In the Operating Room: A While Bengal Tiger Emergency (Full Episode) | Animal ER

Thank you On animal ER the team of Houston's top Veterinarians treat a white tiger in Crisis For the first time But during their daring surgery I got a Little bleeding this life-threatening Complication set in the Tiger's Oxygenation status started to go down And a special companion for an ailing Child they fell in love instantly it Requires urgent intervention this is the Kind of case that can go south very Quickly while a beloved lab needs a Delicate surgery to savor life it's not Getting better If we don't do something it's animal Medicine At a whole new level there's almost Nothing we can't do at Gulf Coast Thank you The staff is going to attempt a first at Gulf Coast today as they get ready to Meet a special new patient A six-year-old white Bengal tiger named Nia He's a rescue who lives five hours away At The Pride Rock Wildlife Refuge Over the last few months she's been Hemorrhaging during her menstrual cycle Nia has never given birth to a litter Her owner called Dr Brian Beal this Tiger is having reproductive problems Basically having discharges and

Occasionally mild infections and what We're going to try to do is get that Uterus out of there they're going to Have to perform an ovario hysterectomy To remove the uterus and ovaries But there's a Twist Gulf Coast is not Equipped to house the tiger overnight Surgery must take place quickly enough That she can go home the same day that Table's on Wheels so we can just wheel It out right oh yeah but being that this Guy is so We're just trying to clear the way to Make it easiest for us to come into the Or move out of the or it's a complex Procedure the animal weighs 350 pounds Dr Beale assembles two interns two Additional surgeons and a team of Veterinary techs as well as exotic Animal expert Danielle Inman to assist Hey Gary So we're all here to give you some help We're glad to be here how was the ride It's not been a uh one of our better Moments but uh she worked up how she Kind of take a peek at her uh Yeah all right they're also attempting Something brand new to use a minimally Invasive technique a hysterectomy like This has rarely been attempted on a Tiger before Bars don't look As to be when she's behind them and She's growling at you

It really made her presence known and it Got all of our attention Nia is restless and Dr Caleb Hudson has the most experience With tiger surgery on this team Big cats are they're very powerful Creatures and even if they're even if They're tame and they're used to you you Know it can be unsafe we won't really be Able to to get close to it and do much Of an exam on it until it's it's heavily Sedated [Applause] By myself sure One of Nia's handlers attempts to calm Her While a zoo veterinarian gets ready to Administer a cocktail of sedatives Powerful enough to temporarily knock out A 350 pound tiger it's been nice knowing You Joe when I hear big cat surgery There's a couple things that come into My mind and one is keeping the cat Asleep so we've brought in an exotic Animal specialist to handle the Anesthetic and also the pain management Of this big cat Either on that side or she's going to Need to be on this side It's a back open All right Knee is in an agitated State they do not Want her to attack the cage and injure Herself or the people around her

Baby [Music] [Music] I'm Miss Sandoval with Harley yeah come To the bed we're ready for you [Music] Harley is a newly adopted puppy with a Serious elbow fracture Harley was Running alongside my husband and she Went to cut in front of him as they were Running and her leg got caught in Between his and they tumbled down and She fell and broke her elbow The family got Harley to be a companion For their daughter Suffers from a rare genetic disorder Our daughter has been in and out of the Hospital her whole life Sawyer has been asking for a puppy for Months We made her a promise that when she was Healthy enough to have a puppy that we Would let her get one We took her to the shelter and they fell In love instantly we went for Sawyer to Have as normal life as possible Having a puppy is all part of that Process So our biggest concern for Harley is That she's unable to run and play like a Normal dog and that's just something I Don't want for her Dr Wayne Whitney an orthopedic surgeon At Gulf Coast is on the case

Brittany nice to meet you why don't you Come over So here's what we're seeing do you see That yeah Okay that concerns me it's fractured Through this part but it hasn't Fractured through the rest of the bone It's it's almost like um piece of wood That you split almost all the way I'm Hoping that we can get to this before it Becomes a full-blown fracture so that's The goal Um I would You know I'd say let's just go ahead and Do it this is the kind of case that I Worry about just walking around on the Hospital floor I know you know this Could go south very quickly You will have to prepare for Ever the worst right I'm I'm sorry You're going to go through this but I'm I'm glad that we're getting a chance to Get it before it becomes a much more Serious and expensive problem I agree Completely and I mean we brought the dog Specifically for our daughters and she Loves her seriously thank you so much Harley is More than just a pet she got this dog For her child that you know has has Special needs and as a father I feel Very responsible to help every way I can You're not just treating a pet you're Treating the whole family Harley's

