Michelle Moyal, DVM (Host): Welcome to the Cornell Veterinary Podcast, where we deep dive into the discovery, care, and learning that happens at Cornell University's College of Veterinary Medicine. I'm your host, Dr. Michelle Moyal, Visiting Assistant Clinical Professor and March Madness fanatic. If you're not watching, you should be.

My guest today is Dr. Andrew Miller, Associate Professor and Section Chief of Anatomic Pathology at Cornell. Don't worry, folks, we will get into all of these definitions. He is also a triple red alumnus. Ooh, Cornell, Cornell, Cornell! Having received not only his Bachelor's degree and his Doctorate of Veterinary Medicine from the Big Red, but also did his residency here as well. Wow! You really like Ithaca.

Beyond that, he's a Diplomat of the American College of Veterinary Pathologists and is involved in other Pathology groups, including the Canine Brain Tumor Consortium, which we will absolutely talk about because I am dying-- not dying because you're a pathologist, and I prefer not to die talking to a pathologist-- but we will learn more about it later. But I'm very excited and welcome to the show.

Andrew Miller, DVM: Well, I'm very excited to be here. I look forward to our conversation. I am not a huge March Madness fan, but it's also college hockey season. So, that's where my interests go, and Cornell just won an opening round upset last night.

Michelle Moyal, DVM: A huge upset for those listening, the Cornell Men's Hockey team won it with 10 seconds left in the third period. I too am a Cornell hockey fan. Women's hockey also did very well. Did very well. They didn't go as far as I wanted, but they had an excellent year. Awesome! Oh, sports fans everywhere, rejoice! We're not just talking science.

Well, first and foremost, we know each other, so this is like fantastic because I just get to chat with you-- like, I want to say not like always because we don't have time to typically talk-- but it is really nice to talk to you in this capacity. First and foremost, because we have like a breadth of listeners here and I would really appreciate if you can talk to those listeners and and tell them what the heck is an anatomic pathologist.

Andrew Miller, DVM: So, Pathology is one of many specialty fields that is part of Veterinary Medicine, Human Medicine too. And Anatomic Pathology is a branch that deals with understanding diseases in tissues, which is either at the gross level, so you're holding a kidney in your hand and you're looking at a lesion and you're trying to figure out what's going on, all the way down to the microscopic level. So, tissues get processed and fixed, and then we look at them under a microscope and then we try to make sense of them and provide a coherent answer to a client, which could be an owner, it could be a veterinarian, it could be someone who's working with lab animals, researcher, lots of different ways.

Our services really divide between biopsies. So, many of the listeners will have their own pets, and their pets may get a lump or bump somewhere that may get excised, that gets sent to a pathologist, and the pathologist will come back and tell them what the diagnosis is.

Michelle Moyal, DVM: Excised means removed. So, I want to make sure I understand the process or everybody understands the process. So, jokes aside, even though I love me some true crime, and I made a little joke, you're looking at animals also who have passed away, but animals that people might not be thinking about, like a live animal, right? They go into their vet, they may have a bump, and we could be worried about things like cancer. So, that bump is removed by someone like me, a general practitioner, and then we submit it to you. And when you say it's fixed, meaning we kind of put it in a jar of like little chemicals to preserve it, and then you are literally like slicing it into microscopic sections to look at it.

Andrew Miller, DVM: We cut it into small tissue sections. They get cut by our technicians into even smaller sections. I don't need to do that, thankfully. And then, they get stained and we look at them under the microscope. We tell them what's going on.

Now, for our dead animals, you know, it's just an animal autopsy, right? Which we use the term necropsy, but it's interchangeable with autopsy. And these are really important, because you could have a herd of cattle and a whole bunch start dying. They're going to send them to a pathologist and hopefully give them an answer that allows them to prevent future deaths. We do a lot of forensic necropsies, right? So, you're a true crime fan, but crime happens, and unfortunately, it sometimes involves animals and it's our job to try to tease out what happened and provide courts.

Michelle Moyal, DVM: Yeah, that's a really good point. And I think those of you who also love true crime, right? We're so used to watching these shows, but there are people hard at work behind the scenes for animal cruelty, both in trying to capture people and hopefully get the animals before something like this happens. But you're actually doing something that can affect things legally, and then you're also working-- So, your work across the board is needed, right? Because we have huge systems or small farms, that really they don't want disease because it can decimate many cows. And then, unfortunately, that can affect business and production. And that affects food systems and that affects food supply. And then, even on smaller scale, maybe we have patient who unfortunately passes away very young and we want to know what happens. And you're a big part of that process for allaying a client's fear, because sometimes they think they did something or maybe they want to alert the breeder. Maybe the breeder wants to know.

Andrew Miller, DVM: Yep. Yeah. And owners often want peace of mind, right?

Michelle Moyal, DVM: Yeah.

Andrew Miller, DVM: You and I are pet owners. Many people are pet owners. And sometimes animals die and sometimes it's unexpected. And you want an answer sometimes. And you know, we're not magicians. We're not going to give an answer 100% of the time. But we do try to provide at least as much closure and clarity as possible.

