The traveling continues

The Region 14 horse show in Kentucky was a busy show for performance equine. We worked long days, and only got to watch a few classes from one of the night sessions.  It was a very hot and humid week in Kentucky so we saw a few colics and dehydrated horses. We mostly gave these horses IV fluids and continued to monitor them for a few days. We also found out that the horse that was sent in for an MRI had a chronic injury to it's suspensory ligament of the navicular bone. The recommended treatment was to inject the navicular bursa and shock wave the suspensory ligament of the navicular bone. We shock waved the horse at the show, and injected the bursa at the horse's farm the following week. From Region 14 we continued to travel. We were back in Michigan for a few days, on of which was a surgery day. We saw some more PRP cases, and Dr. Hill looked at a few referral lameness cases. After the surgery day Dr. Hill started making his rounds to different farms to get horses ready for Youth Nationals. This includes joint injections, shock wave treatments, and diagnostic work. We started by going to Indiana to look at some horses at a couple farms. We then took some time off for the 4th of July, but have started back this week. Dr. Hill has been flying to some farms to look at horses so I've had a few days off. When he leaves I help pack a bag filled with all the medication and other supplies he will need to treat horses. It is difficult to find time in our busy schedule to pack the bag, so I usually do that while Dr. Hill and Dr. Ocull palpate and watch the horses jog. We will continue to travel for the rest of the month. Dr. Ocull and I will meet Dr. Hill in Iowa tomorrow, and then we will drive to Albuquerque, New Mexico for Youth Nationals. I can't wait to see all the exhibitors, it should be a good show! That's all for now!

Interesting In-Patients

            The past few weeks, we have been treating a couple unpredictable cases. The first was a colic that was diagnosed as an impaction on the farm but was also running a high fever. He was brought into the isolation unit at the clinic, worked up, and placed on fluids with antibiotics. His bloodwork was indicative of infection and inflammation, but the specific tests for serious contagious conditions were negative. So, when his fever broke he was moved out of isolation and switched to oral fluids. After a few days, the impaction resolved, his appetite returned, and he began to act brighter. Suddenly, he stopped eating and became even more depressed than he had been previously. Upon rectal examination, we found that his cecum had been displaced across midline. Although his heart rate was low and he was not acting uncomfortable, we encouraged his owner to make arrangements to ship him to Ohio State for further monitoring and surgery if needed. By the time they arrived at Ohio State, he was acting painful and was taken to surgery. The surgeon there found the majority of the small intestine and part of the colon pulled through the nephrosplenic space, so much so that the cecum was pulled across the abdomen. Surprisingly, all of the gut was still viable and after several painstaking hours, was returned to its rightful place. Still not out of the woods, the horse re-displaced his intestines and went to surgery for the second time. Now he is recovering well, but a third surgery is not an option, so hopefully he has no more surprises.

            The second case was a 3 month old filly that came down with diarrhea and a fever. We initially treated her with fluids, biosponge, antibiotics, and a little bit of banamine. Later the following afternoon, she was found recumbent and declining swiftly. With her fast action, Dr. Hill was able to stabilize the filly and get her on her feet, but she remained depressed and refused to eat for the next few days. Despite supportive care the filly did not improve, so we ultrasounded her thorax and abdomen. We found pleural pneumonia and pulmonary abscesses as well as what can only be described as a lake of abdominal fluid and fibrin. With a tentative diagnosis of raging peritonitis with secondary pneumonia, we continued supportive care. The next day, she took a huge turn for the worse and the owners elected to euthanize. Upon field necropsy, we discovered horrible gastric ulcers that had perforated into the abdomen. This led to utter confusion since 1) ulceration in foals is uncommon, especially when this foal has not been previously stressed or medicated and 2) assuming she perforated several days previous when she crashed the first time, how did she live that long and never act colicky? So, Dr. Paradine and Dr. Hill asked their contacts at MSU and OSU for possible explanations.  Dr. Schott has seen babies with sensitivity to NSAIDs that can get ulcers from just one or two doses. He also said foals can more easily wall off perforations, tolerating them better and for longer than adults.

