Veterinary radiologist receives highest academic honour

Graeme Allan and Hugo.Veterinary specialist radiologist Graeme Allan will be awarded a Doctor in Veterinary Science (DVSc) this year in recognition of his prolific contribution to the field of veterinary diagnostic imaging.

The DVSc is a rare honour, awarded to outstanding researchers whose body of work is deemed to have made a consistent and distinguished contribution to veterinary science. Candidates submit a collection of original publications for assessment by examiners who are considered pre-eminent in their respective research field.

The unusual thing in Allan’s case is that his clinical research was undertaken while running a busy private specialist practice. As such he is the first Australian veterinarian in private practice to receive the DVSc by examination.

His thesis, ‘Radiological Studies of Disease in Companion and Zoo Animals’, is a compilation of more than 45 years of collaborative studies looking into a range of conditions, including pioneering studies on contrast radiography, oesophageal dysfunction, radiotherapy for treatment of cancer in companion animals right through to new forms of rickets in rex kittens, osteochondrosis in the cheetah and osteocondritis in snow leopards.The examiners unanimously agreed that Allan’s contribution to the field was outstanding. Professor Donald Thrall, best known as editor of the Textbook of Veterinary Diagnostic Radiology, described Allan as “a Renaissance man, with talents in many areas; accomplished veterinary diagnostic radiologist, investigator of numerous problem areas, teacher, and mentor.”

Emeritus Professor Patrick Gavin, of Washington State University, wrote that Allan’s thesis “will facilitate veterinary education, new veterinary radiologists, residents, interns, and veterinary science students.”

Professor Erik Wisner, Chair of UC Davis’ Department of Surgical and radiological sciences, wrote that “veterinary diagnostic imaging has only recently emerged as a specialty compared to other clinical disciplines and advances in imaging technology and computing power have caused the specialty to expand and evolve at an astonishing rate. Dr Allan, considered one of the pioneers of the specialty, has successfully navigated and adapted to this ever-changing terrain throughout his career.”

The irony is that Allan graduated without ever having had a single lecture in radiology. But when one delves into his early life, imaging doesn’t seem a far-fetched career option.

Born in New Zealand in 1940, Allan grew up in the rural town of Waipawa.

“Dad was the town doctor. He really liked living in the country,” Allan said. “So I spent a lot of time within a farming community, fishing in rivers and enjoying that sort of lifestyle. As I thought more about what I would do with my life I thought that living in this sort of community and being a vet would be pretty good.”

That wasn’t Allan’s only aspiration. He really wanted to be a pilot or a cinematographer.

“I was told I was too tall to be a pilot. Back then you couldn’t be too tall [Allan is 193cm]. I didn’t have great eyesight either and when I look back it is patently obvious that it wasn’t the right career choice: I would have hated to be responsible for all of those people up in the air.”

When he attended an interview at Film New Zealand, the panel advised him ­- incorrectly – that there was no future for cinematography in New Zealand. On hearing this, Allan’s parents, who had driven him to Wellington for the interview, “said it was obviously a loony idea”.

Studying years.Veterinary science emerged as the front-runner.

At the time there was no veterinary school in the country. Instead, the Government provided funding for 25 students to train in Australia – in exchange for working in New Zealand for five years upon graduation. He enrolled at the University of Sydney.

“We were occasionally shown radiographs but we were not taught how they were taken, how they were processed or a systematic approach to their interpretation,” Allan recalls.

“The mystery of radiography at the veterinary school at that time was known only to Arthur Gee, a faculty employee with a background in medical radiography.”

During his studies, Allan met Roslyn Ward, and his plans to return home fell by the wayside. With the support of his future father-in-law he opted to pay out his bursary and remain in Australia, a decision he has never regretted. The pair married in 1966.

In 1965, at the end of his studies, Allan became a locum in Mildura.

“The vet met me at the train station with his whole family bundled into the car,” Allan said. “After a brief introduction, he took me to the practice and he and his family disappeared to the coast. That was not an unusual experience in those days.”

It wasn’t a particularly edifying one either. The practice extended from central Victoria to the Western border of NSW. The practitioner had left Allan with his wife’s Mini-minor, ill-equipped to endure the dirt roads of the outback.

“I was all alone and I just didn’t know a damn thing,” he admits. “I spent a hell of a lot of time driving and getting lost, visiting people who you knew wouldn’t pay you…but it didn’t occur to me that it was that bad. It wasn’t until I learned that some graduates were committing suicide that I realised, and I could understand how some people could be driven to despair in such circumstances.”

Upon graduation, Allan accepted a position at North Shore Veterinary Hospital which possessed a small X-ray machine (it had an output of 90kVp and 30mA). Under the mentorship of Rowland Pursell, a veterinarian who had pioneered the development of tick antiserum, Allan was bitten by the discovery bug.

This signalled a change from his university days, when even Allan admits he wasn’t a stand-out scholar.

“I wasn’t a good student in the traditional sense. I didn’t like lectures and I didn’t learn from the reams of notes that were handed out.”

But reading case reports and journal articles related to the conditions of animals he was treating in practice was endlessly fascinating.

“I found that reading journal articles and looking at clinical material and trying to work out what was going on was a tremendous way for me to learn more about what I did. So all of my early publications related to what I was seeing and doing in practice.”

North Shore was an unusual practice in that two of its four veterinarians were female. One, Jennifer Edols, helped the young Allan write up his very first case report. The patient was a cocker spaniel presented for a routine spey. However, discovery that the bitch possessed an os penis caused much head scratching.

