TAMU's Large Animal Clinical Sciences: Making the Grade - Part 2
By Sherri Barclay

We now begin part two of our journey into one of the largest and most respected large animal facilities in the world. Texas A&M University’s Large Animal Hospital is an amazing and awe inspiring building that is a lot to take in for those of us that have been there- let alone those who have not yet experienced what this cutting edge facility has to offer.
Let’s look deeper into the technology and resources available in the Large Animal ICU as well as the entire hospital itself.
The LA ICU is staffed by highly trained veterinary technicians 24 hours a day, 365 days per year. In addition, fourth year veterinary students rotate through the Emergency and Critical Service, overseen by senior faculty members. The fourth-year veterinary students assist in treating cases in the LA ICU.

The facilities are state of the art. All stalls in the hospital are constructed from concrete blocks painted with a durable waterproof paint. The floors are concrete covered with non-slip rubber mats sealed together to prevent water and debris from getting underneath. The design is critical for proper infection control and cleaning. Infection control is a major concern in a hospital environment and especially when treating colic cases or foals which are more susceptible to infection.

The LA ICU stalls benefit from central heat and air. Each stall is set-up for hanging fluids, oxygen delivery, ventilation machines, etc. Additionally, all the patients in the LA ICU and Isolation units are watched 24-hours a day via closed-circuit television cameras located in each stall and monitored by LA ICU technicians.

One stall in the LA ICU is completely padded. This stall, used for down horses or horses with neurological disorders, has large doors that open to the outside. This allows them to unload horses directly off the trailer into the stall. It also is equipped with an electronic hoist that is used to position horses for examination or treatment or support it if cannot stand on its own.

There are two stanchions for treating patients and a large treatment area. Basic lab work is performed in the LA ICU and more comprehensive lab work is sent via a vacuum tube chute system (like those used in banks) to the Clinical Pathology Laboratory. There, clinical Pathologist and Medical Technologists run tests and interpret their findings for the clinicians in the LA ICU. The results are automatically entered into the hospital’s computer information system allowing for immediate access to the information from anywhere in the hospital.

Now for the equipment available to the LA ICU and hospital -They use several pieces of special high-tech equipment to care for critically ill patients and emergencies. Here are a few of them as well as their descriptions:
1 The Propaq and the Passport are devices used to monitor patient vital signs such as the percent of blood oxygen, blood pressure, heart rate, respirations, temperatures, etc. This is critical information in an emergency.

2 A newly purchased Telemetry Unit allows clinicians and technicians to monitor patient vital signs from a distance using a wireless transmitter. Information from the transmitter is sent to a specially equipped computer located outside of the stall. This is especially useful for skittish horses and pregnant mares.

3 Another new piece of equipment is a ventilator unit. This unit allows the staff to “breath” for premature neonates and other patients requiring mechanically assisted breathing.

4 The LA ICU frequently administers large volumes of fluids to equine patients. These fluids are kept warm (body temperature) in two large incubators. In addition they utilize several electric fluid pumps for delivering smaller volumes of IV fluids and/or continuous infusion of medications.

5 The Anderson Sling is an apparatus used on horses to pick them up or to assist them to stand.

6 An emergency cart with CPR supplies, medications and equipment is always ready to be wheeled anywhere in the hospital for emergency use.

Many of us consider Texas A&M a last resort in desperate situations to help save our equine friends. Mr. Eddleman told me that many of their clients are refereed by veterinarians in emergency situations such as colic, sick foals or fractures. Therefore many people assume that they only treat emergencies. Traditionally, they have not marketed the teaching hospital so many people are unaware of the other services they have to offer. In reality, Texas A&M is a full service hospital offering all types of services from surgery to reproduction to dentistry, etc.

The Large Animal Hospital is much more like a human hospital, as you can see by the facility and equipment described above, than a private veterinary practice. With multiple departments, services, laboratories, business functions, residents, interns, rounds etc. the hospital operations are very similar to those in a human hospital. They also utilize state of the art diagnostic imaging technologies such as computer radiology, nuclear scientography, CT, etc and employ a highly trained staff.

