A Slew of Surgeries

            Although Cleveland Equine does not staff a full time surgeon, I have found myself in the surgery suit quite often lately. Dr. Robertson, a retired surgeon from Ohio State, flew in for a day to take care several elective procedures. His surgery team consisted of Dr. Wilson (for anesthesia), Dr. Hill (to assist), two technicians, and me. We started the day by scoping the horses with respiratory complaints. One turned out to have infected, pus filled guttural pouches, which we flushed and put on antibiotics. The next was a classic example of epiglottic entrapment- the epiglottis was caught in the aryepiglottic fold, causing an airway obstruction. The epiglottis had been entrapped for so long that the exposed aryepiglottic fold was ulcerated. When Dr. Robertson cut the fold with a hooked bistoury to release the epiglottis, we were able to see that the area under the fold was also disrupted. The final respiratory case came in with the concern of dorsal displacement of the soft palate, so Dr. Robertson performed the palate lasering and myectomy that I described earlier this summer.

            After the respiratory horses were taken care of, we moved on to three closed castrations. Here, “closed” not only refers to a castration that does not open the vaginal tunic, it also refers to a primary closure of the skin. Some clients prefer the closed castration for the cosmetics, the minimal aftercare required, or the reduced concern about flies. Since the scrotum is sutured, closed castrations need to be preformed in sterile conditions instead of standing. Although Dr. Hill assisted Dr. Robertson for his three closed castrations, I assisted Dr. Genovese the following day when he performed a closed castration. He even let me man the emasculators and throw in some horizontal mattress sutures for the skin closure.

            The final surgeries for the week were two foals with umbilical masses. The first was a typical umbilical hernia, soft and reducible. Dr. Genovese freed the hernial sac from the surrounding tissues without cutting into the sac itself. He then reduced the hernia back into abdomen and closed the body wall with a “Vest over Pants” suture that I was not familiar with. This method avoids opening the abdomen, so abdominal adhesions and infection are less of a concern. The second umbilicus was firm and non-reducible - an infected umbilicus. The body wall had closed properly, but the remaining cord had become a well-encapsulated pocket of pus. Dr. Genovese removed the mass with Dr. Hill assisting and then Dr. Hill closed with me assisting. The doctors here also do a myriad of standing procedures from open castrations to screwing in fracture lines, but there is just not enough time to discuss them all.

Region 13 Show

This past week we were in Ohio for the region 13 Arabian Horse Show. It was a relatively slow show for us, but we got a bit busier at the end of the week. It was very hot at the show so we had a few horses that coliced and we tubed them and gave them fluids. There were also a few horses at the show that appeared foot sore. Dr. Hill used hoof testers to determine how foot sore the horses were, and we would take x-rays of their feet to see if any of them had rotation of the distal phalanx. Rotation is a big concern for laminitic horses, and it is important to catch it quickly so the horse has the best chance at recovery with very minimal rotation. If there is too much rotation the distal phalanx can come through the sole of the foot. After checking the x-rays we administered one liter of  IV fluids with DMSO. The DMSO is a systemic anti-inflammatory and seems to help laminitic horses. Dr. Hill recommended that the horse lose weight in order to decrease his chances of becoming more laminitic, or having problems in the future. Dr. Hill also drained a set of boggy hocks at the show. The horse had big painful hocks with a lot of increased joint fluid in the tarsocrural joint, which is the top joint space in the hock. It is common to see that kind of effusion if the horse has bone chips in the joint. This was a horse that Dr. Hill has worked on before and they have checked it for bone chips, but there weren't any present. This is why he simply drained the fluid and injected the horses hocks with some steroids and polyglycan. The most interesting case of the week was one horse we have previously seen on its farm. The horse was base line lame on its front right, and was known to have previous problems with that coffin joint. We did a nerve block and the horse blocked sound to a palmar digital block which is the lowest block on the leg and blocks that back third of the foot. We then took x-rays of the joint, and Dr. Hill was not unhappy with what he saw. He then injected the horses right front coffin joint with steroids. This all occurred at the farm at the beginning of the month. The horse was at the show for us to re-check, and her lameness had not changed. She was still base line lame on the right front. Dr. Hill wanted to do another block to ensure the horse blocked the same as it had at the farm, but he later decided he would start with blocking the coffin joint. The horse was much improved after blocking the coffin joint. The owners wanted a more aggressive treatment, and chose to have us pull IRAP on the horse. IRAP is a regenerative therapy and stands for  Interleukin-1 Receptor Antagonist Protein; it is a protein that inhibits interleukins, or inflammatory proteins. The treatment involves drawing blood from the horse, and then processing it so that you obtain the plasma that is rich in the Interleukin-1 receptor antagonist proteins. Once the plasma is obtained it must be frozen; it can then be thawed to inject into the affected joint. We injected the horses coffin joint with one syringe of the IRAP we harvested, and Dr. Hill has scheduled the horse to go in for an MRI to determine what is going on with the soft tissue structures in the hoof around the coffin joint. This will help determine the extent of the injury and the course of treatment. We are now down in Kentucky for the Region 14 horse show. I'll fill you in on that next week.

