Afternoon Rounds

HillPavilionHILL PAVILION

All veterinary and medical students are welcome and encouraged to attend the small animal afternoon rounds at Hill Pavilion.

Affective Aggression and Impulsivity
(30-45 minutes)

FACULTY:

  • Carlo Siracusa, DVM, PhD, Clinical Assistant Professor of Animal Behavior, School of Veterinary Medicine, University of Pennsylvania
  • Stephanie Deutsch, MD, Child Abuse Pediatrics Fellow, The Children’s Hospital of Philadelphia


CASES:

  • Recurrent, affective aggression between two female, mixed-breed household dogs
  • Recurrent, intra-familial perpetration of intimate partner violence

 

dog-growling-by-smerikal-2COLLABORATION:
Affective aggression in humans and dogs is determined by an activation of the stress response, involving the hypothalamic-pituitary-adrenal axis and norepinephrine systems, after the perception of a threat. The ultimate goal of the aggressive response is to remove the perceived threat. Normal affective aggression should allow the individual to cope with the stress experienced and to prevent further recurrence of the aggressive response. A pathological dysregulation of the stress response may cause a frequent and/or excessive activation of the aggressive response, often characterized by a high degree of impulsivity. Genetics, epigenetics, and environmental factors may be at the origin of this dysregulation.

Depressed Young Caucasian Couple Sit On Bed Side

In humans, exposure to violence in the family-of-origin and early stressors such as childhood abuse and neglect result in lasting effects on brain systems and circuits that mediate the stress response. Early adverse experiences permanently impact the neuroendocrine response to subsequent stressors across the lifespan, and have also been associated with trans-generational epigenetic modifications, which in part, may program both adult and offspring psychosocial function.

Dr. Siracusa will present a case of recurrent affective aggression between household dogs, characterized by high reactivity and impulsivity. Dr. Deutsch will present a case of recurrent, trans-generational perpetration of intimate partner violence.


 

Cleft Lip and Palate (30-45 minutes)

FACULTY:

  • Maria Soltero-Rivera, DVM, Adjunct Assistant Professor of Dentistry and Oral Surgery, School of Veterinary Medicine, University of Pennsylvania
  • Jesse Taylor, MD, Attending Surgeon, Division of Plastic and Reconstructive Surgery, Co-Director of the Cleft Lip and Palate Program, Children’s Hospital of Philadelphia

CASES:

  • Secondary cleft palate repair in a juvenile dog
  • Cleft lip and palate repair in a teenage patient

CleftPalatePuppiesPuppyDogMouthHoleFeedingSaving1COLLABORATION:
Craniofacial differences transcend species. Congenital cleft lip and palate is a craniofacial difference that develops early in pregnancy and can occur in humans and dogs, among other species. For reasons that are yet to be elucidated, the tissues that are meant to meet and divide the nasal cavity from the oral cavity fail to do so. As a result, gaps can occur in the upper lip, hard palate, and soft palate. This condition can affect a patient’s ability to nurse, breath, hear, and speak. Chronic rhinitis, otitis, and even aspiration pneumonia can occur. Aesthetics can also be affected, which can have serious social implications. Multiple surgeries and an integrated treatment approach are necessary for a young-teenage-girlsuccessful functional and aesthetic outcome.

Dr. Soltero will present a case of secondary cleft palate repair in a young dog. Dr. Taylor will present a case of a teenage patient with a cleft lip and palate who finishes her treatment with orthognathic surgery. The presentation will also highlight the Best Friends Bash, a one-of-a-kind collaborative effort between Penn Vet and CHOP over the past three years.


Self Injury: Feather Plucking Behavior in Parrots and Trichotillomania

FACULTY:

  • La’Toya Latney, DVM, Service Head, Exotic Companion Animal Medicine, School of Veterinary Medicine, University of Pennsylvania
  • Martin Franklin, PhD, Associate Professor of Clinical Psychology in Psychiatry; Director, Child and Adolescent OCD, Tics, Trichotillomania, and Anxiety Group (COTTAGe), Perelman School of Medicine, University of Pennsylvania

CASES:

  • 14-year-old male intact African Grey Parrot with chronic feather-picking disorder
  • Trichotillomania in a person

COLLABORATION:
feather_plucking_in_parrots_wrnfnFeather-destructive behaviors, or feather plucking (FP) in parrots, is one of the most common disorders recognized in avian veterinary practice. Feather plucking, or the removal by a parrot of its own feathers, is considered an abnormal behavior and has been compared with obsessive behaviors in humans, including trichotillomania. Few studies have examined non-medical causes for FP, however conservative prevalence estimates suggest 10% to 13% of captive pet parrots are affected. African Grey parrots (Psittacus erithacus) and cockatoos (Cactua sp.) are over-represented in the United States, based on histology reviews, and in the United Kingdom (Greys 39.4%, cockatoos 42.4%), based on prospective surveys. A recent study revealed that nearly 50% of biopsies submitted for avian dermatology work-up are secondary to self-trauma. Several behaviorists and avian veterinarians attribute FP to separation anxiety, attention seeking, compulsive disorder, lack of mental stimulation, displacement behavior secondary to stressors, and for prolonged reproductive behavior. FP in parrots reflects a chronic disorder in captive birds. The identification of captivity stressors as a cause of FP ignites strong welfare implications for the pet trade. Fortunately, environmental and behavioral modifications have been clinically shown to significantly reduce or reverse FP behaviors.