Fracture could get worse at any moment Dr Whitney chooses to operate Immediately So our goal is to go in with a scope and Then we can put a clamp across it to Compress the fracture arthroscopically And then put a lag screw across and then Prevent it from becoming a disaster The first step in the surgery is to find Exactly where the fracture is okay Dr Whitney will use an arthroscope to Examine inside Harley's elbow all right Can you see that crack right across There yes All right so there's the fracture Identified the fracture in his scope now Dr Whitney must drill exactly into the Right place to compress it if he is off By even a few millimeters the bone will Heal incorrectly leaving Harley disabled All right so you on your fracture All right There you go All right let's do it A bird is in critical condition it's Having difficulty breathing Dr Natalie Antonov prepares for Emergency surgery spirit is a 16 year Old cockatiel who has a mass growing in Her mouth covering up the opening to her Trachea and that's why she can't breathe Hi baby I know it's awful there's a very Good possibility that we're not going to Be able to get this mask off but at this

Point in time with the way that she Looks today I feel like if we didn't do This procedure she would have less than 24 hours to live okay Dr Antonov gives Spirit a sedative first She must evaluate the mass that is Rapidly growing and choking the 16 year Old pet We're going to do sort of the bird Equivalent of a tracheotomy and then We're going to open up her mouth look And see what we see in there if we think We can get any of this off and give her Comfort we're going to go ahead and Remove it and do our best but if we Can't remove any of it without making Her worse then we're not going to do Anything [Music] Where is she breathing yes Okay so what they're doing is putting a Monitor her on and at the same time I am Plucking the feathers and preparing her For surgery Normally I would be using a drape for This a sterile drape but she's a tiny Little bird and time is kind of of the Essence with her Tiny little window Making my incision It's a pretty small incision into the Skin if I go through the muscle until I Get to the body wall Okay and this is the tricky part popping

In There we go and I'll take that tube So this is the airway tube so this is The equivalent of like a tracheotomy and We're going to test this To see if it expands Ready Good we're in okay [Music] So now I'm just sutureing it in place Dr Antonov finishes suturing the Incision and has to work fast Spirits Advanced age and the sedation Make even a tracheotomy risky before Dr Antonov can examine the mass and Spirits Throat the cockatiel takes a turn for The worse Spirit's heart has stopped beating Let's get some Epic as they would with a human patient They try to kick-start spirit's heart With a shot of epinephrine Okay hang on Now we don't worry so much about being Sterile as we do about getting Everything into her This is delicate CR Ime Dr Antonov is attempting to revive Spirit [Music] A cockatiel with a mass growing around Her throat Moments ago her heart stopped beating

During an emergency Airway surgery Where's that fluid with dextrose I'd Like to get a little bit of dextroge Into her just to drop all right let me Check and see if we've got anything here It's good that we've got at least we got The airway Because I don't think We got something Really erratic let's give it another Round let's get more epi [Music] So nothing Oh we're gonna stop we're gonna stop I'm sorry sweetheart Once we had done three rounds of CPR we I went ahead and said let me just look In her mouth because we really didn't Get the chance to look in her mouth While she was still alive oh you know What the team realizes it was a losing Battle all along the mass and spirit's Throat was already past the point of any Treatment you see that it's on her Trachea It's huge and it's attached really Really firmly I there's no taking that out so I feel Like even if we could take the mouse off Part of it today it's going to come Right back and we're going to be right Back in this exact same situation oh Poor baby this is probably the worst I've seen

I have to call Mr medley and let him Know the news and he he knew Fully going into this what the odds were For her to pull through hey it's Dr Antonoff Um I don't have good news for you about Spirit Unfortunately if she did not make it Through the procedure Never gets easier to make those calls She felt no pain she wasn't suffering I'm I'm so so sorry It's hard it never gets easier if it did I think I'd have to stop being a Veterinarian Thank you [Music] Oh and play with me Allen we're allowed To encourage all of the naughty behavior That we don't encourage in our own Animals Exactly Nia a six-year-old white Bengal tiger is At Gulf Coast to have her uterus removed To stop her chronic bleeding it will be A groundbreaking surgery After just getting her out of her cage And into the hospital is a challenge Oh That was good So what we did in this case is her Keeper was distracting her with some Good little rump scratches and then Dr Joe gave the injection so now what

