusetts Society for the Prevention of Cruelty to Animals; Author, "Tell Me Where It Hurts"): Well, I think there are obvious instances in which the problem is so blatantly obvious it sort of hits us upside the head. But if not, then we're going to move on to, you know, potentially, x-rays, radiographs, CTs, MRIs, blood work, urinalysis, just a whole - ultrasound - a whole wealth of new technologies that we as people take for granted and to have now permeated veterinary medicine to become sort of the normal standard of healthcare for our animals.

GROSS: I want you to tell us about one of your more challenging cases. This is a case - I would describe this dog as almost a hermaphrodite.

(Soundbite of laughter)

Dr. TROUT: Yeah, yeah.

GROSS: It's a male dog that had become feminized. It had - why don't you describe what it had?

Dr. TROUT: This wasn't an easy story to convey and get across, but I tried my best to basically describe a boxer dog who, on the outside, appeared to be male. This dog only had one descended testicle, and the remaining testicle inside had succumbed to a tumor, a tumor that was secreting feminine hormones, and those feminine hormones were making this male dog become somewhat female in nature. This dog would stand to be mounted by other dogs, had somewhat pendulous breasts and had this real sort of hormonal turmoil going on inside of him.

The other problem was, unbeknownst to both me and the owner, that he had a remnant of an embryonic uterus that should have disappeared during his development as a puppy and yet had persisted. And so, this increase in female hormones had sort of turned on a female reproductive organ within his body, and as a result, he had developed what's called a pyometra, which is not an uncommon infection of this male dog's uterus. And so, this gave me this very unique, once-in-a-lifetime opportunity to end up actually neutering and spaying one and the same dog.

(Soundbite of laughter)

GROSS: That's just really bizarre.

Dr. TROUT: It was quite bizarre. You know, occasionally, these cases do get reported in the veterinarian literature. What is more entertaining is how you explain this to a somewhat chauvinistic owner.

GROSS: And how did you?

Dr. TROUT: Well, I like to think the feminine side of his male dog brought out the feminine side in him.

(Soundbite of laughter)

GROSS: How so?

Dr. TROUT: Well, because, you know, he did find it difficult. He was just insistent that this was a male dog and that this couldn't be happening, this hormonally induced ability to be attractive to the other male dog in the dog park. And so, what I ensured at the end of the day was that he should understand that the male side of this dog actually shines through, was the dominant party, and he seemed to be comfortable with that.

GROSS: You know, one of the supermarket tabloids seems to specialize in bizarre animal stories. I wouldn't have been surprised if they picked up on this one, but you know, just have a lot of stories about like the biggest cat in the world or half cat/half dog.

(Soundbite of laughter)

Dr. TROUT: Right, right.

GROSS: You know, they kind of combine the photos together so it's half cat and half dog.

Dr. TROUT: Yes.

GROSS: Do ever run into that, where a tabloid picks up on one of the more unusual medical stories?

Dr. TROUT: I - you've got me worried now.

(Soundbite of laughter)

Dr. TROUT: I'm wondering if I'm going to be inundated with phone calls, but I mean, I think the closest I've come to it is the very real story of a 40-pound cat that - you know, I remember someone showing me a picture of this animal that had come in and just being both shocked and appalled by its size. And it led me into an opportunity really to discuss this epidemic that animals face in our society today, which is not only for us, but also our pets, you know, obesity and overweight.

GROSS: What does this 40-pound cat look like? That's a lot.

Dr. TROUT: I mean, just like carrying a bean bag that you would sit in. I mean, this is just a ridiculous amount of fur and flesh, almost to a point of hardly being able to see where the limbs and head were. I mean, a 40-pound bag of potatoes or whatever is a significant weight to be carrying, let alone to be carrying around with you when your little skeleton is so small and relatively fragile to that body mass.

GROSS: Well, what are the medical problems involved with being overweight, you know, with cats and dogs? I mean, your concern isn't that they look too fat.

Dr. TROUT: Right, right. Yes.

GROSS: You're concerned medically. So, what's the problem?