Dr. Hill filtering the IRAP plasma. 

The IRAP being injected into the coffin joint. 

A halter horse being presented in its class. 

Lamenesses galore at BEH and a trip to the track

With the weather FINALLY warming up and the show season getting into full swing, that means that we have an abundance of lameness exams over the last couple of weeks.  We have had at least 4 lameness exams every day, and sometimes as many as 8!  From barrel racers and western pleasure horses, to pacers and pulling drafts, we have seen the many different ways a horse can be painful and lame.  Dr. Brown prefers to watch the horse trot in hand in a circle each direction on asphalt, and then in a straight line to and away.  During this time we try to determine two things: 1) Is the horse lame? (The answer is usually yes, otherwise they wouldn’t be here), and 2) In which leg (or legs) is the horse lame?  Once he has determined which leg he suspects is the problem he then asks the client for a history.  I like this method of determining lameness because it allows assessment of the horse without being biased by the history or palpation of abnormalities that may be a “red herring”.  After taking the history, Dr. Brown palpates the horse and then does a series of flexion tests to localize the lameness to a specific area.  The next steps vary depending on the horse and owner, but it usually involves a series of nerve blocks to further confirm the problem area, some sort of diagnostic imaging (usually radiographs and/or ultrasound depending on the type of tissues involved), and then the appropriate treatment depending on the type of injury.  One of the common methods of treatment is injection of the joints with hyaluronic acid (which simulates joint fluid) and/or corticosteroids. Last week I got to inject the tibio-tarsal joints on one of our patients!   Assessing and treating lamenesses is very methodical, but can also have a lot of variety that always keeps us on our toes. 

Injection of the tibiotarsal joint with hyaluronic acid and corticosteroids

This week I was also fortunate enough to be able to go over to the Standardbred racetrack nearby with Dr. Hackett to do a dynamic endoscopic exam.  We do endoscopies of horses regularly at BEH to look at their upper airways, but sometimes we can’t find a cause for what the trainer/driver/owner has noticed because we are examining the horse at rest as opposed to during extreme physical exertion.  The dynamic endoscope allows us to do just that.  A more rigid scope is inserted into the horse’s nostril and secured in place so that we can visualize (in this case) the larynx while the horse is exercising. The image is broadcasted to a remote screen as well recorded while the horse works and is then reviewed by the vet after the horse finishes exercising.  The horse we were examining had a history of making noise while working and some exercise intolerance.  Through the dynamic endoscopic exam, we were able to confirm that the horse was dorsally displacing his soft palate over his epiglottis.  This causes the horse to breath through his mouth as opposed to through his nose.  For humans this doesn’t seem like it would be much of a problem, but because horses are obligate nasal breathers, suddenly having to breath through their mouth can cause decreased air intake and poor athletic performance. Going to the track and helping with the dynamic endoscopic exam was something new and different, and it’s always interesting to see the ways technology allows vets to evaluate and treat our patients. 

The saddle pad holds the computer and other components of the endoscope

The endoscope runs from the saddle pad, up between the ears, into the nostril and allowed up to visualize the larynx

The endoscope records and transmits the images to a remote viewing screen.  If the screen was outside of the transmittable distance of the dynamic endoscope, we were unable to see the images in real time, so we had to review them afterwards
  

Our patient doing his job

Reviewing the video after our patient finished exercising

Until next time!

