A Visit to the Ryan Veterinary Hospital A Visit to the Ryan Veterinary Hospital
Dogs, cats, birds, reptiles, and amphibians cared for each year
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Emergency Care
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Ryan Veterinary Hospital/


Walk through the doors of the University of Pennsylvania’s Ryan Veterinary Hospital, and it becomes immediately clear this is no ordinary place. First: the bustle. Ryan Hospital is open 24/7, sees roughly 31,000 patients a year and staffs nearly 400 veterinary professionals. Also: the technology. The hospital includes a minimally invasive surgical suite, eight operating rooms, a 9,200-square-foot imaging and treatment center, and an array of high-tech devices to ensure care that is state-of-the-art. And of course some things that can’t be seen also set Ryan Hospital apart, especially the expertise of its staff, which includes board-certified professionals in every veterinary specialty.

Last semester, a team from University Communications visited Ryan Hospital, shadowing veterinary surgeons, oncologists, dentists, technicians, residents, students, and nurses, as well as clients and their beloved pets. What follows is a glance into a typical day at one of the country’s busiest veterinary hospitals, a place where the highest levels of medical expertise are matched by deeply human compassion and a recognition of the special bond people have with their animal companions.

Clinical Trials
Clinical Trials
A handful of dog owners have turned to Penn Vet with the hope that their pets, diagnosed with an aggressive form of bone cancer, might take advantage of researcher Nicola Mason’s boundary-pushing clinical trials to beat the odds.

Clinical Services/

Clinical Trials

Chasing Down Bone Cancer

Nicola Mason, an assistant professor of medicine at Penn Vet, sports a FitBit on her wrist. But to see her dashing around the corridors of Ryan Hospital, it’s hard to imagine she has trouble meeting her exercise goals.

On this day, Mason is in the thick of clinical trials designed to test a cancer vaccine. Four dogs await treatment, having traveled to Philadelphia from locales as near as Delaware and as distant as Seattle. All of their owners turned to Penn Vet with the hope that their pets, diagnosed with osteosarcoma, an aggressive form of bone cancer, might take advantage of Mason’s boundary-pushing scientific research to beat the odds and maximize their healthy lifespan.

Mason’s work exemplifies translational medicine—research that takes discoveries in the lab and applies them to treating real-world medical problems. The cancer vaccine, developed by Yvonne Paterson of Penn’s Perelman School of Medicine, uses a non-disease-causing form of the listeria bacteria, modified to express a protein found in cancer cells. The idea is to trigger an immune response specific to that protein, generating an army of white blood cells with the particular weapons they need to kill osteosarcoma. The potential benefits extend beyond the dogs in the trial; data from the canine experiments could help pave the way toward similar treatments being widely used in human cancer patients.

Nicola Mason listens carefully as Queen Sheba’s owner reviews her dog’s recent health. The Great Pyrenees and her owner make the drive from North Carolina to Philadelphia every three weeks to participate in the cancer vaccine trial.

First up for the day is Ferdinand, a 100-plus pound Rottweiler who was originally diagnosed with osteosarcoma in his right front leg in June 2012. He is part of a trial that gives the vaccine after amputating the cancerous leg to prevent the disease from spreading. On average, dogs with osteosarcoma that undergo amputation live only a year after diagnosis. Ferdinand, two years out from his diagnosis and already a ripe 10 years of age, is tumor-free and doing extraordinarily well.

Next is a black Labrador retriever named Kasey, who flew in the night before all the way from Seattle. Only 2-and-a-half years old, she is young for an osteosarcoma patient, but Mason says her youth offers an example of how a cancer vaccine might one day help children with the disease.

“If you look at osteosarcoma cells from humans and from dogs, they appear very similar, even at the level of gene expression,” Mason says. “It is difficult to tell which cells came from a human and which ones came from a dog.”

When Mason re-enters the client waiting area, the owners of Shenan, an 8-year-old Bernese Mountain Dog, greet the researcher as an old friend, offering baked goods they’ve brought as a token of their gratefulness. Mason calls Shenan “our miracle dog.” Diagnosed with metastatic osteosarcoma more than a year ago, her right foreleg was amputated and she began receiving the experimental vaccinations in late 2013.