Should happen is she should get very Sleepy pretty quickly here and then at That point she'll be you know a lot Safer and we'll get her downstairs to Begin prepping [Music] Are you sleepy A little bit we're gonna give her like To at least 10 more minutes I wouldn't mind if she had more I don't Think anybody would It's not always easy to tell what plane Of anesthesia patient's at they can act Like they're asleep but certainly we see It in dogs and cats where they seem like They're asleep but when we stimulate Them they pop right back up and want to Bite us There's no way to move Nia without Lifting her onto a gurney and time is Limited they must get her under a more Powerful general anesthetic before the Temporary sedation wears off So we're gonna move her from her crate Onto the gurney so that we can get her Downstairs to the prep room and surgical Suite Up as much as we can One two three Let's go [Music] We're taking the tiger out of the cage We're putting her onto the gurney and Then we're transporting her into the

Elevator and down the elevator to the Hospital and during that time she's just Laying there on the gurney asleep So I'd say there's definitely a little Bit of apprehension We were nervous for a variety of reasons Asia don't always mix well And so we've really got to hurry things Along It was a surreal experience to see a Tiger come down our hallway My technician skills kind of went into High gear so I was really focused on That but at the same time I kept Thinking this is an amazing creature The biggest challenge with treating a Tiger is just her sheer size Which is a massive animal and so just Having enough manpower to lift her is is A unique situation We ready everyone's ready Leading the Gulf Coast team for Nia's Procedure is one of the youngest Surgeons on the staff Dr Caleb Hudson The first surgery that I participated in Was a spay on a cat I was 16 years old I just got my Driver's license from that time on Surgery was very fascinating to me I Trained at the University of Florida There's a lot of big cats in Florida so I have a little bit of experience into Surgery on Tigers but nothing minimally Invasive so to have the the chance to do

You know a laparoscopic surgery on a Tiger is is pretty exciting Doctors Hudson and Beale are going to Try a procedure that has rarely been Done on a tiger before They will use small incisions and a Lighted camera called a laparoscope to Help them remove the uterus The recovery time for this procedure is Far less than with open surgery what We're doing is we're making an incision Into the abdomen and we're going to put A port and we'll allow us to put a scope Into the abdomen The goal is to get Nia in and out of Surgery and able to travel home as fast As possible can we start insufflation Under general anesthesia they're limited To approximately three hours start to Finish to be able to see inside the Abdomen for a minimally invasive surgery You have to distend the abdominal cavity With carbon dioxide gas and that Distension puts pressure on the Diaphragm which tends to collapse the Lungs down so you've got to work very Very quickly so now we should be able to Put the scope in and have a look around [Music] Here it comes [Music] Oh yeah yeah so we're moving forward in The abdomen looking at part of the Stomach and the spleen

As we move back and around you can see Oh there's a part of the Suspensory ligament of the uterus and The ovary and then we're gonna just Figure out where we're gonna establish Our instrument portal which We're going to want to be a lot too far Away Team will use three small incisions one For the laparoscope to illuminate knee As organs and the other two for the Surgical instruments to remove the Uterus this case is more challenging Than most of the cases of laparoscopic Surgery and tigers that have been done Before Can you show me now where it's pointing To make sure I'm not going to stab into The school for whatever reason no one's No one's chosen to use laparoscopic Surgery to operate on a tiger that has a Uterine problem before So it's definitely more difficult There it is That's beautiful that's beautiful So we're progressively cauterizing the Blood vessels and resecting the tissue a Lot of vessels there but so far this is Bloodless yes it's going great Okay let's look at the uterus now Ryan Try to see how much of the uterus we can Actually see just as doctors Hudson and Beale get to the uterus to remove it They discover a problem on one side of

