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The Cornell University Hospital for Animals in Ithaca, N.Y., is synonymous with innovation in veterinary medicine. But sometimes it doesn’t take the form one might expect.

Yes, the hospital - which is run in conjunction with the nation’s top-rated veterinary school - has a new 16-slice CT scanner and is awaiting delivery on a new MRI unit. Every day, researchers pursue advances in cardiology, orthopedics, anesthesia, etc. But innovation can come from the unlikeliest of places, such as the combination of existing therapies or drugs. It’s a multimodal approach to veterinary medicine, and it’s often just as significant - if not more so - than cutting-edge technology. That’s the opinion of William Horne, DVM, PhD, who assumed the directorship of the hospital in July 2009.

After completing a residency in anesthesiology and then a doctorate in pharmacology at Cornell in the 1980s, Horne accepted a faculty position for three years in Cornell’s Department of Pharmacology at the College of Veterinary Medicine. Since then, he has done a number of what some would consider “out-of-the-box” things, including joining a startup company, for which he helped develop new classes of analgesic agents that target neuron-specific calcium channels; anesthetizing polar bears, elephants, walruses and gorillas in the wild and at zoos in Africa and the United States; and serving on the clinical faculty at North Carolina State and the biomedical sciences faculty at Colorado State.

His research involving the molecular mechanisms of heart disease helped earn him the National Institutes of Health Physician Scientist Award in 1984. He was one of the first veterinarians to win the award. Since then he has focused his research efforts on the molecular mechanisms of pain. He returned to Cornell in June 2006 as professor of anesthesiology. Today, as hospital director, he maintains his research lab while leading all the functions of the hospital.

Pain management
Horne traces his interest in molecular mechanisms of disease back many years. “As residents, we used to anesthetize a lot of dogs with GDVs [gastric dilatation and volvulus, a condition in which the stomach becomes bloated and then twisted]. They were anesthesia nightmares.” He decided to study the cardiovascular consequences of the GDV. “My frustration was, after getting them through the tough anesthesia, they would develop heart arrthymias three days later, and die. I wanted to know why, and was there anything I could do about it.” That question led to years of research on calcium channels and calcium channel blockers, which continues today.

In fact, it was around the time of his residency that the first calcium channel blockers hit the market. Although initially used to treat myocardial ischemia [restriction in blood supply], they also proved to be effective in treating a number of cardiovascular disorders. (Since then, a new class of calcium channel blockers has been discovered that can be used to manage pain. Though restricted to use in humans at the moment, the hope is that these drugs will soon be available for animals.)

As more knowledge was gained about molecular changes in the body, Horne and others came to recognize the value of taking a multimodal approach to pain management. “A better understanding of the physiology associated with pain has led to many advances,” he continues. Today’s veterinarians have a multitude of tools - used singly or in conjunction with others - to manage perioperative, post-operative and chronic pain. Those tools include standard opiates, calcium channel blockers, local anesthetics, nerve blocks, NMDA (N-methyl-D-aspartate) receptor blockers and alpha-2 agonists.

“The biggest thing we’ve learned in minimizing post-operative pain is the importance of getting in there pre-emptively with opiates or NMDA antagonists and some of the new Cox 2 inhibitors [non-steroidal, anti-inflammatory drugs],” he says.

“The profession as a whole has become much more aware of the needs of our patients in the area of pain relief,” he says. “A lot of the pain management service is devoted not just to surgical patients, but to chronic cancer patients - to provide a better quality of life following a cancer diagnosis. It’s to the patient’s benefit and the owner’s benefit too.”

In fact, part of the change sweeping the veterinary profession today is the recognition and acceptance of the importance to human health of the human/animal bond. “That’s one of our biggest responsibilities - to enhance and protect [the bond],” he says. “When I first got out of vet school, we didn’t talk about it. We developed a relationship primarily with the patient without taking the client’s needs into account. But over the years, studies have shown there’s much more to it than that. Fifty percent of pet owners consider their pets part of the family. The recognition of that by veterinarians has led to new therapies that are directed toward extending animals’ lives, not just for animals’ sake, but their owners’ sake too.”

Broader view of mission
Indeed, in many ways, Horne sees his task as broadening the mission of the hospital and those in it. That’s where he sees much innovation occurring. “We do stem cell therapy here, and some people look at that as clinical innovation,” he says. “But to me, the merger of pain management and neurology as a single unit is also clinical innovation.”

Being part of Cornell University affords many opportunities to merge disciplines for innovation. For example, the animal hospital is working with the school’s engineering department to study bone fabrication. Another area in which Horne hopes to drive innovation is that of nutrition. At the moment, he is trying to integrate the efforts of a clinical nutritionist into the veterinary medical program.

Along those same lines, he speaks of an innovation that was introduced by one of the hospital’s senior technicians, who created a flow sheet for patients brought into the ICU. In addition to all the questions that are asked, she added the category “nutritional information.”

“Just having that on paper, so the students and residents see it, elevates the importance of nutrition,” says Horne. Educating hospital staff and pet owners about nutrition can lead to quicker recoveries. “That’s what I mean by clinical innovation - looking at the whole process of treating the animal and [interacting with] the client. It leads to better education all around.”

The economics factor
Because Cornell is on the forefront of developing vaccines, doctors there see fewer infectious diseases than they did, say, 10 years ago, says Horne. “New diseases do come up, new viruses appear; but fortunately, not to the extent that they used to.”

However, economics - as well as the human/animal bond - is driving bigger changes in the profession than new diseases, he says. Conditions such as congestive heart failure, cataracts, hip dysplasia and cancer may not be occurring more frequently than in the past. But owners’ willingness to treat them is growing. That, in turn, is driving technological innovation, including advances in ultrasound, fluoroscopy and pharmaceuticals, such as inodilators, which can increase the ability of the heart to contract, with fewer side effects than previous-generation drugs.