Shenan gamely cooperates for a chest X-ray, calmed by reassurances from Meredith Taylor, a fourth-year student at Penn Vet. Radiographs can reveal whether cancer has spread from a dog’s leg to its lungs.

The final patient of the day is the imposing Queen Sheba, a 6-year-old Great Pyrenees who makes the trip up from her home in North Carolina every three weeks, often with decorative ribbons carefully tied in her ample fur. Sheba is a participant in a new trial Mason is conducting in which dogs keep their leg and receive radiation therapy before starting vaccinations.

“In these dogs, we’re trying to see if the vaccine can be effective against the primary tumors,” she says.

Serving Society and Animals

At Penn’s School of Veterinary Medicine and Ryan Hospital, faculty, staff, and students work to better understand how to make animals—and by extension, humans—healthier. This video highlights Nicola Mason’s work studying cancer, including a clinical trial in which Queen Sheba, a 6-year-old Great Pyrenees, is a participant.

All the dogs undergo thorough workups before they receive the vaccine. Kasey’s goes smoothly, but Sheba’s and Ferdinand’s treatments will be delayed due to some underlying issues. And Shenan’s lucky road has hit a bump. A few new lumps noticed by her owners are diagnosed as cancerous tumors. She receives the vaccine, but Mason encourages her owners to keep pursuing Shenan’s “bucket list,” which includes romping around wineries, basking in attention. [Editor's Note: We're sad to report that Shenan passed away after we reported this story.]

In the end, every owner who enrolls their dog in a trial at Penn Vet is motivated by a desire to help their own pet, Mason says. But they’re also driven by a larger purpose.

“The information we’re getting from the dogs is really important,” she says. “It’s telling us that the vaccine can generate an immune response against the tumor cells; it’s telling us that this treatment appears to be working and preventing tumor-forming in the lungs. The owners really like that our work might help their dog, will definitely help other dogs, and at some stage will help human patients, too. It may start off as they’re just trying to help their dog. But through this process, they become part of our team, they become invested in the process, and they become strong advocates for what we’re doing.”

Clinical Trials
Minimally Invasive Surgery
Minimally invasive surgery—which is rarely used in animal medicine—permits veterinary surgeons to operate without the need to cut or saw open a patient’s chest.

Clinical Services/

Minimally Invasive Surgery

Yeager, a 7-year-old chocolate Labrador retriever, presented to the Minimally Invasive Surgery service at Penn Vet’s Ryan Hospital in September of 2014 for chronic pericardial effusion caused by a heart tumor.

A local veterinarian referred him to Ryan Hospital after the effusion—or excess fluid around the heart—was first diagnosed in March 2013. The school’s Cardiology Service evaluated Yeager to determine the underlying cause of the effusion before sending him to specialist Jeffrey J. Runge, an assistant professor of minimally invasive surgery.

Healthy animals have a very small, thin sac surrounding their heart that should contain little to no fluid. Runge says that when excess fluid accumulates in the sac, as is the case with pericardial effusion, the heart has difficulty beating and pumping blood through the body.

“In Yeager’s situation, due to the tumor, he had an abnormally large amount of this fluid being produced,” Runge says. “We had to go in, minimally invasively, and remove this sac so the fluid wouldn’t build up.”

The minimally invasive surgical team consists of both surgeons and anesthesiologists and the operative team is made up of Runge, his assistant surgeon, two Penn Vet residents, an intern, and a student.

Before surgery, Yeager underwent a CT scan of his chest to ensure that there was no evidence of metastasizing cancer, and to assess the thickness of his heart sac. Once the veterinary professionals concluded that Yeager did not have metastatic cancer, he proceeded to surgery in Ryan Hospital’s Buerger Family Foundation Minimally Invasive Surgery Suite.

The minimally invasive surgical team consists of Runge, two surgical residents, an intern, and a student.

Heart surgery in animals is usually performed by either sawing open the sternum, the bone in the middle of the chest, or by making an incision on one size of the chest and spreading apart the ribs. Both typically require large openings. Minimally invasive surgery—which is increasingly used in human medicine but rarely in animal medicine—permits veterinary surgeons to operate without the need to cut open a patient’s chest. This causes less trauma and post-operative pain, and allows for a faster recovery and return to function.

