Week 3 RREH Surgery and some time for fun!!

Hello Everyone! It was a great week that ended with Sarah and I taking a trip to Churchill Downs to watch Triple Crown contender American Pharoah work over Saturday and Sunday!

This week there was a weanling with an elbow fracture. The foal had surgery to stabilize the fracture with a plate that would then be removed 10-12 weeks later! Elbow fractures in young horses can cause angular limb deformities so it important to pay close attention to the foal and it depends on the severity of the fracture, the bone involved, the part of the bone (joint versus mid portion),

the type of fracture, the size, age, and temperament of the horse, the type of work the horse does, and if or if not adjacent soft-tissue is involved. This foal also had a laceration on the same limb as the fracture. Dr. Ruggles and Dr. Skillman (Intern) first sutured the wound and placed a drain tube. Then a plate and 9 screws were placed to fix the fracture through the olecranon!
Warning Graphic Pictures! 

 

Ending on a Great Note!!! Have a great week and I can't wait to see what is in store this week!!!

Thanks everyone! Jackie Tobias 

Week 2/3 Goes to the Dogs

Week two with Equine Athletes went by in a blur.  We saw a little bit of everything at the horse show, from colics and lameness, to respiratory issues and ear problems.  And although horses are great, this weeks post goes to the dogs.

As you can imagine working with horses everyday is great job to have, but having some smaller companions to travel with helps keep everyone happy and sane!

Here are some adorably cute photos of Henna and Perrin.

This cutie is Dr. O'Cull's pup, Henna.  She travels just about everywhere with us. You can see we really overwork her!

This is Perrin, Dr. Hill's brand new addition! He's about 12 weeks old now and this was his first truck ride.










Horses and dogs just seem to go together and at the horse show there were plenty of both, including a big droopy great dane puppy and lots of corgi puppies! People always wonder why I love horse shows so much and this is probably why! :)

Hello from Cleveland Equine Clinic! I have been here two weeks and there are many interesting things to share. I spent the last couple mornings on the backside of a thoroughbred racetrack. I am convinced that racetrack medicine is completely unique in equine practice.

We get to the track pretty early, while horses are still being worked. The first challenge is staying out of everyone’s way. Jockeys are taking horses to and from the track, grooms are hand walking horses in the barn aisle. If you don’t get out of the way you’re liable to get run over; if you get too close to a stall door an ornery horse might reach out and bite you, which happened to me this morning. It’s craziness until around 10:30am when the track closes and most of the horses are back in their stalls.

The laws regarding horses racing while under the influence of drugs are strict. To prevent administration of illicit substances, the only persons allowed to possess syringes or needles at the track are veterinarians. We have to be careful to take all our syringes back to the truck; it’s illegal to leave them at the track, even in the trash. There are a lot of prohibited drugs, and the drugs that are allowed have withholding times before the horse can race and limits on how much drug can be present in their blood or urine post-race. It’s important to find out when the horse is going to race next before using sedation, local anesthetics, injecting joints, or even administering parenteral vitamins.  The only drugs that can be given to a racehorse within 24 hours of a race in Ohio are furosemide and aminocaproic acid, and they must be given at least 4 hours prior to the race. These two drugs are used to reduce the severity of exercise induced pulmonary hemorrhage (EIPH).  

So in the mornings at the track, we administer IV furosemide and aminocaproic acid to horses that will be racing that day. We also have to do treatments for horses that aren’t racing if they require any injectable drugs. We check in with all the trainers we service and see if they need anything. Frequently they ask us to do lameness exams or to inject joints. Yesterday, we examined a horse with a grade 3/5 front leg lameness. The horse was lame with a palmar distal nerve block, but sound when blocked with carbocaine at the buttons of the splint bones, indicating the problem was most likely in the fetlock. Radiographs revealed no significant findings in either the foot or ankle. The veterinarian was worried that there may be a fracture in one of the sesamoids or in the distal cannon bone, or that a fracture may occur if the horse continues to be ridden. The problem with radiographs is that they lag behind actual changes in the bone. Until osteoclasts begin to resorb the bone along a fracture line, you may not see a fracture on radiographs.  The recommendation was to do an MRI of the ankle, which could identify changes that indicate a fracture is imminent.

Week 2 at Saginaw Valley Equine Clinic

Week two at Saginaw Valley Equine has been one crazy ride.  It was my first week on call, and naturally, we had an unnaturally high number of emergencies and overnight treatments.  This was awesome, because I got the opportunity to learn a lot and got a lot of hands-on experience.  Not unlike preparing for exams, the best learning is done in the middle of the night!  However, it was an exhausting experience leaving me a bit heavier and more tired than before.  I should really work on avoiding junk food while staying up all night!