Dr. TROUT: Well, I mean, me personally, you know, doing surgery, the biggest thing I see is significant risk of arthritis and worsening of arthritis. There was a study some years ago that showed something like an 11-to-18 percent weight loss of overweight pets could produce a statistically significant improvement in lameness. And to actually achieve statistical significance is a big deal. And so, I've had many cases over the years, dogs that are overweight. The owner comes in. We talk about a more conservative approach to their dog's hip problems, say, a problem that they originally came in for an expensive hip-replacement surgery. We get the weight off over a couple of months, and I get phone calls saying, I don't need to do that hip replacement surgery. My dog is doing great. I'm very pleased. Losing that weight made all the difference, and so, that's one way in which I feel the big impact of improving animals' body weight.

GROSS: Let me ask you about another case that you write about in your book. In this case, the dog's owner was a man who had lost his wife not long ago. And you figured he was probably closer to the dog than anybody else.

Dr. TROUT: Sure.

GROSS: You must see that a lot, where people are just, like, so close...

Dr. TROUT: Absolutely.

GROSS: To their animal and are therefore so unsure about what to do because they don't want the animal to die. You know, in a situation like this, do you do the surgery? Do you not do the surgery? Will it work? Will the animal die? What are some of the, like, kinds of really emotional conversations you ended up getting into with pet owners when their animals are in jeopardy?

Dr. TROUT: Yeah, I mean, that's - it really varies depending on the nature of the problem. But I think the first thing I try to do is to sort of step back from being sucked into the emotion of the relationship, because my first responsibility is to try to tell the owner what the problem is and what options we have to deal with it. I'm just trying to give them their information because there's obviously so much from their side of the examination table that I don't know, you know, the depth of this relationship, the importance of the animal in their life, their previous experiences with loss, their own health issues, their thoughts on natural death versus euthanasia and, you know, last but not the least, their ability to pay for whatever care would be required.

And so, I think one of the things I - you know, we need to convey is the fact that whatever we are putting our animal through with some of these difficult decisions and these potentially life-threatening problems, that animal really doesn't have an ability to appreciate that, I'm going to have to go through something negative because I have that notion of extended life; I have an understanding that this is all for the good for me because there's the other end of the equation of which life will be improved for me. You know, they're living in the here and now, and so that responsibility of what decision we make very much falls with us as pet owners. And I think we need to look at that carefully and say, whatever we put our animal through, are we going to get - is it reasonable, what we're going to ask? And also, on the other end of this, are we going to see enough upside and benefits to make it worthwhile?

GROSS: This must be one of the more frustrating parts of being a vet; you know, again, you can't talk to the animal and you can't explain to the animal that this is going to help the animal in the long run.

Dr. TROUT: But I think there is that wonderful silent communication, you know, when we are working with these animals, the sense of their understanding that we are doing and trying to do the right thing by them, if only in the fact that so many of them sort of accept it. They appreciate what we're doing, and it's so easy to convey in the silence between us that we mean well and we wanted to do right by them.

GROSS: I'll tell you what, not my cat.

(Soundbite of laughter)

GROSS: My cat is so terrified of going to the doctor, and when we put her in a carrier and then take her into the doctor's office, she starts howling like a wolf. It sounds like the beginning of a vampire movie.

(Soundbite of laughter)

GROSS: It is so pathetic to hear her. And then one doctor actually refused to treat her because she was just - she'd just gotten so wild. It's like she was possessed. One doctor put her in, like, a little pussy cat straightjackets.

Dr. TROUT: Right.

GROSS: So, that he could...

Dr. TROUT: Right, right.

GROSS: So, he could kind of get to her without being, you know, fought by...

Dr. TROUT: Sure.

GROSS: By her. So, I think she doesn't feel that special calming presence.

(Soundbite of laughter)

Dr. TROUT: Well, I think...

GROSS: Kind of - like, really exciting.

Dr. TROUT: At least from all side of the table, we're trying to convey that.

(Soundbite of laughter)

Dr. TROUT: Whether it's reciprocated or not is another matter.

GROSS: But what do you do in a situation like that, when you're facing a cat that's just terrified?

Dr. TROUT: Oh, I mean, it happens. And I think if you can achieve what you are trying to do in order to, you know, find out what's wrong with that animal and you can do it somehow around physical restraint, then that's what we'd do. But there are instances when you just have to say, I'm going to cause your animal far more distress battling away here than if we could just give a little chemical restraint and be able to get to the problem more quickly and without distressing the animal in the process.