“Veterinary minimally invasive surgery is certainly unique,” Runge says. “There are very few practices in the world that can offer this type of care for animals, especially since it requires complex operative techniques, advanced training, and equipment that is not commonly available.”

For the operation, Yeager is positioned on his back and three small ports, each the width of a pencil, are placed into his chest and positioned around his sternum. This enables Runge and his team to put small cameras and miniaturized instruments into Yeager’s chest cavity—tools that provide an adequate view and access to the heart.

“These ports allow me not only to see his lungs and heart, but enable me to manipulate the tissue as well, like cutting into the pericardial sac and suctioning out the fluid,” Runge says.

The surgery takes approximately two hours and is completed without any difficulties. Yeager is up and walking a few hours after surgery, and is able to go home three days later.

“We were very happy with the outcome of the surgery,” says Runge. “There were no complications during anesthesia or during the operative procedure itself. We were able to visualize the heart, take adequate samples for a biopsy, and remove the sac that contained the pericardial effusion.”

Buerger Family Foundation Minimally Invasive Surgery Suite

The state-of-the-art Buerger Family Foundation Minimally Invasive Surgery Suite at Penn Vet opened on Oct. 3, 2011 in Ryan Hospital. The Suite is the first of its kind in any veterinary teaching hospital, and offers a wide variety of minimally invasive surgery techniques, such as laparoscopy, endoscopy, and arthroscopy.

Jeffrey J. Runge, an assistant professor of minimally invasive surgery at Penn Vet, says the Suite is one of only a few in the world built exclusively for veterinary medicine.

“This type of operating room is designed specifically for minimally invasive surgery,” says Jeffrey J. Runge, an assistant professor of minimally invasive surgery at Penn Vet. “It allows us to have streamlined procedures. It allows me to have a lot of information in front of me at the same time. It’s ergonomically made so that I have all my equipment at my fingertips—access to the MRI, the CT scan, as well as the surgical images—as I’m doing the procedure.”

The suite was constructed with support of Connie and Alan Buerger, whose Portuguese water dog, Max, was successfully treated by surgery and oncology teams at Penn Vet.

“One of the unique features of Penn Vet is that we have incredible support from many of our pet owners, as well as friends of the University, which allows us to have equipment and an operating room just like this, which otherwise would not be attainable,” Runge says.

A Look Inside:
Videos from the Minimally Invasive Surgical Suite.
(note: surgical videos may not be appropriate for all members of the viewing community)
Videos courtesy of Jeffrey J. Runge
To prepare to remove a dog’s heart tumor, the surgeon moves a camera in and out of ports located between the animal’s ribs to position tools and view the heart socket.
A surgeon uses minimally invasive techniques to evaluate a cat with chronic liver disease. Working through the cat’s abdomen allows the doctor to take biopsies for diagnosis.
By threading both camera and tools through a single small opening, a surgeon laparoscopically snips out and removes a bulldog’s undescended testicle.
A compilation of clips from both cats and dogs demonstrates how surgeons can remove different types of bladder stones using minimally invasive procedures.
Clinical Care - Dentistry
Dentistry & Oral Surgery
Penn Vet’s Dentistry & Oral Surgery team routinely sees a mix of cats and dogs (and other animals, too) for everything from periodontal disease to fractured teeth. Chances are, there’s some degree of periodontal disease in every animal.

Clinical Services/


“You’re so cute,” Maria Soltero-Rivera says calmly, the tip of her finger nestled between the front teeth of her patient’s mouth. “You’re so handsome.”

Soltero-Rivera stands in front of Johnny, a 5-year-old, black-and-white domestic short-haired cat, who sits in a tight crouch on the exam room table. She patiently waits for him to open wide and reveal his teeth and gums.

At first, Johnny won’t budge. Then, Soltero-Rivera, a lecturer in Penn Vet’s Dentistry & Oral Surgery Department, gives him a couple of gentle pets on his head. Johnny relents and Soltero-Rivera is able to peer inside.

