Brown Equine Hospital: Week One

Hello from Pennsylvania! My name is Shelbe and I am spending my summer at Brown Equine Hospital. The hospital is located in Somerset, Pennsylvania. I have had the opportunity to work with three doctors thus far.

This first week has been a whirlwind to say the least! I have seen so many cases it is hard to keep track, so I will try and provide the highlights! My first week has been focused on teaching me the ropes and learning the ins and outs of the hospital and patient care which has afforded me many hands on experiences!

During my first day I was able to not only observe a enucleation, but I restrained the patient as well. A enucleation is a common procedure done to remove an eye. This patient in particular needed the nucleation because it presented with a tumor. This tumor formed on the third eyelid and was not only obstructing the horses view, but it began to spread to the cornea of the patient’s eye. If you wait too long to remove the tumor it can spread to the rest of the orbit and cause further damage. The surgery went phenomenally and the patient recovered and went home.

Later in the week I was in the operating room for three surgeries. I was able to provide assistance by being the surgical technician to the veterinarians. The first case was of an 18 hour foal that presented to the clinic with a possible meconium impaction. Meconium impaction is when the foal fails to excrete sufficient amounts of meconium, which is the first feces that the foal will pass after birth. The foal was examined and through ultrasound the veterinarian was able to identify fluid in the abdominal cavity and the small intestines were slightly thickened. After this examination it was though that the foal had a ruptured bladder and was taken to surgery. In the operating room the surgeons identified opaque orange-yellow abdominal fluid and enlarged mesenteric lymph nodes. The mesenteric lymph nodes are found in the mesentery which is a fold of tissue that connects the small intestines to the back of the abdominal wall. The mesenteric lymph nodes were also actively leaking the orange-yellow fluid along with thicker material. The small intestines were also found to be discolored, thickened and congested (see attached photos and videos! Hopefully the videos load!). This foal had congenital lymphangiectasia and chyloperitoneum. This resulted in the engorgement of the lymphatic vessels (chyloperitoneum) and rupture results in leakage of triglyceride- and cholesterol-rich chyle into the abdominal cavity (lymphangiectasia). In a normal foal the absorption of fats occurs through the afferent lymphatics to the mesenteric lymph nodes and then to the efferent lymphatics where they will eventually enter the blood stream (May and Good 2007). When there are ruptures or breaks in this system, the fluid will leak into the abdominal cavity and the foal will be unable to properly absorb the much-needed fats. Unfortunately the prognosis for the foal was poor and the foal was euthanized.

The second surgery was an arthroscopy. An arthroscopy is a surgical procedure that focuses on joints. You can do this to examine and treat damaged done to a joint. A endoscope is inserted into the joint through a small incision. This arthroscopy was done on the left hock joint in order to correct the osteochondrosis that was occurring on the distal intermediate ridge of the tibia. The doctor went in and excised the tissue and the patient recovered and went home.

Later a colic presented to the clinic. The horse had been experiencing episodes of colic on and off for the last couple of months without a definitive diagnosis. The horse was ultrasounded and fluid was identified in the abdomen. In order to gain more information, the horse was ultrasounded and no abnormalities were noted. The doctor also decided to do an x-ray of the abdomen and sand was found in the colon. In order to get rid of the sand, the horse was put on psyllium. Psyllium helps to collect the sand and move it through the digestive tract and pass in the feces. The horse stayed in the hospital another three days in order to be monitored safely and was discharged home.

Before Treatment:

After Treatment:

This first week has been busy to say the least, but I am learning a lot and am gaining a lot of hands on experience. I have been able to help with lameness exams and the doctor will ask me where I think the horse is lame before they say where they are lame and they have been giving me great pointers on how to identify it. I have been able to help restrain patients, take radiographs, hold the plate for radiographs, administer oral medications, scrub for joint injections and scrub patients for surgery. The staff has been very helpful and patient and I cannot wait to see what the rest of the summer brings!

References:

May, K.A and Good, M.J. "Congenital lymphangiectasia and chyloperitoneum in a foal." Equine Veterinary Education, 19, 1, 2007, pp. 16-18.