GROSS: Yeah, I think some sedation wouldn't have been a bad idea in this instance.

Dr. TROUT: Well, it'll probably makes you feel better as well that, you know, at least they're relaxing into the experience, because, I mean, it does become silly after awhile because they're very talented with their teeth and claws. And you know, for a good reason that little fight-and-flight mechanism from way back in evolution still happy to kick in.

BIANCULLI: Animal surgeon Nick Trout speaking with Terry Gross. His memoir is called "Tell Me Where It Hurts." More after a break. This is Fresh Air.

(Soundbite of music)

BIANCULLI: Let's get back to Terry's interview with Animal Surgeon Nick Trout, author of the memoir "Tell Me Where It Hurts."

(Soundbite of WHYY's Fresh Air, March 20, 2008)

GROSS: Veterinary medicine has changed so much in the past few years. I remember the first time I heard that a pet was going to get chemo for cancer, and I thought, wow, that sounds so extreme. And now, it's just kind of standard, I think.

Dr. TROUT: Right.

GROSS: For a lot of animals. If you get cancer, you get the treatment. And you know, animals get MRIs now, and therefore, veterinary expenses have just skyrocketed. And it's very difficult for pet owners to keep up with those expenses, and they sometimes have to make very difficult decisions about how much they're capable of spending to keep their animal alive.

Dr. TROUT: Sure.

GROSS: What are some of the interventions that you use now that would have been unheard of 10 or 20 years ago?

Dr. TROUT: Well, as you rightly point out, I mean, MRI is sort of the standard of care now for all these dogs that come in with potential brain problems, spinal problems. CAT scans, ultrasound, bone scans and you know, chemotherapy, radiation therapy, we will do, you know, hip replacements, arthroscopy, endoscopy, thoracoscopy, brain surgery, spinal surgery. You know, if you're doing that on a person, you're pretty much doing it for an animal, at least you have the opportunity to. Renal transplants, open-heart surgery, all of these things are becoming and increasingly the norm when it comes to our pets, because - you know, I think it just comes down to the fact that not only are these options available to us, but also, you know, the shift in the importance of the animal in our lives. You know, pets are family. This is my child, is the standard comment I get from the vast majority of my clients. And if this is my child, then I want the kind of care that I can - would expect for my child. And sadly, in the new millennium of veterinary care, we are becoming not limited by medical advances or surgical advances, but really the ability to pay for those.

GROSS: One thing that you're really opposed to is cosmetic surgery for animals, unless it's medically required. What are some of the typical cosmetic surgeries being done now that you think should not be done?

Dr. TROUT: Well, I like to think this goes back to my British sensibilities, as a member of the Royal College of Veterinary Surgeons and, you know, being educated in England. The Royal College does not approve of any kind of cosmetic surgery, like ear-cropping or tail-docking. And so, the U.K. is full of floppy-eared Dobermans and Great Danes and Rottweilers with long sweeping tails. And so, if the blame lies anywhere, it lies with my upbringing and education. And also now that I work at Angell, which is part of the MSPCA, the Massachusetts Society for Prevention of Cruelty to Animals, in which we perform no tail-docking or ear-cropping or declawing of cats. And that that's fine by me. I think, you know, this - one of things I mentioned, these things called Neuticles, these testicular implants that can be inserted into dogs at the time of neutering and castration. And so...

GROSS: What's the purpose of that?

Dr. TROUT: The purpose, as far as - again, this is my personal opinion - is entirely cosmetic. It is to give them an outline, an anatomical outline, that looks like nothing had happened, that they retain that outward appearance of being male. It serves no medical or hormonal benefit. These are inert inserts that just go into the vacated scrotum. They are purely cosmetic, and I have a problem with that.

GROSS: In the human world, if somebody is sick and in a great deal of pain and they want to end their life, that's not accepted right now. Some - a lot of people think it should be accepted, but it's not. In the animal world, it's always been more accepted to put down an animal, whether it's a large animal or small one, if they're in a great deal of pain and there's no hope for that to improve. Do you think the standard has changed at all with animals?

