From Alex Jones to Zest
The ABCs of animal medicine reach far beyond the borders of campus at UGA’s Veterinary Teaching Hospital
Hamish is a 10-year-old Welsh Cob. His owner, Melissa Hyde-Town, calls him “Steady Eddie.” He’s the go-to horse at Suwanee’s Starting Point Farm—the one who can be counted on to take care of inexperienced riders.
“He takes them out walking on the trails, along the Chattahoochee River, through the water, up the hills, and they gain a huge amount of confidence,” she says. “That’s his purpose here.”
“We have people that won’t ride anybody else but Hamish.”
And that’s why Hyde-Town and her husband, Phil Town, were devastated when they thought Hamish might have to be euthanized. Last fall he began passing out unexpectedly, which led to the discovery of a life-threatening arrhythmia and significant heart damage. Luckily for Hamish, and his many fans, veterinarians at UGA’s Veterinary Teaching Hospital (VTH) were able to insert a permanent pacemaker, a rare procedure that brought together three teams—large animal internal medicine, large animal surgery and small animal cardiology.
Less than a year later, Hamish is back at work and feels better than ever, Hyde-Town says. She credits UGA with getting him back to his calling.
“I have a lot of confidence in the program up there,” she says.
UGA’s College of Veterinary Medicine, including the Veterinary Teaching Hospital, was founded in 1946. Before the school’s permanent building was finished in 1951, they made do with temporary quarters in surplus prefabricated buildings from army camps that were closed at the end of World War II. Sometime in the early 1950s, the hospital’s first patient was a little brown dog named Charlie Bray, who belonged to 6- or 7-year-old Toombs Lewis Jr. Charlie Bray had been hit by a car in front of the family’s home in Greensboro and spent six weeks at the hospital recovering from multiple fractures of the forelimbs and various other injuries. When the family came to take him home, they were told there would be no charge.
The VTH has come a long way since Charlie Bray, with an estimated yearly caseload of nearly 19,000. Clients bring animals from all over Georgia and beyond, but now the vast majority are referrals—patients who have been evaluated by their local vet and sent to UGA for specialized care not available in their community.
Treating patients is just one way that UGA’s Veterinary Teaching Hospital serves the state of Georgia. Educating students—training both veterinarians and veterinary technicians—is another. And pioneering new methods of treatment is the third.
“The three arms of what we do—teaching, research and service—all come together in the hospital,” says Dean Sheila Allen.
It’s a Tuesday morning in May, and Adrienne Zercher, a fourth-year vet student, is examining Alex Jones, a gray tabby with small cell lymphoma.
Corey Saba, assistant professor of oncology, has asked a question: “What is a sign that the treatment is working?”
“Abdominal ultrasound? Blood work? Body condition?” Zercher asks. “Weight?”
“Yes! Weight,” Saba says.
In this case, weight is a good indicator that Alex Jones is doing well. He has cancer cells throughout his intestines, and when he came in last summer he weighed about half of his current 12 pounds. The chemotherapy he’s been receiving has put his cancer in remission, and his prognosis is good.
Saba then asks Zercher to look for something unusual in Alex Jones’ physical exam. Zercher starts at the cat’s head and moves down his body, looking stumped.
“You’re getting warmer,” Saba says.
Near Alex Jones’ tail, Zercher notices something under the skin.
“It feels like a BB,” she says, and Saba confirms her finding.
Though the BB is not relevant to the cat’s lymphoma, it’s a way for Saba to make sure that Zercher is paying attention to details. Like all fourth-year vet students, Zercher is rotating through the departments of the VTH’s Small Animal Hospital in three-week stints, adding real-world experience to what she’s learned in the classroom.
“I call the fourth year dress rehearsal for real life,” Saba says. “The students can order tests and interpret tests, but there’s always someone there to guide them.”
Educating students is part of everything at the VTH, Allen says.
“Everything we do down in the teaching hospital has a student with it,” she says. “Our clients understand that when they come here. The visits take a little longer because they see a vet student first before they see a veterinarian, but that’s part of what we do. The most important function that we have is to train tomorrow’s veterinarians.”
Oncologist Corey Saba examines Alex Jones, who has small cell lymphoma. He receives chemotherapy, and his cancer is in remission.
In 2005 researchers at the Broad Institute of MIT and Harvard finished mapping the genome, or genetic sequence, of a female purebred boxer named Tasha. They discovered that dogs—like mice—have a genome that’s similar to humans. But unlike mice, dogs live in our environment and have naturally occurring (not lab-induced) diseases similar to those in humans. Add to that a shorter lifespan and less genetic diversity in the case of purebreds, and dogs become a better model for human disease.
“It’s much easier to identify a genetic abnormality in a dog with a disease than it is in a person,” says Simon Platt, associate professor of neurology. “We’re all so vastly different that it would take thousands of us with the same disease to find a common genetic abnormality. In dogs we can literally look at 10 dogs with the same disease and find that they all have a single abnormality, which is then a potential marker for the search for a genetic abnormality in people.”
