Alumni Spotlight: Carolyn Arnish, PharmD
Carolyn Arnish, PharmD, has two careers; one as a staff pharmacist at the Cummings School of Veterinary Medicine at Tufts University, and another as the pharmacy manager at Dedham Pharmacy and Medical Supply, an independent pharmacy owned by alum Leanne (Galante) Jasset BSP ’78. This multi-talented pharmacist describes how thinking outside the box enhances both of her chosen career paths.
First off, thank you so much for taking the time to speak with us! Let’s talk about your path to veterinary pharmacy. Last time we caught up with you, you were working with Leanne Jasset BSP ’78 in her independent pharmacy in Dedham, a position you now hold part time with your position at the Cummings School of Veterinary Medicine. Why did you decide to work with animals as well as people?
Actually, my original passion was veterinary pharmacy, but I am terribly allergic to cats. I didn’t think I could work in a vet’s office, so as a senior in high school, I chose to pursue pharmacy. In my third year at MCPHS, I had a sort of crisis: I still really wanted to pursue the veterinary path! My parents had a very sensible reaction. They said, ‘You need to finish your PharmD program, and if you still want to pursue veterinary after that, you can.’ So I finished my PharmD, taking the veterinary elective which MCPHS offered and pursued all possible IPPE and APPE rotations, including an APPE rotation at Tufts with Dr. Ceresia (Michelle Ceresia, PharmD, associate professor of Pharmacy Practice). I volunteered at the MSPCA Angell Spay and Neuter Clinic in Boston, worked with search and rescue dogs, and became a certified therapy dog handler. Everything I did to make my resume better from a veterinary perspective was volunteer work, because there is so little paid work.
Was it intimidating to start working in veterinary medicine? For instance, were there areas of education and reading that you felt you needed to explore?
Absolutely. Because there are so many animal species, it’s impossible to learn everything you need to know while you’re in pharmacy school. And at the time of my graduation in 2014, there was only one residency program for veterinary pharmacy in the entire country, the program at North Carolina State College of Veterinary Medicine. (Now, in 2018, there are three.) So I had to have a backup plan when I applied, because I knew deep down there was not a good chance. I applied, though, and miraculously got into the one spot available in the country. It was unbelievable; truly a nerve-wracking experience. I had to pack all my stuff up and move down south for a year! Happily, two weeks before I was due to arrive I found out that NC State had gotten funding for a second resident, which worked out well for me, as she and I became good friends.
Can you give us an idea of the range of species that you see at Cummings, and tell us a bit about how that range affects your daily practice? Do you feel as if each species presents a completely different and novel set of challenges, or do you see more similarities than differences across species?
The vast majority of animals we see are cats, dogs, and horses, and a lot of times we can extrapolate dosages to other mammals, but there are always exceptions—rabbits, for instance, follow no rules. We also see exotics, like iguanas. We even had a baby emu a while ago. For those species, there are not a lot of data. If there is a drug study on an emu, they probably only treated two emu, so a lot of this work is experimentation. Obviously, the pharmaceutical industry only tries to get drugs approved for animals if the drugs will be financially viable. There are plenty of cat, dog, and horse owners out there, but not as many iguana or hedgehog owners. The FDA has an animal drug division, but again, they only work on the drugs which companies are developing, which means drugs for common pets and livestock. For example, there are no drugs approved for llamas. None! So all drug usage for llamas is what we term off-label usage. We also end up using a lot of drugs initially approved for dogs on cats, and vice versa, based on post-marketing studies. That’s one reason why I encourage every pharmacist to have a veterinary drug resource on hand in his or her practice, and why I’m lobbying to have the Massachusetts Board of Registration in Pharmacy require that every pharmacy keep one on hand. It’s just a book, but it can help you feel much more confident in your practice when you’re asked to fill a veterinary prescription.
What is the most challenging veterinary patient you’ve had so far? Conversely, is there a type of patient that you feel is particularly rewarding to treat?