A Taste of Internal Medicine

            This week brought a couple of cases that fall into the “things you don’t see every day” category. Dr. Hill and I were called out to an emergency late one afternoon for a horse that was lethargic and had spiked a fever. Anticipating some kind of infectious- probably respiratory or GI- cause, we greatly surprised by what we found. Upon arrival, the horse’s head was hanging and swollen to about twice its normal size and he had visibly strong jugular pulses as well as ventral edema. The physical exam revealed an obvious heart murmur, thoracic auscultation of pleural effusion, and an elevated temperature.  Since no one had suspected that a horse with a fever would turn out to be a horse with congestive heart failure, Dr. Hill tried to break the news to the owners slowly. She gave them enough Lasix and Ace make the horse comfortable for a couple days while we ran some bloodwork and the owners came to terms with the news. When his bloodwork returned with a hematocrit of 5% (severely anemic) and evidence of liver distress, the euthanasia was scheduled.

            The second strange case had a happier resolution. This gelding had been diagnosed with renal tubular acidosis by Ohio State four years ago and came back into the clinic for care and monitoring while the owners were out of town. In this case of renal tubular acidosis, the proximal tubules of the kidney are damaged and unable to resorb bicarbonate from the urine back into the bloodstream. The large amounts of bicarbonate lost through urination makes the horse acidotic while the urine becomes inappropriately alkaline. To manage the acidosis, a permanent esophagostomy tube was placed and the owner administers a slurry of baking soda and water through the tube four times a day. She uses a pH strip on his urine and saliva to crudely monitor the bicarbonate levels and adjust the routine as needed.  While he was here, I took over the baking soda treatments and ran a chemistry profile every day to monitor the bicarbonate level. Despite his condition, the horse has been doing well these past four years and is competing in dressage at the Prix St George Level.

Projectile Diarrhea

The last two weeks have been busy busy busy!  The ramping up of show season has brought a lot of lame horses into the clinic.  We are constantly doing lameness exams, taking radiographs, ultra-sounding tendons, and injecting joints with a combination of steroids and hylauronic acid.  With these long days my life has basically become eat, sleep, work, and repeat.  

Now about that projectile diarrhea... When you are doing equine reproduction work everyday and  assisting with trans-rectal ultrasounds you are bound to get pooped on sooner rather than later right? Unfortunately, it only took two weeks for me to get covered in it...yuck!  We were ultra-sounding mares like we do every morning to check for ovulation, but this time when Dr. Rapson pulled her arm out of the mare's rectum, diarrhea came flying out with it and covered us.  I now bring an extra pair of clothes to work every day.  Lesson learned.

This past week we had two foals come in with umbilical hernias that had to be fixed surgically.  The great thing about being at Saginaw Valley is that they include you in the whole process from handling the colts pre-medication, to helping safely lay them down once they are anesthetized, and get them into the surgical suite.  Which, by the way, we use a huge crane to lift the horses from the padded recovery room where we place the foals under anesthesia to the surgical suite where the actual operation is performed. 

Unfortunately, not every case that comes into the clinic has a happy ending.  Late last week an adorable one month old foal came into the clinic with a badly fractured third metacarpal bone.  His mom had accidentally stepped on him a week prior.  The first veterinarian who examined him only put a cast on it.  Take a look at the radiograph below...that fracture won't heal with just a cast, that fracture needed surgery.  Not to get too graphic, but the foals leg was essentially dangling and you could see it move when he put even the slightest bit of weight on it. 

Not only have I been learning veterinary medicine, but I have also been gaining valuable experience in horse handling.  Yes I have been around horses since I could walk and have had two of my own, but with the large volume of horses we see here I have gotten a lot of exposure working with the difficult, crazy horses that we need to make stand completely still to work on.  It's honestly the little tips and tricks you pick up that make the difference.  I personally have not had a lot of experience handling foals coming into this experience but 3 weeks in and I'm already feeling confident handling even the most difficult of foals. 

Well here's to another week and hopefully I can keep the poop off me!

Starting new rotations at LEqMC

During the last two weeks, I've had some changes in my schedule.  I still work in ICU three days a week, but I now spend one day a week with a field veterinarian and one in surgery.
I spent my first field day with Dr. Dunbar who does most of the dentistry for the practice.  We went to a miniature horse farm where she spent most of the day sitting on the ground floating their teeth.  Because of their small size, it is easy to forget that minis are horses too and need regular dental care as much as and even more than regular sized horses do.  The horses we saw that day had fairly good mouths, but it is common for minis to have severe malocclusions and maleruptions.  Dr. Dunbar did have to removed several caps (baby cheek teeth) that were hindering the eruption of the underlying adult teeth.

