Weeks 3 and 4 at Brown Equine Hospital

Weeks 3 and 4 at BEG have been relatively slow compared to my first 2 weeks, but we still have plenty to do.  Dr. Jen Brown has had a steady flow of mares in and out of the clinic for breeding services so I have gotten the chance to do some rectal palpations and assist with artificial inseminations.  A lot of this reproductive work is familiar to me due to my time working at the UC Davis Horse Barn in undergrad, but it is always nice to brush up on these skills.

There have been a variety of cases over the last couple weeks, but I will focus on a couple in this post.

One case was a horse that had an episode of colic a few days prior, and the owners had given Banamine® (Flunixin meglumine, a common NSAID used in horses and cattle) in the muscle.  While this drug is labeled for intramuscular injection, there is a risk of the horse developing a serious condition called Clostridial myositis.  This occurs when Clostridium bacteria dormant in the muscle or on the skin surface proliferates in the muscle producing gas under the skin and release toxins into the blood stream.  This condition is serious and can be fatal.  In addition to giving systemic antibiotics, the method to treat Clostridial myositis involves making incisions into the infected muscle to clean and expose the bacteria to air (Clostridium is an anaerobic bacteria, and does not like being exposed to air).  Unfortunately, the owners elected to have the horse euthanized.  Many people, even some vets, give banamine (and other drugs) in the muscle and never experience this devastating disease, but clients should always be educated about the risk associated with intramuscular injections of certain drugs.

Another case that we are currently working on involves a horse that had a tail wrap applied too tight causing the tissue around the tail to die.  The referring vets tried to remove the dead parts of the tail in addition to several vertebrae, but were unable to close the wound fully.  Warning: The following images may be a bit graphic for some people. 

The tail was very short on presentation to Brown Equine Hospital.  There was some dirt and various topical antiseptic agents on the open wound so we clipped and cleaned the tail and wound to better assess the injury

After cleaning, we could see the wound was a mixture of necrotic (the black tissue) and granulation tissue (the bright red tissue).  

A radiograph of the tail prior to surgery

At the tip of the tail, there was part of a vertebrae remaining from the prior amputation attempts.

Dr. Hackett and Dr. Younkin removed the remainder of that vertebrae and a great deal of the granulation tissue in order to have enough skin to close over the end of the tail.

Closure with a Near-Far-Far-Near suture for tension relief, and then a simple interrupted pattern was placed in between the tension relieving sutures for apposition of the raw edges.

The patient will need to be on systemic antibiotics and anti-inflammatory drugs for several days to prevent further infection and minimize pain, but the prognosis for recovery is good!

The next couple weeks will bring several big changes to the clinic.  Dr. Younkin will be finishing his internship at BEH and heading off to Kansas State for a new position.  He has been a valuable source of information in my first month at BEH and we wish him only the best as he advances in his career.  A new intern who recently graduated from University of Pennsylvania will be starting next week, and BEH will also be welcoming a new board certified surgeon to the team from Tufts University, Dr. Patricia Provost.  I am looking forward to having even more people to learn from! 

Until next week!