RREH continues

Good evening!
     Things are starting to slow down in the surgery department here at Rood and Riddle as the thoroughbred foals get older, and foaling season slows down. We are still getting many arthroscopies and fractures in on a daily basis, but the screw placement surgeries are slowing down. Did you know that you can only correct growth with a screw placement as long as the growth plate has not fully closed yet? Once foals reach a certain age, the screws no longer do anything (see my first post if you need a reminder on the surgery itself!).
     I have started going out on the road with the ambulatory department here at Rood and Riddle, which has given me a chance to see the other side of this job; the field. Dr. Paasch is a veterinarian here that deals a lot with orthopedic related cases. Many of our stops include screw removals on farm, which is very interesting considering I got to see most of these foals in the hospital when we initially put the screws in! The removal entails mild sedation to the foal, followed by a local lidocaine block around the incision site. An amazing aspect of ambulatory practice here in Lexington, is getting to see all of the beautiful farms I have heard so much about! In just one day I was able to travel to farms like Tailor Made, Lanes End, WinStar, and Shadwell; all of which house very famous horses such as Zenyatta, Curlin, Tiznow, Distorted Humor, and many more! I do not get to see most of these famous faces while there, but its the thought that counts.
     Following up on racing around here is a very exciting thing considering RREH works on most of the babies that eventually see the track. I already have a list going of all my favorite yearlings and foals! Just a couple years to wait until these guys are off to the races!
Thanks for reading,
Lisa Reznik

Week 7 at SVEC

            I just finished my seventh week at Saginaw Valley Equine Clinic after being gone for two weeks on a RAVS trip.  RAVS (Rural Area Veterinary Service) is a branch of the Humane Society Veterinary Medical Association and their Veterinarians and Vet techs along with many Vet, Vet tech, and Vet student volunteers travel to underserved areas to provide care to dogs and cats.  We traveled to the Pine Ridge and Lower Brule Indian Reservations in South Dakota and provided spay/neuter/and vaccines to nearly a thousand animals.  It was a very rewarding, yet exhausting experience.

            A day after I got home, it was back to work and things have been staying very busy around the clinic.  We had one horse come in on emergency that had been in a trailer accident after a car tried to cut in front of them.  Luckily the trailer didn’t flip but the horse was banged around quite a bit.  He is definitely body sore, but no fractures, and has some neurological deficits, mainly dragging his toes when he walks.  We are treating him with Vitamin E and Dexamethasone to help reduce the inflammation and heal the nerves. 

            We also had a colic come in to the clinic on Saturday who had not defecated since Thursday but had continued to eat.  He was surprisingly bright but was straining to defecate and uncomfortable.  He had an impaction in his rectum and we were able to break it up with a soapy water enema (a very large enema!).  Since he had continued to eat, his impaction likely involves a large portion of his intestines, and not just his rectum.  We put him on IV fluids to rehydrate him as he hasn’t been drinking and doing lots of hand walking to get things moving.  He is continuing to pass larger and larger piles of manure and is well on his road to recovery.  I have only ever heard of impactions in “tight” spaces in the intestines, such as the pelvic flexure, but not in the rectum.  After doing a little reading on it, it is thought that small colon impactions are actually associated with Salmonella, so we have him in isolation and are taking all the necessary precautions just in case he does have it.  Hopefully, things keep on moving and we can get him home soon!

It's The Little Things...

This week had me thinking about the small and not so obvious struggles and victories of veterinary medicine...   

Going out on a farm call to pull a Coggins is pretty routine for an equine veterinarian.  But what should be a quick and easy blood draw turns into a sweat inducing, dangerous event when horse owners don't discipline their horses.   Just like you discipline your children because you love them, it is necessary to correct your pets when they aren't behaving properly.  I watched Dr. Jones almost get fallen on top of by a horse that reared up when she was trying to draw blood because the owner let her horse walk all over her everyday and never disciplined her.  

Young horses are notorious for getting themselves into trouble.  For some reason this seemed to be the week of foals impaling themselves on T-posts.  T-posts are metal posts that have sharp edges.  Our first case was a quarter horse/thoroughbred yearling who had a T-post go through the outside of his shoulder.  Thankful the wound only went through the muscle belly and didn't hit any major nerves or tendons.  However, the owners initially treated the injury with Underwood horse medicine which is actually caustic.  When the yearling got to us, his wounds were full of lumpy protrusions of granulation tissue.  With a few days of cold hosing and applying medihoney ointment the injury has made vast improvements!  The second foal that cut himself on a T-post was only a few months old and thankful the wound was superficial enough that all we had to do was clean it up and send him on his way.  His owner brought him to us as soon as it happened.  Another thing to think about...it's always best to seek medical attention immediately instead of waiting. 

I've had a few small accomplishments this week.  A month old foal came into the clinic with an umbilical infection.  Shouldn't have been a problem giving this baby chloramphenicol orally...however, the owner hadn't handled the foal at all so he was extremely skittish and fearful of humans.  By the end of his week at the clinic I had the foal relaxed enough to where I could easily catch him and give him his medicine.  May seem like a small feat but honestly it's the little victories in life that get you excited as much as the big ones. 

