October 01, 2013

 

 LEGENDS: Dr. Stephen J. Ettinger

The trailblazer of veterinary specialty medicine 

Dr. Stephen J. Ettinger literally wrote the book on veterinary internal medicine

 



 Dr. Stephen J. Ettinger (Courtesy of Dr. Stephen J. Ettinger)

 

The name Dr. Stephen J. Ettinger has practically become synonymous with veterinary specialties. Not only did he and his colleagues found the American College of Veterinary Internal Medicine, but also, in 1977 he helped establish the Berkeley Veterinary Medical Group, the first private group veterinary specialty practice in the United States. In addition, Dr. Ettinger published the “Textbook of Veterinary Internal Medicine,” the gold standard in veterinary internal medicine texts, among other important veterinary medical tomes. Finally, as one of the profession’s pioneers in veterinary cardiology, he has made substantial contributions to the development of diagnostic procedures and therapeutic regimens for managing cardiac problems in companion animals.

“You’ll change your mind”

Dr. Ettinger was born and raised in New York City but spent much of his time growing up at his parents’ summer home in Pennsylvania. He got involved with 4-H, raising calves, chickens, and pigs.
 
“Then, when I was working on the local farms, the ‘good doctor’ would come around, and seeing what veterinarians would do, it was very exciting for me. That was when veterinary medicine piqued my interest. I learned why some cows milked well and why others didn’t or why they got sick—that kind of thing,” he said.
 
Dr. Ettinger matriculated at Cornell University intending to be a large animal veterinarian. In fact, competition was so tough while he was doing his undergraduate studies that he thought he might not get into the College of Veterinary Medicine, so he considered switching to a premedical major. But, he was accepted into the veterinary program after two years as an undergraduate at Cornell and excitedly accepted the invitation.
 
“During the interview process, they said, ‘Large animal, right?’ I said, ‘Yep.’ They said, ‘You’ll change your mind, coming from New York City.’  There was a lot of prejudice during those days, which obviously does not exist today,” he said.
 
During his studies, Dr. Ettinger became interested in comparative medicine and pathology and wanted to pursue research. His focus shifted when during his third year he took a small animal medicine course given by Dr. Robert Kirk, who became his mentor and had a major influence on his career.
 
After receiving his DVM degree in 1964, Dr. Ettinger completed an internship and residency at the Animal Medical Center in New York City. He was offered a postdoctoral fellowship in cardiology with the National Institutes of Health. During this period, he was engaged in human and canine cardiology research with a group of physicians at the Bronx VA Hospital and the AMC. He also worked with physicians and veterinarians on a clinical study on aging at the AMC.
 
“In the ’60s and ’70s, veterinary and human medicine really paralleled each other. This allowed us to do many of the same procedures on each species and use the same drugs and research. Many of my papers were those that had both animal and human studies included from human cases at the VA hospital and animals at AMC,” Dr. Ettinger said. “ It was really a tremendous opportunity, especially at a time when there were so few veterinary cardiologists.”
 
At that time, only two veterinary cardiology programs existed: those at the University of Pennsylvania and The Ohio State University. Dr. Robert Hamlin of Ohio State would visit the AMC once every three weeks as a consultant, adding considerably to the mentoring that Dr. Ettinger received from the physicians.
 
“Dr. Hamlin really stimulated my interest in cardiology. In fact, he did a lot more than that for me. He introduced me to my wife, Pat,” who had been an Ohio State student, Dr. Ettinger said.
 
The NIH fellowship was tied to NASA and the government’s interest in space travel. Any research activities that might be applicable were fair game during those days. Incidentally, Dr. Ettinger had his first contact with computers during this time—the IBMs that used punch cards.

Beginning of specialties

Moving to California had been a dream of his since he was a teenager, when every year, he would watch the New Year’s Day Tournament of Roses Parade. In 1971, he got a call from a veterinary ophthalmologist, Dr. Seymour Roberts, to do just that. His colleague was engaged in research at Stanford Medical School and noted that not only clinical medicine but also research could be done in practice. He invited Dr. Ettinger to join him, and they started the Berkeley Veterinary Medical Group. The practice had a veterinary surgeon, radiologist, dermatologist, internist, cardiologist, and ophthalmologist.
 
 A year later, the American College of Veterinary Internal Medicine was founded, with Dr. Ettinger as a charter diplomate and member of its board. He remembers that some ACVIM members were reluctant to have multiple specialties, and still other veterinarians didn’t want specialization in veterinary medicine at all.
 
Under the direction of Drs. Robert Kirk, W. Jackson, Gus Thornton, Donald Low, Otto Radostitis, and Harold Amstutz and others, the group came up with the idea of the umbrella concept under the ACVIM. The original subspecialties were internal medicine, neurology, dermatology, and cardiology, the last of which Dr. Ettinger was also a charter diplomate. He was on the ACVIM Board of Regents and was president of the cardiology subspecialty from 1974-1978.
 
