Face to Face: A surgeon’s inspiration

Ilana Mendels and Jeff Mayo.There’s something almost savant-like about world renowned veterinary surgeon Jeff Mayo. He has a compulsion to learn how everything works – and the quiet confidence that he can master it if he sets his mind to it. Even if that means repeating the same task over and over until he achieves perfection.

Mayo, who in July taught two tibial tuberosity advancement workshops hosted by VetPrac at two Australian universities, credits his success to a series of remarkable role models – including his own veterinarian.

I was twelve years old, I’d just bought a horse, and this guy came out to do a health check. That was the day I decided I wanted to be a veterinarian. I spent every day with him til the day I went to college.”

Irv LeVine was something of a renaissance man, not only practicing as a veterinarian but singing and recording music, flying planes and horsing around.

His approach to life in general wore off on me,” Mayo said. “The man just has fun all the time. He doesn’t fight, he doesn’t argue, his medicine was very practical.”

But Mayo didn’t proceed directly to veterinary school. He undertook a degree in respiratory therapy through Boise State University before working as a respiratory therapist at Duke University Medical Centre.

A respiratory therapist (RT) or inhalation therapist, he explains, is an allied health worker trained in the assessment and treatment of breathing disorders including asthma, emphysema and chronic obstructive pulmonary disease. RTs specialise and advise doctors on airway management, mechanical ventilation and acid-base balance.

Mayo proved good at it. In less than twelve month’s he had completed every one of the hospitals 16 additional RT qualifications. He practiced for four years until the hunger for veterinary science drew him back to college.

Mayo was recognised early as a gifted student at Oregon State University College, and something of an entrepreneur. He continued to practice as an RT to pay his way through veterinary school – with the permission of the Dean.

The local hospital gave me a beeper and if they had an emergency that required an RT the Dean had okayed me to get up and leave. I explained that if the beeper goes off I run off and make money, and if I have money I can pay for my tuition.”

Not that Mayo missed anything in class. In fact, he spent much of his waking time at the University involved in a range of projects. In his first year he co-wrote an NIH grant with the dean on the use of ACE inhibitors in pregnancy.

Even his study time was productive. Mayo wrote himself 10,000 multiple choice questions. He then wrote a computer program that would randomise the questions and the order of the answers.

That way it could ask me any of the 10,000 questions I had studied,” he said. “It was great for learning physiology and anatomy.”

Mayo knew the program had applications in other fields, and sold it to a group of RT’s for a tidy profit. Of Mayo’s 34 publications, many of them relate to software. (More recently, Mayo contributed to Odyssey Veterinary Software’s Small Animal Diagnostic Imaging Atlas).

Mayo was singled out by his anatomy teacher, Harold Engel.

To this day I call him my hero,” Mayo said. “He was really, really stimulating. I’d be walking up the steps and he’d be walking down and he’d ask ‘what’s the name of a macrophage found in the liver?’ or ‘what is the name of the sounds you hear when you listen to blood pressure?’ He did it to me for four years – like it was his mission to make me learn. The first time I asked me I wanted him to leave me alone but after a while I liked it.”

Mayo had had a taste of anatomy as an RT student but hungered for more. His enthusiasm was rewarded: each day he would assist his Professor in setting up the practical classes, reviewing anatomical structures for an hour prior to class. He was then able to assist with the teaching.

By this time Mayo already knew he wanted to be a surgeon. His strong grounding in anatomy and willingness to identify structures over and over again stood him in good stead. When he got to final year he completed his surgery rotation not once but three times – at his own request.

I just liked it. I was good at anatomy and I had a very good surgery instructor who spent a lot of time with me. We got on really well, and she had no residents so if she was cutting a case I’d scrub in with her. I had one on one time with her for weeks on end and learned so much.”

While Mayo’s colleagues were mastering speys, he was assisting on laminectomies and portosystemic shunts.

She was a great teacher. When it came to shunts she’d tell me things like not to bother with ‘stupidograms’ – she said that she promised that if you go in and lift up the stomach the shunt would be right there. If you can’t name the blood vessel under the stomach its probably the shunt. She’s been right 85 per cent of the time.”

Mayo worked for a year in an emergency clinic before purchasing a practice in Lynnwood, Washington, with his former wife – working for someone else wasn’t his cup of tea.

It was speed learning because we had cases flying in left and right and we’d have to patch them up, like Hawkeye in M.A.S.H. I liked it but I have a problem with authority and people would get mad if I did an FHO at three in the morning even if the owner said they wanted their cat fixed now.”

A year into his private practice career Mayo and his partner purchased a second practice – also in Lynnwood. Mayo devoted much of his time to learning new procedures in endoscopy, orthopaedics and radiosurgery. He passed the Veterinary Laser Surgical Society’s certification program in 2005.

Mayo and his partner ran these practices for 11 years before selling VCA Animal Hospitals, a conglomerate that runs 470 veterinary hospitals in 40 States across America.

I’d been so busy that when I stopped I didn’t know what I would do… but three months later I was busy again.”

Mayo attended a number of major conferences, taking the opportunity to network with manufacturers of surgical equipment. One of the companies keen to snap him up as a consultant was Ellman International.

They knew about my background in lasers which were their direct competition so they saw it as win:win,” he said. “I’ve been doing clinical research for them and its worked out really well.”

He also works with Securos Veterinary Orthopaedics and As a consultant, Mayo now travels the globe teaching radiowave radiosurgery, rigid endoscopy, techniques in tibial tuberosity advancement, tibeal plateau levelling osteotomy and new techniques of lateral suture for patella luxation. He has designed numerous surgical models for teaching, and is also in the enviable position of being the first to try new surgical equipment.

A lot of this involves being willing to try things that have not been used or done,” he says. “It’s a multiple step learning process. If we try bipolar scissors we need to work out a power curve for those scissors – you can’t just turn them up to 40 and see what happens.”

So when we tested these we did gross cadaver studies to work out the right power setting for the instrument. Once we decide the power settings we have to get a pathologist to look at tissue samples and determine if there is any lateral trauma. We discovered that there are certain sized dogs in which you can crush the ovarian pedicle, cut with bipolar scissors and not have to tie off.”

Mayo was recently made a fellow of the newly formed North American Academy of Veterinary Orthopaedic Surgery.

But its not all about cutting. In 2007 Mayo earned his Diplomate status in Canine and Feline Practice through the American Board of Veterinary Practitioners. Every year he locums at a specialist medicine and surgery clinic, seeing medical and surgical referral cases.

They’re about three to one medicine cases, so its good for my internal medicine experience,” he says.

He currently lives in Mount Lake Terrace, Washington, with his wife Laura, who is also the Mayor of the town. When he isn’t practicing veterinary medicine, teaching or lecturing, he flies aeroplanes, plays the piano and guitar and hits the gym.

His advice to aspiring surgeons is simply to keep at it.

What worked for me was knowing my anatomy real well, going after continuing education courses that provide the best hands on experience and don’t be intimidated.”

Mayo will return to Australia in early 2010 to teach another series of workshops through VetPrac. For further information and to register interest visit http://www.sigmaweb.com.au/vetprac/

Anne Fawcett