TrichotillomaniaDr. Latney will present a case of chronic feather-plucking disorder in an African Grey parrot with a history of chronic environmental stressors.

Dr. Franklin will compare/contrast repetitive body-focused behaviors of people to FP in psittacine birds. Dr. Franklin studies anxiety and body-focused repetitive behaviors (such as chronic tic disorders and trichotillomania, TTM) in children and adults. His clinical and research careers have centered on these disorders, with a particular emphasis on developing and disseminating effective treatments.


 

NEW BOLTON CENTER

Atrial Fibrillation

FACULTY:

  • JoAnn Slack, DVM, Associate Professor of Large Animal Cardiology and Ultrasound, School of Veterinary Medicine, University of Pennsylvania
  • Robert D. Schaller, DO, Assistant Professor of Clinical Medicine, Perelman School of Medicine, University of Pennsylvania


horsesDISCUSSION:

Atrial fibrillation (AF) is the most common cardiac arrhythmia affecting performance in the equine athlete. Evaluation of the horse with AF includes transthoracic echocardiography from right and left parasternal views, standard multi-lead ECG recordings at rest, and exercising ECG or other stress ECG recordings. In systemically healthy horses, valvular regurgitation (especially mitral regurgitation) is the most common predisposing factor for AF. AF can also occur in systemically healthy horses without detectable heart disease, particularly in those participating in high intensity sports such as racing, eventing, and endurance. Treatment options in equine cases persisting more than 48 hours include transvenous electrical cardioversion or pharmacologic cardioversion, typically with quinidine sulfate. Maintenance of sinus rhythm following cardioversion is poorly investigated in the horse, but may include antiarrhythmic drugs, ACE inhibitors, and/or electrolyte management. Regulations associated with various athletic governing bodies often prohibit the use of medications in the period near competition, complicating the use of preventative therapies. Prognosis for maintenance of sinus rhythm following cardioversion depends largely on the chronicity of the AF prior to conversion and whether there is a history of recurrent AF. Mitral regurgitation, atrial enlargement, and atrial contractile dysfunction also contribute to increased risk for recurrence of AF, while the method of cardioversion does not affect longer-term recurrence risk. Repeated cardioversions or repurposing of the horse for a less vigorous sport are the current options for recurrent AF. The latter option requires an exercising ECG to rule out concurrent ventricular ectopy (a potential safety risk for the rider) and to determine if the heart rate is acceptable for level of exertion and intended use of the horse. Unlike human patients, horses are not at risk for stroke if left in permanent AF. Mapping and ablation of persistent atrial fibrillation is not presently applied in the horse.

WeicheltsAtrial fibrillation is also highly prevalent in human patients. Similarly, mitral regurgitation and mitral stenosis, particularly in the setting of Rheumatic heart disease, are predisposing factors for AF. Hypertension, obstructive sleep apnea, obesity, and congestive heart failure are additional risk factors. The vast majority of patients with AF can be categorized into two groups: Paroxysmal, in which AF lasts less than seven days, and conversion to sinus rhythm occurs spontaneously; and Persistent, in which cardioversion (chemically or with transcutaneous direct electrical current) is required. Systemic anticoagulation with Warfarin or a novel oral anticoagulant (NOAC), or aspirin in low risk patients, is a mainstay for stroke prevention. Maintenance of sinus rhythm requires treatment with medications such as beta blockers and antiarrhythmic drugs, which are effective only 40-60% of the time. For refractory patients with persistent symptoms or uncontrolled heart rates, pulmonary vein isolation (PVI) is an option. This procedure is usually performed percutaneously, and includes electrical isolation of the pulmonary veins in the left atrium where premature atrial depolarizations that initiate AF (triggers) come from. Infrequently, triggers outside of the pulmonary veins need to be targeted for complete control. Success rates for PVI in Paroxysmal patients approach 70-80% after one procedure and 60-70% for Persistent patients. Frequently, a second procedure is required. The combination of PVI and antiarrhythmic medications has been shown to be superior to either approach alone. Similar to equine patients, success rates depend largely upon chronicity of AF and left atrial size. Strategies that are currently being investigated include rotor mapping and ablation, as well as targeting of autonomic ganglia in the left atrium.