She confirms that Johnny has a tooth resorption, in which a tooth is destroyed by cells called odontoclasts, usually starting at the gumline. The cause for this disease is unknown, and animals can’t regenerate a tooth once it’s gone. The recommended treatment for this disease, which is both common and painful in cats, is extraction of the tooth.

“They don’t seem to miss them,” Soltero-Rivera says to the owners, both vet techs themselves.

The owners agree to surgery—which is considered elective, since Johnny is still eating without any problems. Once Johnny is anesthetized, Soltero-Rivera will remove the tooth, which can be tricky, since reabsorbed teeth are brittle and are prone to shatter. The team will also monitor Johnny especially closely and give him antibiotics intravenously because he has a heart murmur.

Cases like these are the bread and butter of the Dentistry and Oral Surgery clinicians, residents, technicians, hygienists, and students at Penn Vet’s Ryan Veterinary Hospital. The team routinely sees a mix of cats and dogs mainly for periodontal disease. Tooth fractures are also common in working dogs.

Typically, the doctors extract the teeth, and when it’s necessary consult with experts from other clinical services at Ryan Hospital, from radiology to emergency services. In Johnny’s case, clinicians in both anesthesia and cardiology had to clear him before the dental team was able to proceed with surgery.

The team has seen an increase in appointments recently, and maintains a tightly packed schedule. Appointments stretch out about two months ahead, says Brynne Schiavone, a technician with a background in small animal medicine.

“I’m surprised when we don’t do surgery,” Schiavone says.

Despite being busy, the system of patient intake, appointments, and surgeries runs like a well-oiled machine, designed to expose students on the dentistry and oral surgery rotation to all aspects of patient care. Students are the first people to meet with the clients and do a physical exam. Afterward, they present the case to the faculty doctor, nurses, and techs in a central room at Ryan—a hub of seemingly unceasing activity that is adjacent to the main waiting room at the hospital. In this environment, students outline what they saw, felt, and observed in their meeting with the patient.

"I assure you, there is some degree of periodontal disease in every animal"
-- Maria Soltero-Rivera
Lecturer in Penn Vet's Dentistry & Oral Surgery department

Lisa Fink, a third-year resident in Dentistry and Oral Surgery, says that while they attempt to streamline the process for patients and owners, they’re not meant to be a quick in-and-out clinic.

“We have a responsibility to show students and take the time,” says Fink. “There’s a body attached to the head.”

Soltero-Rivera agrees that Ryan Hospital’s unique teaching technique appeals to some clients. In each appointment, she is able to closely examine soft tissue, checking cheeks and the tongue, looking for tumors, lesions, or evidence of viruses.

“There’s a lot of quality control,” she says, “a lot of checkpoints.”

Case in point is Fink’s mid-morning patient—a friendly bichon frise, Cosmo. (This patient is named after the “Seinfeld” character because of the fluffy mess of hair atop the canine’s head.) Cosmo came into the hospital after he chased a squirrel and yelped while running. The dental consult revealed a gingival mass in the front of his mouth, as well as a fracture of an upper pre-molar.

Fink goes in for a closer look as Cosmo willingly lets her examine his teeth and gums. The owners opt for extraction of the fractured tooth, as well as a cleaning while he’s under anesthesia. Fink will also do a biopsy of the growth in the front of Cosmo’s mouth.

“We can look in any mouth and find something,” she says. “That’s a fact.”

When animals go in for a tooth extraction, they get one medicine to calm them, and then another to put them under anesthesia. This is done for both the safety of the animals as well as for the team working on a patient, says Soltero-Rivera.

During Johnny’s surgery, Soltero-Rivera, fourth-year student Michael Armour, and dental hygienist Bonnie Miller—who organized the dentistry program at Ryan 25 years ago, along with Professor Emeritus Colin Harvey—are outfitted in scrubs, masks, and gloves. Dental surgery is clean, but not sterile, so procedures are done in rooms adjacent to the anesthesia and surgery prep suite.

Miller explains that the tooth is split into two sections so Soltero-Rivera can remove one root at a time, being careful to get every bit of the brittle tooth. Once it is removed, they stitch up the wound, and Armour cuts the suture.

