We had a health scare in the Morgan household recently. During an annual checkup, Harpo was found to have an enlarged lymph node in his torso. Harpo is a ferret, named like his brothers for members of the Marx Brothers comedy team of the 1930s, because ferrets are the funniest animals I’ve lived with.
In the United States, domestic ferrets are highly inbred and thus prone to a number of health problems, primarily adrenal disease. Lymphoma is relatively common as well. The veterinarian did an ultrasound on him and aspirated some cells to send off to the area vet school. The results were inconclusive, our vet reported: The node was “reactive,” responding to something in his two-pound body, but there were no cancer cells in the sample. Since he was showing no obvious behavioral symptoms, we decided to take a wait-and-see approach. I had already insisted on a round of steroids to reduce the node. If it turned out to be lymphoma, he would only have months to live, but in any case the drugs would make him more comfortable.
Something was bugging me, though. A bulb of flesh had slowly been growing on the end of his tail for a year. It didn’t seem to hurt him, and the slight hair loss there was not as concerning as it would be at the base of the tail, a classic sign of adrenal disease. A different vet had seen it the year before and found it unremarkable. I pointed it out this year, and the new vet said it was probably just some sort of skin growth.
A recheck after the round of steroids found the lymph node had gone done a bit. So I set aside my budding suspicions as the vet said the radiologist, while being conservative in the official report, had verbally expressed his guess the issue was indeed lymphoma.
That night, I noticed the bulb had “ulcerated,” bled, at some point recently. Things started clicking in my head. I went online and searched, finding both anecdotal evidence from ferret owners and one scientific case study talking about a fairly rare situation: a slow-growing malignancy called a “chordoma” appearing at the end of the tail rather the base, where it usually presents in ferrets. The good news was, clipping off the tumor typically resolved any resulting issues. The picture in the journal article of a separated chordoma looked exactly like Harpo’s except more advanced. The text description fit it, too, and mentioned that chordomas could ulcerate (bleed).
Back to the vet we went the next day, and there things got a bit heated. I recognize some pet (and child) parents deny scary facts about their youngn’s. I also recognize the vet had no idea of my background. Any regular reader of this blog knows I am very empirical in my thinking. Also, I wrote for a vet school for a couple of years in addition to other medical writing. It helped my case that I could converse at a more technical level than most pet parents.
I found both irritating and intellectually fascinating how much she did not want to listen to my logical, evidence-based argument that the lymph node could be reacting to the chordoma—or even that it was a chordoma! She interrupted me multiple times trying to get across what I already knew, that chordomas usually appear on the butt, and pushing her hypothesis that the problem was lymphoma. The first thing that got her attention was when I mentioned it had “ulcerated,” purposely using the technical term. “Oh, it ulcerated?” she said, looking where I was pointing at the scab.
When setting the appointment I had asked the receptionist to mention the word “chordoma.” As the vet launched back into her monologue, I had to verbally shove my way in to ask if she had found “the study…” (I got interrupted before I could finish the question, and had to talk over her) “about the chordoma at the end of the tail.” No, she now had to say, surprise registering on her face. I had anticipated this and downloaded the study to a memory stick, which I now handed her (cited below). I finally got her to agree the bulb needed to come off regardless, though she clearly remained skeptical that was causing the reactive lymph node.
This is the Research-Practice Gap in action. This vet is very experienced and has worked with many ferrets, an expert on their medical care. It was understandable she did not know about a relatively rare scenario. However, she had not been diligent in researching the possibility even after it was pointed out, because a nonexpert was doing the pointing.
A finer point would be that she resisted evidence from someone with different expertise that she was refusing to recognize as relevant. The vet is obviously the expert on ferret anatomy and physiology. But she knew that I’d lived with six ferrets at different times for a total of 16 years. Thus it’s reasonable to assume I know ferret behavior better. My first three had developed general illnesses at least in old age, and this ferret was not acting like he had one, as I had told her. I kept open in my head the possibility it was lymphoma, but trusted more the combination of the scientific evidence plus my ferret experience, per the tenants of evidence-based management.
The surgery to remove the growth went well. I joked with friends I was going to have a “Doberman ferret,” since some owners of Dobermans have their dogs’ tails clipped. (See the picture above for the resulting look.) When the doctor called after Harpo was awake, she remarked that the bulb “may have been bothering him more than it seemed” because he was unusually active.
This is subjective, of course, but my sense after I got him home was that he was manically active, running around to a greater degree than ever before, which still seems the case weeks later. In a surprising side effect, he also seems more trusting, in that he sometimes sleeps near me as I am working, where before he always went back to the “ferret den.” Maybe he no longer worries as much about his tail getting stepped on?
Last week, a month after the surgery, we went in for a follow-up. The doctor palpated him eagerly, and her face showed she was glad she’d been wrong as she announced the node was basically back to normal.
The lesson for business people is that a relative novice can sometimes come up with the solution to a problem simply because they don’t know any better! Instead of going down the standard checklist, the person with the outside perspective thinks of things that aren’t on that checklist. I have seen the most junior person on a team come up with the winning solution. In this case I was applying my expertise in another realm (diagnosing business problems through science) to veterinary medicine and was able to come up with the right answer instead of the expert doing so.
Harpo teaches experts—meaning you and me, because each of us is an expert at something—to be humble and to listen to the nonexperts before rejecting their ideas. He also teaches us nonexperts, again all of us, to be assertive when we see our questions aren’t being answered. Teams are more successful when every member tries to add value on every topic, regardless of which role we’re in.
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Bonus: Enjoy a cute video of Harpo in action pre-surgery (with a cameo by Groucho!).
Source: Cho, Eun-Sang, et al. (2011), Chordoma in the Tail of a Ferret. Laboratory Animal Research 27(1):53.