Brown Equine Hospital: Weeks 6 & 7

BEH Week 6 and 7

Week 6 and 7 have been filled with a lot of cases and hands on experience here in Somerset. I apologize for my lack of posting, but I have been getting called on quite a few emergencies, which means I have had a few sleepless nights. On the bright side, I have been able to learn and see what an internship could possibly look like for myself. I will try and provide some of the highlights of the last two weeks.

The first big event of the week for me was when I got to scrub in for a bilateral arthroscopy with Dr. Brown! While the patient was being prepped for surgery, the technician taught me how to properly scrub in. Once I finished I was able to run the surgery table for Dr. Brown and hand him the surgical instruments he needed. After he finished with the right hind limb, he let me drive the scope and identify anatomical structures within the hock! It was an amazing experience! The scope was not easy to drive at first, but after a tutorial from Dr. Brown, it was significantly easier! Once we moved on to the left hock Dr. Brown let me remove a piece of cartilage that was causing the OCD in the hock. I was able to grab the fragment and remove it in one try! Here are some pictures of this amazing experience!

A horse presented to the clinic upon referral from another veterinarian. The horse was having issues chewing and quidding its hay and grass. The veterinarian took some radiographs and found a fracture on the mandible near the interdental space. This made it painful for the horse to chew and was therefore the source of the quidding. We took the horse to surgery and placed a wire in the jaw to help it heal. The surgery went smoothly and I was able to assist the surgeon. (sorry I did not get any pictures for this!)

After surgery x-ray:

After surgery the horse was still having issues chewing its food and was still quidding its hay and grass. The veterinarian wanted to investigate the issue further so we scoped the guttural pouch of the horse to see if there was any complications there. Both guttural pouches looked good so we took additional x-rays of the mandible and found an additional fracture on the ramus of the mandible that was causing the issue. The horse was monitored for a couple of more days and discharged home.

Additional x-ray:

The first emergency I had for week 7 was a colic emergency. The horse was very painful upon arrival and after a physical and ultrasound, it was decided that the colic could not be treated medically and went straight to surgery. Once the horse was prepped the surgeon made the incision on the midline of the abdomen. When making an incision on midline one of the first anatomical structures of the gastrointestinal tract you should see is the cecum. For this horse the large colon was visualized. This horse had a 360 degree turn in its large colon, this is called a volvulus. This can be a detrimental problem to the horse as it can cut off circulation to the portion of the GI tract and can cause ischemia in the colon. This horse was referred in time and there was no color change to the tissue. The horse recovered well from surgery. Food was slowly re-introduced to the horse to minimize the reoccurrence of colic and fecal output was monitored. The horse did wonderfully with recovery and was discharged home.

Another colic came into the clinic that also needed to be treated surgically. Once the midline incision was made, the cecum was also not visualized like it normally should be. When the surgeon further explored the GI tract, it was found that this horse also had a volvulus of the large intestine. Unfortunately, this volvulus had caused ischemia of the colon. The surgeon performed an enterotomy on the large colon and the mucosal tissue of the large intestine was ischemic and beginning to slough off. Unfortunately resection of the large colon was not an option because the entire large intestinal tract was ischemic. The horse was euthanized on the table.

Picture of the enterotomy:

The third emergency was a laceration. A horse presented to the clinic with a fairly large laceration that extended from the left flank of the horse to the inguinal area. We clipped the area, scrubbed and numbed it with carbocaine (Mepivacaine). The veterinarian placed some vertical mattress sutures to help bring the tissue together nicely. He then let me place some simple interrupted sutures in between his sutures! Once we placed all of the incisions, we placed a drain in order to help removed fluids that build up after the trauma and to decrease infection. After the drain was placed we put a over the stitches in order to decrease tension on the sutures we placed.

Before:

After: 

We had two more additional laceration emergencies early in week 7. The first laceration was on a miniature horse. The laceration was on the left hock and was fairly deep. We did a contrast study in order to see if the laceration had gone deep enough to get into the joint space. After we did administered the contast, x-rays were taken. Unfortunately the laceration went all the way to the tibotarsal joint. The hock was flushed and amikacin was administered to help with infection. The horse was discharged home and has been doing well since then.

Here is a picture of the contrast study:

The second laceration was in a similar location, oddly enough, but it did not go to the joint. We did a contrast study for this horse as well and it was found to be in the tendon sheath of the long digital extensor. The wound was sutured shut and antibiotics were given. The horse was discharged home and has been doing well.

Speaking of emergencies, I am getting called in for another one as I type this! I apologize for the brevity of this post. Wish me luck on getting some sleep eventually!