The draw of internal medicine at Penn Vet

Janet Blatchley has a tight bond with her horse, Milena. Their relationship is as close as any human connection, so Blatchley noticed subtle signs that the 12-year-old Friesian "just wasn't herself." Her feistiness was gone, and her appetite diminished.

"We had an appointment at New Bolton Center for a checkup," says Blatchley. "But two days before it, Milena fainted in her stall. All bets were off-we went immediately."

Milena arrived at New Bolton Center with slight balance issues and rapid breathing. Her clinical team, led by Joy Tomlinson, assistant professor of large animal medicine at Penn's School of Veterinary Medicine, conducted comprehensive diagnostics on the horse's heart, liver, and lungs.

Tests showed Milena had likely collapsed from a cardiac arrhythmia. Immediate intervention by the cardiology team was able to correct the arrhythmia. Structural abnormalities and pulmonary hypertension were ruled out, so the team looked for a source of inflammation that might have caused the arrhythmia. Bloodwork showed the liver enzymes were abnormal, and a liver biopsy showed an accumulation of protein and severe inflammation, likely caused by an immune response triggered by inflammation elsewhere in the body. The most revealing clue to Milena's condition lay in her lungs.

Milena represents why Tomlinson and her colleague, Daniela Luethy, assistant professor of large animal medicine, work in internal medicine at New Bolton Center.

"Milena's case is a great example of how all the body systems interact," says Tomlinson. "Disease in one system-in this case, her lungs-can lead to disease in other organs like her heart and liver. This is why comprehensive examinations and diagnostics are so important to find the correct diagnosis and institute appropriate care, and the interconnection is what interests me about internal medicine."

"In internal medicine, we see many different diseases across this spectrum of animals, from gastroenterology to oncology to infectious disease," says Luethy. "It's this broad variety of cases that I find appealing. We see one of the highest caseloads of any academic, veterinary health care institution, which allows us to push boundaries in ways we might not otherwise."

Tomlinson added that the caseload combined with an infrastructure that includes advanced diagnostic equipment and clinical staff and faculty in several specialties-among them neurology, ophthalmology, neonatology, cardiology, surgery, and radiology-makes New Bolton Center a special place to practice.

"It's a tremendous advantage to have so many specialties on-site, both as separate services for clients and for consultation on our cases," says Tomlinson. "Milena's care shows how internal medicine and specialty sections, including ultrasound and cardiology, diagnostic pathology, and radiology, work together to provide the most efficient information and the highest level of care for a patient."

This article is by Sacha Adorno. Read more at Penn Vet's Bellwether Magazine.