Large Animal Ultrasound-Only Program

The Large Animal Ultrasound Service at the Cummings School of Veterinary Medicine at Tufts University is pleased to offer ultrasound-only exams and consultation for your equine patients. The ultrasound service offers musculoskeletal, abdominal, thoracic, and ultrasound-guided procedures and cardiac exams that are based upon your clinical findings and work-up. After our assessment is complete, we will discuss the ultrasound findings with you directly so that you may lead all follow-up treatment plans with your clients. As always, we welcome you to accompany your client and patient during their examination.

We pride ourselves on a collaborative approach to diagnosis and treatment, working hard to ensure you and your clients receive exceptional value from our joint partnership. We offer:

  • Specialized expertise in ultrasound
  • A thorough examination, comparison to contralateral leg, and extensive documentation
  • A collaborative clinical approach
  • Exceptional value for your clients

A routine musculoskeletal examination with appointment fee included is $420, with an additional fee for sedation if necessary.

A recheck musculoskeletal examination with appointment fee included is $212, with an additional fee (of $48) for sedation if necessary.

To book an appointment, contact Large Animal Ultrasound Liaison, Erin Synnott at 508-948-7695.

Our ultrasonographers have received advanced training in the fellowships offered at University of Pennsylvania New Bolton Center under Dr. Virginia Reef and at University of California Davis under Dr. Mary Beth Whitcomb. Together, our doctors have more than 21 years of experience in all facets of diagnostics.

Dr. Wade Tenney
Following his Large Animal Ultrasound Fellowship at the University of California Davis in 2005-2006, Dr. 
Wade Tenney worked at Steinbeck Country Equine 
Clinic, a large referral hospital on California’s 
central coast. During
 this time, he focused primarily on sport horse medicine, including pre-purchase exams, lameness exams, and ultrasound. He worked at the HITS horse show series in Thermal, CA during the winters from 2008-2012, providing sports medicine services to clients attending the shows. In April of 2013, Dr. Tenney joined the Tufts Hospital for Large Animals at the Cummings School of Veterinary Medicine, where he works closely with the Sports Medicine, Internal Medicine, and General Surgery departments, providing diagnostic ultrasound services.

Dr. Tenney made his inaugural trip to Wellington to perform ultrasound consultations in the winter of 2013, and will again be offering ultrasound services for equine patients at the 2014-2015 Winter Equestrian Festival.

Dr. Kate Chope
Dr. Kate Chope brings a strong expertise in clinical ultrasound use to her work as a Clinical Assistant Professor at Tufts Hospital for Large Animals at the Cummings School of Veterinary Medicine. Prior to joining the faculty at Tufts, Dr. Chope earned her bachelor’s degree from Brown University and her Veterinary Medical Doctorate from the University of Pennsylvania, where she also undertook a fellowship in equine cardiology and served as an academic lecturer. Dr. Chope is one of the few academically trained veterinary ultrasonographers who specialize exclusively in large animal ultrasound, and she appreciates the access to state-of-the-art ultrasound equipment that Tufts Hospital for Large Animals provides.

Dr. Chope loves a challenge, and especially enjoys working with clients to make a confirmed diagnosis in complicated lameness and internal medicine cases. Since joining the faculty in 2003, Dr. Chope has lectured at both national and international equine conferences, including meetings in France and Colombia, and also provides continuing education, lectures and teaches wet labs to her colleagues throughout the Northeast.

 

Meet the HLA Teams

General Diagnostic and Surgical Service
LAX Group 002 C(L-R: Dr. Thomas Jenei, Dr. Amanda Bergren, veterinary technician Katie Calicchio, Dr. Deanna Gazzerro and Dr. Carl Kirker-Head.)

Board certified surgeons, Dr. Thomas Jenei and Dr. Carl Kirker-Head, lead the General Diagnostic and Surgical Service, which oversees many varieties of cases and offers all types of diagnostic procedures—from nerve blocks to tissue biopsy to CT and MRI—as well as performs surgery. This includes procedures required for horses, camelids, and farm animals, including orthopedic surgery, lameness, wound repair, septic joint management, gastrointestinal surgery, and urogenital procedures. A podiatry specialty medicine and surgery service is also provided by Dr. Kirker-Head, who works in collaboration with farriers in the region, and Dr. Bryan Fraley from Hagyard Equine Medical Institute.