My second field day was spent with Dr. Tisher, at the Colorado Horse Park where there is a six week long horse show going on.  We saw a few lame horses, one of which had multifocal swellings on its hind legs.  The same horse had strangles several months ago, so Dr. Tisher was concerned that it may have been developing purpura hemorrhagica, a Type III hypersensitivity reaction that sometimes occurs after strangles infection.   Antigen-antibody complexes become deposited in the lining of capillaries and cause an inappropriate immune response leading to vasculitis and subsequent edema, especially in the legs.  The horse had none of the other signs like petechia on mucosal surfaces, but Dr. Tisher still decided that further evaluation would be needed later at the clinic. 
This last Saturday, Littleton Equine Medical Center sponsored a Grand Prix at that same horse show.  Everyone who works at the clinic was invited.  One thing I have learned about Colorado, though, is that you really can't be too firmly set in your plans.  The day can start out sunny and bright with not a cloud in the sky then have severe thunder storms in the afternoon.  Sure enough, They had to delay the competition for about half an hour as it haled and then sheeted rain. 

 

Until next time
~Rebecca

Michigan, Minnesota, Ohio

The past two weeks have been filled with travel and horses. We started out working in Michigan where we did another gastroscopy, and some more lameness exams. In the middle of the week we flew to Minnesota to work up horses there in preparation for a horse show. It was a nice change of pace and scenery. The farm we were working at was very nice and had some pretty scenery. We did a lot of shock wave treatments there, and there was one interesting case. We saw two horses with tendon tears that were around a week old. The one horse reacted painfully to palpation of the tendon, but the other did not react very painfully. The one that was not painful had been injured the week before and another vet came out to examine it. We later found out that the other vet had shock waved the tendon the previous day. We found it interesting that the shock wave treatment made such a distinct difference in the comfort of the horse. The horse reacted to palpation as if the injury was older than it was. The shock wave treatment greatly decreased the amount of pain the horse was in. That was the most interesting case we saw there. I then flew back to Michigan with our equipment, and we started work again Monday of last week. Again, we started the week in Michigan. We did some more lameness exams, and we did one neuro exam on a horse that someone suspected may have EPM. It was interesting to see a different kind of exam, as I am now used to Dr. Hill's lameness routine. We also saw a horse that had several bone chips in one of its hind fetlocks. One chip was within the joint space, and there were two outside of the joint. There were more interesting diagnostic cases later in the week. We went down to Ohio to work at one farm for two days. The first day we did flexion tests on all the horses, and watched them under saddle. Dr. Hill had me flex some of the horses, which made the day go by a bit faster and was a great work out. We treated a few horses that day, and treated the rest the following day. We had seen some of the horses the previous month, so Dr. Hill wanted to do more diagnostics on some based on their flexions. We had treated one and it flexed off on the limb we treated, so we took x-rays of it's fetlock. The x-rays showed some spurring in the joint, which explained its poor flexion. There was another horse that had been lame for some time, and they could not figure out why. Dr. Hill decided to take x-rays on that horse too. We started with it's foot where we found a fracture in its navicular bone. Another interesting case from Ohio was one with a stiff neck. Dr. Hill did some chiropractic work on it, and planned to later inject the horse's neck. Neck injections are ultrasound guided and Dr. Hill scans their necks first to determine where there is arthritis. When scanning this horses neck all the facets appeared to be normal, and because of this Dr. Hill chose not to inject the horse's neck. When he palpated the horse's neck again it was not reactive. The past two weeks were filled with diagnostically interesting cases, and now we are about to head to back to back horse shows. First we'll be in Ohio, then in Kentucky. I'm excited to hit the road for two weeks, and I'm sure we'll see some interesting cases I'll let you all know about!

A torn tendon on ultrasound. The black is the tear. 

Bone chip inside the joint space. 

The two bone chips outside of the joint. 

One view of the fractured navicular bone, 

D/P of the fractured navicular bone. 

Skyline view of the fractured navicular bone. 

An Abundance of Abscesses

Things have been busy at Clinton Veterinary Service! In addition to the “routine” calls, we've seen an increase in nasty foot abscesses recently. This is not particularly surprising in light of all the wet weather and mud Michigan has experienced, but can be very concerning to owners because the horse can progress from normal to three-legged lame very quickly. 

