Blizzard of 2010 no Obstacle for Owner of Beloved Horse

Paula Hicks walks her colicky horse to NBC for emergency surgery and care

 

The unrelenting snow last February brought six-foot drifts, severely limited visibility and impassable roads. It consumed almost everyone’s thoughts in Chester County. Paula Hicks, however, was one exception.

Her mind was on her 18-year-old fox-hunter Landfall.

The Thoroughbred-Holsteiner mare was clearly uncomfortable, standing then laying down repeatedly and sweating.

“From the moment I saw her I realized this was not a mild colic, and I was concerned,” said Paula.

Hours of hard work with her primary care vet had kept Paula’s horse stable, but the pain was not abating. It seemed likely Landfall would need surgical intervention for any chance of survival. And that meant getting to the hospital despite the raging blizzard.

The trailer was buried in snow, but there was another way to get the help that Landfall needed. Paula zipped on her warmest gear, pulled Landfall from the barn, and began the half-mile walk down West Street Road to New Bolton Center. Her primary care vet followed closely behind in her truck, hazard lights flashing.

 

24 hours a day, 365 days a year

Throughout the blizzard, New Bolton Center maintained an emergency care and support crew. Veterinarians, techs and maintenance crew slept anywhere they could find.

“My vet called ahead to let New Bolton Center know that we were walking over since all trailers were snowed in and the roads were almost drifted shut,” said Paula. “The entire team was ready and waiting. I literally breathed a sigh of relief when we walked in the door, knowing she was in expert hands.”

Drs. Janet Johnston and Janik Gasiorowski were two of the emergency team on site that day. They examined Landfall, observing a rapid heart beat and toxic mucous membranes. On palpation per rectum, the veterinarians found multiple loops of distended small intestine, and the mare remained persistently painful despite heavy sedation. An intravenous jugular catheter was placed and Landfall received 10 liters of fluid, but continued to deteriorate. Surgical intervention was recommended. Paula agreed without hesitation.

Once the mare was anesthetized and her abdomen opened, Dr. Johnston found 12 feet of dead small intestine strangulated by a mesenteric lipoma. A lipoma is a benign fatty tumor that grows on the mesentery of the intestinal tract of older horses. Most are harmless but some grow on a long rope-like stalk and this ball-and-chain-type mass can wrap around loops of intestine inside the abdomen. As the trapped segment swells, the obstruction becomes tighter and tighter until all venous and arterial supply are cut off and the intestine dies. Once that tissue is dead, the toxins and bacteria that are usually well-contained by the gastrointestinal tract can penetrate devitalized barriers and be absorbed by the body leading to endotoxemia, septicemia and profound sickness. Left to its own devices the patient will die. The affected segment must be resected (cut out) and the cut ends of the healthy intestinal tract anastomosed (sewn together).

“Landfall received excellent care at New Bolton Center,” said Paula, “and during the surgery I was pleased to be contacted very frequently about how her progress was coming.”

Drs. Johnston and Gasiorowski performed a jejunoileostomy (re-connecting of the jejunum to the ileum – two parts of the intestine). The strangulating lipoma was removed from the abdomen and the compromised segment of bowel was laid out in a ring. Moist, sterile towels were packed all around the segment to catch any contamination once the ends were cut and the non-sterile gastrointestinal contents exposed. The vessels radiating from the base of the web-like mesentery like spokes on a wheel were each carefully ligated (tied off). The dead bowel plus a foot of healthy bowel on either side was cut and removed from the site. The ends were cleaned and hand-sewn back together in two layers with suture that would be absorbed by the body after healing had occurred. Landfall’s abdomen was flushed with sterile saline and closed.

 

Back home and aftercare

Seven days later, Landfall took the short trip back home, this time in the trailer. Her recovery involved a month of stall rest followed by a month of limited turnout in a small paddock.

“I was very exact about her coming-back-to-work schedule,” said Paula, “starting with 10 minutes of walk, and working in tiny increments to the canter. Landfall is now foxhunting with enthusiasm, enjoys her hacks, and jumps like her former self. She still has many good years of enjoying life and being ridden left!”

Just recently Landfall and Hicks enjoyed a glorious autumn day, riding to hounds with the Cheshire Hunt.

 

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Winter-time Colic

Colic is one of the most common ailments seen at referral hospitals such as New Bolton Center’s George D. Widener Hospital for Large Animals.

Colic, essentially a term for abdominal pain, is caused by a number of reasons, but during the cold season New Bolton Center veterinarians frequently see a specific type, which includes impaction of the gastrointestinal tract, especially of the large colon. These impactions of the large colon occur when the large intestine is blocked by a mass of firm, thick, dry ingesta (feed material).

There are three main reasons why impactions occur commonly during the winter:

1. Consuming less water in colder weather;
2. Eating increased amounts of concentrate and grain since less grass and natural forage is available, which may alter digestion;
3. Inactivity due to confinement during the colder months, which may also contribute to a change in movement of ingesta along the gastrointestinal tract.

Horse owners can help lower the risk of their horses developing impactions by a few simple management practices, including:

• Ensuring access to clean, fresh, unfrozen water at all times;
• Turning out horses to stimulate digestion, provided they have appropriate winter coats or blankets and access to shelter;
• And using hay rather than grain to increase caloric intake.

 

 

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Happy Holidays, Healthy Pets

Keep these tips in mind for a safe holiday season with your pets

“Keeping pets healthy and safe during the holidays can be more challenging than you’d think,” said Dr. Kenneth Drobatz, chief of the Emergency Service at the Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania (Ryan-VHUP). “But if you take a few preventative measures you’ll make it through the season without a trip to the ER.”

Here, Dr. Drobatz offers some tips to keep pets healthy – and out of the emergency room – during your holiday festivities.

 

Festive foods

Maintain your dog and cat’s regular diet. Treats of turkey, ham, gravy, cookies and other goodies can lead to gastro-intestinal upsets like diarrhea and vomiting. Be sure, too, to dispose of all bones carefully so pets can’t get to them.

“Poultry bones are particularly dangerous,” said Dr. Drobatz. “They splinter and can cut the intestines or get lodged in your dog’s or cat’s esophagus.”

Guilty human pleasures, like chocolate and alcohol, can be toxic to pets.

“Keep chocolate, nuts, and alcoholic beverages out-of-reach from your pets as they can cause vomiting, diarrhea, or a condition called pancreatitis, which can be deadly,” said Dr. Drobatz. Additionally grapes and raisins can be toxic to pets as well.

 

Deck the halls

“Tinsel, extra wires for decorations and glass ornaments all pose an arsenal of potential pet problems,” said Dr. Drobatz. “Tinsel cut the intestines and cause severe injuries. Electric wires look especially appetizing to puppies and kittens, and, if they succeed in chewing them, can suffer burns or shock that can cause seizures, loss of consciousness and fluid in the lungs. Glass ornaments and ornament hooks are hazardous as they break easily; pets can ingest the splinters, cutting their mouth, esophagus or intestines. Holly and mistletoe berries are toxic to pets when ingested. Symptoms include vomiting, bloody diarrhea, and dehydration.

“In addition, dough ornaments, because of high salt content, are not good for pets,” said Dr. Drobatz, “and ingestion can cause vomiting, diarrhea, and in severe cases, seizures.” Certain plants can be toxic to pets if ingested, especially cats. Therefore keep all plants in locations that the pet cannot get to.

 

Good gift-giving

Give toys that are too big to be swallowed or get caught in the animal’s throat and don’t give anything with a string attached. Remove bells or squeakers. All of these things can be swallowed.

 

In case of an emergency…

Despite our efforts to keep our pets safe, some of them will get into something they shouldn’t. As with any potential emergency that could take place year-round, getting immediate attention from your veterinarian is very important. Remember to keep your primary care veterinarian’s phone number and address placed in a visible location – like on your refrigerator – and be sure everyone in your family knows and understands what Fido and Fifi can and cannot have.

If you notice that a pet has gotten into something potentially hazardous, call your primary care veterinarian immediately and be prepared to describe what the pet has ingested and/or gotten into.

Often, practices close up shop around the holidays so have an emergency facility phone number on hand, as well and posted in the same location as your primary care veterinarian. Ryan-VHUP’s Emergency Service is open 24 hours a day, seven days a week, 365 days a year. In an emergency, call 215-746-V911 (215-746-8911).

 

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Fighting the Disease

A cancer diagnosis is life-changing, but there are people who can help

The Matthew J. Ryan Veterinary Hospital at the University of Pennsylvania (Ryan-VHUP) is a special place for clients whose beloved pet has been diagnosed with cancer and are dealing with the effects of the disease or the treatment. In addition to our staff of compassionate, knowledgeable and top-rate oncologists and veterinary technicians, Ryan-VHUP offers individual counseling and support groups on a regular basis.

“It gives clients whose pets are undergoing chemotherapy or cancer treatments – or for those who have opted not to treat their animals – an opportunity for fellowship,” said Michele Pich, grief counselor. “It gives owners something to do and get tips and tricks from other clients if their pet, for example, won’t eat.”

Michele, who first became interested in pursuing this kind of support group when her dog, Cleopatra, was diagnosed with Stage 4 lymphoma on July 29, 2009, finds that these kinds of offerings are therapeutic for owners and gives them an opportunity to open up in a safe, encouraging environment.

“We talk about the different types of cancer and what people can expect from the cancer and the cancer treatments,” she said.

These free-for-Penn-Vet client groups meet on the third Thursday of every month at 12PM. In addition, for those who have lost a pet, there is a Pet Loss Support Group on the first Thursday of every month at 7PM. For more information about these groups, visit http://www.vet.upenn.edu/SpecialtyCareServices/GriefCounseling/tabid/1916/Default.aspx.