All surgery is performed by the faculty surgeon, with assistance of a surgical house officer who is also a graduate veterinarian. Caregivers include a knowledgeable team of technicians, senior veterinary students, house officers, and attending faculty. Using this team approach Tufts Hospital for Large Animals at Cummings School of Veterinary Medicine is able to provide 24-hour quality care.

Internal Medicine Service
int mED 002 a
(L-R: Veterinary technician Emily von Gal, Dr. Melissa Mazan, Dr. Daniela Bedenice, Dr. Nicholas Frank, Dr. Mary Rose Paradis and veterinary technician Maggie Underwood.)

The Internal Medicine Service works hand-in-hand with board certified, on-site radiologists, pathologists, ophthalmologists, cardiologists, and dermatologists to offer the best possible care under one roof in diagnostics, therapeutics, and intensive care management for large animals. Dr. Mary Rose Paradis, Dr. Daniela Bedenice, Dr. Melissa Mazan, and Dr. Nick Frank run this service, and are all board certified in Internal Medicine. In addition, Dr. Bedenice is the only board-certified specialist in Large Animal Emergency and Critical Care in New England. Patient care is enhanced by the help of the hospital’s outstanding technical staff and the Cummings School of Veterinary Medicine at Tufts University’s eager, knowledgeable, and compassionate students.

Tufts Hospital for Large Animals offers 24-hour service for emergencies; and when routine diagnostics and treatments have not solved an animal’s problem, the clinicians’ expertise, sophisticated diagnostics, imaging, and cutting-edge therapeutics are available by appointment.

Equine Sports Medicine and Surgical Service
SMED HLA 001(L-R: Veterinary assistant Laurie Gendron, veterinary technician Darlene Staplins, Dr. José Garcia-Lopez, veterinary technician Kelly McMahon and Dr. Kirstin Bubeck.)

The Equine Sports Medicine and Surgical Service is operated by two clinicians, Dr. José M. García-López and Dr. Kirstin Bubeck, both Diplomates of the American College of Veterinary Surgeons (ACVS) and American College of Veterinary Sports Medicine and Rehabilitation (ACVSMR).

The service focuses on offering the evaluation and management of conditions affecting the performance of equine athletes, including lameness examination, advanced imaging (Nuclear Medicine, MRI, and CT), orthopedic surgery (including arthroscopy and fracture repair), and upper respiratory evaluation (resting and dynamic endoscopy) and surgery (tie back, tie forward, DDSP, etc.).

The Equine Sports Medicine and Surgical Service prides itself on its fast-track outpatient and inpatient appointments for sport horse medicine and surgery. This new division operates closely with the Ultrasound Service, and consultations with the Diagnostic Imaging, Internal Medicine, Cardiology, Dermatology, Ophthalmology, and Theriogenology services are also coordinated.

Ultrasound Service
Pick 003
(L-R: Dr. Wade Tenney, Dr. Kate Chope and veterinary assistant Erin Synnott.)

The newly re-established Ultrasound Service is led by Dr. Wade Tenney and Dr. Kate Chope, and supports all Tufts Hospital for Large Animals at Cummings School of Veterinary Medicine services and referring veterinarians in the region. Service includes imaging with the most recently developed Toshiba APL10 300 Ultrasound Imaging System, ultrasound-guided biopsy, tendon and joint imaging, and intra-lesional injection of stem cells.

“Ultrasound-only” appointments allow the clinicians to work directly with referrers as a team of health care providers for patients. This program applies to cases that have already been worked up and require an ultrasound of a specific area of interest. The patients are admitted directly to ultrasound for in-and-out appointments. Following the exam, the results are relayed directly to referring veterinarians so that they, combined with the clients, can decide on the best course of action for the patient.

