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.