Hello all,
My time at Littleton Equine Medical Center is coming to a close. It's been a great summer learning in the ICU and meeting some amazing doctors, technicians, and fellow vet students from around the country. If you are an MSU CVM student thinking about applying for this position, please reach out to chat with me (denneyk1@msu.edu).
I thought I would wrap up my blog posts with a grab bag of unusual cases we have seen the last week or so.
In mid May a yearly Arabian presented to our emergency service for a hemoabdomen following a routine castration. Although I hadn't arrived at Littleton yet to watch this case work up, the doctors ran diagnostic blood work and gave the gelding a plasma transfusion. He did not improve enough with the transfusion, so the next day he was given whole blood and the clinical team started to investigate the reason for his hemorrhaging. Suspecting a possible coagulation issue, a coag panel was sent off. The results showed that this gelding had a defect in factor 8, a rare issue in horses. Factor 8 is part of the intrinsic pathway of the coagulation cascade, which meant his PTT time was elevated. He was diagnosed with hemophilia A. After the blood transfusion, the doctors were able to get his hemorrhage under control. The diagnosis was explained to the owners and he was sent home with instructions to watch him carefully and return to the clinic if he sustained any trauma because he would not be able to clot properly. This week our favorite little Arabian gelding returned with a hematoma the size of a basketball above his tuber sacrale. He had been frolicking in the pasture and took a spill into a T-post. The trauma caused him to hemorrhage and form the hematoma. He has remained in the clinic for close monitoring this week. The hematoma does not appear to be changing in size and he doesn't appear to be continually losing blood. We have closely monitored his mucous membranes, CRT, and heart rate on an hourly basis to assess if he is losing blood. The hemotoma was ultrasounded to confirm it was in fact blood filled. This current plan is to go home on stall rest until the hemotoma resolves and to remove as many dangerous items from his pasture as possible. Although our surgeon wasn't thrilled about the idea of having to take a hemophiliac horse to surgery, we discussed the safest ways to do that if it had to happen. One note our internal med doctor made was that vasopressin stimulates the release of more factor 8, which it is an expensive medication, but would be helpful to control bleeding in this case if surgery was necessary. Luckily, this guy doesn't currently need to go to surgery.
This summer we have also seen a few horses with severe ulcers. One of the most effective ways to treat them is with an SPL (sub palpebral lavage system). This is where a medication diffusing device is placed under the eyelid and a line is run up the horses mane. Most horses do not respond well to having eye medication placed daily, so an SPL helps to deliver medications in a safe and reliable manner. We usually give "ulcer mix" which has gentamicin, +/- atropine, artificial tears, and acetylcysteine. We also give serum via the SPL to help with the healing process. I had never seen an SPL before coming to Littleton, so it has been fascinating to watch the placement of them and how well they help to heal ulcers.
My last interesting case for this week was a mule who came in for a ovariohysterectomy (spay). This isn't commonly done in horses because their heat cycles are controlled well with hormonal medications like Regumate, but this mule had severe behavioral issues and the concern was that they were stemming from hormonal issues due to a possible ovarian tumor. On ultrasound the left ovary was considerably larger than the right and was anovulatory. The concern was that this mule had a granulosa cell tumor (GCT) producing testosterone in her ovaries that was leading to her behavioral issues. The ovaries were removed via laparoscopic surgery and we will wait to see if the behavioral issues resolve. One way to test for GCT's is with an AMH and testosterone test. Her's was negative, but our surgeon has had that happen in the past and send the ovary in for histopath and it was in fact a GCT. This was another unusual case that was very cool to watch unfold.
It has been a roller coaster of a summer here in CO. I am very grateful for this opportunity and for all I have learned and the amazing folks I have met. Please always feel free to reach out if you have any questions.
All the best,
Kaity
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