“I assure you, there is some degree of periodontal disease in every animal,” says Soltero-Rivera.

Maria Soltero-Rivera, a lecturer at Penn Vet, performs tooth resorption surgery on Johnny, a five-year-old domestic cat.
Comprehensive Cancer Care
Comprehensive Cancer Care
Penn Vet’s Comprehensive Cancer Care program is structured to foster interdisciplinary and sometimes serendipitous collaborations that reflect the multilayered nature of cancer.

Clinical Services/

Comprehensive Cancer Care

As Erika Krick, assistant professor of oncology, shuffles through the halls of Penn Vet’s Ryan Hospital juggling paperwork in one arm and a crated cat in the other, she stops in her tracks when she notices a colleague with a familiar feline in hand.

“Is that Tiger? Has she been prepped for radiology yet?” Krick says, peering into the crate at the bashful tabby. The colleague nods, and the two exchange updates about the cat’s medical record. Krick then readjusts her cargo, scoops up Tiger, and personally delivers each cat to their destinations.

Such encounters, in fact, are not happenstance—they’re by design. In contrast to traditional veterinary oncology departments, which often silo services by specialty, Penn Vet’s Comprehensive Cancer Care program is structured to foster interdisciplinary and sometimes serendipitous collaborations that reflect the multilayered nature of cancer.

“We have a very integrated approach so that we’re part of the process from diagnosis, to staging, to supportive care, to end-of-life decisions,” says Krick, co-director of the Comprehensive Cancer Care program. “We’re all behind the scenes working together, talking about cases in rounds, and listening carefully to patients and their owners so that we can make sure they talk to the exact person they need to talk to.”

When patients first arrive at Penn Vet, they’re evaluated by a member of the program’s core team, who assesses the patient’s medical background, history, and previous care record. The veterinarian collaborates with fellow team members to determine a diagnostic and treatment strategy customized for each patient.

“With cancer, it is often the case that surgery is not enough,” says Karin Sorenmo, a professor of oncology. “Most of the patients that come in need more than one treatment modality. Some patients need radiation, chemotherapy—sometimes they need everything. The advantage with the Comprehensive program is that we’re all here having those important discussions as part of a team, as opposed to in fragments.”

The program is composed of four core services: medical oncology, surgical oncology, radiation oncology, and interventional radiology. It’s supplemented with additional clinical resources such as anesthesia, critical care, nutrition, and grief support.

“It makes everything a lot more streamlined and less stressful for patients because they get multiple doctors involved in evaluating their pet—not just one,” Krick says.

“We have a very integrated approach so that we’re part of the process from diagnosis, to staging, to supportive care, to end-of-life decisions.”
-- Erika Krick
Assistant Professor of Oncology
School of Veterinary Medicine

In the case of Tiger—a 5-year-old tabby currently in remission of lymphoma—she’s been cared for by nearly 30 providers since her diagnosis in January 2013. On this particular visit, she’s at Ryan for a three-month checkup fresh off of a successful 15-month course of chemotherapy treatments.

“The quality of care has been just phenomenal,” says her owner Joan Janusz, who over the years has made numerous trips with her husband John from their hometown of New Egypt, N.J. to treat family pets at Penn Vet. “There’s expertise here that you’re just not going to get anywhere else. And expertise aside, Dr. Krick and the team have been amazing about follow-ups, about personability, and about accessibility. We feel comfortable, and Tiger feels comfortable.”

The program’s comprehensive nature holds value beyond the lives of current patients like Tiger. It broadens the scope of oncology research to include unique, cross-disciplinary perspectives—an important goal in supporting Penn Vet’s “One Health” initiative, which underscores the concept that human, animal, and environmental health are intertwined.

“We’re suddenly able to expand research topics because we have, say, a surgeon’s perspective at the same time we have a medical oncologist’s perspective,” Krick says. “Ultimately, that’s going to allow us to investigate new topics as a group, and eventually, advance fields.”