Even with that success, Dr. Ettinger’s practice struggled, because area veterinarians were reluctant to refer cases. The clinic closed its doors in 1977. It wasn’t until the 1980s that specialty clinics in general became more widely accepted. That was when emergency clinics hired specialists during the daytime hours to work with patients that came in with complex cases or were referred as emergencies. At the same time, other veterinary specialists began taking on more complex procedures in hospitals designed for their needs. 
 
“For about the first 10 years, (ACVIM) had more academics than we did practitioners, but more recently, veterinary practitioner specialists have outnumbered academic members,” Dr. Ettinger said. “It’s true we do a lot of teaching, and most academic faculty are specialists and members of ACVIM, but really, the primary purposes of ACVIM are to offer the public the best in veterinary services, be it in large or small animals, and to train new veterinary specialists.”
 

Dr. Ettinger has worked in both academia and in private practice. He also taught at the University of California-Davis School of Veterinary Medicine for about eight years. It started with his traveling there once a week to work and teach with another of his mentors, Dr. Peter F. Suter, a radiologist with whom he worked at the AMC. The two published the first veterinary small animal specialty textbook, “Canine Cardiology,” in 1970.

Human medicine had internal medicine textbooks, and Dr. Ettinger was asked to help develop one for veterinary medicine. In 1975, he published the “Textbook of Veterinary Internal Medicine,” a two-volume treatise.
 
“At the time, I thought it was a good idea. I thought I would write and edit a 300-page book. It turned out to be a 2,300-page book, and now I’m working on the eighth edition,” Dr. Ettinger said. It’s been published in five languages. During this period, Dr. Ettinger advanced at UC-Davis from a clinical lecturer to a clinical professor.
 
In 1980, he left for Los Angeles to join a multigroup practice, the California Animal Hospital, which evolved into several practices. Dr. Ettinger’s group of 24 veterinarians was the California Animal Hospital Veterinary Specialty Group, which was sold in 2007. Dr. Ettinger also served as chief medical officer of PetDRx, a national veterinary practice group from 2007-2010.  

Good-natured people

In his nearly 50-year career, Dr. Ettinger’s clinical research has been prolific—to say the least—and led to many important discoveries. Much of his early investigations centered on the effects of digitalis on the heart. He progressed to clinical studies with furosemide, ACE inhibitors, and pimobendan, and, over the past seven years, he’s been active in studies involving brain natriuretic peptide and other hormones produced during heart failure.
 


In 1999, Dr. Ettinger and his wife, Pat, were recognized as major benefactors to his alma mater, Cornell University College of Veterinary Medicine. (Photo by Jon Reis/Cornell University)
 
Those studies have culminated in papers looking at hormones that are made by the heart that can be used to identify various states of heart dysfunction. These hormonal concentrations are used in both the human and veterinary medical fields. One review article written by the group of veterinarians studying these hormones came out recently
(see JAVMA 2013; 243:71-82) and identifies most of the studies published to date.
 
Dr. Ettinger and his associates have trained more than 75 interns as well as the hundreds of externs who have rotated through his practices over the years. A substantial number of boarded cardiologists and internists have completed their residencies at the California Animal Hospital Veterinary Specialty Group.
 
Dr. Ettinger says he feels fortunate to have had the experience to work with as many people as he has in the profession. “Veterinarians are great people, good scientists, and good-natured,” he said.
 
Now, he works in several clinics and consults for companies. He served on the Dean’s Advisory Council at the  Cornell University College of Veterinary Medicine, was elected to Cornell’s board of trustees, and was the secretary to the World Small Animal Veterinary Association.
 
He credits the pharmaceutical industry for giving him the opportunity to engage in research areas that otherwise would have been financially impossible. “There are a lot of people who complain we’ve been bought by the big pharma companies, and, to some degree, perhaps there’s some truth to that, but there’s not much money in clinical veterinary medical research, and they have given us the opportunity to study and improve the quality of medicine we practice,” he said.
 
Dr. Ettinger also is involved with the one-health movement. He has collaborated with Barbara Natterson-Horowitz, MD, a human cardiologist at the UCLA Medical Center. Dr. Natterson-Horowitz co-authored the book “Zoobiquity” and has served as the principal coordinator for one-health seminars focusing on the interaction and similarities between human and veterinary medicine.
 
“We are interested in one health, but one health still remains a goal yet to be attained. The future holds great potential for veterinarians to work with physicians and public health professionals in the area of world health,” Dr. Ettinger said. “I think the opportunities for young veterinarians today go far beyond clinical practice.”