Advice for Taking on the Disease

According to Michele, there are a few first steps owners can take to come to terms with their pet’s cancer diagnosis. These include:  

 

Taking a deep breath.

Ask questions of your vet. “Ask about the different procedures and treatment options, ask what they would do if it were their pet, ask where you can go for a second opinion,” she said. “But the message is that you shouldn’t be afraid to ask questions. Treating cancer in dogs and cats is different than treating the same disease in humans, so ask as many questions as you need to.”

Weigh the quality of life for your pet.

Know that support is available. If you’re a Penn Vet client, take advantage of the support groups run by Michele. If you aren’t a Penn Vet client, Michele recommends looking for online pet support groups or calling her for a personal telephone support appointment.

 

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Fighting the Disease

A brave Westie – and his owner – take on nasal sarcoma

“We thought he had allergies,” said Chuck Christy about his dog, a little West Highland White Terrier named Mac Duff. “But after a few months of being treated for allergies, I started questioning that, especially because he was getting worse.”

Then, about six months later, as Chuck was preparing to take Mac Duff for a visit to Chuck’s mother’s assisted living facility, his fear was confirmed.

“I found him on the kitchen floor laying in blood,” said Chuck.

Immediately Chuck took Mac Duff to his local emergency vet and, at their recommendation, made an appointment at Penn Vet.

At Penn Vet, Mac Duff’s veterinary team performed a series of tests, including blood work, chest X-rays, a CT scan of his nose and a biopsy. The results showed a mass.

“Mac Duff’s entire right nose and into left nose, behind his right eye, compressing his brain and pushing out his eyeball,” said Dr. Lili Duda, adjunct associate professor of radiation oncology. The dog had nasal cancer. Luckily, the cancer had not spread anywhere else, and Mac Duff was otherwise a healthy and happy dog.

Nasal tumors, found in the nasal passages and sinuses, account for only 1 to 2 percent of all cancers in dogs. The tendency of tumors in this location is to grow into surrounding tissue; rarely do these kinds of tumor metastasize (spread) to other places in a dog’s body. When they do, however, the tendency is to go to the lymph nodes, and then lungs.

Without treatment, dogs live an average of three to five months. Radiation therapy can extend a dog’s life up to one year and sometimes longer, but eventually symptoms return and a dog will succumb to the disease.

“I was devastated, but I knew I had to do something. We had a couple of options,” said Chuck. “I could put Mac Duff to sleep, I could decide not to treat him or I could opt for palliative radiation. I chose radiation.”

The decision to treat Mac Duff with radiation therapy meant a big commitment on the part of Chuck. Ryan-VHUP oncologists treated Mac Duff once a week for six weeks. Each 10-minute treatment necessitated putting Mac Duff under anesthesia to ensure he wouldn’t move during the therapy. And each visit lasted a couple of hours.

In addition to dedicating time at Ryan-VHUP, Chuck was sent home with very specific at-home directives.

“I irrigate Mac Duff’s nose with saline six to 10 times a day and use a Q-tip to open up his nose,” said Chuck.

In addition, doctors recommended keeping Mac Duff’s eyes moist and suggested Chuck use a humidifier.

“We’re pleased with how Mac Duff is doing,” said Dr. Duda. “He was diagnosed in early December [2009] and we finished his palliative radiation on January 10 [2010]. He just had his nine-month check-up, and he is as spunky as ever! Much of how well Mac Duff is doing is the result of how well Chuck is treating his dog in his after-care regimen. Chuck has really done everything he can do to help Mac Duff’s condition,” said Dr. Duda.

But Chuck says he’s just doing what he feels is right and is only returning the favor to his beloved dog.

“Mac Duff has pulled me through 10 years. I’ve been sick for eight of those years and this little dog gives me a reason to get up,” he said. “No matter what, he wants to play. And that makes me better. The affection we share with each other means everything to me.”

 

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Emergency Equine Care at Widener Hospital

Medical emergencies are not something that anyone likes to think about. But knowing what to expect if you do need to take your large animal to a veterinary hospital for a medical emergency can relieve some of the stress of the situation.

At Widener Hospital, almost all of the emergencies are referred. When the call comes in from the primary vet, the emergency veterinarian gathers information about the horse’s age, breed, gender, clinical signs, medications administered and any changes in the horse’s environment. The owner or caregiver will be told where to park the trailer transporting the patient, and, upon arrival, will come directly to the admissions desk to fill out the appropriate paperwork.

A nursing assistant will then accompany the client to help take the animal off of the trailer. Sometimes animals with fractures may be taken straight to radiology, while those with diarrhea or other potentially infectious disease will go straight to isolation.

Most patients, however, will go directly to Clinic Hall where they will be examined by the senior clinician and intern or resident. As New Bolton Center is a teaching facility, veterinary students will most likely be involved in the preliminary examination. A nurse may also be on hand.

During the examination, the horse will have a patch of hair clipped for insertion of an intravenous catheter. If the horse is showing signs of colic, a stomach tube will also be passed and a rectal examination performed. Blood will be drawn in the majority of cases, as it can give valuable information about the stability of the horse, underlying problems and the prognosis. If warranted, 10 to 20 liters of intravenous fluids will be administered. Caregivers should know that horses may be sedated or a twitch used to manage the animal. The veterinarians will then consult with the client about options for care of the animal.

Following examination of the patient, the client will be given a good faith estimate of the cost of treatment and asked for a deposit. It’s a good idea for owners or caregivers to have an idea of what they are able and willing to spend for emergency veterinary treatment, and to have insurance information, if applicable, on hand.

While the client may be present for the examination, if is decided that the animal requires surgery, the client will be asked to wait in the lobby.

Following Blaze’s stay at Widener Hospital, Joan Kauffman said that the experience of coming into the hospital as an emergency was overwhelming. “We knew that colic could potentially be fatal,” she says, “and we were worried we weren’t going to have a horse when it all played out. There were so many people, and we didn’t know who they were. Everyone was calm, though, and really seemed to know what they were doing. When Dr. Southwood explained that she was the surgeon on call, we knew who to direct questions to. We were also reassured by the fact that we were at New Bolton Center, one of the best places in the country, so we trusted them.”

 

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Animal Disaster Preparedness Week

September 11. Hurricane Katrina. The earthquake in Haiti. The Gulf oil spill. Would you know what to do with your family – including your pets – if a disaster struck your home or community?

“No one thinks about the preparation involved with a disaster because they think it’s boring or that it’s not going to happen to them,” said Dr. Cynthia Otto, associate professor, Clinical Care at the Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania (Ryan-VHUP). “But planning is the most important part. Are you going to stay? Are you going to evacuate? What’s your plan?”

The month of September is National Preparedness Month and the week of September 26th is Pennsylvania Animal Disaster Preparedness Week. Take the time to celebrate by putting plans in place that can potentially save the lives of your beloved pets.

“The primary goals are awareness and planning,” said Dr. Otto, who served as a responder for September 11th and Hurricane Katrina. “People need to think about what kind of emergencies and disasters they need to plan for – earthquakes, floods, snowstorms, power outages – and have a plan in place about how they’re going to handle their pets.”

“Having an evacuation plan is important for anyone and having contact numbers for owners, shippers, vets, hospital, etc. readily available is also important for any situation,” said Dr. Louise Southwood, associate professor, Clinical Studies, New Bolton Center.

Should You Stay or Should You Go?

If evacuation is not mandated by the local emergency management agency, according to Dr. Otto, there are two options: evacuating or staying put. “If you’re going to stay, are you safe where you are, are you self-supporting? Do you have enough food and water? And if you’re going to evacuate, where are you going to go? Is it safe there? And do you have all the supplies you’ll need?”

Making the decision to stay or go is paramount. Statistics show that people who do not have a pet evacuation plan and think they will come back at a later time to retrieve that pet often are not able to go back. Sadly, in the case of farm animals and horses, people often don’t have a choice and must evacuate leaving their animals behind.

“It is important to be sure children and adults are safe prior to rescuing animals,” said Dr. Southwood. “Ensuring human safety during any rescue attempts should be a first priority.”

Have a Plan

In 2006, as a direct result of Hurricane Katrina, the Pets Evacuation and Transportation Standards (PETS) Act was passed, which requires communities and state emergency preparedness authorities to develop evacuation plans that include accommodating household animals in the event of a major disaster.

To help fire and rescue personnel rescue your pets, Dr. Otto recommends using a window sticker that alerts emergency response team members that there are animals in your home. These “pet finder” stickers can be found at an array of online stores. Some of these stickers also allow you to indicate how many dogs, cats or birds live in your home so responders know exactly what they’re looking for.

Once everyone is safely out of the danger zone, you need to know where you’re going to go. Most emergency shelters do not allow pets. Check out pet-friendly hotels in advance and keep their information on-hand in case of emergency.

If you stay, know your building. If you’re at home, you might know where to turn off the gas supply, various escape routes and the location of all the control valves you might need.

However, what if you’re stuck at work? Do you know the emergency evacuation routes? Do you have a plan in place with your family about how to contact them? And what about your pets?

You should have a plan in place whereby a neighbor, family member, friend or boarding facility that’s properly equipped is willing and able to pick up and house your pets if you are unable to get home for any extended period of time.

Large Animals, Special Considerations

“We have seen horses stuck in streams and swimming pools and have assisted horses in trailer accidents. We often help older horses stuck on hillsides who cannot get up due to musculoskeletal conditions,” said Dr. Ashley Boyle, assistant professor, Clinical Studies, New Bolton Center. “A lot of the success comes from a team effort with a knowledgeable leader to get the horses out of these situations.”