Michelle Moyal, DVM: Yeah. That's really neat. I'm going to ask in a little while, I'm going to kind of like hold some of these questions in, because now you've just allowed all these questions to pop up in my head. So, you answered what I was thinking about earlier, like why are they so important? You're clearly important in this process-- don't let it go to your head-- "You're very important in Veterinary Medicine," she says with an eye roll. I'm just kidding, right? So, this is clearly very important, right? It really has big ramifications. And by the way, for the family who's looking for an answer for their pet that passed away, also big ramifications, like allaying that anxiety and giving people peace is truly important.

I guess my question is what does a day look like for you? Like, is every day similar?

Andrew Miller, DVM: You know, pathologists have lots of different roles throughout the world, and my role is Academia. My job is on a daily basis, it's probably different than someone who's a pathologist, say, in a large drug company.

Michelle Moyal, DVM: Oh, interesting.

Andrew Miller, DVM: For me, my time is split between research, which we'll talk about later; service, which means being on clinical service, either the biopsy service or the necropsy service; and teaching. The pathologists here have extensive teaching roles throughout the preclinical and clinical curriculum. Knowing how to do a necropsy and perform it competently and collect the right tissues is a requirement for students to graduate. So, our fourth year clinical students are rotating through the rotation.

And, you know, we talked about herd health issues, right? A herd health conversation can be had with a shelter vet, the same as it can be had with a bovine veterinarian who's got a 500-head dairy, right? The same principles are still in play. So, we really try to make sure these students leave with a basic understanding of Pathology and how to collect tissues and process them and send them to the right lab. There are lots of state diagnostic labs throughout the country, but not every state has a diagnostic lab. So, some states, you'll go there and work and you'll need to figure out what the closest lab is that you can use to send tissues to to get answers.

Michelle Moyal, DVM: And if you're worried about certain diseases, you may have to send it to a very different lab. So, this can get very, very specialized or based on what's going on. I wanted to highlight, for those of you listening who think, "You are not going to be a pathologist," maybe you want to be a general practitioner like myself and you're like, "You probably won't need that," let me tell you something. Apologies to Dr. McDonough, who was one of my professors when I was at Cornell learning this as a fourth year student, right? But I don't think I realized what role it would play for me as a general practitioner. So, I actually started doing necropsies, because we have a lot of people that had some financial limitations and maybe we couldn't send the dog to someone like you. And so, I started looking for irregularities. And then, when I found something, I would send it to someone like you, so then the cost would be less.

So, I just want to emphasize that I think sometimes people think this won't affect their careers or that they may not enjoy it, but I used to invite the rest of the hospital and we would review Anatomy and all with the owner's permission, always, right? And we would learn these things and then we would submit these samples to hopefully get them an answer. So, I just want to encourage everyone, not just lovers of true crime, to understand that this is super important and might be something you end up doing. It was actually a pleasant surprise on my part.

Andrew Miller, DVM: Listen, a lot of our classmates are in practice, right? And we all know they're sending tissues because they're doing their own necropsies, and they need answers then from a board-certified pathologist. And that's really, really important. And it's part of Vet Med that I don't think is talked about as much as it probably should be, nor do have really the perspective that you need until you're probably out in practice and then you realize how important it really is.

Michelle Moyal, DVM: Yes. And that is why you're here talking to me on the Cornell Veterinary Podcast. See? See how that happens? But okay, so we know it's important, we know it has wide range effects, but what made you decide to go into Pathology? Were you like, "Yes, I want to do this"? Which by the way, I do know students that, as soon as they went to vet school, they knew they wanted to do Pathology.

Andrew Miller, DVM: Sure. I'm an upstate New York kid. I grew up in the Capital District, close to Massachusetts in a very rural part of upstate New York. I think it was seventh grade and I wrote an essay for home ec that was about going vet school because I loved animals, which frankly, all of us have ever done at one of our life. We've always written that essay and that's like, "I just want to cuddle with cats. So, that means I should go to veterinary college, because that must be what they do there."

Michelle Moyal, DVM: Right. We just pet puppies. Cuddle kittens all day.

Andrew Miller, DVM: Nothing. Lots of slobbery kisses. It's great.

Michelle Moyal, DVM: Yes.

Andrew Miller, DVM: So, the summer of '99, I was home for school, I was between my sophomore and junior year of undergrad. And New York State has a long history in Wildlife Pathology, and the main unit at that time was based in Delmar, New York, which is up near Albany. And I'd contacted them for a summer job, not knowing what else to do. And they hired me because they needed summer help, like many places do. And that entire summer was spent driving around New York state, picking up roadkill, bringing roadkill back to the lab, dissecting it, boiling out specimens, making teaching preps. We would then go to some state fairs and have exhibits of different skulls and teach--

Michelle Moyal, DVM: Oh, gotcha. When you say teaching-- so sorry to interrupt. Like teaching preps, like you would isolate, like remove tissue and have just the bones or like just a certain organ.

Andrew Miller, DVM: So, I'd grab a skull. And say, "Hey, this is a fox's skull," and teach the kids about teeth and dentition, what all that means.

Michelle Moyal, DVM: Awesome.

Andrew Miller, DVM: So at that point, I was like, "Well, if I can get paid to just to dissect animals and figure out diseases, well, this is great." So, I actually applied to veterinary college with the sole purpose of becoming a pathologist. I actually have never had a desire to do clinical medicine. So, I was lucky enough to get to Cornell, did my four years there. I spent all three years pre-clinic working in the Pathology Department as a student technician. Many of the services here hire student workers, routinely. So, I got to do a lot of stuff there, kind of almost apprenticeship, because I was just here working all the time, and then stayed for my residency. And I would not have done it any other way.