Weeks 8 and 9 at Brown Equine Hospital

Happy Independence Day, everyone!   Things have been rolling along at Brown Equine.  Dr. Provost (the new surgeon), and Dr. Moschgat (the new intern) have assumed their new roles and quickly become part of the BEH Team.  Over the last couple weeks, we’ve had fewer externs rotating through, so in that sense, things have calmed down a bit.  Also, breeding season in coming to a close for Dr. Jennifer Brown, so the barns have been relatively free of overnight patients (but still very full with outpatients during the day). 

In the last few weeks I have had the amazing opportunity to scrub in on several arthroscopic procedures.  One in particular was a horse with an apical fracture of her lateral proximal sesamoid bone. 

There are several types of fractures that can occur the proximal sesamoids – Apical, mid-body, basilar, abaxial, axial, or comminuted – which refers to the location of the fracture, and each carries a different prognosis.  Apical fractures like this patient had usually carry a good prognosis if removed early before causing damage to the suspensory ligament.  It was a great experience getting to scrub in, work with Dr. Brown, help pull out the bone chip, and even put in a couple sutures!

Pulling out the bone chip from the fracture

Looking at the screen to assess the surface of the bone where the chip from removed

Putting in some sutures

The bone chip.  A little over 1 cm long.

At BEH, Dr. Brown likes the interns/externs to take an active role in cases to help the learning process.  While Dr. Brown oversees the entire case, this gives the interns/externs the opportunity to analyze patient findings, propose which tests should be run, and discuss a treatment plan for our cases.  It is extremely nice to have the guidance while I am still learning, but still have the chance to start thinking like a vet (which will be VERY important once I enter my clinical rotations in January).  One case that I worked on was a horse that came in with a severe case of gas colic.  Usually we don’t see many cases of gas colic because, if they are a mild form, they usually resolve with administration of banamine and never have to come to BEH.  Unfortunately for this case, he did not get better after getting banamine, and had to come to us.  He abdomen was so distended upon presentation that Dr. Brown couldn’t even get his arm in the horse to rectally palpate the GI tract.  Based on the signs, Dr. Brown thought the horse had a displacement of some kind of his large colon.  Surgery was not an option for these owners, but they asked us to do what we could to manage his medically.  We began by relieving some of the gas distention by trocharizing his large colon, which involves sticking a large needle in near the top of the flank to vent the gas out of the colon.  This helped for a few hours, but soon the gas built up again, and our patient was painful.  After discussing options with Dr. Brown, we tried adding additional pain management medications to the horse’s treatment plan.  When I left the hospital that night, I was sure I would receive a call in the middle of the night to tell me his condition had deteriorated.  I woke up repeatedly throughout the night and checked my phone, convinced that I had missed a call (I hadn’t).  Upon arriving at BEH the next morning I found that my patient was much more comfortable and had actually passed some feces!  It was a great feeling, but I knew we still had a long road ahead.  Over the next few days we were able to wean our patient off of pain medications, then IV fluids, and then gradually re-introduced him to food.  After almost a week in the hospital, I’m happy to say that the horse recovered and was able to return home.  Since this patient in particular had a history of gas colic episodes, we discussed diet changes with the owners, especially decreasing the amount of grain given in an attempt to decrease the amount of fermentation and gas production in the colon.  We prepared the owners that this may happen again, but for now they are thrilled to have their companion back home and healthy.

It’s hard to believe that I’m in my last few weeks at BEH; time has really flown by.  I look forward to seeing all that I can in my remaining time here.  I hope everyone has a safe and happy Fourth of July!  Until next time…

Beautiful view from BEH as I worked the night shift last week. 

Changing of the guard

The interns I spent the first part of my fellowship with recently finished out their year here.  While they are all happy to be moving on to other things, they were glad for their experience at LEqMC.  You hear a lot about internships and residencies at school, but it was nice to here an insiders perspective.  They agreed, the internship made them much more confident about their skills, and they felt much more ready to go out into practice than they did after graduation.  Not everyone who goes for an internship is planning on doing a residency; you just have to find an internship that gets you ready for what you do want to do.
Just as we said goodbye to the old interns and welcomed the new, things suddenly became very busy here at Littleton Equine.  We have had quite of few colic cases come in for management in ICU.   One Arabian mare came in with severe gas distention making the doctors suspected a torsion.  In the time it took to get permission to take the horse to surgery, however, the horse passed most of the gas.  She stayed in ICU for a couple days but did not show any further signs of improvement.  The doctors began to think she may have sand colic since she was housed in a sandy pasture.  When a horse eats off sandy ground, the sand settles in the ventral colon and can gradually build up and cause an impaction.  I did not get to see it, but the mare was taken to surgery, and the surgeons removed several gallons of sand from her ventral colon.  She has been recovering very well so far.  She receives psyllium to help her pass the remnants of the sand.  Sand colic is relatively uncommon in this region, but this case is a good reminder to take the horse's individual living conditions into account.