Hello again from
Littleton!
It’s been very
busy around here lately, as summer and the horse show season is in full
swing! I have still been spending most
of my days working in the ICU, which has generally been pretty full. Most of the horses admitted to the ICU are
for various colics, but there have also been a few mares and foals, major
laceration survivors, and an interesting cardiac case. I was able to watch when Dr. Mullen, the
internist, did an echocardiogram of a horse’s heart and saw an abnormal
mass. The horse had been admitted with a
heart rate of 170 bpm (normal is around 28-44 bpm) with a lot of premature
ventricular contractions. Bilaterally,
this horse also had thrombosed jugular veins, so had to be catheterized via the
cephalic vein. He was treated with
heparin IV, oral aspirin, Plavix, and lidocaine IV and was monitored with a
Holter monitor. His jugular veins were
also observed via ultrasonography to assess blood flow and the extent of the
thrombi formation. I am interested to
keep learning more about his case partly because I could really use a good
review of cardiology!
I have also
gotten to see a lot of colic cases come through so have learned a lot lately
about the different causes of colic, modalities for diagnosing them, and their
subsequent treatment options. I learned
that a nephrosplenic entrapment can be treated with phenylephrine HCl (to
contract the spleen) and trotting for 5-10 minutes to try to release the
entrapped colon from the space between the spleen and kidney. Also, you need to use caution when treating
with phenylephrine, especially in older horses and at higher doses, because it
can potentially rupture the spleen. You
can also anesthetize the horse and physically roll it around (I haven’t seen
that one yet but that would be neat-o) to try to free the entrapment as well.
On Mondays, I
spend the day in the field with one of the veterinarians. Sometimes, the day is mostly filled with farm
calls and other days many of the cases are at the clinic. Last week, I spent the day doing repro work with
Dr. Dietz. We spent the first part of
the day checking mares and it was a really good review of horse
reproduction. I spent two years in grad
school learning the finer aspects of sheep reproduction and estrus
synchronization, and this was a great refresher of how mares are opposite of
sheep and cows in many, many ways. Even
mares’ ovaries are inside out. One mare
that we saw was suspected to have a uterine infection, so Dr. Dietz took two
swabs of the uterus; one for cytology and one to be cultured. She then lavaged the uterus with sterile
saline and treated the mare with enrofloxacin (a broad spectrum antibiotic),
dexamethasone, and oxytocin. When we
went on some farm calls to check local mares and on one particular mare, Dr.
Dietz saw that she had an ovulatory follicle and lavaged her then checked again
afterward and saw that she happened to ovulate while being flushed. It was really neat to see what a freshly
ovulated follicle/corpus hemorrhagicum looks like.
I know it’s
really common, but I got to see a Caslick’s procedure performed for the first
time that day too. Dr. Dietz did the
closure with a Ford interlocking pattern, which is less complicated than I
imagined it would be. Caslick’s
procedures are useful for mares that have poor vulvar conformation or are prone
to pneumovagina, both conditions of which predispose them to infections of
their reproductive tract. Later in the
day, we went to a farm for a colic emergency, and Dr. Dietz quizzed me on colic
types and treatments along the way. Once
there, she diagnosed a small impaction via rectal exam, and we passed a
nasogastric tube to administer a bolus of fluids and electrolytes as well as
some mineral oil. The mare ended up
recovering well overnight.
One emergency
farm call that I went with Dr. Harbourd on involved an older pony that was down
and could not rise. I learned a useful
recipe for a “Lazarus cocktail” that can be administered IV and is comprised of
butorphanol, banamine, calcium gluconate, and dextrose with fluids to help a downed
horse. This cocktail provides pain
relief, fluids (if they’ve been down for a while, they’re likely somewhat
dehydrated), and easily utilizable energy.
Fortunately with the help of Dr. Lori and some butorphanol, we were able
to get the pony up before administering it.
More useful information that I learned on that farm trip was that you
should do your best to move the front end of the horse or pony away from the
wall or corner of the stall, because they need a good amount of space in front
of them to get up.
As always, the
Monday morning meetings have been full of great information. Lately, we have learned about field
management of colics, colic diagnostics, and how to minimize the risk of
veterinary misadventures (as well as how to resolve them if they do
occur). This morning’s talk in
particular was extremely useful. One of
my major concerns about being a new graduate within a few years is how to
recognize and resolve complications as they arise. This morning, Dr. Toppin taught us how to
recognize and treat an anaphylactic reaction, how to minimize the risk of
inadvertently doing an intra-carotid injection, and how to treat vaccine
reactions. I feel better about being
able to recognize when a complication has arisen, and about how to go about treating
it one day if it occurs.
Last week, I
spent Monday working with Dr. Toll doing farm calls. First, she repaired an uncomplicated
laceration below the stifle, trimmed proud flesh from a heel bulb injury on the
same horse, and applied chlorhexidine ointment as a treatment to help prevent
the reoccurrence of proud flesh (excess granulation tissue). At another farm, I scrubbed the site for IRAP
injection at the lateral femorotibial joint and learned that the landmarks are
the lateral collateral ligaments, lateral patellar ligament, and tibial plateau
ventrally. IRAP is useful for treating
osteoarthritis and general joint inflammation by stimulating the horse’s own
immune cells to produce anti-inflammatory mediators. She also floated an older pony’s teeth and I
learned how to open a horse’s mouth more easily without getting my hand gnawed
off. At the end of the day, we saw a
horse that had an allergic reaction to who knows what in its stall. Its eyes were nearly swollen shut and its
muzzle was so inflamed that it was squeezing out past its halter. It also had hives over the rest of its
body. She treated it with an IV
injection of dexamethasone and oral hydroxyzine (an antihistamine).
Also, I got to
see a DDFT tenotomy done on a horse with chronic laminitis. This procedure is a salvage procedure, and
the purpose is to reduce the backward pull that the DDFT exerts on the coffin
bone. It was performed as a standing
procedure, and the vets also worked with the horse’s farrier to see that it was
outfitted with heartbar shoes and the dorsal hoof wall was trimmed back to
improve the breakover in the horse’s foot.
Anyhow, I’ve
learned a ton so far and am excited to keep seeing and helping with more
here. I’m sad that my time here is
officially halfway over but hope you’re all having a great summer as well!
-Calli
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