One of the hoof abscess cases we saw presented initially like a case of laminitis; we were called out to see a 20 year old gelding with severe lameness in his front left leg. The owner had recently started turning the horse out on fresh pasture for several hours a day, and when we arrived he was in a “toe-pointing” stance, holding the lame limb forward with only the toe touching the ground and shifting his weight to his hind limbs as much as possible. The farrier had been to the farm recently and had noticed some mild lameness, but could not identify any abscesses in the hoof. We performed a physical exam and as much of a lameness exam as the horse would allow. There appeared to be a small draining tract and a black spot on the sole of the foot, near the toe, which Dr. Trombley inferred may indicate an abscess the farrier had caused to partially drain. Pairing away the sole in this area revealed a deep draining tract and only a small amount of pus. The gelding was not more comfortable after opening this area, so we continued examining him with the hoof testers to identify any other sensitive areas. Unfortunately he reacted strongly no matter where the hoof testers were placed on the front left limb, making it difficult to identify the issue. In order to rule out laminitis and hopefully identify the issue, we took radiographs of both front feet. The hoof radiographs revealed no signs of rotation to P3, often referred to as the coffin bone, which would have been indicative of laminitis. Instead we saw the draining tract Dr. Trombley had opened at the toe and further evidence of abscesses. Dr. Trombley began to carefully pair away the sole along the white line to look for the abscesses, which proved to be deep and quite impressive once found. 

No evidence of P3 rotation. (Sorry for the poor quality image)

Essentially, as the sole was paired away the abscess  began to drain along the white line along the entire lateral half of the hoof. When Dr. Cynthia set the hoof down for approximately a minute, there was a small pool of black fluid on the cement when she picked the hoof up again. I had never seen so much fluid expressed from a hoof abscess. The photo below indicates some of the black pus draining from the sole (red arrows). 

 We treated the hoof with a product called CleanTrax that cleanses the hoof of bacteria and fungi without damaging the sensitive tissue of the hoof. We mixed the CleanTrax with a gallon of water and soaked the hoof for 45 minutes. The instructions indicated that after the initial soak, the solution should be poured out on the stall bedding material and the horse left tied to stand in the vapors for an additional 45 minutes. Dr. Trombley says she has had good success with this product for bad cases of hood abscess and white line disease.

The owner was instructed to keep the hoof padded with nitrofurazone and DMSO gel and wrapped with daily changes until there was no more drainage evident on the padding material. After 3 days the owner called to say the gelding was considerably more comfortable within 24 hours and there was no more evidence of drainage on the wrap material.

Apart from the profound amount of drainage, this case is fairly representative of many of our emergency farm calls because hoof abscesses can be so painful and occasionally baffling to localize.

In my next post, I hope to share a bit about the cases of Potamic Horse Fever we've already seen this summer.
Until then,
-Valerie

Lameness Galore

            Lameness is a major part of any equine practice and I have been learning about the finer points from Dr. Genovese. After 50 years in practice, Dr. Genovese is still seeing appointments six days and taking students from high school through vet school under his wing. He uses a precise and systematic approach to each case, which ensures a complete and detailed evaluation. All of the vets here, including Dr. Genovese, take a very different approach to evaluating lameness than I have been exposed to. When the horse walks into the clinic, a technician takes a detailed history and the students (including me) perform a physical exam. Then Dr. Genovese palpates each limb and the back thoroughly, noting any abnormalities. Following him, we students palpate the horse to get the feel for normal and abnormal. When I began, I could only palpate a digital pulse; now I can identify tenosynovitis, capsulitis, stifle laxity, hock sensitivity, and effusion of the stifle/carpus/carpal sheath/ fetlock/coffin joint. I am still working on differentiating effusion of the specific hock joints and identifying swelling in the suspensory ligament. After the palpations, we take the horse out to jog on the cement. Dr. Genovese usually selects a student to flex all four limbs (I have lost track of the number of horses I have flexed in the last four weeks, but I am now 100% comfortable performing flexions.) Being a truly wonderful teacher, he always takes the time to explain what he sees or hears that indicates lameness. If the case dictates, we then lunge the horse on a soft surface. Depending on the situation, we will then perform diagnostic nerve blocks, take radiographs, ultrasound the limbs, or jump straight to treatment.
            Dr. Genovese was one of the pioneers of using ultrasound to evaluate soft tissue injuries in the equine limb. He, again in a very systematic manner, scans the zones of the “affected” limb and the contralateral “normal” limb in both longitudinal and cross-sectional orientations. Then he takes a split screen side-by-side comparison of each zone in both limbs to identify subtle increases in size. Once he has completed his scan, he gives the probe to me to play with. Some days, he gives me assignments to find specific structure attachments or zones. Other days, he challenges me to replicate his complete scan on the normal limb. Ultrasound is a very tricky art (frustrating for me), but Dr. Genovese is very encouraging and patient, helping me slowly improving each time I put a probe on a leg.
            As a side note, the vets here use many more parameters to evaluate the horse lameness than we were taught in school. The “down on sound” adage in the forelimbs still stands, but here they look for a hip hike to denote hind end lameness. On top of that, they look at the length of stride over all and in the front/hind ends individually. The path and pattern of each footfall, especially in the hind end, can help differentiate a potential problem in the stifle from the hock from the fetlock. It amazes me how accurately they can diagnose a problem by synthesizing the history, palpations, motion, and flexion findings before even blocking the area of suspicion. This is especially helpful on the road when taking the time to systematically block from the foot up is not practical.