There are five equine exam rooms in the large animal clinic used primarily for outpatient procedures and new admissions. The food animal unit has several areas with chutes and head gates for conducting examinations and treatments. In addition, they have lameness evaluation areas and several treatment rooms that can be used as exam rooms if needed. The newly constructed Equine Pavilion utilizes specially designed exam and treatment areas for equine reproduction cases and boasts one of the most state of the art reproduction labs in world.

There are four operating rooms (Orthopedics, Soft Tissue, Colic, & Standing surgery) used primarily for equine patients and one food animal operating room. In addition, there are several treatment areas where minor “surgeries” and other procedures are performed. The surgeries vary with the time of year. They can range from one or two per day, to six or more depending on the time of year. Spring is typically the busiest time of year. This year it looks like they will perform somewhere between 500 to 700 surgeries. Most of these will be equine patients with the most common surgery being arthroscopy and colic surgery (exploratory laparotomy).

The surgery success rate is difficult to measure because of a number of variable factors - including financial concerns, risks adjustment, etc. Moreover, it is difficult to define “success.” For example, does a successful arthroscopy mean the horse walks again? Or does it mean the horse is able to win the Derby after surgery? The concept of success rates can be even more difficult for colic surgeries. Some animals are euthanized in surgery due to poor prognosis and/or the financial constraints of the owners. Additionally, they often see colic cases that have been unsuccessfully treated elsewhere, making treatment and recovery even more difficult.

There are challenges with being a teaching hospital. Probably one of the biggest challenges is maintaining a wide variety of cases from which to teach students. Students rotate through different service areas every two weeks. Seasonal variations in caseload can make it challenging to ensure every student will see the all the different types of patients they may encounter when they enter private practice. For example, most neonatal foals come to them in late winter and spring. However, not all the students will be on the Emergency and Critical Care rotation during that time. Therefore, they may not get the chance to work with sick foals. To compensate, the faculty provide didactic course where they provide in-depth lectures about certain subjects.

The hospital operates like any business as it receives only a small percentage of their annual budget from the state. Like most businesses, they set their fees based on the cost to produce the services rendered.

It is very hard to compare the hospital at Texas A&M to private veterinary practices when it comes to pricing. For similar service and medications, they strive to set their rates similar to market prices. However, this is like comparing apples to oranges. For example, it is very difficult to compare a surgery performed at the Texas VMTH to one at a private practice. There is generally a great deal of difference in to the types of anesthesia and surgical products used, the degree of asepsis, and the amount of after care provided. Because they are a teaching hospital they always strive to provide and teach the best possible practices and these aren’t always the least expensive options. Sometimes, they are criticized for their prices being too low, especially on outpatient procedures. They do however try to make sure they are neither above nor below market pricing for similar services.

Texas A&M is located in College Station which is located in the center of a triangle from San Antonio, to Houston, to Dallas/Fort Worth. Travel time is about 1.5 hours from Houston, 1.5 hours from Austin, 2.5-3.0 hours from San Antonio, and 3.0 hours Dallas/Fort Worth.

For the final of many stories from Texas A&M the one that came to Mr. Eddleman’s mind started as a tragic barn fire. “Not long ago, in the middle of the night, a stable a few miles away from the hospital caught fire with several horses inside. The police department called the hospital to see if we could help and notified us of the potential for several burn victims. One of our LA ICU technicians was one of the first on the scene. He helped get horses out of the building and round them up. Our equine ambulatory clinician also went to scene and administered treatment to the horses. Some of the horses where too badly burned to be saved and had to be euthanized. Several required prolonged treatment at the hospital but have recovered. Because of the expense associated with prolonged treatment of these animals, several of the hospital staff took it upon themselves to develop a fundraiser to help the barn fire victims. There efforts were very successful in raising funds to help pay for treatments. I think the hospital staff and the clinicians were the real heroes of the tragedy because they did more than anyone asked of them to help these animals and their owners”.

If you are still not in awe over this cutting edge facility from these articles then you need to take it upon yourself to see it with your own two eyes. The drive you make will be well worth the experience of seeing such a facility first-hand. Heck, gather up a few “horsey” friends and make a day of it. Trust me, you won’t regret it.

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