“This led to karotyping the dog, something which was completely new to me and made me realise that there was so much that I didn’t know. It also led to cooperative work with members of the medical profession, who had the skills and laboratory facilities that enabled us to stretch our investigations.”

The article, entitled ‘A case of male pseudo-hermaphroditism in a cocker spaniel’, was published in the Australian Veterinary Journal in 1968.

The realisation that practice generated new knowledge constantly was to see many papers follow.

“I found it was through clarifying my own ideas by reviewing the literature, and writing, that I could best further my knowledge as a new graduate.”

Allan immersed himself in his work, probably – he reflects – a bit too much.

“At our recent reunions people from my year have talked about the fact that back then we expected to work seven days a week, we expected to be on call seven nights. We knew we’d be back at work after dinner, we would have to work on weekends and when the phone rang at 2am we would have to get out of bed – it came with the territory,” Allan said.

Despite the gruelling hours, Allan enjoyed his work.

“My wife once told me that she didn’t know anyone who looked forward to going to work in the morning the way I did. I still do.”

Allan was fortunate at the time to have two close friends – Rolfe Howlett (then a PhD candidate investigating bone pathology), and Bruce Duff (then training in veterinary pathology). The trio exchanged ideas about cases and acted as a “brains trust” for one another.

No one in Allan’s practice at the time really knew what to do with the X-ray machine, least of all him.

“My shortcomings as a radiographer became manifest as frustration with the modality. I used to spend my weekends radiographing animals and hanging the film on pegs on the clothesline in the backyard. I realised that not only did I not know anything about radiology, but hardly anyone else did either.”

He commenced a Masters by research under Richard Dixon at Sydney University. Dixon had recently returned from Colorado State University where he had received advanced training in radiology and radiotherapy. He proved a wonderful mentor, helping Allan investigate contrast media in cholecystography of dogs.

Another faculty member, Graham Cotton, arranged for Allan to observe radiology rounds at the Royal North Shore Hospital.

“These weekly sessions introduced me to a medical radiology community. While I found these sessions richly rewarding, the medical radiologists in turn were fascinated by the range of skeletal disorders that we encountered in dogs and cats.”

Soon after completing his masters, Allan joined the partnership at Ku-ring-gai Veterinary Hospital, where he investigated dwarfism disorders in German shepherds.

“It’s never easy accumulating data in a practice situation where expensive tests and procedures are required, and invariably the cost of pursuing interesting case material was self funded,” Allan said. “This is a situation that has existed for my entire career.”

Allan, along with Clive Huxtable, Rolfe Howlett, Rob Baxter, Bruce Duff and Brian Farrow, published the seminal paper on pituitary dwarfism in German shepherds in the Journal of Small Animal Practice – at the time the most prestigious small animal medicine journal in the Commonwealth.

While at Ku-ring-gai , Allan took charge of refurbishing the radiology suite, installing a high output X-ray machine and an automatic film processor. But the frustration of not being competent at radiography proved overwhelming. Training in North America was the only solution.

“This was an agonising decision as I was a part owner of the practice. My family, Rolfe Howlett and Richard Dixon were all influential in helping me decide to leave my safe veterinary practice environment, sell my shares in the practice, and move to Ithaca in upstate New York.”

Allan completed a residency at the New York State College of Veterinary Medicine under Victor Rendano. His overseas experienced opened up new worlds – Allan had a taste of diagnostic ultrasound, radiotherapy, contrast studies and advanced imaging as well as radiography. Allan sat his board exams and passed with flying colours.

Upon returning to Sydney he worked hard to create a viable practice relying solely on referral work. It was a dry period. Allan spent much of his spare time writing case histories for the Australian Veterinary Practitioner, covering diseases which were and remain difficult to diagnose.

“These cases were designed to demonstrate that ordinary practitioners could practice ‘on the edge’, just as effectively as many better qualified colleagues,” he said.

Allan developed one of the first distance education programs offered by the Post Graduate Foundation in Veterinary Science, now the Centre for Veterinary Education. It remains one of the most popular distance education programs.

Together with Robert Nicoll he established Veterinary Imaging Associates, a diagnostic imaging consultancy which provides services to veterinarians around Australia. Allan and Nicoll taught diagnostic imaging at the University of Sydney for over a decade while maintaining their private practice. With Paul Mahoney and Andrew Wood he created the Australasian Association of Veterinary Diagnostic Imaging, aimed to further the education, knowledge and skills of the local veterinary diagnostic imaging community.

Having celebrated his 70th birthday, Allan shows no signs of slowing down. He continues to work a four-day week, visiting practices in the Sydney region to read films and perform ultrasound while mentoring dozens of practitioners and sharing his wisdom.

Retirement is not imminent, but Allan is asked almost daily when he might give up the game.

“You do get to a time in your life when people are obviously thinking ‘You are an old bugger and why are you still here?’” he said. “There is a palpable bias against old people in the profession and you do hit that wall. I will continue doing this while I enjoy it.”

His secret seems to be that enthusiasm for discovery and thirst for knowledge that bit him with his very first paper.

“At a recent reunion one of my year mates told me he hated being a vet all his life – and I thought that was really strange. I can’t imagine not enjoying what we do. There are so many clinical syndromes that we come across in practice all the time, and if you keep your eye open you can build very interesting case histories. Imaging is just imaging, but where I’ve been successful is in collaborating with others to help elucidate strange disorders. I’ve been so lucky to be surrounded by inquisitive and enthusiastic people.”

Anne Fawcett