Dr. Boyle said that these kinds of equine disasters can be mostly prevented by keeping fencing maintained, having older horses on level ground and not allowing horses to access places that could be precarious. Similar prevention measures should be enforced for other kinds of farm animals, as well.

Stocking Your Emergency Preparedness Kit

Whether you evacuate or stay where you are, you’ll need supplies and Dr. Otto recommends always having an emergency preparedness kit fully loaded and on-hand.

Pet Emergency Preparedness Kits should include:

• A First Aid Kit
• Bandages/tape
• Hydrogen peroxide
• Saline for rinsing eyes/noses
• Betadine solution
• scissors
• Triple antibiotic ointment
• Tweezers
• Benadryl
• Latex gloves
• Thermometer
• Pen and notebook
• Styptic powder
• A first aid book
• Water (6 – 10 ounces/day for each 10 lbs of body weight)
• Enough food to last for at least one week
• Muzzle
• Leash
• Photo of you and your pet
• Pet’s medical records (proof of vaccination, any required medication and a signed release for emergency treatment)
• Blankets
• Toys
• Treats
• Clean up supplies (litter/bags)
• Crate

“The most important thing is water,” said Dr. Otto. “I always have a case of water at home and jugs filled with water that I freeze so they’re ready to grab and go if I need them.”

In the case of farm animals, your kit should include most of the above-mentioned items plus a halter and readily available trailer/s for transport.

For a full list of what should be included and for more information and guidelines to best prepare for emergencies, visit the American Veterinary Medical Association online at http://www.avma.org/disaster/#family. Here you can find information about what else to include for dogs and cats, as well as kit contents for farm animals, horses and special species, including amphibians and birds.

 

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Solving a Case of Colic at NBC

While not uncommon, the causes of colic can be tricky to pin down

When Cody’s Blazin’ Hobby (Blaze) was led off the trailer at New Bolton Center on August 5th, the three-year old Paint gelding was sweating and clearly in pain. Though he never showed any violent signs of distress, typical of his quiet nature, Blaze’s owners Joan and Brian Kauffman reported that he had been restless, repeatedly laying down and then standing up again, for several hours. Banamine®, and other pain medication administered by his primary veterinarian at the facility where he is boarded, offering only temporary relief, but the signs of pain reappeared.

Preliminary examination by Drs. Louise Southwood and Suzanne Stewart at New Bolton Center’s George D. Widener Hospital for Large Animals indicated high respiratory and heart rates. While Blaze’s mucous membranes and temperature were normal, an abdominal exam per rectum, routine in suspected cases of colic, revealed a gas-filled colon, suggestive of an obstruction or displacement. A stomach tube was placed through the horse’s nose into his stomach and three liters of stomach fluid were obtained. This is normal in a routine colic work-up, as a horse is unable to vomit. At the same time, intravenous fluid therapy was started and a dose of xylazine administered to temporarily relieve the horse’s pain.

Colic accounts for about 65 percent of the equine emergency cases at Widener Hospital. The term “colic” actually refers to clinical signs of abdominal pain, rather than a diagnosis, and the causes are typically gastrointestinal in origin. When the horse is not responding to medical management, or is in severe, unabated pain, surgery is indicated. It was evident that Blaze’s pain was not lessened by the pain medication, and the decision was made to proceed with exploratory surgery in an effort to locate the source of the suspected obstruction.

Under general anesthesia, Blaze was positioned on his back and an incision made along his midline, revealing a gravel impaction in the large colon. A large amount of sand and gravel was removed through a relatively small incision in the colon. Once the impaction was relieved, the colon was lavaged and a mixture of psyllium and water placed in the intestine before closure.

Blaze recovered without incident from anesthesia, and began eating small amounts of hay the following afternoon. Post-operatively he was treated with fluids, pain medication and antimicrobials. He was also given an additional psyllium treatment via nasogastric tube to increase the clearance of the gravel from his intestine. He was discharged from New Bolton Center four days later.

When Blaze returned home, he faced a slow, three-month recovery. After being hand-walked for four weeks, he will be turned out a few hours at a time on small pasture for another four weeks. After another two to three weeks on large pasture he will be able to return to his job as a pleasure horse for 15-year-old Lydia Kauffman. According to her mother, Lydia has grown to appreciate her horse even more after this experience. “It’s sad I can’t ride him,” said Lydia, “but I’m glad I have him to walk.”

The source of the gravel was a mystery at first. On Dr. Southwood’s advice, some detective work was done and it was discovered that Blaze had been picking up gravel along with his hay when turned out in a round pen. She advised that neither Blazer nor any of the other horses at the barn be fed at this location, unless they are not fed on the ground. “We learned to be careful of the ground that your horse is eating from,” says Joan Kauffman. “And that it’s very valuable to have your horse at a place where people really know him, and will realize quickly if he is not feeling well.”

 

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Penn Vet's Renovated Swine Unit Reopens

On a sweltering summer day in July, groups of robust pink pigs are rooting through deep straw, wandering casually to the watering fountain for a drink, or enjoying a snooze on the cool solid surface flooring. Most, in fact, are snoozing. They are quiet, at ease, and appear to be quite comfortable. All 100 of them.

The pigs, technically called “gilts,” a term reserved for female pigs that have not yet produced a litter, are the first residents of the newly renovated Swine Teaching and Research Facility in the far southwest corner of the New Bolton Center campus. A cross of Landrace and Yorkshire breeds, these girls are about three-and-a-half-feet tall and currently weigh in at about 300 pounds, well on their way to an adult weight of 500 pounds.

The renovated facility, which reopened on May 15 after an expansion and update, reflects University of Pennsylvania School of Veterinary Medicine’s commitment to livestock farmers. That commitment includes giving livestock producers models to understand the changing times, and tools for staying at the forefront of animal husbandry. The improved Swine Facility promises to keep Penn Vet at the leading edge of swine facility design and animal well being research in this country.

The original 10,000-square-foot facility first opened in January, 2001 and employed an alternative model for the housing of pregnant and lactating sows that has since been adapted by swine producers on more than 20 different farms across the country, impacting approximately 40,000 sows. The renovation included an additional 6,000 square feet of new facility designed animal space.

The 16,000-square-foot building features state-of-the-art technologies for animal comfort, including feeding and nutrient management for the sows and piglets. The adults are able to roam the facility freely, and have a choice of bedding styles within the gestation area. Now, with the recent expansion, the pigs also have an opportunity to go outdoors at will, weather-permitting. The building is climate-controlled, and despite the sweltering temperatures outside, the interior is cool and airy.

The sows eat when they are hungry. A computerized feeding system utilizes a microchip to uniquely identify each animal and ensures individual animal nutrition even in a group-housed setting. One significant change is the modification to the farrowing rooms, which are now completely free of crates. Instead, farrowing pens, where sows give birth, are designed with specific areas for piglet sleeping, piglet nursing/sow laying and sow elimination. All of these changes provide opportunities to research the type and need for bedding, outdoor access and alternatives to the traditional farrowing crate.

Who cares? Producers of pork. Supplying meat to burgeoning niche markets for consumers who are interested in the details of how the animal are raised provides the farmer with new and rewarding financial opportunities. Says Ines Rodriguez, VMD, the veterinarian in charge of swine health and welfare at the center, “What we are doing here is defining what the practical impact of alternative ways of raising pigs could be, and whether those changes will be economically sustainable for producers. We are approaching this project objectively.”

Nearly 10% of the sows housed on Pennsylvania farms are utilizing pen gestation systems like those used at New Bolton Center. “This project,” adds Rodriguez, “has been good for both large and small Pennsylvania producers looking for different niches in the marketplace.”

Not only does the facility offer a comfortable atmosphere for the breeding and gestating sows and their offspring, but it also strives to have a minimal impact on the environment. Another feature of the facility is its capacity to meet 10% -- 12% of its energy requirements through solar power.

So far, things are looking good. Dr. Rodriguez says the quiet, for example, is telling. “Usually, you would hear a lot of noise and squealing in a facility with this many pigs. The fact that you don’t is an indication that the animals are relaxed and comfortable.” She also notes – with the caveat that it is still too early to make any solid claims about the success of the facility – in the farrowing room, where the first group of four sows has just given birth, things are also going well, as piglet growth and activity has been exemplary.

Thomas Parsons, VMD, PhD, associate professor and director of the Penn Vet Swine Teaching and Research Center, designed the new facility based on his studies of European farms where customer demands have required the development of alternative husbandry practices. “We are grateful to have been able to build a facility that affords us the opportunity to explore issues that are important and challenging to both the US consumer and farmer. We are positioned to address so many exciting questions at the moment. Our progress will be determined by the availability of future funding for specific research projects.”

An educational facility, the center is designed to allow for observation of the animals while still maintaining a high level of biosecurity. A 1,000-square-foot classroom in the center of the facility has a wall of windows overlooking the gestation area and viewing windows in the ceiling of the new farrowing facility, which constitute the floor of a loft observation area. The approximately 4,000 piglets born at the facility each year will be sold to independent producers with interests in the niche market. An additional 100 piglets are sold to young participants of the Chester County 4H Pig Club.

 

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Penn Vet’s Ralph Meyer searches for non-surgical spay/neuter solution

Meyer wins Found Animals grant to study options to keep shelter overpopulation at bay

Ask anyone at any of the estimated 3,500 animal shelters scattered across the US about their challenges and right at the top on their list will be the issue of overpopulation.

“It is my hope – as well as the hope of Found Animals – to find a non-surgical, safe and effective sterilization method for animals that is cost-effective and widely available to help put a stop to our pet over-population problem,” said Meyer.