Innovation

THE USE OF COMPUTED TOMOGRAPHY IN THE DIAGNOSIS OF SEPTIC ARTHRITIS/OSTEOMYELITIS IN THE NEONATAL FOAL
Mary Rose Paradis*, Mauricio Solano*, Amy Tidwellᵠ , Louise MarandaŦ; *Cummings School of Veterinary Medicine at Tufts University, N. Grafton, MA, ᵠ Private practice;Ŧ UMass Medical School, Worcester, MA

Septic arthritis/osteomyelitis is a recognized sequela to bacteremia (bacteria in the bloodstream) in the neonatal foal. It manifests as lameness with increased joint effusion. Historically, a diagnosis of osteomyelitis is made by radiographic examination of the suspected joint or growth plate, but radiographic evidence of osteomyelitis often lags behind the clinical signs. The hypothesis of this study was that computer tomography (CT) would detect bone lesions earlier and more reliably than radiography in the neonatal foal. Twenty foals between the ages of 8 hours to 36 days were presented to the hospital with lameness secondary to septic arthritis/osteomyelitis during the foaling seasons of 2002 -2006. Clinical information was collected for each foal. A total of 54 joints (34 clinically affected and 20 normal) were evaluated by radiographs and CT.  Foals enrolled in the study had radiographs and CT of the affected joint and contralateral normal joint within 5 days of each procedure (mean =1 day). The images were evaluated by 2 board certified radiologists (individually and blinded) for the presence of osteomyelitis. Descriptions of the lesions were noted. It was found that investigators were more likely to agree on the presence of osteomyelitis from CT on normal and abnormal joints (Kappa 1 and 0.86 respectively) than normal and abnormal radiographs (Kappa 0.714 and 0.476.). CT was 1.7 times more likely to detect osteomyelitis than radiography. Our conclusion was that osteomyelitis lesions in foals with septic arthritis are more likely to be seen earlier with the use of CT than radiographs. This could have an effect on both the treatment choices and prognosis for affected foals.

Clinicians and Staff

Mary Rose Paradis

Mary Rose Paradis, DVM, MS, Diplomate ACVIM(LAIM)

Mary Rose Paradis is a 1978 graduate of the School of Veterinary Medicine at the University of Georgia.  Post-graduation, she completed an internship, 1 year of residency and a Master of Science at Washington State University and finished a second year of residency at Michigan State University.  After 2 years of private equine practice on Long Island, NY, she joined the faculty of Tufts University School of Veterinary Medicine at Tufts University in 1983.  She became board Certified in Internal Medicine in 1985.

During Dr. Paradis’ tenure at Tufts University, she has been the course director of the large animal medicine and surgery course for third year students and the large animal medicine clinical rotations for third and fourth year students.  One of her clinical accomplishments includes the establishment of the Marilyn Simpson Neonatal Intensive Care Program.

Dr. Paradis has trained 22 residents and 19 interns in large animal internal medicine. She has acted as faculty mentor and thesis advisor for 10 NIH Research veterinary students and 14 Dorothy Havemeyer Post-Doctoral Fellows.  She received the Norton Teaching Award and was inducted into the inaugural class of the Faculty Hall of Fame by alumni of the Cummings School of Veterinary Medicine at Tufts University as someone that contributed substantially to their education.

Most of Dr. Paradis’ research has been centered on clinical studies of the horse at the 2 extremes of age – the neonate and the geriatric horse.  She is the author or co-author of 41 peer-reviewed papers and 34 book chapters.  She had the privilege of being the editor of a text book published in winter of 2006  – Equine Neonatal Medicine – A Case Based Approach.

Topics of Discussion

Septic arthritis/osteomyelitis is a manifestation of septicemia (widespread infection) in foals.  Approximately one-fourth of foals presented to Tufts Hospital for Large Animals with a suspicion of sepsis also present with or develop evidence of septic arthritis. Cohen and colleagues recognize infectious arthritis as a cause of death in 12.5% of foals (8-31 days of age) in Texas. The problem arises from hematogenous (through the bloodstream) seeding of the synovium (joint lining) and the physis/epiphysis (actively growing bones in the joints) with bacteria. Foals may present with one or multiple joints affected.

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Clinical Case Review

Septic arthritis and osteomyelitis in a neonatal foal
Mary Rose Paradis, DVM, MS, Diplomate ACVIM(LAIM)

’11 Royal Reign, a 10-day old crossbred filly was referred to the internal medicine service at Tufts Cummings School of Veterinary Medicine, Hospital for Large Animals, with a one day history of sudden hind limb lameness. On her physical examination, the filly was bright and alert but had a rapid heart rate of 120 beats/minute and a fever of 103.5. She exhibited left hind limb lameness at the walk; however, no joint or limb swelling was noted. Physical examination of the left hip and sacroiliac (lower back) region elicited a painful response. The filly’s initial blood work was within normal limits with the exception of a low IgG (antibody level) of 400 mg/dl, indicating that she had not had sufficient transfer of antibodies from her dam.