The uterus they were not expecting [Music] Sir uterus is super large on this side This uterus was many many times normal Size let's get we got a little bleeding It turned out that the uterus was very Abnormal she had a condition that we Call a pyometra which is an infection Which makes the tissue unhealthy it Makes it break more easily it makes it Bleed more easily We were not anticipating that [Music] Are you Duchess is a nine-year-old Lab Mix who is suffering from a lump in her Head and a persistent discharge from her Left eye well my concern is we know She's not feeling well and her skull is Caving in There's a concern that what is going on Inside of her head is cancer she's a Part of the family So we're hoping for the best and that is Not Dr Heidi hottinger a soft tissue Specialist orders an MRI and conducts a Physical exam can you look at me baby Girl there we go so this little lady has A condition going on in her middle ear Could be cancer But more likely is a benign process Called a cholesteatoma It erodes through bone it actually is Invading into her brain compressing her

Brain so she has a lot of muscle loss Right here rounded over here caved in Here and then also her eye is sunken and She's not producing tear enough tear Either so she's got an ulcer on her eye Surgery appears to be the only option For Duchess hi Mr Sparks hello I'm Dr Heidi hottinger nice to meet you have a Seat we're going to talk about a few Things So I can't give you a guarantee yet that This is not tumor right I wish I could But she does fit a lot of the picture of A dog that has this condition which is Called a cholesteatoma here's what we Know about them is that if we can go in And get a lot of that waxy material out We can kind of get a lot of this under Control things we have to keep in mind Though is that some of the nerve damage That is present May not go away So The biggest thing I do have a concern About is the eye There is the option of saying wow if all Of this is to make her feel better if She has an eye that's always ulcerated And painful maybe she would be better Without that eye exactly let me show you A few things on her MRI too so you kind Of know what we're doing So here we have this little bit of black Here we have this great big area of kind

Of white stuff and look at her brain on This side notice how it's touching her Brain I do See we really don't know if it's tumor David in there we do so here's what we Would do when I go in If it's tumor Versus this cholesteatoma they look Completely different they have a Completely different texture I'll know If you want some time to think through All of this The truth Heard that yes give her a good quality For a while that's kind of why my wife And myself have decided to do great We'll get that all set up and then I'll Give you a call after a surgery already Okay thank you so much I will take good Care of your girl I know with Duchess It's only going downhill from here it's Not getting better if we don't do Something All right baby go ahead I see you later Dude You're a good girl Dr Whitney is operating on an elbow Fracture on Harley a therapy puppy and The Beloved playful companion to a Two-year-old girl named Sawyer Dr Whitney must insert a tiny screw to Compress the fracture in exactly the Right place all right There you go

If he is even millimeters off the bone Will not heal correctly Sawyer could lose her playmate All right let's do it [Music] Okay now we're going to screw the head Of the screw in as Dr Whitney positions The screw he watches the fracture in the Scope to see if it compresses correctly [Music] Perfect All right we're done It's beautiful I can be happy with that It's gonna feel very good about it I Don't want to jinx this but it was Exactly what we thought so we went ahead And compressed it back down and that That headless compression screw that we Put in And hold it there and should allow it to Heal and this stuff should do great Foreign [Music] The next day Harley's family returns to Pick her up Yeah no Harley doesn't need a stroller No Harley's gonna walk because we got Her leg fixed hi guys hey how are you Thank you for your patience how are you Great hi hi Harley are you gonna see her As a father it was definitely Emotionally gratifying she feels all Better that dog's gonna do great and be

There to support that little girl for a Long time you know that's probably the Part of this case that feels the best Tell Dr Whitney thank you You're very welcome [Music] It will take a few weeks to determine if Harley's elbow heals correctly and she Can go back to being the rambunctious Puppy Sawyer needs Nia a white Bengal tiger has been in Surgery for 90 minutes when things take An unexpected turn We were expecting a uterus that was Going to be pretty small maybe slightly Bigger than normal size this uterus was Many many times normal sized she had a Condition that we call a pyometra which Is an infection we got a little bleeding Try and try to focus on this area right Up here to see if we're getting any Hemorrhage from right in here We were not anticipating that we're not Gonna be able to do anything about that There's too many vessels so we're just Gonna have to get it out they're hoping To be as minimally invasive as possible But the Tiger has a serious infection And internal bleeding And now a new and troubling problem Suddenly emerges for Nia one of one of Her Vital Signs starts falling her blood Oxygen level Uh 77 let's see