His work in non-surgical sterilization stems from the cancer research conducted earlier in his career and treatment complications that often lead to long-lasting infertility problems in humans.

“Chemotherapy patients often have long-lasting infertility problems,” said Meyer.

Such infertility occurs despite the fact that germ cells are well protected in the body. Meyer has been studying a defensive mechanism that helps germ cells survive and began work to manipulate the cells in order to prevent the infertility. It was in that research where Meyer’s world collided with work in preventative reproduction at University of Pennsylvania’s School of Veterinary Medicine.

“I realized the opposite might be possible and that if properly controlled and administered, the millions of animals euthanized in shelters each year may be spared. And I thought this would be something that would create something unequivocally good,” he said.

Meyer’s approach is different than what may come to mind when thinking of population control. “This is totally different,” says Meyer. “It is not a contraceptive, but a chemical way of spaying and neutering.”

Meyer’s lab works hand-in-hand with the researchers at the Found Animals Foundation at every step of the way in his findings. “This is not my own,” said Meyer. “Science is collaborative and this is something that I feel is a unique opportunity to really make a difference.”

About Found Animals

Found Animals Foundation (www.foundanimals.org) is a privately funded Los Angeles-based nonprofit organization dedicated to animal welfare issues and led by business and medical professionals. The Found Animals team works directly within the animal welfare community to improve animal shelter processes, fund pet sterilization research, promote effective animal welfare policy, and provide funding to area shelters and spay/neuter clinics. The organization also sponsors and promotes pet adoption, spay/neuter, microchip programs and various animal and pet-related events.

To date, Found Animals has received 107 letters of intent since January 2009 and thirty-three full grant proposals have been invited and reviewed. Seven of those have been recommended for funding for a total potential of $3.5 million. Of those, three such grants have been awarded to researchers across the country, totaling $1.5 million and another four are under negotiation.

 

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Tiny Horse, Big Surgery

They call him Tank, despite the fact that, at 70 pounds, the dwarf mini horse weighs in at about one-twentieth what an average horse weighs, and barely skims the knees of an average-sized person. That diminutive size, coupled with the severity of his birth deformity – a malformed right forelimb – made surgery on the young horse a complicated challenge for the surgical team at New Bolton Center. 

Lily and Victor Leonhard had first become smitten with Tank when they saw him lying down in a field at two or three months old. “We didn’t realize until we got him home how severe the deformity was,” said Mrs. Leonhard. 

New Bolton Center William Boucher Field Service’s Meagan Smith, DVM, a board-certified specialist in the practice of equine veterinary medicine, and Tank’s primary vet began treating Tank conservatively, but when no improvement was made, Meagan recommended that he visit New Bolton Center. Tank came to the George D. Widener Hospital in late January with a history of a deformity of his right forelimb, centered at the fetlock joint. It caused him to walk on the side of his hoof wall instead of flat-footed. A radiograph revealed a deformity of the right cannon bone, the longest bone in the horse’s front leg. In addition, he was unwilling or unable to place the heels of both hind feet on the ground. 

Liberty Getman, DVM, a board-certified large animal surgeon, recommended surgery. The complicated procedure required strategically fracturing the bone that had grown crooked, taking a triangular-shaped piece of bone out of the middle of the deformed bone, straightening the bone, and then using a special locking compression plate to repair the fracture that was created. For the Leonhards, the decision was pretty straight-forward. “To watch your animal and see him not standing right, and realize that he could live that way for 20 years, is not a good picture in your mind. We couldn’t imagine him having a good quality of life without the surgery,” said Mrs. Leonhard. 

The surgery was performed on January 28, and the procedure took about two-and-a-half hours. “This is a major surgical procedure that is not commonly performed,” said Dr. Getman. “There are many potential complications when doing a surgery like this. We are breaking a major, weight-bearing bone, and there is always concern about infection when you are putting a plate on horse bone. A successful outcome depends on many things, not the least of which is having specialized facilities, equipment, and personnel capable of doing this type of surgery.” In the operating room with Dr. Getman were surgical resident Ben Ahern, DVM; board-certified veterinary anesthesiologist Lin Klein, VMD; nurse anesthetist Diane Hurley; surgical nurse Emma Geoghan; and chief of the farrier service Pat Reilly. 

“The biggest challenge we faced for this procedure was Tank’s size. His cannon bone is about the size of my index finger,” said Dr. Getman. “Specialized medical equipment was necessary to make the cut in the bone precise enough.” The equipment was provided by Synthes Vet in West Chester. “It was extremely helpful to have the people from Synthes Vet bring the equipment to us and assist during surgery.” 

In addition to straightening the deformed bone, a glue-on extension was placed on the lateral wall of the right front foot, along with a full-limb bandage and splint. Toe extensions were also placed on his hind feet to help treat the flexural deformity he was developing in those limbs. 

Tank recovered from surgery showing little sign of pain. “We managed the pain preemptively,” said Dr. Getman. “He was on pain medication before and during the surgery.” Post-surgery, Tank was bearing full weight almost immediately, with a normal temperature, fecal production and appetite. He was discharged five days later and never experienced any complications associated with the surgery. Follow-up was provided at the Leonhard’s home by Drs. Smith and Getman and farrier Pat Reilly. “His prognosis is excellent,” said Dr. Getman. “In fact, the leg we did surgery on is now his most normal leg. He should be able to live a normal healthy life. Without the surgery, he would likely have been crippled within a year, and at risk of foundering on the opposite leg.” 

Tank, said Mrs. Leonhard, is so easy going with everything. She has watched his slow recovery, including eight weeks of stall rest, and observed the little horse adjusting to his corrected limbs. “He has had consistent, good attention from the New Bolton Center staff. That’s what stands out in my mind. They have been so kind and thoughtful and caring, whatever they were doing,” she said. Mrs. Leonhard is looking forward to taking Tank for walks through the woods, “and many years of enjoyment with him.”

 

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Summertime Health Tips

Bite wounds. Parvovirus. Vomiting. Diarrhea. Trauma. During the summer months, Kenneth J. Drobatz, DVM, director of Emergency Services at the Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania (Ryan-VHUP), and his staff see it all.

“During the summer months, animals get out more and therefore have more exposure to conditions such as trauma, poisons, other animals with infectious diseases or exercise more, which might bring subclinical problems to the surface,” said Dr. Drobatz.

But, with a little common sense, Dr. Drobatz says pet owners can make sure their furry friend stays healthy through their most active time of year.

Perhaps the most obvious hot-weather -threat is heat stroke and other heat-related illnesses. The key to keeping your pet cool, says Dr. Drobatz, is paying attention to the temperature and heat index in your area.

“Be aware of the heat,” he said. “Dogs in particular will run until they die from heatstroke or at least pass out and then develop severe complications.”

He recommends offering plenty of shade, fresh water and letting your dog spend its day in an air-conditioned home, office or room, if possible. Clipping your pet’s fur to a shorter length might also offer some cooling benefits.

Signs your pet might be suffering from the ill effects of the heat include:

• Excessive panting;
• Excessive salivating;
• Weakness or inability to get up;
• Seizures;
• Coma;
• Ataxia (uncoordinated movements);
• Vomiting;
• Diarrhea.

In addition to the heat-related issues pets can suffer from, there’s a greater risk for pests, accidents and athletic injuries as people often are more active during the longer days.

Because of that outdoor living, insect bites and the allergic reactions they can cause are more likely.

If you know your pet was bitten or stung and has a reaction, you can administer Benadryl, said Dr. Drobatz, at a ratio of 1mg/pound. So, if you have a dog that weighs 75 pounds, he can be given up to 75 mg of Benadryl to help with the effects of the sting or bite.

If, however, your pet experiences a severe allergic reaction, you should get him to the vet as soon as possible. Like humans, pets can experience swelling so badly that it affects the lungs and respiratory system, making it hard to breathe. In this case, Benadryl will not work and more advanced care is needed.

Serious accidents – like being struck by a car – also spike in the summer months. In all cases, pets should be transported immediately to receive veterinary evaluation. Pets can also suffer from athletic injuries, much like humans. Strains, sprains and muscle pulls are all common orthopedic injuries that can likely occur as the pet exercises more.

 

More Tips to Keep Your Pets Safe

·         Keep your pet well groomed. Daily brushing or combing lets you check for fleas and ticks. Fleas can cause allergic reactions and “hot spots” in dogs. Hot spots are large, wet skin sores that appear suddenly in areas where the dog has scratched. See your veterinarian for flea and tick preventives or if a “hot spot” appears. Certain ticks can transmit infectious diseases to your pet or to the owner as well.

·         If you have a swimming pool, do not leave your dog unattended in the pool area. Contrary to popular belief, not all dogs can swim or they may know how to swim but don’t know how to get out of the pool.

·         Use a heavy screen on windows or keep them closed if you have cats. During the summer, the number of cats suffering from “high rise” syndrome, or falling from windows,increases dramatically.

 

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Summertime: Prime Time for Heartworm

By Kelly Stratton

 

Keep your pets healthy by proactivelypreventing this dangerous parasite

After a long winter, Memorial Day weekend marks the unofficial start of summer. In addition to lazy days, lemonade and family vacations, pet owners may also know that with the warmer weather comes heartworm season.

Heartworms (Dirofilaria immitis) are parasites that, if left untreated, can be serious and deadly for cats, dogs, ferrets and many other species of mammals. But what, exactly, is a heartworm, how does a pet get them and what can an owner do to protect his pets?