Michelle Moyal, DVM: You heard it here. Triple red. Yeah. So, you feel like it worked out just really well for you, like that journey worked out perfectly for you.

Andrew Miller, DVM: Yeah. I think about this sometimes, you know, what other route would I have gone? And the only other thing I was considering if I hadn't gotten into Veterinary College was heading off to do a PhD, probably in Endocrinology or Reproductive Endocrinology, because that was where I had some interest at the time. But luckily enough, I got in and was able to keep on doing what I want to do.

Michelle Moyal, DVM: I love that. That's also great because then I don't have to talk about Reproductive Endocrinology right now. No offense to those people. We're going to focus on this.

Andrew Miller, DVM: That wasn't on my docket for today either.

Michelle Moyal, DVM: So, okay, kind of back to your training, because we both went, we overlapped a little bit, which was a lot of fun. So, how was your experience in vet school? Anything that comes to mind that you were like, "That was the day I was like, 'I'm going to be a veterinarian'" or that day where you were like, "This will never happen." I like to share both highs and lows with our audience, because our audience knows that you experience both. This isn't all rainbows and flowers.

Andrew Miller, DVM: It's true, it's not.

Michelle Moyal, DVM: Thank you.

Andrew Miller, DVM: Reality is I can't give you a lot of lows. If I had to go back and do it again, I would totally do it again. I loved veterinary college. It was like the best four years of my life. Yeah, you studied a lot. You worked long hours. You were here at the veterinary college, at least at that time. You know, I was usually here at night until about 9:00 or 10:00, studying with friends in various tutor rooms and lecture rooms. But the weekends, we had fun. We did a lot of intramural sports. There was a lot of other stuff to do. And you got to learn from many people who wrote the textbooks, right? So, you know, you go to anatomy and the people teaching you or the people who wrote the textbooks that you are Yes. following along with.

Michelle Moyal, DVM: That was pretty daunting at the time. I remember thinking, "Wow, that's incredible."

Andrew Miller, DVM: Yeah, a hundred percent. How do you say no to that, right?

Michelle Moyal, DVM: Yeah.

Andrew Miller, DVM: I think when you and I were in veterinary college, the student class size was somewhere around 80 to 90, somewhere around there.

Michelle Moyal, DVM: Yeah. I had 81.

Andrew Miller, DVM: You know, it was a very tight-knit community. We worked very close together. We were supporting each other. That's what you remember most, I think. And honestly, any little minor blip in the radar, you're going to forget at some point anyway. So, it's best to remember the good things, and not let the bad things drag you down.

Michelle Moyal, DVM: I really, really agree with that. I think I was pretty fortunate to be in a class size like that. I do agree. We were very close. Some of my best friends to this day are my classmates from vet school, which I really loved. And, you know, the day maybe we didn't do as well on a test that we wanted to do well on, maybe that was a low at the time, but no one cares now. It doesn't matter what you got on that test, and I love that.

Andrew Miller, DVM: I certainly remember one of the worst tests I had in veterinary college was Block 7 exam where we had to do like TPRs and all that stuff because, no offense, that's not what a pathologist cares about. And I still remember to this day, "Oh, I didn't do well on that. Well, it's a good thing I'm going to be a pathologist."

Michelle Moyal, DVM: Translation. That's when we do basic physical exams on animals and he's talking about taking the temperature and getting the pulse and the breathing rate. And he is like, "Nope, this is not for me."

Andrew Miller, DVM: There's some numbers you need to know definitely. In clinical practice, you got to know those for sure.

Michelle Moyal, DVM: You do, need to know. You need to the right heart rate. And yeah, that's really solid. So, I want to jump in and talk about your research because I think people who really enjoy research are a really unique type of person. I like research, but I like applied, like clinical research. And I know a lot of people at the university do it, and at the college. But I'm just curious, did you ever have a day when you were doing a necropsy and you were like, "What?!"? Like you found something and you could not believe it. Tell me you found like a horseshoe in a dog and you were like, "How did this happen? Oh my gosh."

Andrew Miller, DVM: Diseases present in weird ways that you're never going to think of. There are lesions that you see and, at the moment, you're dumbfounded because you have no idea how a disease could present that way. Sure, we find all the usual weird foreign bodies and all the different types of cancers that everybody gets, but I think the important thing about Pathology is that it humbles you every day.

And the hard thing, the really hard thing is gross pathology, where you're doing necropsy, autopsy, what you think in the flesh, you're looking at an organ, you're saying, "Oh. It's going to be this." A lot of times, you get to the microscope. You're kind of like, Ugh. Yeah, I was totally wrong." So, it humbles you a lot. And, you know, it mimics diseases that mimic each other. Lots of cancers can look similar to one another. So, the microscopic detail is really critical to let us understand what the pathology is.

Michelle Moyal, DVM: That's neat, and I appreciate that because I think sometimes all we want to do, especially as young doctors, is be right. And sometimes things surprise us. You're right, animals present with all sorts of different clinical signs and sometimes they're hard to interpret and we can make a guess based on experience and based on the information we have so far with testing, but that changes. So, I really, really appreciate that.

