Week 2 (and a half) at BEH

This entry is a bit later than I had planned due to how busy we have been.  My first Sunday in Somerset we (myself, Dr. Younkin - BEH intern, Carlos - a vet from Spain, and Dr. Hackett - a relief vet working weekends at BEH) all went to Dr. Brown’s parents’ house to watch Dr. Brown and his brothers practice some pulling with their Belgian draft horses.  I have seen these pulls before, but was still in awe of the power these animals have, as well as how eager they are to go to work.  It was a nice relaxing afternoon, and a great way to get to know everyone a little better.  

Apparently it was also the calm before the storm. 

Sunset over the clinic

We had a busy week of emergencies and interesting cases, but it seemed that colic (abdominal pain) was a recurring theme.

            We had several colic cases present to us in the last week with a variety of causes.  Our first colic of the week presented with severe abdominal pain.  He had been admitted over Easter weekend and undergone surgery for a large colon volvulus (twist), and had been home since then recovering.  Upon arrival last week, he was so painful that standing still while I did a physical exam was almost impossible.  After administering some medications to ease his discomfort we placed a catheter and began administering IV fluids.  Unfortunately, due to the expenses associated with the surgery performed only 3 weeks ago, taking this patient to surgery again was not an option for the owners so we did what we could to treat him medically.  We continued to give various treatments to ease his pain, but overall his physical exam, blood work, rectal exam, ultrasound, and other diagnostic tests were rather inconclusive.  He spent most of the day sprawled out on his side laying quietly, but obviously in a great deal of pain.  We would get him to his feet every so often to examine him, and then he would immediately lie back down once we were finished.  This went on for several hours until that evening when the horse got up suddenly and was seemingly back to normal. We kept him two more nights for observation, and he went home with his very thankful and relieved owners. 

The second colic of the week was an 28 year old gelding that most likely had a strangulating lipoma, which is a fatty tumor that usually has a long stalk that can then wrap around parts of the gastrointestinal tract and cause obstructions and/or cut off blood supply to parts of the gut.  This type of colic is very common in older horses, but as surgery was not an option, we cannot confirm this.  However, we still did what we could to keep the patient comfortable while attempting to treat the colic medically.  Surprisingly, by the next morning he was doing much better and Dr. Brown suspects that the strangulation undid itself or the lipoma “popped off” and relieved that obstruction. Regardless, the horse was extremely lucky and went home a couple days after being admitted.

Our third colic case of the week came to us with a nephrosplenic entrapment, which is when the large colon moves out of its normal position and gets trapped on a ligament between the spleen and the left kidney.  Sometimes this can cause the colon to twist, which is usually a surgical problem, but in this case we were able to administer a drug that helps shrink the spleen a bit and then jog the horse allowing the colon to slip back into its normal position.  And our final colic case of the week was a displaced and twisted colon that then became impacted and did not allow feces to pass through the colon normally.  The horse was taken to surgery and has made a full recovery.
Colic is a common problem with horses, so it has been interesting to see just some of the many different presentations and causes of the condition, as well as the different ways to treat it.  We have been fortunate to have so many positive outcomes with our recent cases.  Last week was long and exhausting, but I have been settling into the “routine” (or lack there of in some instances) at BEH and have been really enjoying the work.  I am learning so much and can’t wait to see what the next 10 weeks bring.