Dr. TROUT: No, I don't think so. I think, you know, that the euthanasia is still a very important part of what we do. You know, people have religious, spiritual, moral issues with euthanasia and that's, you know, that's obviously a very personal decision on their part. And you know, some of it comes down to the fact that for veterinarians, we still have that oath and there's still that thought of, you know, first do no harm, and if that harm is actually putting to - an animal to sleep, you know, are we going against that oath? But I think - the way I look at it, what I mention in the book is the fact that, you know, I think all of us aspire to that death in which we died peacefully in our sleep, and you know, that holds some appeal and that, you know, veterinarians have this responsibility or at least this option to cause a loss of consciousness, to alleviate pain without the application of pain, that we can bring to bear a dignified and graceful end to an animal's life. But it is a very difficult and emotive issue.

GROSS: What do you tell people about what to expect if they're watching the lethal injection?

Dr. TROUT: I think I've learnt the hard way to very much prepare them because a whole variety of things can happen. I've come to very much prefer having a catheter, plastic tubing into a vein, so that we can deliver the injection without the act of a needle when they witness the event. I've told them that dogs may take a deep breath, a sort of final sigh. They may pant; they may paddle; they may lose control of bodily functions. I do warn them that, for the most part, dogs and cats leave this world with their eyes open, that that sort of Hollywood ending of laying on of hands and that - closing their eyes sometimes doesn't happen.

And I've learned, you know, make sure you tell them that this is - you know, you're just flushing the catheter with the saline solution, because you give them the injection, they look at you surprised that their animal is still alive. I've also warned them it's very quick; it's very painless. Some people are so surprised that it happens so gracefully and so quickly. You know, they really expect something more. And you know, there's some solace to be taken in it actually being a sort of quiet and peaceful event.

BIANCULLI: Animal surgeon Nick Trout speaking with Terry Gross. His memoir is called "Tell Me Where It Hurts." We'll hear more of their conversation in the second half of the show. I'm David Bianculli. And this is Fresh Air.

(Soundbite of song "Dogs Are Everywhere")

Mr. JARVIS CROCKER: (Singing) Dogs are everywhere, almost everywhere that I go. They can't help themselves, and so they help themselves to my home. They leave their scent behind them everywhere they go.

Oh, dogs are everywhere. Dogs are everywhere....

BIANCULLI: This is Fresh Air. I'm David Bianculli in for Terry Gross. Back with Terry's interview with Dr. Nick Trout, a veterinary surgeon who has written a memoir called "Tell Me Where It Hurts." He treats cats and dogs at the Angell Animal Medical Center, which is part of the Massachusetts Society for the Prevention of Cruelty to Animals.

(Soundbite of WHYY's Fresh Air, March 20, 2008)

GROSS: On the dust jacket of your book, "Tell Me Where It Hurts," there's a photo of you with your two dogs, and one of them is a big Labrador who's sitting next to you.

(Soundbite of laughter)

GROSS: And he looks really large. And then there's a little - was it a Jack Russell?

Dr. TROUT: Correct, yeah.

GROSS: Who's sitting on your lap, and you know, he's really small, particularly compared to the big Lab. Did you intentionally get a really large and a really small dog?

Dr. TROUT: That's my youngest daughter's doing. When Emily said she wanted a dog, what am I going to do? She - we got the terrier initially. Sophie is 11 years old, and I - you know, incredible dogs, very smart dogs. You know, she's got that sort of Red Bull running through her veins, and she actually, now at 11 years old, has slowed down just slightly. And so, I like to think that that gives me an opportunity to empathize with the terrier owners. And then I, of course, have the Labrador, which was another pick by my daughter, and this gives me the orally fixated, happy-go-lucky retriever, and gives me a chance to empathize with the retriever owners.

GROSS: What about in your house now? Who's the dominant dog? Is it the big Lab or the little Jack Russell?

Dr. TROUT: Oh, the Jack Russell.

GROSS: Little Jack Russell, yeah.

(Soundbite of laughter)

Dr. TROUT: Oh, yeah, the terrier is completely in control. She just rules the roost, and the goofy Labrador seems quite content to live on her terms. Yeah, it's a nice mix, actually. I was very surprised that it worked out as well as it did.

GROSS: Let me read something you wrote in your acknowledgments at the end of your book. You write about your wife, "Like so many mothers of children with chronic disease, she has quietly sacrificed her life for the greater good of our family." What is the disease that your daughter has?

