Sniffing Out Which Surgical Patients Will Have Less Anxiety And/Or Depression

My man, Chamberlain, never ceases to amaze me with his broad knowledge base. This English dude seems to know something about everything. Maybe that’s what happens when you punt a hectic clinical practice and become a bartender. It opens up the noggin so to speak. 

Holding up a teaspoon of sugar in front of me, he clears his throat to get my attention from the tiny television over his shoulder showing replays from the last Manchester United game. “Imagine, if I put one of these into a swimming pool twice the size of an Olympic one, do you think you could proffer a technology that could detect that?”

Now I really had to dig deep in the mental recesses. Shaking my head, I finally found a couple of swirling and, to me, nebulous terms circulating in the mental ether.

“What about mass spectrometry or liquid chromatography?” I replied without the least idea of what these technologies really were or how they worked, but I was not going to let Chamberlain in on that. That is not how we mentally sparred.

“Well, those might work but you would probably have to concentrate the water from the pools first before they could pick up this concentration. One teaspoon of sugar in that volume is about one part per trillion.” Now he was starting to sound like Carl Sagan, the way he pronounced “trillllllllion!”

Trillions, billions — even millions, for heaven’s sake — are conceptually difficult to grasp and fully understand when one applies these numbers to a substance dissolved in a liquid, or even a distance like light years for that matter. Dammit, these are all just numbers that sound really big. How much longer would it take you to drive a billion miles versus a million?

“Really, Chamberlain, how can we differentiate or make some significant reference to numbers this large when big is just really big, and you know what I’m asking,” I replied to him with intellectual resignation.

“OK, you know that a billion is a thousand times a million and a trillion is a thousand times a billion,” he instructed.

“Yes, I know that you uppity, pompous windbag but give me a little reference here for understanding,” I said with my defensive tone.

“Imagine time. You know what a second is and can quantify that. That’s about one-tenth of your attention span right now, I suppose.” Now he was making me mad but I let him continue. A good thing about getting really irritated is that your focus increases a little.

“A million seconds is 11 days. A billion seconds is 31 years. Therefore, a trillion seconds is 31,000 years. Go back that far and all our ancestors were ambulating in a semi-quadrupedal style with hairy knuckles dragging the ground and saying goodbye to the last Neanderthals.” Now that put it into perspective for me. The two teaspoons of sugar in a double Olympic pool were not doing it for me.

“I just got the machine that can do this type of detection,” he boasted.

“Bovine feces, my friend! Where did you come up with a million plus dollars from your bartender gig?”

He suddenly whistled very loud and a few seconds later, this beautiful black Labrador comes running into the bar from the back kitchen. “She’s $2,500, a lot less than a million,” he informed me.

I quickly got off my barstool and bent down to meet my new canine acquaintance while he quickly buried his nose into my netherland, sniffing and snorting.

“What’s his name?” I asked while trying to pull his head away from me.  Chamberlain barked back. “Her name is Wiffy and he is a she.”

“Sorry, I didn’t have time to do the gender check while fighting Wiffy away from bits and pieces.”

Gathering myself and wiping off dog slobber off on my new chinos, I had to ask him. “Why in bloody hell would you name a dog ‘Wiffy’?” My English gentlemen friend then went on to explain his nomenclature process for the canine.

“You see, this is a specially trained dog. This dog may just look like a black Lab to you but she is indeed a specially trained medical detection dog. Wiffy, you see, can detect cancers, including breast, lung and prostate cancer to a level of a minimum of 95 percent accuracy, earlier than many lab tests we have now. Some folks like to call them bio-detection dogs. Wiffy can detect lung cancers, in all stages, at a 99 percent accuracy, just by sticking her nose up by your mouth.”

Scratching my head, I was perplexed on why my retired psychiatrist/now bartender friend would want to purchase a canine that could whiff out disease. “So why did you buy her and why are you showing me this during happy hour?”

Chamberlain grinned as he heeled her over to me. “Here, I bought her for you. She is my gift to you.”

I was totally stunned. I love dogs but just couldn’t see how it would work in my chaotic life. “I would love to have the dog but I spend too much time at the office,” I said.

“She is for your office, you dolt.”

Now I was really confused. “What? I can’t take her to the office.”

“Oh yes, you can. Consider her your newest diagnostic tool.” I had no idea what he was referring to. “She’s better than the Patient Health Questionnaire 9 (PHQ-9) for God’s sake. Wiffy, you see, is also trained to detect cortisol levels, ergo stress and fear.”

Now I remembered having this long chat with Chamberlain about preoperative evaluation and it seemed that no matter what surgery we were going to do, especially peripheral nerve surgery, there was no really good way to determine who was going to do really well postoperatively and who would not. The screening tests such as the Generalized Anxiety Disorder 7 (GAD-7) questionnaire and some of the other questionnaires used for depression and anxiety fell far short. I explained to him that when dealing with denervation surgery, depression and anxiety played huge roles in patient outcome. Pick the patient with no anxiety or depression, and the chances of your surgical result being optimal are far greater than in the patients with depression and anxiety.

Handing the leash to me, Chamberlain added: “There is no CPT code for her. Have her sniff the pre-op patients in the afternoon. Cortisol levels in the depressed patients are higher then.”

Turning quickly away from Chamberlain so that he would not see the tears of happiness welling up in my eyes, I walked toward the back exit of the tavern.

“Thank you, man. You have given me the greatest of gifts,” I said over my shoulder with a crackling voice. “She will be well taken care of.”