I actually also really appreciate that you mentioned that the surprise was on the microscopic level. But just so we know, was there anything on the gross level that was not even related to a disease where you were like, "What?" And you don't have to talk about a specific patient? We would never do that. But just something like you were just really surprised.

Andrew Miller, DVM: Well, in the heat of the podcast moment, think of a good example.

Michelle Moyal, DVM: Yes, I get you. It's only if you're in the hot seat.

Andrew Miller, DVM: Yeah.

Michelle Moyal, DVM: Or the triple red seat according to Cornell.

Andrew Miller, DVM: So, I don't have a good answer for it now, but we can edit that part out.

Michelle Moyal, DVM: Yeah, absolutely. I could share something. I actually went to surgery with a dog that we thought ate a toy, became blocked and I removed it. I'll never forget it, it was a plastic Turkey, like a little squeaky Turkey, and they had given this dog this toy on Thanksgiving, but I didn't cut it out until after Christmas. So, that thing was hanging out in there for like a while. So, just so you all know, beware of the plastic turkeys. Sometimes they get back.

Well, that's really awesome. Okay. So, we kind of talked about what you do on the day to day, which is really interesting in Academia, right? Because somebody in maybe corporate practice or practice at a hospital, they might have a different day to day because maybe they're just doing Pathology-- I say just, I don't mean just-- but like they're looking at a lot of samples all day long where you're teaching pathology or service essentially means we like go to committee meetings and do these other things. So, you have to do research, a lot of us do. What is the focus of your research right now? Tell us about it.

Andrew Miller, DVM: So, I've always been drawn to Comparative Pathology in general. In fact, my first job post-residency was at Harvard Medical School as a comparative pathologist before I came back here on faculty.

Michelle Moyal, DVM: Will you just tell people what comparative means?

Andrew Miller, DVM: Yeah. So, Comparative Pathology just means taking lesions in an animal and comparing it to similar diseases in humans. Not all are translatable, right? Some things that dogs get-- that's all-- that dogs get it, nobody else does. Same thing for humans. Lots of things humans get, we've never described in Veterinary Medicine, although maybe we'll at some point.

But my goal is really to kind of better understand disease presentations, especially neuropathology. So, pathology of the brain, spinal cord, peripheral system, and tumors as well. I'm very interested in cancer broadly. Neurology, you know, I think those of us who were here up until the late 2000s that were trained by Sandy de Lahunta and Brian Summers and others, you can't not have left here with an interest in Neurology.

Michelle Moyal, DVM: Correct. Impossible.

Andrew Miller, DVM: And for me, Neuropathology. And, you know, there's not a lot of people that do Neuropathology. There's a kind of a small cadre of us around the country that collaborate with one another frequently. And for me, a lot of the issues are that we're still lacking a lot of the descriptive, basic understanding of entities. And if you don't have that basic understanding, you can't ever think about how you can translate that into new treatments, new prognosis, new ways to translate it to a human disease, and so on. So, that's where my interests have always laid.

Michelle Moyal, DVM: Gotcha. What do you mean by we're lacking descriptors of entities?

Andrew Miller, DVM: Yeah. So, let me give you an example. Gliomas are one of the most deadliest cancers of the brain. They arise from a variety of glial cells and their precursors. And they're devastating in humans.

Michelle Moyal, DVM: They sure are.

Andrew Miller, DVM: Especially in pediatric patients where they, unfortunately, do occur with some irregularity. And they occur pretty frequently in dogs, especially certain dog breeds, Boxer dogs, for instance, Boston Terriers, Frenchies.

Michelle Moyal, DVM: Oh, a lot of brachycephalic breeds, like smushy face breeds.

Andrew Miller, DVM: Not all the brachycephalics, but many of brachycephalics are predisposed to them. They've all got some similar genetics in their background, so they probably all carried forward whatever the underlying mutations are.

Michelle Moyal, DVM: Interesting. Sure.

Andrew Miller, DVM: There was never really a good diagnostic grading schema for these things. And if you don't have grading schema, for instance, you can never actually develop prognostic studies that say, "Hey, this dog has this tumor, and then treat it with X drug. This is the outcome," right? You need, you need to define the basic diagnostic features first before you take the next step. And sometimes I think we've maybe not done that to the detail that we need to in Veterinary Pathology. So, that's where a lot of my interest has laid. And that's actually how one of the arms of the Canine Brain Tumor Consortium that you mentioned earlier, that is a group that is funded out of the National Cancer Institute, and whose goal is really to utilize the dog as a potential model for human brain cancer.

We started with gliomas. There's lots of different arms to it. I'm just involved in the Pathology arm. But there's, you know, biomarker discovery. There's outcome groups and whatnot. Our group, though, really kind of redid the grading considerations for gliomas in the dog. And now, there's a well-published and well-accepted grading scheme that can be applied for prognostic studies, and that allows for far better research that is easily applied to studies, no matter what those study goals are.

Host: Gotcha. So grading, meaning we can look at this tumor and say, whether it's a number grade or high grade, or low grade, like meaning really disease or really bad, helping us to say, "Oh, we think this dog has this grade of mass." So, their prognosis, meaning how long they might live, and even we hope how they will respond to treatment, which is a huge benefit if we can correlate those, right? Like, prognostic indicators with treatment options. That's so neat, and I really, really appreciate the comment that you made. Like you're in one arm of this, so you're working with many other doctors, oncologists, I'm sure you're working with other researchers as a group to try to figure out and navigate this road.

