The past couple of weeks have involved a couple of firsts for me.
For one, I injected my first joint on a live horse. We were at an appointment for a horse with chronic hock issues. The right side was worse than left. Under Dr. Trombley's guidance, I was allowed to perform the injections of the left hock. I attempted to inject the distal intertarsal joint from the medial aspect below the cunean tendon and the tarsal metatarsal joint from the lateral aspect just above the head of the splint. In both cases, I demonstrated where I needed to place the needle, scrubed the injections sites and was sucessful.
A second first was performing a uterine antibiotic infusion. A couple weeks ago, Dr. Trombley had breed a mare. She did not take and was pooling fluid in her uterus. After a few uterine flushes failed to eliminate the fluid, the decision was made to treat with a local infusion of antibiotics. I was allowed to carefully rectal the mare to visualize the remaining fluid by ultrasound. Afterwards, Dr. Trombley guided me in how to keep my equipement sterile for this procedure by myself and on placement inside the mare. I had trouble locating the opening to the cervix during my attempt. I kept ending up on top of it instead entering. Dr. Trombley ended up taking over to place the pipette then allowed me to feel where it was going. It was a good learning tool. I definitely need more experience palpating.
I also got some experience with the complications of field surgeries during to different mass removals. The first was the removal of what appears to be a fibroma from near the point of the shoulder. The mass was a firm rounded ball that was not firmly adheared to the muscle and lacked a blood supply. The removal itself was uncomplicated, with the exception that it was more adheared to the skin than expected. It was more difficult to manage the people. Clients and their children do not always understand what needs done during a field surgery and what rules need to be followed while the doctor is working. This time, this resulted in the contamination of part of the surgery pack. It was a lesson to me not only to pay attention to what your patient is doing, but also of what the clients are up to while you work. It is a good idea to make it clear to them before getting started what they are not allowed to touch or do until the procedure is finished.
The second mass removal come with it's own set of masses. The horse had a mass just lateral to its rectum. Previously the mass had been treated with topical steroids and oral antibiotics. At that time it had completely regressed. A bunch biopsy had been taken and revealed a granuloma. Recently, the mass returned and the decision was made to remove it. Sterility was one issue encounted during the surgery. The tail was wrapped and tied to the side but it kept working its way loose. There was always an eminent risk of the horse defacating, which thankfully never happened. Oh and the barn cats were running through the rafters, showering us with hay. It was certainly a surgery where the scrub needed to be kept close at hand. Another issue was lighting. The barn was very dim and the head lamp was not working. We improvised and had me hold a flashlight and direct as best I could at the surgery site without getting in the way. Stocks also would have been helpful for this surgery, because the horse kept moving from side to side trying to keep his balance while sedated and the floor had become slick after the incision bled. At one point I was holding up the flashlight in one direction and pulling the tail away with my other hand while trying not to slip. Regardless, we completed the surgery and got the sutures placed without major incident. Upon cutting into the mass, we found a sharp demarcation in color and texture that was concerning. The mass has been sent for furthur evaluation.
One other interesting case was a foal with a laceration near its eye. We were called to the farm for an eyelid laceration. It was not known what the foal had caught itself on. Upon inspection, it was found that the eyelid margin was intact and the laceration was slightly below the lid. The eye was not involved. The foal had however torn about 1/2 inch V-shaped flap that was a little deeper that expected. The foal was sedated, a deep suture was placed to help hold the tissue better then the flap was tacted down using absorbable suture and a buried pattern to help prevent sutures getting caught if the foal rubs. The margins came together well and the laceration should heal well.
The variety of cases and complications that come with field work are certainly keeping me on my toes.
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