The Heartworm Lifecycle

Transported to animals from mosquitoes, heartworms have a rather complex life cycle that affects cats and dogs differently.

At maturity, the name “heartworm” makes sense, especially for dogs. They appear long, skinny and white like worms. However, rather than residing in the dog’s heart, they take residence in the lungs and pass to the heart when they die. Before they reach maturity and this worm-like form, the parasite begins much smaller as microfilaria. These microfilariae are released into the blood stream of an infected dog. At this stage the microfilariae simply exist, not damaging its host in any way.

Enter the mosquito. That’s when things get nasty.

After the microfilariae are released into a dog’s blood stream, the dog is bitten by a mosquito. This blood meal allows the mosquito to draw up microfilaria in the blood its ingested and it’s here that the microfilaria reach their next stage of life as larvae. It’s also within the mosquito that these larvae become infectious to mammals. That is, microfilariae need to pass through a mosquito in order to infect dogs or cats. Plus, with every microfilariae-filled mosquito that bites a dog or cat, the potential for disease transmission is increased.

At the mosquito’s next canine blood meal, the mosquito leaves behind some of the infected larvae that enter the dog’s system through the mosquito’s feed site. These larvae find their way to the dog’s blood stream and eventually settle in the heart, lungs and blood vessels. Here they reach full maturity.

Eventually, these parasites, if left undetected and untreated, become problematic. Heartworm disease is categorized in to four stages with the most serious being Stage 4, Caval Syndrome, which needs surgical attention.

Treating Heartworm Disease

In the first the three stages, another treatment method is used, in which your veterinarian administers adulticide therapy and injects a dog in its lumbar muscles with an organic arsenical compound drug over a series of visits.

The adulticide is effective in killing the adult heartworms. The adult worms then disintegrate and are eliminated from the dog’s body. However, depending on the number of worms present, this can be risky business because the disintegrating worms can enter the lungs and block arteries causing complications. The way to minimize the risk is to keep the animal strictly exercise prohibited (on cage rest) for the two months during which worm death is likely to occur.

If the dog has reached Stage 4, it means that heartworms have dropped in to the heart, a syndrome called “Caval Syndrome.” These worms must be removed surgically.

“You gain access to the heart via the jugular vein and remove them manually,” said Meg M. Sleeper, VMD, associate professor of cardiology; chief, section of cardiology. “We use imaging with moving radiographs (fluoroscopy) but we’re grabbing blindly. We’ve pulled as many as 90 to 100 worms out of some dogs.”

In Our Feline Friends

While the life cycle of the heartworm is very similar in cats and in dogs, cats' systems can often rid themselves of infective larvae. According to the American Heartworm Society Website (www.heartwormsociety.org), “Cats are resistant hosts of heartworms, and microfilaremia (the presence of heartworm offspring in the blood of the host animal), is uncommon (usually less than 20 percent of cases). Some cats appear to be able to rid themselves of the infection spontaneously. It is assumed that such cats may have developed a strong immune response to the heartworms, which causes the death of the parasites.”

Numbers of worms are lower in cats than in dogs, but the worms can still be devastating to their feline hosts, causing pulmonary damage and lung injury. “Cats can have significant respiratory signs and pathology associated with heartworm larvae that never develop to the adult stage,” said Dr. Sleeper. “Therefore, although cats may be negative on serologic testing, they can have significant disease associated with the parasite.

Slippery Diagnosis & Attention to Prevention

Diagnosing heartworm disease in cats and dogs can be difficult, as most animals do not show signs of infection until later stages of heartworm development when the issue has become more serious. Weight loss, inactivity and coughing are some signs that are easily misdiagnosed.

“The main reason to use prevention is that it eliminates pulmonary pathology from developing at all (rather than treating the heartworms after the animal has significant lung disease – which may not be reversible),” said Dr. Sleeper.

In addition, prevention is much cheaper than treating an infected dog and some dogs die in spite of aggressive treatment.

“Beginning June 1, in this part of the country, heartworm transmission is possible and we recommend people give their cats and dogs a heartworm preventative they can get from their veterinarian,” said Dr. Sleeper. “Many vets recommend keeping pets on year-round preventative because oftentimes the heartworm medications have other benefits. Plus, getting into the habit of administering it once a month makes it less likely that an owner will forget.”

In February, the American Heartworm Society released its guidelines for prevention, which includes annual testing for heartworm disease and year-round administration of preventatives.

 

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Two Heifers Return Home to Enjoy the Simple Pleasures

By Sally Silverman

There might not be anything unusual about a pair of year-old heifers enjoying the rich springtime grass on a sunny afternoon. But Faye and Meggie are lucky to be home on the farm, indulging in such a peaceful, mundane activity. 

The pair was presented to the Widener Hospital on March 5^th. The diagnosis for both: Type B Botulism toxicity, caused by Clostridium botulinum. Both yearlings were disinterested in eating, a sign of something amiss. Meggie displayed the milder symptoms of the two. She was alert, responsive and standing. Upon examination she was found to be mildly dehydrated and had slow, weak rumen (stomach) contractions. Her eyelid tone was decreased and, though she had normal tone in her tongue, she had some difficulty getting food into her mouth. 

Faye’s condition, on the other hand, was grave. She was lying down, unable to stand, and had neuromuscular weakness throughout her body, including tail, jaw, tongue and eyelid. Her heartbeat was rapid, but her other vital signs were within normal limits. Her owner initially believed that there was no hope of saving the heifer, and brought her to New Bolton Center only for the purpose of having her euthanatized and a necropsy performed to determine the cause of her illness. His hope was to prevent whatever was sickening the two animals from spreading throughout the herd. 

Diagnosing Botulism can be tricky. Routine blood tests are often unremarkable, and the most reliable diagnostic tool, the mouse bio-assay test, takes days to produce results. Researchers at New Bolton Center, which serves as a reference lab for other Botulism labs in the country, are currently involved in a research project exploring a more expeditious option based on the presence, detected by PCR (Polymerase Chain Reaction), of Clostridium DNA in feed or gastrointestinal contents from affected animals. The results of a clinician’s observations of the animal’s symptoms, however, remain the most valuable tool for diagnosing Botulism toxicity. 

Both Meggie and Faye displayed symptoms typical of Botulism toxicity, particularly the classic loss of muscle tone in the tongue. The sample of the feed brought in with the two animals tested with a pH of 6.5, a level which favors botulinum toxin production. Botulism toxicity was a logical diagnosis. In fact, because the clinical signs in Faye were so striking, and because there are usually no diagnostic post-mortem lesions with Botulism, the decision was made to treat, rather than euthanatize and necropsy the heifer. 

There are many forms of Botulism, and the Clostridium botulinum spores responsible for sickening the two young cows are found almost everywhere. In their inert state they are harmless. It is when the spores are given an opportunity to produce toxins, such as a moist, high pH, oxygen-free atmosphere, that they become dangerous. Type B predominates in cattle and horses in the Mid-Atlantic region. It is frequently the result of an insufficient level of acid produced in silage or other fermented feed, allowing the Botulism toxin to be produced from the spores. Almost any type of food that is not very acidic (pH above 4.6) can support growth and toxin production by Clostridium botulinum. In all forms of Botulism the toxin disrupts communication between nerves and muscles. It is a rapidly progressing, potentially fatal disease if untreated and timely treatment with a Botulism antitoxin is often required to save the animal. 

Once the diagnosis was made, Meggie was treated with the intravenous Botulism anti-toxin. She received supportive care in the form of fluids and alfalfa meal delivered via a stomach tube. She was able to drink and eat sufficiently throughout her hospitalization and was released two days after her admission to Widener Hospital. 

Faye also received a dose of Botulism anti-toxin. She was supported initially with intravenous fluids, nutrition delivered through a stomach tube and frequent changing of position to avoid developing pressure sores. Over the course of two weeks, her tongue tone gradually returned and she began to eat hay and grain on her own. She was also able to change positions independently and eventually stand with assistance. On March 21, Faye was able to rise and stand, as well as drink and eat, on her own. Because of an increased respiratory rate and intermittent cough she was placed on the antibiotic to control for possible infection. On March 25, almost three weeks after admission, she was allowed to return home. 

Raymond Sweeney, VMD was one of the clinicians involved with both heifers. “It’s always gratifying when you can work with an animal that is so severely afflicted and have a positive outcome. This case was particularly rewarding because the heifer that we saved was brought in to be put down. We convinced the owner that it was worth trying to save her, and we were successful.” 

It was also a very satisfying case for the March Madness students, those fourth-year veterinary students with a particular interest in large animals or food animals, to be involved in caring for the calves.

 

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Goats have a reputation for being voracious and undiscriminating eaters. It’s a reputation that is well deserved, and that inclination to nibble on just about anything can get them into serious trouble. Such was the case in late March, when a small herd of pet goats escaped from the pasture and made their way into the garden where they feasted on some usually forbidden forage. That evening all seemed intoxicated and some were vomiting.

The next morning, all six goats were admitted to New Bolton Center’s George D. Widener Hospital for Large Animals with varying degrees of symptoms. Admitting veterinarians Drs. Ray Sweeney and Michelle Harris report that the goats were recumbent, vomiting and appeared dull. Test results revealed electrolyte abnormalities consistent with vomiting and dehydration. Grayanotoxicity, which causes severe gastrointestinal irritation and abnormal cardiac function, was the preliminary diagnosis. The suspected cause? Ingestion of a toxic plant.

The first course of action was to administer intravenous fluids to correct dehydration and to deliver activated charcoal in an attempt to absorb any toxins. The charcoal was delivered via stomach tube to each goat’s rumen, the first and largest chamber in a goat’s digestive system.  