Platt is studying canine degenerative myelopathy, a progressive disease of the spinal cord seen in breeds including German shepherds, Welsh corgis and boxers. There are no treatments for this condition, but clinical trials offer clients subsidized options that may benefit pets as well as furthering research. Degenerative myelopathy is similar to Lou Gehrig’s disease in humans, so research may lead also to progress in human medicine.
Assistant Professor Michelle Turek emphasizes that animals are enrolled in clinical trials only with owner consent and only when the trial offers a potential benefit for the animal.
“As in human medicine, clinical trials are available for veterinary patients, with the aim of improving upon our existing treatment regimes to increase quality of life for our patients,” she says. “Many trials are done in parallel with what’s happening in the human world in order to inform both sides.”
Turek, a specialist in medical oncology and radiation oncology, uses a linear accelerator to treat cancer in dogs and cats. The linear accelerator, which emits high energy x-rays, is also used to treat humans with cancer.
“By making advanced technologies available for veterinary patients, we are able to contribute relevant clinical information to the broader understanding of how this technology works for cancer. We can get this information much faster than is possible in the human population.”
John Peroni, associate professor of large animal surgery, says that horses offer a similar model for using regenerative therapies to address musculoskeletal injuries like tendonitis.
“We don’t even have to create anything,” he says. “They just come in with that injury, and (regenerative therapies) can be utilized to help the horse and at the same time gain information about how they would aid in the healing of humans with similar injuries.”
Peroni uses adult—not embryonic—equine stem cells and platelet-rich plasma to boost the healing process for musculoskeletal injuries.
“There’s an obvious need to improve on the quality of healing of what we call musculoskeletal injuries—injuries to the limbs, joints, bones, tendons, ligaments,” he says. “The support structures of the limbs are injured often in horses and people, and we haven’t really made a lot of significant advances in how well these injuries heal with traditional therapies.”
Although the researchers are excited about the possibility of having an impact on human medicine, their first priority is their animal patients.
“We recognize that the financial value of our work to the human field can be considerable,” Platt says. “The emotional value to the pet owners is something we’re very interested in, though, too.”
Lindsey Boone, a Ph.D. candidate and surgery resident, works on media preparation under a ventilation hood as research technician Merrilee Thoresen watches. The two work in the regenerative medicine lab directed by large animal surgeon John Peroni.
The intensive care unit (ICU) at the Veterinary Teaching Hospital often is full. That’s because there are a variety of patients sharing the space—the very sick, emergencies, surgical patients recovering from anesthesia and those who are less sick but need fluids and monitoring.
“We actually receive emergencies directly into the ICU, which is not ideal,” says Amie Koenig, associate professor of emergency and critical care. “You want the ICU to be a quiet place to rest and recover, and then there are emergent patients arriving and contributing to a busy atmosphere.”
“It would be beneficial to everybody—both the people working in the ICU and the animals that are being cared for—if we could separate those different functions. Right now we just don’t have the space for that.”
Space is a common problem at the VTH, which is housed on South Campus in a wing that was added to the original building in the late 1970s.
“When this current hospital that we’re in now was built, we didn’t do ultrasound, we didn’t do CT scans, we didn’t do MRIs, we didn’t do endoscopy, we didn’t do laparoscopy or radiation therapy for cancer patients,” Allen says. “None of those things were being used at that time on animals. We’re doing all of that now, and that’s in response to client demand.”
“Medical technology is exponential in how rapidly things change, and we need to keep pace with that, not only for providing service for the clients, but the students need to learn state of the art.”
In fact patients are shuttled to the Coverdell Building for MRI on a machine that is shared with researchers across campus. Limited availability means that clinicians are faced with the choice of waiting or using an inferior imaging tool. It also means that surgery is delayed because patients must be shuttled back to the VTH and undergo a second round of anesthesia. An in-house machine would allow patients to go directly from MRI into surgery. And it would also allow for MRI of horses, which the Coverdell Building cannot accommodate.
“We have to try to provide that for all species, so it takes more room,” says Gary Baxter, director of the VTH.
Australian cattle dog Zest and her owner, Faith Davis (right), meet with the team that helped Zest recover from a weeks-long stint in ICU: (left to right) Andrea Wang, internal medicine resident, and students Jordan Mracna and Caroline Monk.
In addition to keeping up with technology, the VTH is also addressing the state’s changing needs. Georgia’s population has increased 18.3 percent since 2000, compared to 9.7 percent nationally. As the population grows, so does the need for veterinary care for companion animals, care for animals involved in food production and greater numbers of veterinary graduates. Since 1979, the VTH’s annual caseload has grown 37 percent and full-time staff has increased 339 percent, but the hospital square footage has grown only 4 percent. Compared to peer institutions, UGA has 1,700 fewer square feet per student.
