The Emergence of Clinical ‘One Health’: Reflections on the Collaboration of Physicians at UCLA and Veterinarians at the Los Angeles Zoo
In the past decade, ‘One Health’ has emerged largely out of concerns in the areas of public health, zoonotic illness and even homeland security. Collaborations to meet challenges in the areas of environmental conservation, bioterrorism and infectious disease are becoming more commonplace. Still infrequent, however, are formalized clinical collaborations between veterinarians and their physician colleagues. Over the past 3 years, the veterinarians at the Los Angeles (LA) Zoo have fostered a collaborative relationship with members of the University of California, Los Angeles (UCLA) Division of Cardiology and UCLA Division of Cardiothoracic Surgery in order to better treat and prevent cardiovascular disease in their patients. This close collaboration has benefitted not only the animals at the LA Zoo but has had a significant impact on the perspective of the human cardiologists, house officers and students at the UCLA School of Medicine.
Veterinary and human medicine subspecialties have operated largely on two parallel and rarely intersecting paths. Yet, the vast majority of the diseases treated by one group are routinely encountered and treated in the other. The experiences and resources of each group may contain benefit and potential for improvement in patient care on both sides. Many zoos around the country utilize the expertise of human health professionals in the treatment of their patients. The benefits to animal and human health through such collaborations are important to consider and document.
Objectives and Methods
Over a 3-year period, faculty of the UCLA Division of Cardiology were consulted to assist with a variety of cardiovascular conditions in patients at the LA Zoo. Most of these patients were primates including western gorilla (Gorilla gorilla gorilla), common chimpanzee (Pan troglodytes), orangutan (Pongo pygmaeus), golden lion tamarin (Leontopithacus rosalia), and sooty mangabey (Cercocebus torquatus atys). Non-primate patients included California condor (Gymnogyps californianus), sea lion (Zalophus californianus), and African lion (Panthera leo). Consultation was typically requested in association with ultrasonic imaging (echocardiography-transesophageal or transthoracic). Discussions regarding clinical scenarios occurred prior to, during and after the imaging procedures. Cardiovascular diagnoses encountered included cardiomyopathy (fibrosing, hypertrophic and dilated), hypertension, atherosclerotic disease of the aorta, and endocarditis. Some of these cases were discussed with appropriate clinical experts at UCLA Medical Center and pathology specimens were reviewed by human pathologists as an adjunct to conventional veterinary pathologic assessment. Published clinical guidelines used routinely with human patients (cardiomyopathy) at UCLA’s Cardiomyopathy Center were shared and discussed with the veterinarians at the LA Zoo.
Animal cases were also presented informally and formally in several venues at the UCLA Medical Center including Internal Medicine Grand Rounds and Chief Resident’s Rounds. House officers and medical students were encouraged to review the veterinary literature to enhance their understanding of the pathophysiology of disease by learning about its presentation in non-human patients.
This collaboration yielded many benefits, some expected and others not. The exchange of clinical guidelines from the UCLA cardiologists to the LA Zoo staff had some influence in the approach to some patients with heart failure. Assistance with transesophageal echocardiography (TEE) allowed for more precise characterization of disease of the heart and great vessels. In one lion, pericardiocentesis was made possible by TEE visualization of a large volume pericardial effusion causing tamponade physiology. An echocardiographically based screening program for evidence of early cardiomyopathy in tamarins was undertaken. Identification of plaque (via TEE visualization) in the aortas of primates including gibbon (Hylobates gabriellae) and western gorilla influenced clinical decision making in the areas of lipid management and use of aspirin.
Bringing awareness of animal correlates of human disease impacted medical students and residents at UCLA. Following presentation of animal cases, multiple medical students and house officers expressed great interest in further collaborations with veterinarians in the areas of subspecialty medicine. Some internal medicine house officers have selected ‘One Health’ based projects for their senior projects. Knowledge that the results of human clinical trials are used in veterinary medicine stimulated many discussions and much interest. Senior residents expressed interest in joint programs in veterinary and human subspecialty medicine at the post-graduate level.
Clinical ‘One Health’ is emerging through informal collaborations between animal and human physicians. How these collaborations may further benefit both animal and human patients is yet to be seen. However, the UCLA/LA Zoo collaboration has yielded benefits to both the animal patients and veterinarians at the Zoo and to human patients, physicians and medical students at UCLA.
From the veterinary perspective, this alliance has permitted a direct conduit between academic cardiologists (results of clinical trials, advanced instrumentation) in a major urban city and the veterinarians caring for animals in that city. Clinical benefits to animal patients in the areas of imaging and intervention have been demonstrated. From the human medical perspective, since the first presentation of animal cases at UCLA, a multi-species medical conference has been conceived and is being organized. ‘One Health’ projects involving public health and zoonotic infections have been initiated by several senior residents. Clinical investigators, having been made aware of the use of clinical trials in the care of non-human patients, have expressed interest in facilitating clinical ‘One Health’ activities. UCLA’s Electrophysiology Group’s arrhythmia specialists have reached out into the veterinary community and have invited veterinary cardiologists in Los Angeles to present complex arrhythmia cases at UCLA. Thought leaders in the field of lipid function are considering the clinical management of plaque in the nonhuman primate heart and bringing these considerations into their discussions of the management of dyslipidemia in humans.
The collaboration between the veterinarians at the Los Angeles Zoo and academic cardiologists at UCLA has stimulated much interest and thought about the emerging role of clinical ‘One Health’ in the management of the shared cardiovascular diseases of patients of multiple species.