75. did it just suddenly decline or has It been like them for a while we started To have a few anesthetic issues this Lack of oxygen to the brain is called Hypoxemia a condition that mountain Climbers get when they collapse in high Altitudes and they can die if their Levels don't stabilize the Tiger's Oxygenation status started to go down And so we look for that value to be Somewhere above 95 percent and when it Starts to drop lower and lower into the Low 90s or the 80s or the 70s you start To worry about getting brain damage Potentially [Music] I started to get pretty nervous because You know you don't have a lot of time Left at this point but also you know You're not really that close to being Done with the surgery The nail biter you become more and more And more nervous I became more and more And more nervous you know just watching Those vitals change in a negative way it Became more and more critical that we Finish this and we finish it quickly and We were only halfway done so it wasn't Like we could just stop and close and Say well we'll fix it tomorrow we had to Continue on to make matters worse Nia's Uterus is too swollen to remove it Through any of the small laparoscopy Holes we're trying to make the decision

Where to go and open open her up and Just get it knocked out real quick You could probably just get our uterus Out of this right yeah yeah let's let's Go ahead and make it I think we need to Get my guess is that we had about 45 Minutes to an hour from when we started Opening uh but the longer you get more Chance there is that she may not wake up Okay from the anesthesia it's just go in And open this and get the last piece out We can't lose this tiger under Anesthesia and if they have to start Waking her up we have to be done with The surgery before they wake her up okay Let's go can we surgery lights on please Okay Blood oxygen level falling and the time They can keep Nia under anesthesia Running out Dr Hudson attempts to Enlarge the small portals created for Nia's surgery to pull out the rest of Her infected uterus immediately you know I started to get pretty nervous we need To open this and move forward very Quickly [Music] There we go All right Yeah good it's coming up okay great Color looks much better yeah it's Actually very good that we went in and Got this out I don't think she would Have uh lasted long with a plus filled

Uterus like we saw here [Music] All right let's have some are we gonna Have some flush We weren't able to do the whole surgery As minimally invasively as we'd hoped But based on the size of the uterus that We found in there we were able to do it As minimally invasively as you can with The uterus of that size the surgical Task is done and Nia's vitals are Getting better but Dr Hudson knows that Nia isn't out of the woods yet Damaging complications from being under Anesthesia this long are still a big Concern looking up at the screen and Seeing that the numbers are lower than You expect them to be I start to get Very nervous because I start to wonder Will we be able to get her back is she Going to wake up from this surgery or Not I didn't know what was going to Happen [Music] Dr hottinger's team prepares Duchess a Nine-year-old Lab mix for surgery It's pretty prominent with all the hair Clipped off Yeah Yeah it's okay it'll go back into look All pretty again Dr hottinger will remove duchess's Ulcerated left eye and some of her ear Canal before the most critical part of

The surgery Cutting deep into duchess's ear canal And determining whether the lumpy Substance near her brain is cancerous Duck Butt you can't be 100 sure until You go in there This could be tumor and if it is the Whole game plan changes [Music] So right now we're dissecting around the Ear canal and then that will get us down Where all of this debris has accumulated Dr hottinger has to carefully remove a Growth from the left side of duchess's Head A nine-year-old Lab mix who came in with A lump on her head and an ulcerated eye Only open surgery will determine whether The lump is cancerous or not This is great it's not a camera So what I found when I opened up was Exactly what I was hoping for was this Material that is consistent with a Cholecyatoma and basically it looks like Soft candle wax and you just scoop it Out lots of it this is good Dr hottinger has ruled out cancer but She still needs to remove more of the Waxy substance around the brain Here's where we're kind of getting into The brain okay so if anybody comes to The door no okay I couldn't be distracted when I was Working up in a very deep dark hole

Around her brain I needed to not tremble Move Look Away when someone talked with Me no I I needed to have it all about Duchess [Music] Thank you All right You know makes for a good day and you Feel like you made a difference Especially for a sweet little lady like This [Music] Hi it's Dr hottinger calling Everything went very well no cancer it's Like hip hip hooray you guys can Celebrate tonight okay thank you bye-bye [Music] Here at Gulf Coast we provide the care For our staff dogs We actually have a running waiting list For employee dogs we can fit them in And once it's their turn You bring them in Everything went great Best thing of all is when you get those Huge heartfelt hugs But it's sweetie pie it just makes it All worthwhile She's good he's good Nia the Tiger has just finished a Dramatic surgery that removed her Infected uterus One two three however a full half hour Afterwards Nia is still out