Jesse, a strapping year-old American La Mancha goat weighing about 150 pounds, and Randy, a diminutive dwarf pygmy goat, were more stable than their herd mates upon arrival at the hospital. They responded well to the medical therapy, and their condition improved over the next few hours as they stopped vomiting, became brighter and began to eat hay. Two of the animals, Moo and Jumanji, also La Manchas, continued to vomit and experience dropping heart rates. With their conditions deteriorating despite aggressive medical treatment, the decision was made to perform surgery on both Moo and Jumanji to remove any toxic materials from their rumens. At surgery the culprit was revealed. Attending surgeons Drs. Marie-Eve Fecteau and Ben Ahern took out enough azalea leaves and stems from each of the goats to fill a half-gallon bucket.

Once the offending materials were removed, the contents were replaced with normal rumen contents from Mocha, New Bolton Center’s resident rumen donor cow, and activated charcoal, to absorb any remaining toxins. An important member of New Bolton Center’s clinical team, Mocha was surgically equipped with a passageway from her skin to her rumen about six years ago. By making the contents of her healthy rumen, full of positive microbes and protozoa, available, Mocha is able to improve the health of many of Widener Hospital’s ruminant patients.

The following day Moo and Jumanji were both much brighter and enjoying timothy hay. When the four herd mates were reunited they all began eating better and showing more animated behavior. Within 48 hours all of the goats were acting like their former friendly, playful and ravenous selves. Each of the goats was treated with intravenous antibiotics to provide protection against pneumonia, a potential hazard of aspirating vomit, while the post-surgical pair also received anti-inflammatories. Moo’s initial episodes of trembling, attributed to discomfort, responded well to analgesic treatment. Sadly, two of the goats were too ill to save.

According to Assistant Professor of Toxicology at New Bolton Center Dr. Lisa Murphy, ingesting any one of a number of members of the Heath family (Ericaceae) of plants, including rhododendrons, azaleas, mountain laurel and Japanese pieris are known to cause grayanotoxicity.

“All parts of the plant, even the nectar, are toxic,” says Dr. Murphy. “And it doesn’t take much. As little as a handful of leaves could certainly make a dog sick.”

Such poisonings have been reported in a variety of animal species including cattle, sheep, goats, horses, dogs, cats and birds. The effects might be mild, irritating the walls of the stomach or rumen causing gastrointestinal distress including vomiting or diarrhea, which, in turn, may cause dehydration and an imbalance in electrolytes. The plant material is also toxic to the muscles of the heart and, if enough is ingested, will create arrhythmias or irregularities in heartbeats that will soon lead to death.

Dr. Fecteau says, “This is so often a fatal disease. We were extremely happy that we were able to send four of the goats home healthy.” The case was particularly satisfying for the fourth-year students on rotation through the Food Animal Medicine and Surgery Department at the time. “Soon to be full-fledged veterinarians, these students were able to triage the group of goats and manage them, displaying great responsibility. They commented afterwards that this case was really rewarding for them, too.

“It’s no myth that goats will eat anything,” says Dr. Fecteau. “That’s how this group got into trouble. They are very mouthy, and very curious, and I’ve seen goats eat baling twine, plastic bags, paper and all kinds of candies and cookies. ”

Randy, Jesse and Moo were all discharged three days after admission, with Jumanji going home on the fourth day. The prognosis for each of the goats is very good, and their owner Dawn Fonte, who frequently adopts rescue goats, reports that they are doing very well at home. “I couldn’t have asked for better or more attentive care. These goats are my babies and I am so happy to have them back at home.” But she’s not taking any chances. “We’ve removed all of the potentially poisonous shrubs from our property.”

 

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Simba Farmer’s March 23, 2010 appointment at the University of Pennsylvania’s Matthew J. Ryan Veterinary Hospital (Ryan-VHUP) wasn’t his first. The 13-year-old domestic shorthair had come with his owner, Petra Farmer, for a visit to cardiology nearly 10 years prior to this appointment. Then, it turned out to be nothing serious. But now, Simba was potentially dealing with cancer.

“A few years ago I noticed it, but it just looked like a lump,” said Petra about the swollen nodule on her cat’s left hind leg. “It was just a fur-covered lump.”

Still, Petra’s primary care physician wanted to be sure that it was just a lump and conducted an aspiration. A bit of clear yellow fluid was drawn, but nothing else.

But when the fur-covered lump began to bleed and ooze a clear discharge a couple of years later, Petra took Simba back for another sampling. This time, the vet was concerned that it was cancer and sent away for a biopsy of the fluid.

“I knew that whatever was going on that I was going to end up at Penn, so I made an appointment for a second opinion.”

“The mass had been there a while,” said Dr. Ezra Steinberg, third year resident and Simba’s attending veterinarian. “It was big, near the hock (ankle) and because it was ulcerated it was giving the cat some grief.”

Because of the size of the lump, which had now grown to a 4cm x 4cm mass on Simba’s leg, Dr. Steinberg knew there was no good way to remove it without serious reconstructive surgery.

“We talked about how there wouldn’t be enough skin around the foot to close the surgical wound,” said Petra.

Petra, with consultation from Dr. Steinberg, decided to have the cat’s leg amputated.

“Whatever needed to be done to save his life that wouldn’t affect his quality of life in a hurtful way is what I was prepared to do,” said Petra.

“It’s a fairly standard procedure,” said Dr. Steinberg, “but I wanted to consult with other areas of the hospital – like cardiology and anesthesia – to really consider Simba’s heart condition, age and any other underlying conditions.”

Petra left the cat in Dr. Steinberg’s care and immediately, as with any case, a number of Ryan-VHUP veterinarians, certified vet technicians and nurses were consulted to prepare Simba for surgery that would take place the next morning.

While the cardiology unit was monitoring the cat’s heart murmur to make sure he was strong enough for general anesthesia and the stress of surgery, full blood work was being drawn and studied to ensure there were no underlying conditions. Chest X-rays were performed to evaluate the heart and to look for any signs of metastatic cancer.

“His heart murmur was a concern for me,” said Petra, “but I found Dr. Steinberg to be an exceptional doctor and I knew right away that I could entrust my Simba’s life to him without reservation.”

All was clear, so an early-morning surgery was planned for the next day.

“I was at work when Simba was in surgery,” said Petra, “but Dr. Steinberg called me as soon as it was over to tell me it was a success.”

“He didn’t miss a beat,” said Dr. Steinberg. “Amputation patients adjust quickly and Simba was no exception. He got right up, fumbled for a few minutes to get his bearings and was then completely fine.”

The cat was released to Petra the next day wearing an E-collar and with orders of bed rest and follow up care with either her primary care vet or at Ryan-VHUP for Simba’s suture removal. Dr. Steinberg also recommended that Petra set a follow up appointment with Ryan-VHUP’s cardiology department to ensure he’s properly medicated and with the oncology department for continued treatment of his cancer.

“The first two days after he came home, I kept him confined in a carrier, but by the third day, he was getting a little rammy and trying to tear that carrier apart,” said Petra. “So, I left him in my bedroom with steps he could hop up to get to the bed.”

By the end of day five, Simba had the run of the house again with the rest of Petra’s menagerie.

After the amputation, Simba’s leg was sent to pathology for a complete biopsy. This time, the results came back positive for spindle cell sarcoma – a cancer that’s fairly common, but more so in dogs than in cats. Luckily, the cancer had not yet spread to the cat’s lymph node.

“I was so happy to find out it was a type of cancer that has a low rate of metastasizing,” said Petra, “and I breathed a sigh of relief when I found out the lymph node came back negative.”

“Lumps and bumps that people find on their pets should be aspirated or biopsied when they are first noticed,” said Dr. Steinberg. “And in Simba’s case, Ms. Farmer did the right thing when her first biopsy came back inconclusive – she got a second opinion.”

As with many cancers, early detection and treatment can mean the difference between life and death. When the lump is still small, it can be removed in its entirety and biopsied and has less of a chance of having already spread to another area of the pet's body.

While Simba’s cancer hadn’t spread within his left hind leg region, it’s not clear whether it had gotten to other areas of his body. Because of that possibility, Petra’s next steps include a visit with Ryan-VHUP’s oncology specialists to determine whether the cat should undergo systemic chemotherapy for preventative reasons.

“If it makes sense, we’ll do it,” said Petra. “But I don’t want to be so selfish if it’s just going to make him miserable. He’s a happy cat. And I will do what I can to keep him that way.”

 

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Baby Alpaca Receives Cataract Surgery at New Bolton Center

By Sally Silverman

Dr. Mary Utter was charmed the moment she saw her patient in late January, 2010. “If you have never seen a baby alpaca, it is just the most adorable thing. All curly and poufy, with those big, dark eyes.” But it was those eyes that caused the concern. They weren’t dark and glossy, the way the eyes of a three-and-a-half-month-old cria, as a baby alpaca is called, should be. Star Dancer’s eyes were cloudy at the center. This baby was born with cataracts. 

A cataract is any opacity of the lens in the eye and can occur at birth or develop with age for a number of reasons. In either case, cataracts impede vision from a minimal amount to completely. Star Dancer appeared to be almost totally blind from birth. At home she clung close to her mother and was disinterested in interacting with the other crias in the herd. Though they reported that she could get around “well enough” and her vision wouldn’t impact her function as a producer of fine fibers, owners Jim Bajzath, Bonnie Belfiore and Doug Kittrell felt that Star Dancer’s quality of life was compromised. And so, they came to New Bolton Center to investigate the possibility of cataract surgery. 