Big Hello from Rood and Riddle!
       This place truly never slows down; There are always at least 12-15 surgeries per day, most of them being performed on yearlings as well as foals. Handling these babies is no joke! I would describe it as trying to coax a bratty baby... except it weighs 700lbs on average. Despite all the cute and deadly children, it is still truly a dream come true! So many surgeries to see, and always something new and different!
        Last week, Dr. Latimer removed a mass from a horse's third eyelid. Eye surgeries seem very high pressure to me, since you are working so close to the fragile eye. However, Dr. Latimer is our eye specialist, so I am sure it was a breeze for her.

Mass we removed from the third eyelid 

       Another interesting surgery, was an elbow fracture that came in for Dr. Ruggles. In the case of fractures, a plate is placed onto the break and secured with screws. The plate is later surgically removed, the same way it was put in, once the fracture is healed. 

Every number on this radiograph represents location and size of the screw that was inserted into the plate at various spots. The plate itself was placed caudally to the elbow, along the radius and ulna. 

Thanks for reading again! Stay tooned for more to come! 

Lisa Reznik 

Week 5 @ SVEC

            I have successfully made it through five weeks at Saginaw Valley Equine Clinic!  This week was once again very busy and ended with a couple of emergencies.  On Friday, we were called out to a farm to look at a miniature horse with colic.  Her owners found her acting painful and rolling in the morning.  Dr. Jones performed her examination and found that she had a heart rate of 20 (this was unexplained as pain normally results in a high heart rate), no reflux after passing a nasogastric tube and she could not palpate any impaction or distended loops of small bowel.  However, she took a sample of manure, which felt gritty and performed a swirl test (mix the manure with water in a rectal sleeve and let it settle and if there is sand it will settle to the bottom of the fingers).  When we checked the bag prior to leaving the farm, it had a significant amount of sand in each finger, leading Dr. Jones to believe she likely had sand colic.  Sand usually moves through the small intestine okay but once it reaches the colon, it accumulates and is very irritating to the intestinal mucosa.  The sand can be cleared from the intestines with a product called psyllium, which carries the sand out.  The mare was brought to the clinic for further observation and care where unfortunately things started going south.  She became more and more painful and had to be kept sedated to keep her comfortable.  We did an ultrasound which showed distended loops of small intestines and that finding along with her age (17 years) and pain level, it became more likely that she had a surgical lesion, such as a strangulating lipoma, as the cause of her colic and not sand.  Surgery was not an option for these owners, so sadly, she was euthanized.

