Behind the Scenes at the New Bolton Center

Before 2006, the University of Pennsylvania's New Bolton Center (NBC, formally the George D. Widener Hospital for Large Animals) was just one on a list of well-respected large-animal veterinary teaching hospitals in the United States.

And then came Barbaro.

The Thoroughbred racehorse and Kentucky Derby winner broke down that May during the Preakness Stakes in Maryland. He was transported to the Kennett Square, Pa., facility for emergency surgery and months of intensive care.

During his time at NBC, Barbaro amassed a global following of supporters, who left fan letters and care packages at the normally quiet, bucolic campus. Barbaro's veterinary team and the NBC itself became mainstream-media regulars during the horse's eight-month battle for survival. Laminitis finally forced Barbaro's euthanasia in January 2007.

Lion at NBC

NBC veterinarians have been called in to help treat large animal exotic cases, such as a lion from the Philadelphia Zoo.

Barbaro thrust NBC into the limelight, but in truth his was one among many such cases that this busy hospital sees every year. Even experienced horse owners might be surprised to learn the breadth and depth of the NBC caseload. At a lecture during the Dressage at Devon show, which took place Sept. 25-30 in Devon, Pa., Chelsey Miller, DVM, a resident in veterinary ophthalmology at NBC, gave her audience an exclusive look behind the scenes.

Not Just Equines

Most of the patients at NBC are horses, but this large animal hospital, situated not far from Pennsylvania Dutch country, sees its share of other species, too. The veterinary staff also care for ill and injured dairy cows, beef cattle, swine, goats, sheep, alpacas, and more. There's even the occasional exotic animal, such as a camel or an emu chick with a fractured tibia, Miller said. Most exotics are treated at the University of Pennsylvania's Mathew J. Ryan Veterinary Hospital, NBC's sister small animal facility in Philadelphia. But NBC veterinarians have been called in to help treat large animal exotic cases, such as a lion from the Philadelphia Zoo, Miller said.

NBC is not just a hospital; it's home to a variety of large animals, as well. Nearly 400 cows and calves live at the Marshak Dairy, a working "teaching dairy." The campus also houses a herd of semi-feral ponies, who are an invaluable study resource for veterinary and equine behavior researchers.

The Facilities

Like many large animal hospitals, NBC has the equipment for virtually every kind of diagnosis, treatment, and rehab--from ultrasound and radiograph machines to surgical facilities and a neonatal intensive care unit. But NBC is home to a few additional features that benefit patients with varying conditions.

For example, not all fractures are easily detected via radiograph. Miller explained that veterinarians best diagnose pelvic fractures using nuclear scintigraphy (bone scan), in which an injected radio isotope travels to areas of active bone metabolism. These "hot spots" indicate areas of trauma.

In most post-surgery cases, anesthetized horses wake up in padded stalls. A horse coming out of surgery to repair, say, a severe fracture (think Barbaro), however, is placed in a special raft in a pool. The water slows his movements, and there are no walls or floor for him to hurt himself against. A tense, critical moment during recovery is when the conscious, blindfolded horse is hoisted out of the pool using a special sling.

Neonatal ICU at NBC

NBC's neonatal ICU helps sick or injured foals on their road to recovery.

And a high-speed treadmill isn't your average "horse walker." NBC's model can be turned up to full-gallop speed for use with a heart monitor and/or cardiac ultrasound to detect heart trouble, or with an endoscope to check for airway problems. Surprisingly, almost all horses quickly learn to use the treadmill, Miller said.

The NBC staff points proudly to its James M. Moran Jr. Critical Care Center, which Miller called "the most advanced for biosecurity in the country." The center, which opened in 2010, is essentially a dual-purpose emergency wing: one side for colic cases, the other an isolation unit. With 1,200 emergency admissions at NBC per year, most of which are for colic or diarrhea, this facility is key to preventing disease spread. The heightened biosecurity measures also make sense in light of a 2004 outbreak of multi-drug-resistant Salmonella that forced NBC's Widener Hospital to close for nearly three months.

Another unit, the Moran Center, contains 10 isolation stalls and 14 colic stalls. The design, materials, ingress/egress procedures, and more help ensure that diseased or susceptible patients do not come into contact with others.

The latest addition to the NBC campus is the Equine Performance Evaluation Facility. Currently in the initial phase of development, the facility will feature an indoor riding arena, an exterior longeing area, and a hard-surface trot-up track. (Currently there is no covered space for evaluating sport horses in hand or under saddle.) A second phase will include stalls, a procedure area, a new farrier shop, and a conference room, according to NBC literature.

Human Resources

With a "very varied caseload," approximately 30% of which are "very unusual," said Miller, a facility like NBC needs a broad spectrum of top veterinary experts. Currently NBC's best known staff member is leading large animal surgeon Dean Richardson, DVM, who operated on Barbaro and treated him during his NBC stay. But Richardson's colleagues are distinguished in their own right: Miller points to Amy Johnson, DVM, "the only vet in the country with both internal medicine and neurology board certification," as one example.

Just as most of us would rather recuperate from an injury or illness at home than in a hospital bed, animals also tend to be happier and more relaxed in their home environment. To that end, NBC pioneered its "visiting nurse" program, Equi-Assist, to help owners whose horses are recovering at home and need a bit more than standard TLC but not hospital-level care. Certified veterinary technicians provide skilled nursing care and serve as liaisons among the members of the horse's health-care team.

At the Forefront

According to Miller, NBC holds the top spot among U.S. large-animal hospitals for caseload numbers and treatment of equine orthopedic disease. It's why the likes of Barbaro and other celebrity clients continue to make the trip to Kennett Square for treatment.

Although no horse lover wants to see an animal in trouble, high-profile cases such as Barbaro's do have the effect of focusing attention on those ailments. Post-Barbaro, NBC and the rest of the equine-veterinary world saw more funding for laminitis research, Miller said. Should a breakthrough in laminitis treatment be discovered, NBC will surely be among the earliest adopters.

Disclaimer: Seek the advice of a qualified veterinarian before proceeding with any diagnosis, treatment, or therapy.

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