Renal Care and Transplation
Renal Care and Transplantation
Penn Vet’s Ryan Hospital is one of a handful in the country that perform hemodialysis on animals. It’s expertise that has drawn patients to fly in from as far as Dubai.

Clinical Services/

Renal Care and Transplantation

Properly functioning kidneys purify blood by cleaning out invaders like excess fluid, salts, and foreign toxins. They produce hormones that keep bones strong and blood healthy, and properly balance blood pressure by maintaining optimal levels of potassium and sodium. But when the kidneys aren’t working properly, waste accumulates in fatal amounts, causing both humans and animals to experience a lack of appetite, lethargy, vomiting, diarrhea, and overall misery.

When a person develops chronic kidney disease, or when a mischievous canine accidentally ingests a bottle’s worth of ibuprofen, doctors can perform hemodialysis, a process that allows blood to flow through a dialyzer—an artificial kidney—to extract excess wastes and fluids.

But unlike in human medicine, there are few hospitals in the country that perform hemodialysis on animals. And there’s only one that offers a Nephrology program complete with dialysis and minimally invasive renal transplantation for those with chronic kidney failure: Penn Vet’s Ryan Hospital. It’s expertise that has prompted patients to fly in from as far as Dubai in the Middle East.

“Normally, the kidneys get rid of the normal byproducts of metabolism we accumulate simply by being alive,” says JD Foster, a staff veterinarian and director of the hemodialysis and extracorporeal therapy program at Penn Vet. “This process simply helps to remove hundreds of those toxins for kidneys that aren’t working anymore. But dialysis is not like riding a bike. You’ll face new problems with each patient, and really with each treatment, so unless [a hospital] is doing it often like we are, it’s hard to be proficient.”

It’s a meticulous process from start to finish. The workspace is sanitized, the extracorporeal circuits—or bloodlines—are flushed with saline to clear air bubbles that could cause potential clotting, and the dialyzer is calibrated with a prescription unique to each patient’s case. Patients are fitted with a catheter at the neck, which is then connected to the dialyzer via the extracorporeal circuits. Over the course of several hours, blood flows through tiny straw-like tubes with pores that dissolve the toxins and flush out the patient’s system.

At Ryan Hospital, Foster says he sees more cats than dogs as dialysis patients, likely because of Penn Vet’s in-house transplant program, as well as the hospital’s urban setting. He explains the difficulties in performing hemodialysis on small patients.

“We’re about to process [the animal’s] entire blood volume over and over,” Foster says. “It’s challenging because animals like cats can be so small, but we need to flow their blood through this machine designed for humans at probably 50 miles a minute, which is pretty quick. With a catheter flowing at maximum capacity, if a cat wiggles, or turns their neck, or even blinks too hard, their catheter will kink, and there are various measures we have to take to fix that.”

Foster says most patients at Penn Vet are treated for acute kidney injury, which requires two to three treatments per week for as many as four weeks, and sometimes longer. It’s an expensive and involved process, but it’s one Foster says pet owners are increasingly willing to do—especially since it’s often a final lifeline for patients.

“When kidneys shut down, it’s a poor prognosis,” Foster says. “And if they’re bad enough that they need dialysis, it’s about a 50 percent survival rate, which sounds horrible. But when you think about it, every single patient that we treat has absolutely failed regular therapy and would have died. Yes, there are sad cases, but we take half of those patients, send them home, and they get to on and live really good lives. And that’s fantastic to be able to do.”

Feline Renal Transplant Program

Having seen approximately 150 cases, Penn Vet’s Feline Renal Transplant Program is the busiest in the country, and the only program offered in conjunction with dialysis treatment. Lillian Aronson, founder and coordinator of the program, selects potential donor cats through a unique collaboration with the SPCA in York, Pa. Cats can accept a kidney from an unrelated feline, as long as they have the same blood type and are cross-match compatible. Following transplantation, clients are responsible for adopting the donor cat and giving them a good home. By rescuing them from potential euthanasia at the shelter, Penn Vet gives these friendly felines a new lease on life, and they, in turn, do the same for the cats in need of a kidney.

Matthew J. Ryan Hospital for Companion Animals

3900 Spruce Street
Philadelphia, PA 19104
(215) 746-8387