Tuesday night we had a foal born, as well as a miniature horse stud come in with sand colic.  I stayed at the clinic from 10 pm until 7 am with that stallion, after working a 9 hour day that day!  Wednesday had no new emergencies, but night treatments at 11 pm and 3 am.  Thursday also had 11 pm and 3 am night treatments, but as a Haflinger with a testicular torsion came in for emergency surgery, I was there until after 3 am anyway!  Friday night required night treatments for the mini and the Haflinger.  Saturday I was at the clinic at 7 am, and left after 9 only to come back in again for treatments in the middle of the night.  We had a new emergency that was to spend a few days at the clinic – a retired barrel racing quarter horse with a uterine infection.  She ended up having to have a large piece of dead vaginal tissue removed but is now doing well.  Sunday and Monday were also extremely long days.  However, I have today off to sleep in and try to reflect on the past week’s experiences.  I definitely learned a lot and got a taste of the schedule of a vet on call! 

Week 2 at Rood and Riddle!

I cannot believe it has only been two weeks that I have been here! I have been learning so many things and seeing so much! I have become proficient in flushing broodmares and am getting more comfortable at palpating them as well. This past week has been a nice mix of routine farm calls and emergencies. One of the more exciting calls we went on was a horse that sliced his eyelid open and it needed to be sewn back together. It looked terrible when we arrived and when we left, you could barely tell he had even injured it at all.

One thing I have liked about ambulatory is that we have routine farms in the morning where I can follow the progress of the horses that we work on. My favorite case so far has been the mare that tore through her rectum during an unattended foaling. It has been fascinating to see her recovery process as how well her colt's leg has been healing. He was born with a contracted tendon and he is almost completely back to normal now.

Outside of the ambulatory work, I have been able to attend a steeplechase at Kentucky Horse Park as well as The Split Rock Jumping Tour. I was also able to take a day off for Memorial Day and explore the Appalachian Mountains. It really is beautiful down here! I have also gotten to meet so many students and veterinarians from not only around the U.S. but around the world. It is wonderful to hear all about the other schools and countries and all of the possibilities for veterinarians.





That is all I have for now! I look forward to more exciting cases throughout the week that I can share with you!

Week 2 in Surgery RREH!

      It has been a busy week 2 in surgery at Rood and Riddle! I have started to learn the ropes which has made it one of the best 2 weeks of my life! This week was filled with incredible surgeries and I was able to help in many ways, including with dropping horses (safely allowing the horse to fall to the floor) and prepping them for surgery! The week started off with an ovariectomy on a 5 year old thoroughbred mare. She had a tumor on her left ovary and it needed to be removed. The horse was under heavy sedation and local anesthetic for the procedure. She was placed in stocks with a table to rest her head on. Her left paralumbar fossa (left flank) was blocked with lidocaine to numb the area for the local anesthesia where the surgery would take place. The first picture is of Dr. Woodie and Dr. Broyles making the incision to locate the ovary. The incision is made in the center of the paralumbar fossa (right in the middle of the last rib and point of the hip) going in a dorsal to ventral (top of back toward belly) motion only cutting through one layer of muscle at a time in clean smooth strokes. An ovariectomy can also be completed with a horse under general anesthesia in a dorsal position. This approach is beneficial because the horse can have a faster recovery time and less anesthetic risks because they are not placed under general anesthesia. Once the incision is made and the ovary is located it is important regardless of the approach of the surgery to ligate the ovary pedicle which is the connective stalk of the ovary containing the ovarian artery and vein, connective tissue and nerves. This stalk must be ligated to prevent fatal hemorrhage of the ovarian artery post-surgery. The equine ovarian artery is a major blood supplier to the ovaries and related structures and it branches directly off of the aorta, therefore it is very important to make sure this is successfully ligated! After the ovary is removed the surgeon can then close the incision and the horse will be placed on post-operative pain medications. The next surgery that I wanted to share with you the elective caesarean section on a thoroughbred mare. The surgery was performed by Dr. Embertson, Dr. Broyles (Surgical Resident) and Dr. MacDonald (Hospital Intern). The owners had elected to do a c-section because of past foaling problems with the mare. The mare was placed in dorsal recumbancy under general anesthesia and intubated. Everyone had to work extremely fast to deliver both a healthy mare and foal. An incision was made on the linea alba of the ventral midline. The incision is cutting through skin and fascia then muscle layers making up the rectus sheath, the external abdominal oblique, internal abdominal oblique, and transversus abdominis. The rectus sheath is a sheath that surrounds the muscle the rectus abdominis due to the ventral aponeurosis of the previous muscles mentioned running superficial or deep to the rectus abdominis. The incision will also be cutting through the transversalis fascia and peritoneum lining the abdominal cavity. Then the uterus is located and an incision is made in the uterus near the foals hock to allow the surgeon room to remove the foal. A set of Carmalt forceps are used to crush the umbilical cord. Once the umbilical cord is cut then the foal is pulled from the uterus and a crew is waiting to revive the foal while the surgical team stays to finish the surgery on the mare. The uterus is checked and placenta was manually separated from the uterine wall and in this surgery the placenta was left in for the mare to expel on her own. She was given oxytocin to stimulate uterine contraction and milk let-down. The uterus is then closed and the abdomen is lavaged with sterile saline and suctioned to remove all of the fluid. There is a final sponge count and then a final check to see if there is any areas still bleeding. Then the cecum is decompressed of air and the incision is closed. A filly was successfully delivered!!!! I have never moved so fast in my life and it was an incredible experience to be a part of!! I am so thankful to all of the people at Rood and Riddle for teaching me and it has been a great week 2! I can’t wait to see what next week has in store! Thanks for reading! Jackie Tobias