Dr. Slack will present a case of chronic (persistent) atrial fibrillation in an upper level performance horse. Dr. Schaller will provide comparative information on evaluation and treatment of atrial fibrillation in human patients.


 

Obesity and Aggression in Domesticated Pigs: The Dilemma of Fat and Happy vs. Lean and Mean

FACULTY:

  • Tom Parsons, VMD, PhD, Associate Professor of Swine Production Medicine, School of Veterinary Medicine, University of Pennsylvania
  • Tanja Kral, Associate Professor of Nutritional Sciences, School of Nursing, University of Pennsylvania


pigsDISCUSSION:

Obesity has profound health implications for those who suffer from it – and it is a problem for both humans and animals. A complex web of peripheral and central hormonal interactions converges on multiple sites in the hypothalamus to drive eating habits and set body weight. These regulatory mechanisms are influenced by a host of behavioral, genetic, and environmental factors, and provide potential opportunities for the treatment or prevention of obesity. In domesticated animals such as dogs, cats, horses, and farm animals, obesity is an especially challenging problem, as these animals are typically reared in environments very different from those where their eating habits evolved. Thousands of years of selective breeding rarely has been able to undo the impact of millions of years of natural selection on something as primal as a species’ feeding behavior.

Swine, an omnivorous species that in the wild are incessant foragers, serve as an interesting example. They will spend most of their waking hours searching for the occasional store of energy-dense food such as nuts, insects, or small vertebrates, while otherwise passing the day by grazing on less energy-dense plants. The result is a domesticated animal with an unprecedented feed motivation. While young and still growing, pigs are fed free-choice or have unlimited access to feed until most of them go to market at around six months of age. However, if they are selected as a breeding animal, they will remain in the herd for several years to produce offspring. Standard feedstuffs require that, once these sows reach mature weight, their caloric intake must be restricted in order to prevent obesity by limiting the amount of feed they receive. However, these attempts to control body weight create other challenges. The strong inherent feed motivation of a sow yields competition within the group for feed when it is available in a limited amount. This competition can result in feed intake discrepancies between animals, as dominant animals consume more of the available feed or even escalate to overt aggression. These problems, historically, have been managed by housing gestating sows as individual animals. Unfortunately, common types of individual animal housing compromise the animal’s ability to perform many other natural behaviors such as the ability to simply turn around. Today, both legislative and market forces are at play to eliminate this type of housing.

Dr. Parsons will discuss strategies, viewed through a pig-centric lens, to manage both the nutritional and behavioral needs of this population of domesticated animals when housed in groups. Particular emphasis will be placed on the use of technology to individualize feed intake in a group setting and environmental modifications to minimize aggression and address other behavioral vices. The overarching goal of this case is to better understand how to optimize both the welfare and productivity of gestating mother sows.
runningDr. Kral, a nutritional scientist with training in human ingestive behavior research, will provide a response to Dr. Parsons’ presentation, commenting on parallels in human nutrition. Dr. Kral’s NIH-funded research focuses on the cognitive, sensory, and nutritional controls of appetite and eating in children and adults and their relevance to obesity. She studies how familial predispositions to leanness or obesity interact with environmental factors, such as the omnipresence of palatable, energy-dense foods, to produce individual differences in energy intake regulation. The overarching goal of her research is the identification of behavioral phenotypes for obesity and evidence-based dietary and behavioral economic strategies that promote healthy eating through personalized behavioral interventions for at-risk individuals.


 

Tour of New Bolton Center

Located on 700 acres in Chester County, Pennsylvania, Penn Vet’s New Bolton Center is the University of Pennsylvania School of Veterinary Medicine’s large animal hospital and campus. New Bolton Center hospital handles more than 4,000 patient visits per year, while its Field Service veterinarians treat more than 37,000 patients on local farms.New Bolton Center is a leader in veterinary medicine, ranging from primary care through the most complicated and sophisticated medical and surgical techniques. Clinicians are board-certified in specialties including large animal internal medicine, cardiology, neurology, ophthalmology, reproduction, sports medicine, surgery, and emergency and critical care. Known for its pioneering work in diagnostic imaging, New Bolton Center recently installed and is developing protocols for a revolutionary robotics-controlled imaging system for use in the standing and moving horse. A leader in orthopedic surgery, New Bolton Center has a pool recovery system for horses awaking from anesthesia after complex fracture repair surgeries. The hospital features a state-of-the-art, biosecure critical care center, divided to accommodate colic patients on one side, and patients being treated for infectious diseases on the other. New Bolton Center’s campus also includes extensive diagnostic and research laboratories, as well as a swine center, a working dairy, and a poultry unit that provide valuable research for the agriculture industry. The Marshak Dairy has 180 milking cows, which produce a total of 1,500 gallons of milk per day. The Swine Teaching and Research Center, home for 200 sows and their piglets, features an open housing model that allows sows more freedom of movement than traditional gestation stalls.