The College of Veterinary Medicine is seeking public and private financial support for a new, larger hospital that will provide improved patient care and enhanced educational opportunities as well as allow increased enrollment. The new facility will be located off College Station Road, just 2.7 miles from the existing veterinary medicine campus.
“There’s no doubt in my mind that the University of Georgia needs a new veterinary hospital,” Baxter says. “And really they needed it several years ago.”
On a day early in June, concerns about research questions, evolving technology and space issues seem far away. A happy reunion is taking place in the VTH’s small animal waiting room. Faith Davis and Zest, her Australian cattle dog, have been joined by members of Zest’s medical team—internal medicine resident Andrea Wang and fourth-year vet students Jordan Mracna and Caroline Monk. Zest is clearly happy to see everyone, but keeps trying to head for the door in between greetings.
Her reluctance to stay is understandable. Just two short months ago Zest was admitted with symptoms of vomiting and lethargy and began a stint in ICU that lasted more than three weeks. She lost 22 pounds and could barely walk. She was diagnosed with immune mediated hemolytic anemia, an autoimmune condition in which the body destroys its own blood cells. During the course of her treatment she received 10 blood transfusions from the VTH’s blood donor program, which stores blood from screened donor animals that belong to faculty, students and staff.
“I am so grateful for the transfusions,” says Davis, who lives in Franklin County. “She wouldn’t have made it without them.”
Zest also suffered complications including pneumonia, a bleeding ulcer and a urinary tract infection.
“It was a crash course because it all happened so fast,” says Mracna, who was on rotation with internal medicine when Zest was admitted.
When he finished his rotation, Mracna passed the case to Monk. She found herself reading about everything she could—immunology, radiology, lungs, urine culture and urinalysis.
“The classroom learning is one thing, but having to know things for a specific patient is different,” Monk says. “It was overwhelming. I didn’t sleep much during those three weeks, but it was worth it.”
And although it was a valuable learning experience, the bottom line for Monk is that Zest is healthy again.
“It’s amazing to see her look normal,” she says.
Sealed with a kiss
Shilo has a good reason to kiss Chloe. Two years ago, Chloe saved his life. A groomer noticed that Shilo, a 4-year-old Ragdoll, had become extremely thin under his thick fur, and subsequent testing indicated renal problems. Shilo had been born with only one kidney, and it was failing. His owners, Melissa and Charles Barrett of San Antonio, Texas, began looking into kidney transplants, and they found UGA and soft tissue surgeon Chad Schmiedt (DVM ’00). UGA is one of a half dozen places in the world that offer feline renal transplant surgery. And they found a donor in 9-month-old Chloe, a healthy stray available for adoption at their vet’s office. Testing indicated that Chloe was a match, and the cats were flown to Georgia. The surgery took place in June 2009, and after recuperation they headed back to Texas, where Chloe went to her new home with Shilo and the Barretts. “The donor cats all live—that’s important for people to know—and they are adopted by the recipient cat’s family,” Schmiedt says. And Shilo also has a new lease on life. Before the surgery he had lost five pounds and didn’t feel well enough to go outside. Now the Barretts are keeping an eye on his weight, and he enjoys hunting lizards. “It’s a big surgery, but when the kidney starts working they’re like a kitten again,” Schmiedt says. “They feel great. All of a sudden they’re not sick.”
More public service and outreach:
Vets for Pets and People educates vets and the public about the link between animal abuse and domestic violence and provides help for victims with companion animals. http://www.vet.uga.edu/vetsforpetsandpeople
The Wildlife Treatment Center, funded through donations, provides medical treatment and care for injured wildlife. This year the WTC cared for Daisy, a mallard duck and unofficial mascot at The Lovett School in Atlanta, after a goose attacked and broke her leg. http://www.vet.uga.edu/hospital/services/exotics/wildlife-treatment
Dog Doctors is part of the college’s pet visitation program. Bernese mountain dogs and vet students go into elementary, middle and high school classrooms as well as nursing homes to share information about animals, research and careers in veterinary medicine. http://www.vet.uga.edu/vpp/activities/dogdocs
At the Southeastern Cooperative Wildlife Disease Study, experts work with private, state and federal authorities to monitor parasites, diseases and death in wildlife. Earlier this year SCWDS investigated the sudden deaths of thousands of blackbirds in Arkansas and Louisiana. http://www.vet.uga.edu/scwds
Georgia Veterinary Diagnostic Laboratories, located in Athens and Tifton, provide diagnostic services to veterinarians, companion animal owners and the livestock industry as well as non-traditional species including aquarium animals, marine mammals and zoo species. http://www.vet.uga.edu/dlab
UGA’s Veterinary Teaching Hospital http://www.vet.uga.edu/hospital
UGA’s College of Veterinary Medicine http://www.vet.uga.edu.