Andrew Miller, DVM: Yeah, one of the really cool things about that Brain Tumor Consortium was that it has brought together specialists in the Veterinary Medicine realm and the human medical realm. So for our Pathology boards, we had MD pathologists and DVM pathologists, and that really provides a layer of context that is often lacking in Veterinary Medicine.

You know, I'm a big proponent of not having us be siloed. There's a lot of communication that should happen between the medical fields. And not every disease is applicable to humans as it is to animals. But there are some tactical advantages you can use when partnering with MDs, that they have more tools often than we do, or at least we do yet, and maybe we will in another 10 years or so. And you know, if you look at human brain tumor diagnostics, they're really deep into the genetics and looking at what are the underlying genetic causes of those tumors? And we're not even there yet in Veterinary Medicine, but because we've been able to start this project, we are now starting to understand what some of the mutations are. They're very different than many of the mutations in human medicine. But the dog, if you compare their genomic landscape, is actually potentially a really good model for pediatric gliomas in humans. They share a lot of similarities. So, that's why, you know, every cancer that dogs get, you could study in this way. And many people do. You know, there are people who focus just on urothelial carcinoma, which is a tumor of the cells that line your urinary bladder and related tissues. There's also a good model potentially for some human diseases.

So, this is where I think Veterinary Medicine is going to really start to grow in the next decade. There's so much to be done, and there's so much from an academic pathologist perspective to be done that no one can do it in one lifetime. We have 10 plus pathologists here, everyone with their own different specialties. Some are focused just on diseases of the skin. Some are specialists of hematopoietic organs like lymph nodes and spleen. Because while we're generalists, we have to at least have some organ system or some desire to focus on one thing.

Michelle Moyal, DVM: Yeah. I really appreciate all of this info, because I think it's really helpful. And I think what sometimes people also forget when we go into Veterinary Medicine is the perspective of one health, right? Like we can actually really help human medicine, right? Maybe what you are doing as a veterinary pathologist is helping a pediatric patient who unfortunately might be diagnosed with a glioma and vice versa. Maybe we take some of the technology, the tools they have, the approaches to help animals on our side. And I love that. And when we take our oath, right? We do take an oath when we become doctors, and part of that pledge is to help humankind, like we're helping animals. And that's really important. So, this is a great example of that.

Andrew Miller, DVM: Yeah, absolutely.

Michelle Moyal, DVM: That's awesome. I know you're trying to answer like a lot of questions, but if you could think of one question, maybe two. I can give you two. One question, you're like, "I would love to know the answer to this in my research," what would it be? Or do you say to yourself each day when you work with a consortium, like, "This is my goal. This is the question that keeps me going"?

Andrew Miller, DVM: I'm going to delve into a different tumor now. So, there's a really common tumor of dogs, that they get in their skin and subcutaneous tissue, called a soft tissue sarcoma, which is a really kind of cruddy name anyway, because it doesn't tell you anything about the tumor. There's a grading scheme for it, that's been applied for probably close to 20 years now. And no one knows what cell type these tumors arise from. We really don't have a good handle on what's predictive or even what tumor types are captured in that whole broad diagnosis of a soft tissue sarcoma. We just finished up a research project here looking at the genomics of these tumors, but I'd love to figure out what is the cell that these tumor are coming from. I think there must be some sort of stem cell or pluripotent cell somewhere in the subcutaneous germinal tissue--

Michelle Moyal, DVM: Like a cell that starts out, meaning a cell that starts out as one type, but it can become this other type of sarcoma cell, right?

Andrew Miller, DVM: That's where a lot cancers arise from, right? Because they have the internal machinery that allows them to proliferate, whereas differentiated or end stage cells, less likely to transform. if I could figure out what cell type those tumors are coming from, I'd be thrilled.

Michelle Moyal, DVM: That would be awesome. As a practitioner who's cut many off of dogs, and let me tell you, they're in places, by the way, listening audience, that often they make them very difficult to remove. You know, legs where there's not a lot of skin. Oh, sometimes on the elbow. It can be really, really difficult. So, learning more about this can really help with treatment because we really just try to cut as much of it out and sometimes it's really, really difficult. So, definite translation into my side of things, which I really, really appreciate. That's awesome.

Wow. You had one question. I'm like, I don't know. I can't think of a question every day. But that's awesome.

Andrew Miller, DVM: I mean, I have lots of questions, most of them are existential, but I don't have any answers to those.

Michelle Moyal, DVM: Oh my gosh, when a tree falls in the forest, he asks himself that every day. So, you do a lot of things. What is your favorite thing about being a pathologist in Academia or pathologist in general?

Andrew Miller, DVM: That's a tough one to answer. You know, one of the reasons I love Academia, and I grew up in an academic family, so I was always drawn to Academia, and that's where I ended up with my career.

Host: Oh, neat.

Andrew Miller, DVM: But I love teaching the students, but especially my residents. You know, I've trained several dozen residents now over the last almost 20 years now since I got boarded. And they challenge you, they keep you honest and, you know, I love seeing them then succeed in whatever their next path is.