PHILADELPHIA ZOO

Great Ape Cardiology and Management of Cardiac Disease

FACULTY:

  • Tim Georoff, VMD, Associate Veterinarian, Philadelphia Zoo
  • Gregg Pressman, MD, Associate Director, Cardiovascular Diseases Fellowship Program; Associate Director, Echocardiography Laboratory, Einstein Medical Center

CASES:

  • Management of cardiomyopathy in a 30-year-old adult male silverback western lowland gorilla
  • Management of cardiomyopathy and congestive heart failure in a 57-year-old male adult human

8394602749_282c718309_b.jpgCOLLABORATION:
Heart failure is one of the most common reasons for hospitalization of humans. The underlying cause is often a cardiomyopathy (heart muscle weakness). Generally speaking, cardiomyopathies can be divided into those due to prior damage from heart attacks (ischemic cardiomyopathy) and those due to other causes (non-ischemic cardiomyopathy). Those causes include hypertension, toxins, viral infections, and autoimmune diseases. However, in many cases, a specific cause cannot be identified (idiopathic).

Captive gorillas are susceptible to similar types of cardiac disease, and captive male gorillas have a higher incidence of cardiac disease as they age. Fibrosing cardiomyopathy accounts for 41% of deaths in adult male gorillas and 70% of deaths in male gorillas over 30 years of age.

older-man-white-T2Dr. Pressman will present a case of adult human cardiomyopathy and cardiac failure and outline therapy. Dr. Georoff will present a case of cardiomyopathy in an adult male western lowland gorilla. He will discuss the challenges of case management and will focus on screening individuals for subclinical heart disease. In addition, he will share information about the zoo’s participation in the multi-institutional collaborative, The Great Ape Heart Project.


 

Severe Enteritis in a Pediatric Patient

FACULTY:

  • Keith C. Hinshaw, DVM, Director of Animal Health, Philadelphia Zoo
  • Louis M. Bell, MD, Chief of the Division of General Pediatrics, The Children’s Hospital of Philadelphia

CASES:

  • Severe enteritis and associated complications in an 18-month-old Coquerel’s sifaka (Propithecus coquereli)
  • Severe enteritis and associated complications in a five-month-old human infant with bloody diarrhea and seizures

lemur.jpgCOLLABORATION:
Diagnosis and treatment of severe enteritis in a pediatric patient can be challenging, given the size of the patient and potentially uncooperative demeanor. Coquerel’s sifaka (Propithecus coquereli), a highly endangered species of lemur, are notorious for susceptibility to a variety of causes of severe enteritis, such as cryptosporidiosis and clostridial disease. Complications of acute enteritis account for a high proportion of mortalities in this species.

Dr. Hinshaw will discuss the case of an 18-month-old 2.7 kg sifaka who developed severe enteritis and sepsis attributable to Salmonella spp, and required intensive medical care to address the enteritis and associated complications.

iStock_000010211189Large.jpgDr. Bell will discuss current diagnostic and treatment strategies for severe enteritis in the pediatric patient, beginning with a case presentation of a five-month-old infant who presented with bloody diarrhea and seizures. He will then consider the differential diagnosis and initial management of infants who present with enteritis.


 

Behavioral Variation in Response to Exposure to a Novel Environment

FACULTY:

  • Marieke C. Gartner, PhD, Animal Behavior and Well-Being Postdoctoral Research Fellow, Philadelphia Zoo
  • Margaret C. Souders, PhD, Assistant Professor of Human Genetics, School of Nursing, University of Pennsylvania; Pediatric Nurse Practitioner, Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children’s Hospital of Philadelphia

DISCUSSION: Using behavioral analysis to understand non-verbal individuals

An individual’s behavior is affected by a multitude of inputs, both external and internal. Behavioral analysis is a scientific approach for discovering external or environmental variables that reliably influence behavior, and for developing a technology of behavior change that takes practical advantage of those discoveries.

phila-zoo-tigerAnimals given access to a novel trail system at the Philadelphia Zoo, which provides both novelty but also more space, show a number of behavioral changes in response to both anticipated access and access itself. These changes include choosing which space to use, what they do within the space, the amount of time they use the space, and how they react to other animals in the same and other enclosures. Dr. Gartner will discuss how these changes in behavior can be used to help assess the animal’s well-being, and therefore allow for targeted, individual management.

iStock_000013009049LargeDr. Souders will discuss how novel environments can affect non-verbal children, particularly those individuals diagnosed with Autism Spectrum Disorder, and how behavioral analysis can benefit those children.