Dr. TROUT: My daughter has cystic fibrosis, which is the number-one genetic killer of children and young people in this country. And she was diagnosed at about two and a half years of age. And you know, there was no way not to pay homage to my wife in this acknowledgment because, you know, she has sacrificed a lot for our daughter, for our daughter's care. And you know, it's funny, the - when you first get this diagnosis, I'm sure so many parents of children with chronic disease, there's all the anger and frustration. And I think at that time, I did question, you know, I'm here treating pets, yet this child, who is my own, you know, sharing some of my genes and DNA, is so sick. Should I be reconsidering what I'm doing? Should I be thinking about becoming a human doctor or research scientist, trying to find a cure? And all that anger sort of builds up in you.

And then, you know, as the time goes by, you start to realize that you are so blessed and so lucky to have this child in your life, and she's such a great kid. And you start to accept your situation, the good fortune you have, despite what she goes through. And I think some of that has been beneficial to me in my dealings with pet parents, because I see in them the same kind of fear and concern when they're faced with a similar crisis, for someone who is a child to them, who they love just as much as I do my daughter.

GROSS: Is she the daughter that chose the two dogs?

Dr. TROUT: Yes, of course.

(Soundbite of laughter)

Dr. TROUT: I mean, again, she - to be honest, with regard to Meg, the Labrador, she and I were in the critical care unit at Boston's Children Hospital; it was about two o'clock in the morning. And she said to me - and she must've been about eight to nine at the time - and she said to me, Daddy, are you going to get me that yellow Labrador I want? What are you going to say? She's got you completely cornered.

(Soundbite of laughter)

Dr. TROUT: So, I said yes. She was quick to remind me when she came out of hospital, and so it happened.

GROSS: Let me ask you now. You mentioned that you know that some of the pet owners who bring their pets to you love their animals as much as a parent loves a child. That will sound offensive to some people. Some people think that, you know, animals can't possibly have the weight or be worthy of the same depth the feeling that a child can be.

Dr. TROUT: I would have to disagree. I mean, you know, obviously everybody's welcome to their own opinion. But I mean, I've seen it with my own eyes. You know, there can be no question in my mind that the depth of love and affection for the animals in some people's lives is no less than I've seen with people with children. You know, I talk in the book about one section in which - I referred to the chapter as Dangerous Liaisons, because some people, you know, just get so invested in their animals; I mean, one gentleman who legally changed his middle name to that of his dog because he just felt that at the end of his life, he wanted his dog to be buried with him, his - the dog's ashes to be buried with him, and that for people to look at this tombstone and say, you know, that's how much that dog meant to me. I mean, that's intense; that's so deeply-rooted.

And you know, there's a woman who's so obsessed with the dog in her life, she'll happily endure injections on a twice-weekly basis and live with an inhaler because she's horribly allergic to the animal, but it still sleeps in the same bed, shares a pillow. I mean, this is deeply-rooted. And I think the other thing to take away is the fact that when these animals that we bring into our lives, we consider them to be our children, you know, the natural order of things is such that we should not bury the children in our lives. You know, they should outlive us.

And yet, we embrace them with all that love and commitment that - full well knowing that probably in our lifetime, we're going to have to let them go and live without them again. And that's what's so hard, the - you know, that you love a creature so much and yet you're sort of living with this anticipatory grief. One of my friends just got a new Shih Tzu puppy, and you know, she is so in love with this animal, she's saying to me already, I don't know how I'm going to cope with losing this animal, I mean, something - 15, 16, 17 years in the future, and yet there's already that sort of niggling fear that this is going to have to come to an end.

GROSS: Well, Dr. Nick Trout, thank you so much for talking with us.

Dr. TROUT: Well, thank you for having me.

BIANCULLI: Animal surgeon Nick Trout speaking with Terry Gross. He's a staff surgeon at the Angell Animal Medical Center, which is part of the Massachusetts Society for the Prevention of Cruelty to Animals. His memoir about his experiences working with cats and dogs is called "Tell Me Where It Hurts." Coming up, scientist Irene Pepperberg tells us about working with an animal that actually talked back. I'm David Bianculli, and this is Fresh Air.

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