Ovary with tumor!

Incision for c-section!

Uterus with cecum on left side of picture!

Pulling the foal!

Live Foal! It's a Filly!

Suturing up the uterus!

Lavage before closing

Decompressing the cecum so it can be closed

Closing



Greetings from Littleton, Colorado

Hello everyone!
I will be spending the summer at Littleton Equine Medical Center in Colorado.  LEqMC is a full service primary care, referral, and emergency center. There are 15 full time doctors, including 2 board certified surgeons, and 4 rotating interns. The hospital has the advantage of having its own on-site laboratory. There is also a wide variety of imaging modalities available for the doctors to use including digital radiology, ultrasound, standing MRI, endoscopy, and nuclear scintigraphy. Some doctors also perform acupuncture, chiropractics, and laser therapy.

Darkelly, a 1994 Quarter Horse stud, stands at the hospital. When I first met this handsome boy, I would have never guessed that he was 21 years old!

On my first day Thursday last week, I came in to a newborn baby filly! She has quite the personality and has a great mom!

I will mainly be working in ICU during my time here. After a couple more weeks training in ICU and around the hospital, I will assist one of the field veterinarians on Mondays,  assist with surgeries on Tuesdays, and my remaining days each week will be in ICU. We haven't been extremely busy so far but this has given me the chance to take care of post-op and medical colics, assist with lameness exams, observe part of a carpal joint scope, assist in preparation for a colic surgery, among other things. Everyone has been wonderful so far and willing to teach me as well as quiz my knowledge. I've had the chance to apply my radiology skills a few times the past week. I assisted with a couple fetlock and foot radiographs as well as a thorax study. The horses stand on blocks to help elevate their feet off the ground to get the best possible view of the hoof.

The best part of Colorado is the gorgeous view of the mountains while working with the horses!

I also had the opportunity to go hiking Sunday in Boulder! This is the view from the top of Royal Arch. 

Week one

Pardon my tardiness on getting this blog written!

Week one under the careful tutelage of Dr. Brad Hill and Equine Athlete began promptly the Sunday after final exams and there has been little down time since!  We traveled to Indianapolis that afternoon where we performed lameness exams and flexion tests on close to 30 horses.  Between Sunday and Monday, I lunged horses for Dr. Hill and his associate, Dr. O'Cull, jogged for flexion tests, scrubbed more joints than I can possibly count, and learned more about equine lameness in those 2 days than I had in the past month in vet school!  After completing our work in Indianapolis Monday evening, we drove to Cleveland so that we could begin working on another group of horses early Tuesday morning.

The goal in seeing so many horses was not only routine maintenance of these incredible athletes, but also preparation for the upcoming show season.  After performing each lameness exam and flexion test, Dr. Hill and Dr. O'Cull palpated nearly every inch of these horses to try and located the source of any problems.  If needed, we also radiographed and ultrasounded horses that palpated sore or flexed lame.  Anyone thinking about this position next year, will be extremely grateful that the last unit in first year anatomy is the equine limb! This was a great opportunity to apply what I had just learned in school! On this first road trip, I was not only able to scrub for and observe the more common joint injections, but also watch an ultrasound guided injection of the trochanteric bursa and sacroiliac joints.

On Sunday, we had a day full of surgeries.  After prepping horses for surgery, I was able to observe the arthroscopic removal of a sesamoid fracture, a closed castration, and the removal of a mass on an udder.  The most interesting case of the day was an arthroscopy of the femoral patellar joints on a yearling with trochlear ridge OCD.  With this horse, the doctors found OCD lesions on the caudal aspect of the patella that sits and glides over the trochlear ridge of the femur.  It was interesting to see the innovative ways the surgeon found to remove this lesion as it appeared incredibly difficult to get to with straight metal instruments.

I've now entered my 2nd week with Equine Athlete and I'm writing to you from Columbus, Ohio.  Equine Athlete is the official show vet and we've arrived early to make sure all the horses are happy and healthy after their long journeys. I promise this week there will be pictures and more interesting cases. Stay tuned and thank you for reading!