And the great thing about Pathology, it's so diverse a field that one may go work in a zoo as a pathologist for a zoo, one may go work in Academia at a different institution, one may go work in industry or pharmaceutical, and they can all succeed in different parts of Pathology. And until I lose that drive, I don't see myself going anywhere else because I just enjoy teaching them so much. And hopefully, they feel the same way, although sometimes I have to be a little bit hard on them.

Michelle Moyal, DVM: Tough love. Is that what I'm hearing?

Andrew Miller, DVM: Uh-huh. Yeah.

Michelle Moyal, DVM: Any of his residents, feel free to email me at any time? No, actually, I would say one of the best things about teaching, and I think that this is what you're also alluding to, is seeing that light bulb moment when they're putting stuff together is so cool.

Yeah, agreed.

I love that. And it's very meaningful to have that moment with them and share that, right? Because now they know it and hopefully it stays in there. I say that, but I've forgotten many things. So, that's fun. And I really love that because again, teaching is important and then those residents will potentially go on to teach others.

Andrew Miller, DVM: We have plenty of our residents who are in Academia at different veterinary colleges, and I'm in contact with all of them. Almost all of them text me on a weekly basis about something. And that makes me feel good, right? I don't want to be there to continue to support them as they start their career. I think mentorship is something that none of us are trained to be mentors when we go through veterinary college, right? A very specific thing that we're trained to do and that's not it.

Michelle Moyal, DVM: Yes.

Andrew Miller, DVM: We've got to learn on the fly, especially when you're in Academia. You know, having people who mentored me over the years and seeing how they were successful was a great way to give back to my community. 

Michelle Moyal, DVM: Agreed. For those listening who are looking for a mentor, it is true, sometimes we're not taught and we do learn on the fly. We kind of take what we love from different mentors and we hope that we can take those abilities and share them with our mentees. But it is a two-way street. And because I talk about mentorship a lot, right? Like, we want someone who also actively seeks knowledge and looks for your help. Maybe after they've taken the journey to try to find the answer on their own, right? Like you are there to provide answers, but at the same time, the learning process is just as important, if not sometimes more important.

Andrew Miller, DVM: Absolutely. And that's why -- not to plug our curriculum here-- but our curriculum here is a case-based curriculum and that allows a student to develop in that way, because that's what you do as a clinician. It's what you do as a veterinary scientist if you're in industry or in government, right? You're all still thinking that way. And, you know, that's why I was drawn to this, to come here anyway. Of course, I was also a New York State resident, so we collect in-state tuition as always.

Michelle Moyal, DVM: Triple red.

Andrew Miller, DVM: Two thumbs up.

Michelle Moyal, DVM: True.

Andrew Miller, DVM: But you know, sitting in lecture, it's very passive, right? It's just a one-way street. Whereas active learning is really, I think, such a critical way to set yourself up for success when you end up with whatever your first job is.

Michelle Moyal, DVM: Agreed. For those of you who have not looked into veterinary programs, there are a lot of programs that have lectures, much like in college and undergraduate studies where you're sitting in lecture and you're learning a whole lot of good things still. But a case-based learning program or a problem-based learning program essentially allows us to get into small groups and kind of navigate an actual medical case, a veterinary medical case, and that is how we identify themes and learning issues. And then, it allows us to go and use our abilities, how we like to learn, and how we like to look things up and study. We kind of go off on our own and utilize our best skills and then come back together as a group and discuss the answers, which I love. Because sometimes I'm like, "I read this," and then someone's like, "Oh, and then there was this." And I'm like, "Where was that?" And they're like, "In the paragraph next to the one you read." I just completely ignored it. So, there's that.

Andrew Miller, DVM: And that's what makes, you know, Grand Rounds, for instance, that's what makes them so much fun, right? You've got specialists from different parts and you can't do this all in a vacuum. So when you have six different specialty groups in one room together, all sharing their stuff and producing this large coherent story, it's a very successful way to be a veterinarian.

Michelle Moyal, DVM: Yes. I like no silos anywhere. Collaboration is where it's at. I'm telling you, kids.

Andrew Miller, DVM: Well, except on farms. You need to have silos on farms.

Michelle Moyal, DVM: Yeah. That's really valid. So, do you have a moment-- I love this. This question was given to me and I'm going to use this because I think this is a great question. It is you're at a cocktail party. But let's say you're not even drinking, you're just at a party, right? You're talking, you're having some snacks, and people decide to share work stories, and there's one story you go to as you sip your non-alcoholic beverage, right? Or in my case, stuff a donut in my mouth. Like, what story are you sharing with people about being a veterinarian?

Andrew Miller, DVM: Well, I have learned that, most people, like 99.9% of the population, get really grossed out whenever I share anything to do with Pathology.

Michelle Moyal, DVM: Yes, I feel you.

Andrew Miller, DVM: Yeah. So, I generally avoid that conversation a lot. Students like to ask me what's the coolest animal I have necropsied and that's a reasonable question. I'll give it to them. Although I usually find interest in most everything except for the really rotten animals, because that's just kind of not great.

Michelle Moyal, DVM: Yeah, that's tough.

Andrew Miller, DVM: There's a number of years ago where I was necropsying a giraffe in an unnamed New England zoo. And it was behind this giant blue tarp, and it was a school day, and there were like school children walking past this tarp and I could here them all laughing and giggling. And I'm like,"If they only knew what was happening behind this tarp..."