            The other emergency had the potential to be very bad, but thankfully had a much better outcome.  This mare was in a paddock with another horse who started chasing her and she ended up going through the fence and ran into the road where she was hit by a car.  She was struck on the right side behind her elbow.  She had tried jumping over the vehicle so the point of impact was fairly small, but she was lifted up and thrown by the vehicle.  (All of those in the car were okay!).  For having been hit by a car, she looked remarkably good.  She had road rash on her legs and 3 of the areas were lacerated deep enough that they had to be sutured and she was understandably very muscle sore.  We also ran blood work, which came back normal other than an elevated neutrophil count which can be attributed to stress.  But there was no indication of any organ damage or hypovolemia.  Her ultrasound showed an enlarged spleen and also a swelling filled with fluid in the area where she was hit, likely blood from the contusion.  In this area, you could see the cranial lung lobe elevated.  Dr. Jones was concerned that it could have been loops of small intestines in her chest indicating a diaphragmatic hernia, but she was able to rule that out by verifying that the diaphragm was intact.  We got her wounds cleaned and stitched up and sent her home on Equioxx (an NSAID), SMZ antibiotics, UlcerGard (she has a history of ulcers and those are likely to return with this stressful event).  She definitely needs several weeks of rest but she has a great prognosis and should be back to barrel racing soon! 

Week 5 at Brown Equine Hospital

Another week in the books at Brown Equine Hospital; I can’t believe how time is flying by and how much I'm learning!

At the beginning of the week, we had a maiden mare (a female horse that has never had a foal) give birth at the clinic.  I arrived at the clinic Tuesday morning at 7 am and saw the night techs running to and from the upper barn where the mare had been staying.  Usually I walk down to the office before checking on the patients, but I knew something was wrong and went to investigate immediately.  The mare had given birth around 1:00 am and while the birth itself was uneventful, the events after were of great concern.  As “prey” animals in the wild, it is very important for foals to stand and nurse very soon after being born, usually within the first 2-3 hours of life.  Here this foal was going on 6 hours and hadn’t even stood up yet.  It is also very important for foals to nurse within the first 24 hours in order to get adequate transfer of antibodies from the mother’s milk before the gut “closes” and is no longer able to absorb the protective antibodies. In addition to the foal still not having stood or nursed, the mare had also retained her placenta, which is considered a medical emergency after about 3-4 hours post foaling.  We helped get the foal to its feet and guided it to the mother’s teats.  After several failed attempts, the foal finally became steady on her own and began nursing.  Once Dr. Younkin arrived, he was able to exteriorize the placenta, which involves moving the already detached portions of the placenta out of the uterus so that the weight of the placenta helps the mare pass it more naturally than having a doctor manually remove it (which can be very dangerous).  Shortly after doing this, the mare passed the uterus in its entirety.  After tackling those first major hurdles, we focused on making sure the mare and newborn foal continued to do well through out the day.  Four days of systemic antibiotics for the mare, and a plasma infusion to provide additional antibodies for the foal, both are doing WONDERFUL and should be going home in the next day or two.

Another case that we had this week was relative short and simple, but it is still very interesting despite having a bit of an “ew” factor (And OF COURSE I have pictures!).  Young horses sometimes get something called an atheroma or an epidermal inclusion cyst.  These cysts are found in the false nostril of the horse, are not painful, and do not usually obstruct the airway.  They usually do not have to be removed, but owners may elect to have them removed for cosmetic reasons.  Cells lining these cysts produce a white to grey, creamy to milky substance that fills the cyst.  Atheromas can be surgically removed, but it is VERY important to remove the entire lining to prevent recurrence.  Another method of “removing” these cysts is to drain them and then inject them with formalin to kill the cells lining the cyst.  It is almost like popping a big pimple!  Not the most exciting treatment ever, but very satisfying. 

And lastly, I was able to assist in removing a plate and screws from the cannon bone of a horse that had had a fracture repair.  Due to the size of horses and the weakened nature of the bone after removing the plate and screws, these procedures are done with the horse standing and employ sedation and local anesthetics instead of general anesthesia, which would have the risk of re-fracturing the leg as the horse tries to stand up following the procedure. After the leg is prepared and blocked so they horse cannot feel the procedure, small incisions are made over each of the screws for removal.  Once all the screws are removed, an incision is made at the top of the plate, the plate is slid out, and the incision is sutured closed.  A bandage was then applied to the leg for additional support of the limb and the horse went home the following day.

Radiograph of the leg with the plate and 12 screws that we would remove.  The two screws below the plate were left in place.

Intra-operative radiograph with needles place in the skin over the screws to assess their location

Intra-op radiograph. 4 screws fully removed, 6 screws mostly removed (still in the leg for assessing location of remaining screws) and 2 screws to go.

The plate!

All bandaged up!

Until next week!