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Clinical Case Review

CURRENT STEM CELL RESEARCH

Andy Hoffman, D.V.M., D.V.Sc., D.A.C.V.I.M., Professor, Director, Lung Stem Cell Laboratory and Jose Garcia-Lopez, DVM, DACVS, Associate Professor.

The clinical scenario:

Charger, a 9-year-old Oldenburg gelding, presented to clinicians at the Hospital for Large Animals at the Cummings School of Veterinary Medicine at Tufts University for non-resolving hind limb lameness. During evaluation, Charger displayed excessive toe dragging of the rear limbs and abduction (outward swinging) of the right hind. When trotting, Charger exhibited a 2 out of 5 (0= sound; 5= non-weight bearing) right hind limb lameness, with a positive upper limb flexion test (indicating pain in the upper portion of the leg). Continue reading

Clinicians and Staff

CURRENT STEM CELL RESEARCH

José Garcia-Lopez – VMD, Diplomate ACVS

Dr. Garcia-Lopez

Dr. Garcia-Lopez

A fascination with equine athletes and sports medicine drew Dr. Jose Garcia-Lopez to join the faculty of the Cummings School of Veterinary Medicine and its Hospital for Large Animals, where he specializes in lameness, orthopedic and respiratory surgery for its equine patients.

Dr. Garcia-Lopez’s areas of clinical expertise and interests include orthopedic and upper respiratory surgery, as well as innovative lameness evaluation using advanced imaging techniques such as nuclear scintigraphy, MRI and CT. He further focuses and advances novel treatment modalities, which include procedures using Stem-cell, PRP (Platelet Rich Plasma) and IRAP (Interleukin-1 Receptor Antagonist Protein) therapy. In addition, his area of research expertise includes development and testing of new instrumentation and implants used in equine orthopedic surgery. He continues to improve and develop new techniques and instrumentation which aid in management and treatment of fractures and joint injuries.

Andrew Hoffman – DVM, DVSc, Diplomate ACVIM

Dr. Hoffman

Dr. Hoffman

 

Dr. Andrew Hoffman is a Professor in the Department of Clinical Sciences and Director of Regenerative Medicine.   His research interests include the fundamental biology of stem and progenitor cells and their potential application in cell therapeutics.  Projects in the Regenerative Medicine Laboratory involve over 12 faculty and 5 trainees with a focus on the safety and efficacy of stem cells used for treatment of autoimmune diseases and traumatic injuries to tissues. “

Topics of Discussion

CURRENT STEM CELL RESEARCH

Andy Hoffman, D.V.M., D.V.Sc., D.A.C.V.I.M., Professor, Director, Lung Stem Cell Laboratory and Jose Garcia-Lopez, DVM, DACVS, Associate Professor.

Understanding Stem Cell Potency: Can the Veterinary Profession Do Better?

Stem cells have now captivated the veterinary profession and for good reason.  These cells produce a vast array of molecules that promote repair and regeneration of damaged tissue. The signals produced by stem cells are so numerous and complex that they cannot yet be reproduced in the laboratory.  Harnessing their potential is the central focus for many laboratories around the world. The hope is that stem cells will revitalize tissue in healing wounds, and reduce inflammation, fibrosis, and auto-immunity. It’s a tall order but there is good evidence from animal models that stem cells or their derivatives can accomplish these goals.  Continue reading

Topics of Discussion

The Problem with Puncture Wounds

It is uncanny how some of the smallest, seemingly innocuous wounds can become the most life-threatening. Those located around synovial structures (joints, tendon sheaths and bursas) often fall into this category. Early recognition of synovial structure involvement followed by aggressive therapy wins the battle in many cases, but not all. The statistics are worse when recognition or therapy is delayed. Having owners who are caring but also knowledgeable about limb anatomy is an important first step. Owners are often the first responder – making the decision on whether to contact their veterinarian.  It is an easy decision to make when blood is spurting, flesh is hanging, or bone is visible but not so easy when the wound is a puncture or just an inch or so in length. Perhaps some of the following information will be helpful in highlighting the importance of small but badly placed wounds. Continue reading