“Such a surgery is not common in camelids [the family of animals that includes camels, llamas and alpacas],” says Dr. Utter, “because the significance of visual ability is usually dependent on the needs of the animal.” People have cataracts removed and vision correcting lenses inserted at the same time. And they frequently elect to have the same surgery performed on their dogs. Horses typically undergo cataract surgery at New Bolton Center because sight is such a crucial part of so many of their activities. Imagine jumping a five-foot ditch with a compromised depth perception, or negotiating a racetrack at 45 miles an hour with fuzzy vision. 

One of the unique aspects of veterinary ophthalmology, according to Dr. Utter, is that, unlike with other specialties, treatment of eye diseases and conditions is successful across many species simply because the anatomy of the eye is similar in so many types of animals. Since she began practicing, Dr. Utter, a board-certified veterinary ophthalmologist, has performed eye exams or surgery on a pit viper, crocodile, Siberian tiger, hyacinth macaw, kangaroo, zebra, chinchilla, as well as the domestic pets and farm stock. Her practice has been limited to New Bolton Center since 2006, and here she has operated almost exclusively on equines, bovines and, yes, camelids. 

When Star Dancer arrived at New Bolton Center in early February, she presented in general good health. An ophthalmic examination revealed an absence of a menace response, where the hand is rapidly pushed towards the eye without making contact; a normal response would be to blink or pull back at such a threat. Dazzle and pupillary light reflexes in both eyes, however, were positive, suggesting that the retina was functioning properly. The eyes appeared to have no abnormalities other than the cataracts, and the likelihood that the cria’s vision would be corrected with surgery was good. In her stall, Star Dancer walked in circles, her head tilted upward. Routine phacoemulsification or removal of the cloudy lens material was recommended. 

The surgery, even though it is a common procedure, is technically difficult. Performed under a surgical microscope, a small incision, about the diameter of a pencil eraser, was made in the cornea, described by Dr. Utter as “the windshield of the eye.” The cloudy portion of the lens was broken down with high speed ultrasound and then suctioned out. The opening was closed with an absorbable synthetic suture material about the diameter of a human hair. Anesthesia plays a particularly crucial role in cataract surgery. Because of the delicacy of the surgery, there is no tolerance for movement of any kind. Hence the patient is anesthetized to simulate paralysis, and is temporarily placed on a ventilator to assist with respiration. “Intubating a camelid can also be a bit tricky, both because of their conformation, with those long necks, and the unique structure of the larynx and trachea.” 

The positive response to surgery was thrilling for Dr. Utter and the rest of the surgical team. “As soon as Star woke, we could see a difference,” says Dr. Utter. “She was responsive to a menace test, interested in her environment and began investigating her surroundings almost immediately.” 

Star Dancer, however, was still in a delicate position. She received systemic and topical antibiotics and anti-inflammatories before and after surgery, throughout her two day hospitalization. Medication was given intravenously to protect against gastric ulceration that could result from both the stress of hospitalization and the systemic medications. She was sent home with topical antibiotics, steroidal drops and atropine. While her prognosis for continued good vision, though far-sighted, was excellent, it was emphasized to the owners that post-operative complications, including uveitis, glaucoma and corneal edema, were still possible and could be both painful and result in blindness. Star Dancer’s at home care and daily monitoring were of utmost importance. 

When Star Dancer returned to New Bolton Center one week following surgery, Dr. Utter found that she was bright and seemed to be seeing well. A mild amount of corneal clouding and low intraocular pressure were observed; these were deemed appropriate following cataract surgery. Another recheck two weeks later showed continued improvement. 

Reports from her owners in the weeks after surgery indicate that as soon as Star Dancer returned home to Double 8 Alpaca Ranch in Jobstown, NJ, she began investigating her surroundings for the first time with her eyes instead of her nose, mouth and ears. While she used to get lost in the alley on the way to the pasture, now she runs out with the herd and interacts normally with the other crias. 

“This isn’t necessarily a story of an innovative or particularly uncommon surgery,” says Dr. Utter. “But it is a story that emphasizes so clearly the impact that we as veterinarians can have on the quality of an animal’s life. It has been so rewarding to get updates on how much we were able to make a difference for Star.”

 

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Bald eagle toxicology performed at New Bolton Center

The bald eagle. As the national bird and majestic symbol of the United States, its image draws up thoughts of strength and stoic heroism.

But on September 17, 2009 an adult male bald eagle needed help. Reportedly, the eagle had hit a power line while it was soaring, fell to the ground and was reported to the Pennsylvania Game Commission. The Game Commission came to the site of the report in Lancaster County, PA and took the bird to Tri-State Bird Rescue & Research, Inc. in Newark, DE.

“On admission, the bird was thin, he was dehydrated, covered in lice and was wobbling and uncoordinated, showing signs of ataxia – an indication of a neurological disorder,” said Dr. Erica Miller, veterinarian at Tri-State Bird Rescue & Research. “He would rest on his hocks rather than stand, and when he was disturbed, he would throw his head from side to side, attempt to walk but then fall backwards.”

In addition, the bird had a suppressed heart rate and slightly elevated white blood count.

“The initial concern was for head trauma since the impact and fall had been witnessed, but our staff was very concerned about potential poisoning,” said Dr. Miller. “The signs he was exhibiting were more classic of chronic lead poisoning and the suppressed heart rate suggested that there may be organochemicals, like pesticides or pharmaceuticals,or other toxins involved.”

As such, samples were sent to the University of Pennsylvania’s School of Veterinary Medicine’s New Bolton Center Campus to be tested by the Pennsylvania Animal Diagnostic Laboratory System (PADLS).

“Toxicology testing at New Bolton Center is routine protocol for all of our eagles, loons and gannets,” said Dr. Miller, “and it’s an important part of our protocol because we’re trying to monitor environmental contaminants like lead and mercury in these ‘top-of-the-food-chain’ species,” she said.

“The tests confirmed the elevated blood lead level and also ruled out mercury poisoning as another possible cause of the bird’s clinical signs,” said Dr. Lisa Murphy, assistant professor of Toxicology, Department of Pathobiology. “In addition to the lead, further blood testing revealed significant quantities of barbiturates, which also probably explained the eagle’s unusual symptoms. It is not uncommon for birds of prey and other scavengers to become sickened by these drugs, generally after feeding on a euthanized animal,” she said.

Meanwhile, quick treatment of the bald eagle at Tri-State Bird Research & Rescue was key.

“Every case we receive is treated with a sense of urgency,” said Dr. Miller. “Wild birds shouldn’t be able to be easily captured by people, and by the time they can be captured, they’re usually in critical condition, needing immediate medical care. This bird’s neurologic condition certainly indicated that fast treatment was going to improve his chance of survival. The first priority was to try to stabilize the bird – increase the heart rate, provide fluids – and then provide a quiet atmosphere where the bird could rest and recover from the stress of capture, transport and being handled by humans.”

“When we received the lab results on September 23, fluid therapy was extended to continue to flush the barbiturates from the body,” said Dr. Miller. “We assumed the bird picked up these chemicals from eating a carcass that was euthanized, but we have no way of proving that. But we better understood why this bird wasn’t rebounding from the lead poisoning as quickly as birds usually do, and it helped to explain some ‘stargazing’ signs and slow reactions that we were observing.”

Treating wildlife is different than treating companion animals and the Tri-State Bird Rescue & Research team aimed to keep human handling to a minimum.

“Birds are typically handled only for necessary treatments and cage cleaning is done while they’re being treated to minimize stress and interaction with humans,” said Dr. Miller. “He was handled two times a day because of the need for extra fluids, but as soon as we were able to get him to self-feed, which happened pretty quickly, we put his medication and fluids into his food and cut back on the number of times he was actually handled.”

Still, the brave bird worked his way into the hearts of the staff and earned himself nicknames.

“We did occasionally use terms like ‘The Pharmacist’ or ‘The Multiply Drugged Bird’ since he had more than one chemical on board,” said Dr. Miller.

"In addition to clearing the toxins from the bird, he needed time to recover from the possible head trauma from the impact and fall,” said Dr. Miller. “He also had some lesions in one eye, suggestive of a prior West Nile Virus infection”

But by late December, it was obvious the brave bird was ready to go back home.

“He was flying well in a large flight cage,” said Dr. Miller, “and he demonstrated good visual response to stimuli. So from that point, we exercised him to build strength.”

On January 8, 2010, members of the Tri-State Bird Rescue & Research team, Dr. Murphy and members of the Pennsylvania Game Commission traveled to a little-known spot by the Susquehanna River. On the blustery winter day, the eagle was set free in an area that houses 18 active bald eagle nests and is known for its generous supply of food.

Given the first chance at freedom in more than three months, the bald eagle awkwardly and anxiously burst out of his transport cage, wobbled a bit and then took flight into the tree tops – his strength, power and presence fully restored.

“It was a total success,” said Dr. Miller. “And our hope now is that he finds a mate.”

 

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Student Fundraiser For Haiti

Chili cook-off winners: Alicia Andras, V'13, Kevin Oran, V'13, Joel Takacs, V'13, Stephanie Olchowski, V'13 and Jeffrey Barnet, V'10

The student club, SCAVMA (Student Chapter of the American Veterinary Association), held a chili cook off to raise money for Haiti. Custom-printed t-shirts were also sold. Students, faculty and staff were encouraged to contribute chili and 36 pots of chili were entered into the contest.

Winners were picked based on three categories: Faculty Judges' pick, Popular vote- meat chili and Popular vote- vegetarian chili. Faculty judges were Dean Joan Hendricks, Dr. Kurt Hankenson and Dr. Peter Hand.

