Professor Clare Rusbridge – Veterinary Neurologist at Wear Referrals and the University of Surrey
What or who inspired you to become a vet?
I am the stereotypical vet who always wanted to be a vet. Indeed, I wrote this down aged 4-years old. Undoubtably my father influenced this early decision. He was a farmer’s son who left school at 14 but later decided that driving a tractor was not his future. He went to biology evening classes (where he met my mother who, not permitted to do biology at her convent school, had also found an alternative education route). My father ultimately became Professor of Biological Sciences at Caledonian University. However, first and foremost he was a naturalist and, although I did not fully appreciate it at the time, my childhood was rich and immersed in the wonders of nature and science. Weekends were spent walking, observing wildlife, looking at pond and insect life through microscopes, reconstructing shrew skeletons from dissected owl pellets, making plaster casts of animal footprints and more.
What is your current job? Do you hold clinics as well as carrying out research?
I have two salaried jobs. For 50%, I work at the busy multi-disciplinary hospital Wear Referrals and yes, I still hold clinics. Although I live in Surrey, I travel to Northeast England for 5-days a month of onsite clinical work. The remaining time I work remotely including online consulting for epilepsy and (maladaptive) pain management. For 50% of my time, I am at the University of Surrey where I am Professor of Veterinary Neurology and I split my time between research and teaching. I am also passionate about welfare aspects of dog breeding – especially when dogs are bred according to human wishes to have welfare compromising conformation. Consequently, I also devote time to charitable roles as trustee for the Dog Breeding Reform Group and Patron of Cavalier Matters.
What drew you to your field of study and what motivates you to continue?
When I was a PetSavers Resident in Neurology at the Royal Veterinary College, I met a Cavalier King Charles Spaniel called Beau. Whilst Beau walked, he rhythmically scratched towards his right shoulder without making skin contact. This greatly puzzled me and I wanted to know the cause and the anatomy of that maladaptive scratching action. It took a couple more cases and the veterinary profession gaining the ability to perform spinal MRI before I finally had a basic answer of syringomyelia (fluid-filled cavities in the spinal cord) due to canine Chiari malformation (disproportion between the size of the brain and skull resulting in a cerebrospinal fluid pathway obstruction). I have been researching that disease ever since – now for 25 years. I am still looking for answers to my questions. This burning desire for answers and the pain and suffering that this disease causes motivates me to continue.
Discuss the impact your research has had on the profession. How have those in general or referral practice benefited from your research?
The greatest impact for vets in general practice must be my treatment algorithm for canine Chiari malformation and syringomyelia which I first drafted in 2006. I made this freely downloadable on my personal and other websites, regularly update it and even had it translated into several languages (https://veterinaryneurologist.co.uk/chiari-likemalformation-and-syringomyelia). This is not something that would be measured by regular impact measures such as the Research Excellence Framework (REF); however, I am proud of it because I know that hundreds of lives have been influenced by it, especially dogs owned by those that do not have access to a veterinary neurologist.
From a pure science point of view our greatest impact is better understanding the conformation changes of canine Chiari malformation and syringomyelia; however, I cannot take single credit for this. In her PhD under my supervision, Dr Penny Knowler ascertained that pain associated with Chiari malformation is associated with brachycephaly, whereas syringomyelia is associated with a combination of brachycephaly and craniocervical junction overcrowding and angulation. Dr Knowler is an amazing and inspirational woman who obtained her PhD aged 71 and after working (unpaid!) as my research assistant for 17 years. She is also my mother!
Has your research served as the foundation for other studies or developments in the field, and what will happen after your study is complete?
The holy grail for those investigating syringomyelia is to understand what we refer to as ‘the filling mechanism’. To quote the late Bernard Williams, one of the grandfathers of the syringomyelia field, ‘we haven’t quite cracked this yet’. There are many researchers in many disciplines trying to find answers to this enigmatic disease.
At the University of Surrey, I have the privilege of working with researchers whose primary discipline is engineering and maths. This multidisciplinary approach is exciting and rewarding and has pioneered veterinary studies in computer modelling and machine learning.
My immediate goal is to develop an AI machine learning approach that will easily and objectively screen breeding dogs for this disorder. My ambition is not just to achieve it but to see it implemented. This ability to identify at risk dogs would not just be based on MRI or CT but on their head shape, i.e. would require a photograph rather than expensive testing under general anaesthesia.
Tell us a little about your own experience. What does your research mean to you personally and what have you gained from it?
My research gives me immense job satisfaction. I enjoy clinical work and teaching, but it is doing all three that gives me an exciting and fulfilling veterinary career.
I admit to being obsessed by Chiari malformation and syringomyelia. Barely a day goes by without me thinking about the problems and challenges of this disease. It consumes, drives, and motivates me, infusing me with a burning passion to continue. Although some might consider this a curse, I think this makes me lucky because it has made me more resilient to failure. Much of research is not about the successes – it is about picking yourself up after the methodology did not work, that grant rejection, those poisonous social
media or even direct obstruction from those who do not like you or your message – picking yourself up and continuing until you achieve your goals.
What is your favourite aspect of your work, and what has been your most important/surprising finding?
My most surprising finding was the fictive scratching action first demonstrated to me by Beau, which was first described by Sherrington in 1906. His observations were made in dogs a few months after he transected their spinal cord in the caudal cervical region. It is a poignant reminder that sometimes the answers to questions are written in the past not the future.
However, there are still many questions about the fictive scratching in syringomyelia. PetSavers has helped provide some of the answers by funding student projects. Rather than the horrific experiments that Sherrington employed, we have found answers from the clinical data from affected dogs. We have shown that the fictive scratching is associated with a wide syringomyelia in the mid cervical region extending to involve the superficial dorsal horn. This knowledge was hypothesis generating for a novel treatment.
What does PetSavers offer the profession in your opinion?
PetSavers funds clinical research that will translate to a tangible benefit to general veterinary practice. In doing so they also provide opportunities and inspiration to the young researchers who may become leaders of their field in the future. The veterinary student doing a PetSavers-funded summer project may be the professor of the future. The postgraduate embarking on a PetSavers-funded master’s or PhD may end up running a research team.
There are surprisingly few funders of clinical research. Most funders prefer the more predictable and less risky laboratory and rodent model-based studies. However, clinical research is one of the best ways of improving knowledge of disease, understanding how that disease evolves over time and determining the most effective way to diagnose and treat it. For example, canine acute polyradiculoneuritis (like Guillain Barre syndrome) is a challenging diagnosis in veterinary practice involving referral, electrophysiology and nerve and muscle biopsy. The consequence of PetSavers-funded research was the identification of an antibody biomarker. Soon this could be translated into a blood test that general practitioners could use to avoid referral and expense. In addition, this research has improved our understanding of this immune-mediated disease. (https://www.bsava.com/petsavers/our-impact/published outputs/serum-antibodies)
What advice would you give to vets considering carrying out clinical research for the first time?
Go for it! However, beyond the glib response I would suggest finding a mentor. I was lucky that when I was in my first referral practice, I went on a weeklong course at Cambridge University called the Clinical Research Outreach Program. This gave me the basics in study design and statistical analysis; and provided a mentor – in my case, Professor Nick Jeffery. This support really helped, and I am forever grateful to him and Professor Mark Holmes who organized the course.
Many universities offer support to those in practice, and indeed at the University of Surrey we have two clinical research lecturer positions (companion and production animal) with the specific aim of enabling research-curious general practitioners to start and complete that journey.
All research starts with a question, and general practitioners at the cutting edge will have relevant questions for which the answer may have great pertinence to veterinary life.