The Gulf Coast team led by Dr Beale and Dr Hudson fears she could be suffering From the adverse effects of prolonged Anesthesia as shown by one of Nia's Vital signs that they're watching The anesthesiologists were periodically Monitoring the electrolyte values and What they were finding was a trend where The potassium was going up every time They measured it Make sure she has plenty of water to Drink Potassium is mildly elevated that's not A big problem for the body but if the Potassium starts to get very very high It can actually result in death I mean It can be fatal Oh there we go Breathe in faster now so when her oxygen Went back up to normal and she was Breathing on her own that's a good sign But then I still had to worry about did That low oxygen tension in her blood do Anything to damage her her brain [Music] Thank you When a tiger's waking up from anesthesia We're watching for some indicators that She's waking up okay all right that her That her mental status is okay at six Years old Nia is in the prime of Life Under normal conditions she could live Another 10 to 12 years but big cats Don't always metabolize anesthesia so we

Want her to to just be [Music] We'd like her to be lifting her head and Have a little more wherewithal before we Send her home Get her in the trailer gear out of the Sun if you'd love to have a sunburned Chummy [Applause] Every minute that passes with Nia Unconscious creates more concern about Her full recovery what we want to see is That she starts trying to move she's Kind of making an attempt to write Herself to get into a more normal Position for a tiger to to to sit or lay Come on Come on Leah [Music] Come on girl you know as I'm looking at Her and she's she's taking much longer Than I want her to to wake up She's been given the antidotes for the Drugs the sedation that we gave and so She should be there with us but she's She's not she's still sedate and so it's Scary [Music] Less than 24 hours after ear and eye Surgery near her brain Duchess is ready To reunite with her owner There's a girl number hair is Cliff She says we're on this side she's like I

Hear your voice There we go hello Hey I heard you was a good girl I don't think he was a good girl she is Such a wonderful girl we love her I'm glad to see Duchess back I think That everything that we had done here Is going to make her happier dog You know we got Duchess from a no-kill Pet shelter and we've had her we've had Dutch's eight years You know it's we're her no kill family Oh they Is part of my job The best part of the job that never Stopped I know When you get that hug it means the world Thanks bye [Music] Come here Harley Two-year-old Sawyer Sandoval's parents Wanted to give her a puppy to help her Cope with the stress of her rare genetic Disorder and now five weeks after Dr Whitney's precise surgery sealing a Stress fracture on her elbow Harley is Living up to her promise of being an Active companion to Sawyer We are thrilled that Harley is doing so Well so iron Harley just love to play They're up and down the stage hairs all The time come here Harley hold on we're So relieved that she's gonna be able to Enjoy her puppy and they're going to

Have a wonderful life together Open your eyes girl [Music] Nia the white Bengal tiger who had an Emergency hysterectomy has still not Come out of anesthesia her surgical team Is concerned about possible brain damage And won't leave her side until she wakes Up Under anesthesia you know there's really No movements I mean the body is Relatively paralyzed You need to be watching for the subtle Indicators that she's waking up okay That we didn't cause any harm by Anesthetizing her Come on Come on Nia Come on girl Come on girl Come on baby Come on baby Let's go Let's go Come here Come on baby What's going on baby Come on girl Come on girl There we go Yeah she finally like opened her eyes And She's looking at Danielle now she's

Waking up to Danielle yeah she's about To lift her head she wants to Come on girl Come on girl Come on get him come on good girl There she goes yeah Here we go That's when I started to relax that's When I started to breathe aside relief And say this is a normal recovery I mean It just looks like a large version of a Domestic cat waking up from anesthesia I think she's gonna be fine being able To work on a tiger it was it was a very Happy experience for me Faced with the challenges we were faced With today we we really shined you know Everyone did a fantastic job came Together that made me happy Thank you thank you this surgery was a Big surgery for us it built a lot of Morale and it showed people at our Hospital that they could do things that They didn't know that they could do Gary hey it's Dr Beal how did Naya do on The on the trailer ride home Uh after we got her out of the trailer Here [Music] A big hug for me okay Really that tiger Made me think that there's almost Nothing we can't do at Gulf Coast now [Music]


Leave a Reply

Your email address will not be published. Required fields are marked *

Verified by MonsterInsights