But economics are intervening. “Clients are bringing in their animals, and we’re seeing them,” says Horne. “But many of them can’t afford treatment.” In the most extreme cases, they are choosing euthanasia. Similar choices are being made with production animals just as they are with pets, he says. This past summer, the falling price of milk hit the dairy farmers in Upstate New York particularly hard.

No doubt students notice the effect that the economy is having on veterinary care. Anxious that they take that sensitivity with them into the professional world, Horne is bringing financial accountability for the hospital’s programs down to the section level, so that faculty and residents both can see the economic impact of the decisions they make every day. “With that exposure, and by developing courses to help them, they’ll come out of here with a better business sense. And there’s no better time for that than now, when we’re in a national economic crisis.”

The future for today’s students
Indeed, economics as well as science will affect the veterinarians who graduate from Cornell. Those who want to pursue a career working with production animals may sense the change the most. The family farm has, in many cases, succumbed to large production facilities, whose owners are much more savvy dealing with disease than ever before. And those owners are making decisions about veterinary care that are directly related to their revenues. James Herriot-type veterinary care has given way to broad, population-based medicine. “That’s the trend, and I think it will continue,” says Horne.

Yet the need for veterinarians to serve production animals continues to grow. In fact, Cornell University College of Veterinary Medicine has made a commitment to increase its class size by 30 students per year, with 50 percent of the growth dedicated to preparing veterinarians with an interest in food animal medicine. (The Class of 2013 is 92 students.)

Specialties also continue to grow in popularity, says Horne. Anesthesiology, surgery, radiology, ophthalmology, dermatology and cardiology continue to attract attention from students. “With the growth of specialty practices in places like New York City, the demand is there,” he says.

Even so, there doesn’t appear to be any shortage of young veterinarians willing to pursue general practice. “It will always be there,” says Horne. Because of technology, general-practice vets can do so many more things today than their predecessors could, he says. And that certainly is a magnet. But perhaps an even bigger one is the opportunity to help strengthen the human/animal bond about which Horne speaks so often. “People thrive on that,” he says. “And veterinarians still have that fire. They want to make a difference.”

Sidebar

Cornell University Hospital for Animals

Opened in 1996, the Cornell University Hospital for Animals is comprised of three inpatient facilities: Companion Animal Hospital, Equine Hospital and Farm Animal Hospital. Through its Ambulatory and Production Medicine Service, the hospital treats animals on farms within 30 miles of Ithaca.

Companion Animal Hospital
More than 18,500 dogs, cats, birds and other small mammals receive health and medical care each year at the Companion Animal Hospital. Veterinary students in the third and fourth year of their DVM program, assisted by veterinary technicians and supervised by faculty veterinarians, examine and treat companion animals during scheduled appointments.
Many patients in the Companion Animal Hospital have been referred by their veterinarians for evaluation by a Cornell faculty specialist. Specialty services include: anesthesiology, behavioral medicine diagnosis and treatment (behavior modification, medication, etc.), cardiology (including implantation of pacemakers and repair of cardiac defects), dentistry diagnosis and treatment, dermatology, emergency medicine and critical care, internal medicine diagnosis and treatment, diagnostic imaging, neurology and pain management (including neurosurgery), oncology (including radiation therapy, chemotherapy, surgery), ophthalmology, advanced soft-tissue and orthopedic surgery), theriogenology (all aspects of reproductive health), and wildlife and exotic animal medicine.

Equine Hospital
Approximately 2,500 horses receive healthcare each year in Cornell’s Equine Hospital. An additional 2,000 horses are cared for each year by the ambulatory and production medicine service, whose staff travels to area farms and ranches. In addition to the treatment of individual patients, the Equine Hospital also investigates herd outbreaks to diagnose, treat and prevent disease.
Specialty services include many of those provided by the Companion Animal Hospital, in addition to equine performance testing (e.g., gait analysis, orthopedic problems and identification of respiratory obstruction); and farrier services.

Farm Animal Hospital
Approximately 1,000 farm animals - cattle, sheep, goats, swine, llamas, etc. - receive health and medical care at the Farm Hospital annually. Ambulatory and Production Animal Medicine Veterinarians visit more than 400 farms in a 30-mile radius of Ithaca each year to provide care for more than 37,000 cattle, 1,650 sheep, 400 goats, 350 swine, and 200 llamas and alpacas. In addition to the treatment of individual patients, the Farm Animal Hospital staff investigate herd outbreaks. Specialty services include many of those listed above.

Clinical residency programs
Cornell University Hospital for Animals offers clinical residency programs in:

• Ambulatory Medicine (minimum 2 years).
• Anatomic Pathology (3 years).
• Anesthesiology (minimum 2 years).
• Animal Behavior (minimum 2 years).
• Avian, Exotic (minimum 2 years).
• Cardiology (minimum 3 years).
• Dermatology (minimum 2 years).
• Diagnostic Imaging (minimum 3 years).
• Large Animal Medicine (minimum 3 years).
• Large Animal Surgery (minimum 3 years).
• Medical Oncology (minimum 3 years).
• Neurology (minimum 2 years).
• Ophthalmology (minimum 3 years).
• Radiation Oncology (minimum 3 years).
• Shelter Medicine (minimum 3 years).
• Small Animal Medicine (minimum 2 years).
• Small Animal Surgery (minimum 3 years).
• Theriogenology (2 or 3 years).
• Zoo and Wildlife Pathology (3 years).
• Zoological Medicine (minimum 3 years).