Michelle Moyal, DVM: Oh, it's so tough, right? Because things happen. That's why you're there. Oh my gosh. Yeah. I don't know if you would share that at a party. Hmm. That's true. How about vet school? Do you have any fond vet school memories that come to mind?

Andrew Miller, DVM: That are shareable on the podcast? Boy, that's tough one. You know, one great thing about vet school that you know very well is we were two years apart and I was obviously very close to your class for a variety of reasons, which means I sort of got to do vet school twice. So, you know, I was a resident when you were in your third and fourth year and I got to see you on clinics in fact as resident, which means I got to enjoy the best of both worlds almost twice, which was great.

Michelle Moyal, DVM: That's neat. I didn't think of it like that. I think what I would think is you're so focused on your residency, you know, that maybe you didn't have the time to kind of enjoy and go through it, but that's really awesome. Actually, just fun fact, each of us found a spouse on the Cornell campus, which I really love. I really love that.

Andrew Miller, DVM: True. I actually met mine in undergrad, but then eventually we're several years apart and ended up in your vet class. And then, that's when we started dating.

Michelle Moyal, DVM: Mine was intramural basketball. We're back to sports. We're back to me being a March Madness fan.

Andrew Miller, DVM: I will say, I remember when I offered my residency, I was home in rural eastern New York because it was early December and I was studying for the NAVLE. And I was taking it in Albany at that point.

Michelle Moyal, DVM: The NAVLE is our national board exam to become a veterinarian, everyone. Big, big test.

Andrew Miller, DVM: And this would've been December of 2000, no internet at my house. Most people didn't have internet then.

Michelle Moyal, DVM: Same.

Andrew Miller, DVM: Just a landline, which for those who don't know is phone that gets stuck in the wall. And you pick and answer it.

Michelle Moyal, DVM: It's tethered.

Andrew Miller, DVM: At that time, Cornell offered residencies. You had to provide an answer in 24 hours. So, no one could find me because I was sequestering myself to do the studying for the board exam. And they eventually found Allison who was in your class. And then she knew where I was. So then, she called me and said, "Hey, you got to call Cornell back because they need to offer you a residency." So, I could have lost on my residency if I never called back, I suppose.

Michelle Moyal, DVM: Right. By the way, we also studied for that test with books.

Andrew Miller, DVM: That's correct.

Michelle Moyal, DVM: Heavy books. There was no like Vet Prep or like all these other courses. Yeah, that was the time.

Andrew Miller, DVM: Trusted the process. You just assumed, you got what you needed in vet school. You supplemented with some--

Michelle Moyal, DVM: Yep. Some review books. I remember a large animal review book and a small animal review book. We did that.

Andrew Miller, DVM: And then, lectures on chickens and pigs because there are diseases that we didn't talk about much in New York state, or at least we didn't at that time.

Michelle Moyal, DVM: Yes. We didn't at the time. Oh my gosh. Okay. So, now we're going to get to little lightning round. Well, actually before I jump to that, because I do want to get this little nugget of info, what's something that people don't know about you? Just share it with this whole audience. Something right off the bat that you think, "You know what, somebody probably doesn't know this about me."

Andrew Miller, DVM: Life-related or veterinary-related?

Michelle Moyal, DVM: You can pick. The world is your oyster.

Andrew Miller, DVM: For people that don't know me, I'm pretty much an open book. So, people who do know me know exactly what I'm into and what I'm going to do. People who know him, also email me and tell me what you think, okay?

Avid bird watcher. Love birdwatching. I love learning about new birds. Anything outdoors really is where I want to be. My closest friends know I'm an Adirondack 46er, which is actually this mug says.

Michelle Moyal, DVM: I don't even know-- was that a sentence? What does that mean?

Andrew Miller, DVM: 46ers means you've hiked the highest 46 peaks in the Adirondacks, which is a mountain range in kind of the north central New York state.

Michelle Moyal, DVM: Gotcha. People who hike. Outdoor stuff. Okay. So, I mean, I like to be outside. I refer to myself as outsidey, not outdoorsy, right? No, no, no. I don't want to be like trapped anywhere. There needs to be a working bathroom nearby, but I am willing to go outside. An occasional hike. I mean, I did Camelback recently. I'm not going to lie, I think I thought I was going to die. Dr. Martha Klein, if you're listening, I'm very sorry about my lack of hiking ability. But it was definitely a fun time. But birdwatching, I'm scared that I think that this is what happens as you age, it's amazing, but with binoculars in my house because I don't want to go outside. I'm in my house.

Andrew Miller, DVM: I've been birdwatching since I was a little kid, but I really took to it in Block 3, which is in vet school is the course that straddles the end of your first year and the start of your second year. I don't know why that was the moment in my life where I really wanted to do it. But obviously, I needed some sort of like outside Zen at that time. That's when I took to it.

Michelle Moyal, DVM: So interesting. I mean, you were learning a lot. So now, oh, I have bird houses with cameras in them now.

Andrew Miller, DVM: Oh, yeah. That's a step up. Yeah, that takes it a whole new level.

Michelle Moyal, DVM: I get notifications on my phone. Joyful. I'm like. You know, some people are looking at TikTok, I'm like, "Excuse me, there was a Blue Jay on my feeder just now. I have to look at that." Yeah. So, okay, you're in the lab, you're working either on the microscope or you're doing gross path, is music playing?

