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!