One thing people overlook about veterinary medicine is that every drug is administered by a human, so in a very real sense, your patient is not just the pet but also the owner, as one unit. If the owner is at work, that’s a limitation to dosing. My most challenging patients are non-compliant owners, who may not understand that their animal is in pain because animals don’t present pain the same way humans do. The symptoms manifest differently. So, my most difficult patients are also my most difficult clients. (This is one way that veterinary practice is like pediatrics.)
In terms of rewarding patients, I’ve noticed that everyone who works at the veterinary hospital shares an interesting trait: whatever pet they have is their favorite animal to treat. I have a standard poodle, so I cue in on them. A coworker has a French bulldog, so whenever one of them comes through the door, there’s excitement. Cat people want to see cats, bird people want to see birds; it’s a funny human trait.
There’s a character in the latest “Jurassic Park” movie who is a paleo-veterinarian, charged with figuring out dosages for dinosaurs. Obviously, that job doesn’t exist, but you must feel a twinge of the unfamiliar whenever an exotic animal’s prescription comes in. When you’re confronted with a species that’s new to you, like an emu, what is the mental process of care like?
A lot of figuring out the right course of treatment has to do with “allometric scaling.” which is the process of using what we know about one species to extrapolate to another based on body weight and metabolism. I haven’t taken veterinary anatomy, so I’m still learning new facts every day. For instance, at our Society of Veterinary Hospital Pharmacists (SVHP) conference this June, I attended a talk about turtle and tortoise anatomy, which is of course prehistoric, ancient anatomy. I learned that some species of turtles can breathe through their butts—I mean, [laughing] how would I ever guess something like that? Learning new and fascinating stuff like that every day is a huge part of why I love this job. I am never bored.
Now that you’ve worked with animals for a little while, which feels easier—veterinary practice or working in a traditional pharmacy?
It is much easier to work with humans. There is so much more data, and that makes it much easier to treat humans. The insurance industry, although occasionally frustrating to deal with, does allow us to do so many things in human medicine that we can’t consider doing in veterinary medicine, because the financial question always comes first. Additionally, euthanasia is another common procedure unique to veterinary practice. The combination of financial stresses and access to euthanasia drugs are just two factors that have made the suicide rate very high among veterinary professionals, which is a sobering topic in our field. In the last five to ten years, our awareness of the mental health issues in our profession has exploded. We now have a licensed social worker on hand for both our clients and our staff; it’s a topic we discuss a lot more.
One other thing that makes veterinary pharmacy challenging is that veterinarians don't need pharmacists. Veterinarians can legally prescribe and dispense completely independently, whereas human doctors can only prescribe and not dispense. This makes justifying the need for a pharmacist in veterinary practice challenging, because you constantly have to prove your worth and show that your education differences are valuable to veterinary healthcare.
With all that in mind, what would you say to students who might be in the same position now that you once were—wondering if veterinary pharmacy is right for them?
I get so many emails from students all over the country who are excited about veterinary pharmacy just like I was. I have to remind them that it’s not puppies and kittens all day long. In fact, I don’t get to actually physically see animals in my daily work, unless I’m wandering around the hospital.
Working in this field means embracing a lot of outside-the-box thinking; often, there’s no guaranteed right answer. Additionally, you have to be willing to pack up and move across the country, if necessary. There are only 30 veterinary schools, and very few jobs. At this point, very early in my career, I have worked for every veterinary pharmacy in the state, and I don’t even have a full-time position at my current job. There are maybe only six people in the entire state of Massachusetts who do this full time. So you have to have a backup plan. My experience in retail pharmacy [at Leanne (Galante) Jasset ‘78’s independent pharmacy, Dedham Pharmacy & Medical Supply] is invaluable to my veterinary pharmacy work. Because of that experience, I can tell my veterinary clients what a drug costs in the real world, and can also tell vets what is happening in human medicine so that we can extrapolate backwards from humans to animals.
Finally, there are many other ways to work with animal pharmaceuticals besides working in a veterinary hospital. You could work for the FDA in animal drug approval and regulation, for a veterinary pharmaceutical company, as a consultant, in compounding, or in an agency like the Food Animal Residue Avoidance Databank (FARAD), which helps calculate drug residues in the animals we eat. There are a lot of options!