The winners were:
Judges' choice: Joel Takacs, V'13
Popular vote- vegetarian: Jeffrey Barnet, V'10
Popular vote- meat: tied between Stephanie Olchowski, V'13 and the team of Kevin Oran, V'13 and Alicia Andras, V'13

The cook off raised $1988 which will be donated to the American Red Cross Relief Efforts in Haiti.

See more photos from the cook off here>>.

 

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Burned Horse's Spirit Not Broken 

Widener Hospital staff nurse Suki’s wounds helping the horse to heal physically and emotionally

In the early morning of July 10, 2009, a barn fire broke out in Oley Township, PA. While most of the horses were turned out to pasture, there were several horses kept in the barn that night. Although the horses in the barn were set free once the fire broke out, one of them, a handsome mare named Suki, was spooked and ran back into the burning barn, her only known safe haven. 

Suki, an Oldenburg measuring about 17 hands high and weighing approximately 1,460 pounds, was badly burned. After initial consultation with her local veterinarian in Oley, Suki’s owner was referred to the George D. Widener Hospital for Large Animals located on the University of Pennsylvania School of Veterinary Hospital’s New Bolton Center Campus. Suki was taken there immediately and admitted to the Hospital’s Emergency Service at 5:00 a.m.

“Between 65 to 70 percent of her body was burned,” said Dr. Kelly Kalf, Suki’s primary veterinarian at Widener Hospital. “I first saw her at 7:00 a.m. on the morning she was admitted. There was severe eschar and scabs from the burn along her back and her ears were stiff and blackened.”

In addition to the eschar on her back and her badly burned ears, Suki’s hair on her face was gone, her eyes were swollen shut, her head was hanging low and she had a rapid heart rate; she was in shock. The Emergency Service team tended to her and sent the horse to the ICU where she received IV fluids, pain medication, broad-spectrum antibiotics, anti-inflammatory medicine and topical ointments designed specifically for burn injuries.

“We didn’t dissect the burn to determine the degree – whether they were first-, second- or third-degree – like they normally do right away in human medicine,” said Dr. Kalf, “because we wanted to get her stabilized and keep any protective layers of skin in place.”

Aside from the burns, the most alarming symptom to Dr. Kalf was the fact that Suki was developing sever nasal and head edema (swelling). One of the biggest immediate concerns, aside from her extensive burns, was how much smoke and soot inhalation damage there was – and whether or not Suki would require a tracheotomy, whether she’d develop life-threatening pulmonary edema or later on develop pneumonia.

“We were always prepped for a tracheotomy,” said Dr. Kalf. “Suki did develop a cough and a fever, but these problems resolved part-way through her hospitalization.”

Another concern was her eyes, which were initially swollen shut. She had corneal ulcers in both eyes due to thermal injury, which resolved with medical treatment. “Even after the ulcers healed, we were worried that her corneas might not be getting the lubrication they needed, but, once the swelling subsided a bit, she was able to open and close her eyelids normally, which provided enough lubrication to the corneas with the tear film.” By the time she was discharged, Suki was able to open and close her eyes normally. Still, doctors and staff were afraid she would eventually need reconstructive surgery on the upper lid of the right eye, once the resultant skin shortening from the burn was fully complete.

“After the first 48 to 72 hours, when she’d lifted her head and was eating, she never looked back,” said Dr. Kalf, “and her attitude was good and strong.”

 

Apples, Molasses and Gummy Bears

An integral component of Suki’s treatment was the care she received from the ICU team. Because of the severity of her burns on her head, face and neck, Suki couldn’t wear a halter and administering oral medication was challenging.

“The ICU, physically, was a good location for Suki because it’s temperature-controlled and there’s oxygen set up in every stall,” said Dr. Kalf. “There’s also round-the-clock nursing care and the nurses work intimately with the patients. The nurses and residents are on top of the cases more than anyone else and can say, ‘This changed in the last hour. This changed over night. She’s not responding to this.’ And they knew exactly how to administer drugs since Suki’s head couldn’t be touched and she couldn’t wear a halter.”

The team used apples, molasses and gummy bears to administer Suki’s medications. “Whatever she wanted, would eat, we gave her,” said Dr. Kalf. “She was spoiled rotten with gummy bears.”

Slowly, Suki’s burned skin began to slough off in phases and new hair growth was beginning to show, indicating her burns were first- and second-degree. Throughout her stay at Widener Hospital, Suki’s wounds were treated topically and Dr. Kalf consistently conducted wound debridements, a process by which dead, damaged or infected skin or tissues are removed in order to promote new growth. “I knew she was making real progress and that she’d be okay when I saw that her hair was growing back.”

“The best moment was when Suki was well enough to get on that trailer and go to her lay-up facility for continued care,” said Dr. Kalf. After 47 days at Widener Hospital, the horse had made enough progress to be released to the lay-up facility where she continues to make progress.

“I stay in touch with Suki’s owner, the staff at the lay-up facility and we email all the time,” said Dr. Kalf.

Suki will continue to be housed at the lay-up facility for several more months. As she continues to heal, Dr. Kalf and Suki’s owner will monitor her progress. “Seeing that trailer on her release date was bittersweet because we were all so happy to see her go, but knew we would greatly miss her.”

 

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Close Calls for K9 Diablo

MJR Veterinary Hospital staff treats immediate needs and heads off further complications for a Dec. 1 release date

“When I first saw him, we could not touch this dog,” said Dr. Elaine Holmes, surgery resident at Matthew J. Ryan Veterinary Hospital, of her recent patient, Diablo, a police dog from New Castle County, Delaware.

A Belgian Malinois, Diablo was rushed to the Hospital’s Emergency Service in the early morning hours of November 11 after he’d been shot – in his chest and left hind leg – in the line of duty. Luckily, the shot to his chest had only caused external injuries; however, the shot to his leg had left Diablo with a shattered tibia. And he wasn’t happy about it.

“He was feeling compromised, he was on edge, he didn’t trust us and every once in a while he would bear his teeth. He would just give us that look,” said Dr. Holmes.

Diablo has since been released from the Hospital’s care, but his stay wasn’t an easy ride – behaviorally or medically speaking.

“I first saw him at about 7:00 a.m. the day he was admitted,” said Dr. Holmes. “The Emergency Service had stabilized him right away. They administered IV fluids, antibiotics and pain medications, and we set him up in ICU so we could maintain his stability before we went in for surgery.”

That afternoon, Diablo went in for surgery. While the surgery itself was a success, Diablo’s most troubling health issues were just coming to light. He was showing signs of worsening lung function. And, as the anesthesia wore off, he was also getting a bit more ornery.

“While the shattered leg was concerning, we (the ICU) were managing his overall stability, and it quickly became obvious that what was most life-threatening was the state of his lungs,” said Dr. Elise Mittleman Boller, a staff veterinarian in the ICU. “He needed multiple rounds of anesthesia to deal with his leg, a blood and plasma transfusion and he had pneumonia. All of these things created a perfect storm that probably led to that worsening lung function, making him more and more oxygen-dependent. He was having more and more difficulty breathing,” she said. Finally, Diablo had to be placed on a ventilator to optimize his oxygenation and to help alleviate the respiratory distress he was experiencing.

“He was a trauma victim,” said Dr. Holmes. “His overall systemic health was compromised and that made him more susceptible to complications. Just having a severe trauma like a gunshot wound can cause the whole body to function inappropriately. He was having difficulty handling the anesthesia. The lungs were was our biggest close call and the days I felt most defeated were the days that his lungs took a turn in a negative way,” she said.

Slow progress in Diablo’s lung health was made and, after four days, when he no longer had to be on a ventilator, doctors collaborated to find creative methods – like epidurals and nerve blocks – of providing pain killers for the daily bandage changes to his leg.

“He did not like having his feet touched. At all,” said Dr. Holmes. “Diablo’s handler could do anything,” she said, “so we recruited him to help with some bandage changes.”

 

ICU – Constant Attention, Continued Healing

Diablo’s continuing respiratory recovery depended on the expertise and attention of the ICU team.

“Pre- and post-operative care is essential to a surgical patient’s outcome. End of story,” said Dr. Boller. “And in Diablo’s case, ICU care was absolutely critical. Dr. Holmes couldn’t physically be with Diablo all-day, every day. As with any patient, the ICU nurses are the front lines. They’re administering products, identifying subtle changes in Diablo’s status, assessing the situation on a constant, hour-by-hour basis. Every single person in ICU had a role in that dog’s care,” Dr. Boller said.

“I really depended on the ICU nurses and doctors to keep tabs on Diablo and let me know if anything had changed for better or worse,” said Dr. Holmes.

Plus, the constant attention paid to the dog allowed him to trust his nurses and doctors.

“He became a perfect gentleman,” said Dr. Boller. “The ICU nurses became attached to him and he returned their affection. Some of the nurses would bring him toys and he especially loved a stuffed lamb toy that was given to him. He comforted himself by carrying that toy in his mouth constantly.”

On Tuesday, December 1, after a 21-day stay in the hospital, Diablo was well enough to go home with his handler.

“This was a huge team effort,” said Dr. Boller, “and it was focused between the four walls of the ICU and incorporated surgeons, anesthesiologists, the blood bank, a nutritionist and many other services.”

“It’s true,” said Dr. Holmes. “His entire stay was in the ICU. We could have moved him after his pneumonia was under control, but he’d formed such a bond with the nurses and techs that we thought it was best to keep him there until discharge.”

Diablo continues to make progress and visits often for bandage changes and checkups.

“His wound looks awesome; we’re moving in the right direction,” said Dr. Holmes. “And now when we see him, he’s not showing his teeth unless it’s to get a treat or catch his toy. He’s become a total lap dog.”