Andrew Miller, DVM: On the necropsy, music is usually playing.

Michelle Moyal, DVM: Okay.

Andrew Miller, DVM: Sadly, we have an old stereo that gets like two stations.

Michelle Moyal, DVM: Oh, okay.

Andrew Miller, DVM: One of which is country, which no offense to my country fans, I rapidly turn it off of country.

Michelle Moyal, DVM: Ooh. People everywhere are--

Andrew Miller, DVM: Yeah. Sorry. I know.

Michelle Moyal, DVM: I get you. To each their own.

Andrew Miller, DVM: it depends on what kind of music I need. i'm writing in my office, it's classical music, that's what's on.

Michelle Moyal, DVM: It's classical music, okay. Because you're like hyper-focused.

Andrew Miller, DVM: Correct. If it's just music in the background, I'm a '90s kid, so there's a lot of alternative rock that's going to be on Spotify.

Michelle Moyal, DVM: I support that.

Andrew Miller, DVM: Classic rock is also going to be there somewhere as well as '80s. Pretty much everything.

Michelle Moyal, DVM: I like where you're coming from on this. I like where you're coming from. Although somebody put on what they thought was classic rock in the OR because I would allow the students to pick the music when they were doing the surgery. And Classic Rock was Nirvana and Temple pilots, and I almost fell over. People, we're not that old, I swear. Oh my gosh, heartbreaking. Okay. So, we've got our food, we've got our music. Snacks. Talk to me, sweet or salty?

Andrew Miller, DVM: Yeah, mostly sweet. I have a problem with sugar. Addicted to it, I won't lie. I love a good cookie. I love them all.

Michelle Moyal, DVM: Same. Same. Really? Okay. Awesome. And then, if you are faced with a cookie challenge, which cookie would it be?

Andrew Miller, DVM: Depends on the time of year. And now, I'm really going to let it all out here. My family has this tradition of making a lot of Christmas cookies. We have recipes that go back many, many decades. So, we make like 20 different types of Christmas cookies. They're all really good. My kids are always super excited when December comes.

Michelle Moyal, DVM: That's awesome.

Andrew Miller, DVM: I make a German pastry called Stollen.

Michelle Moyal, DVM: I don't know what that is, but it's a pastry, so I'd eat it.

Andrew Miller, DVM: It's bread with candied fruit. It's got confectionary sugar on it. You can add nuts if you want. Fruit sits in rum.

Michelle Moyal, DVM: Wait, take that back. I don't know how I feel about candied fruit.

Andrew Miller, DVM: Oh, it's good. Yeah. Yeah.

Michelle Moyal, DVM: Okay. All right., I'll take your word for it. And finally, this is a question I've asked quite a few times.

Andrew Miller, DVM: Oh, no.

Michelle Moyal, DVM: I believe there is a right answer. Star Trek or Star Wars?

Andrew Miller, DVM: Oh, you know, this is an impossible question.

Michelle Moyal, DVM: Oh, my God.

Andrew Miller, DVM: So, as I said, I'm an '80s, '90s kid, right? So, Star Trek, The Next Generation probably one of television shows ever written.

Michelle Moyal, DVM: These Cornellians have to overanalyze. Okay. But yeah, The Next Generation, that's true. Yeah, it was a good show.

Andrew Miller, DVM: That Deep Space Nine and Voyager are equally good, but they provide a different part of the Star Trek world. Little more war-y, you know, the Deep Space Nine got a lot of war going on. Voyager is just trying to get home. I actually don't think you can compare them because Star Wars is also great. I'm a big Star Wars fan, but it's really just a giant soap opera in the universe. So I love sci-fi stuff. And if I need to have like a wind-down session, I'll watch a Star Trek episode before-- and I haven't watched any of the new Star Wars stuff on Disney.

Michelle Moyal, DVM: They're so good.

Andrew Miller, DVM: I know. The Mandalorian is a great show. But I love star Trek.

Michelle Moyal, DVM: Kenobi. You love Star Trek. Yeah, that's your answer. But really, the answer is Star Wars. Okay. Thank you, Dr. Miller, for being on the show.

Andrew Miller, DVM: You know, the whole light saber, it's just, you know... You know, it's fine, I guess. I'm more of a phaser guy, than a light saber guy.

Michelle Moyal, DVM: You're a phaser guy. They have though-- well, similar-- you know what? I'm not getting too deep into this. Before we nerd out everyone, you could turn this episode off. All right. No, I really thank you so much for spending time with me. I know I took you down a rabbit hole with some of those last questions, but I just think it's really nice to get to know people and share that with everyone listening. Because yes, you're a pathologist, but you're also a human being, and that's really important for me to let people know, like we're all just people just trying to do our best.

Thank you so much for being here on the podcast with me. And everyone, have a listen, look more into Pathology if you like. Or maybe you've made a decision now that you just really want to be a general practitioner like Dr. Moyal.

Andrew Miller, DVM: Or strike while the kettle is hot and become a pathologist now. Decide that's where you want to go.

Michelle Moyal, DVM: Or, you know what, that's a very, a very valid, valid point. Thank you so much everyone for listening. Thank you again, Dr. Miller. Listen and subscribe. Give us a like on your favorite platform and we will talk to you soon. Thank you.