Week one at Saginaw Valley Equine Clinic

Monday morning was my first official day at Saginaw Valley Equine Clinic.  Although myself and the other fellow at SVEC went in at 9 am for orientation, we were told as we arrived that we would be going on a farm call to relieve a choke on a mammoth donkey instead.  Of course I was excited to start off my first day with a case, and this was just a sampling of the things to follow that week.  The most striking thing for me this week was how different equine medicine is from small animal medicine.  I worked as a veterinary assistant in a small animal practice throughout my undergraduate education, and what we saw in the clinic was generally routine vaccinations, toe nail trims, spays and neuters, and the occasional diagnostic.  This week was dominated by embryo transfers, stallion collections, artificial inseminations, pregnant mare ultrasounds, pre-purchase exams, lameness diagnostics, chiropractic and acupuncture visits, and foal care, with a few surgeries and other diagnostic procedures sprinkled in.  It was a week filled with new experiences and I really enjoyed seeing half a semester of veterinary physiology applied during five minutes of a case involving a dummy foal with kidney failure.   I can’t wait to see what next week brings!

Week 1 in Surgery at Rood and Riddle Equine Hospital

Hello Everyone from Lexington, Kentucky! It has been a busy week since I arrived here in beautiful Kentucky to spend the summer working with all of the incredible people here at Rood and Riddle Equine Hospital. The pastures are green and the weather is amazing since both Sarah and I arrived here to start our summer journey. Sarah and I are living on a beautiful farm with 3 other interns, where we all get to share our different experiences here at the hospital at the end of the day. After starting work on Monday, I have spent the last 5 days working in surgery and it is amazing! Everyone works hard as a team to take every equine patient through surgery safely! My favorite part is how friendly everyone is and all of the different surgeries that are performed here at Rood and Riddle on a daily basis! Everyone works together as a team to make sure that every horse has a safe surgical experience. This first week I have been learning how to take a horse through surgery from induction, anesthesia, surgery, and then recovery. Some of the different surgeries that were completed this past week include sesamoid fracture repairs, various arthroscopies, an eye enucleation, a tie back surgery, colic surgeries, inguinal hernia repairs, a condyle fracture repair, and a bilateral cryptorchid! I have learned so much this past week and I can’t wait to continue on this journey! The day starts out by preparing for the different surgeries that are scheduled and then each technician will help induce, scrub and prep each patient, and then assist the doctor in surgeries, then help the horse to the recovery stall. It has been a great experience being able to be a part of the surgical process from start to finish. The surgeons at Rood and Riddle are Dr. Bramlage, Dr. Embertson, Dr. Ruggles, Dr. Woodie, Dr. Hopper, and the Surgical Resident Dr. Broyles. Every day multiple different surgeons perform different surgeries simultaneously so there is a lot happening all at once and so many opportunities to learn! A surgery that I thought was really interesting and I was able to help with from start to finish was a horse who was a bilateral cyrptorchid. Cryptorchidism means “hidden testes” and it is used to describe a condition where one or both testicles do not descend into the scrotum correctly. If a horse is only unilaterally undescended then it can still be fertile, but if both testicles are not descended then the horse is typically sterile. The retained testicles can be located in the abdomen or within the inguinal canal. It is not known what causes the retained testicles, but it is considered to be a combination of genetic, hormonal, and mechanical factors. All horse breeds are susceptible, but it is very common in quarter horses, saddlebreds, percherons, and ponies. The horse that had surgery was a thoroughbred. Surgery is recommended for treatment of cryptorchidism. The standard surgical approach was performed by Dr. Embertson and Dr. Broyles with the horse placed in dorsal position under general anesthesia. An incision was made over the external inguinal ring and the testicular tissue was carefully removed. The external inguinal was then closed and then the incision was closed routinely.

Anesthesia! The horse is in dorsal position.  

  Dr. Embertson and Dr. Broyles starting the surgery!

Searching for the testicles!

















Placing the emasculators to remove the first testicle!

Both testicles have been removed safely and now it is time to close!

 

Closing!

Thanks everyone for reading!!  

-Jackie Tobias

Week 1 at Saginaw Valley Equine Clinic

My first week here at Saginaw Valley Equine Clinic has flown by, but yet it feels like I've been here forever given all that I have learned in the past seven days! Saginaw Valley Equine is a four doctor practice located in Saginaw, MI. Dr. Cumper owns the practice and sees appointments as well as travels to high level horse shows all of the MI and the country. Dr. Jones sees most of the ambulatory cases as well as being responsible for mares and foals. The hospital is equipped with a foal alert system which calls Dr. Jones as well as Diana, one of the techs, and whoever is on call, which this week was me. If a mare is in labor, Dr. Jones arrives in minutes to assist. Dr. Rapson is responsible for most of the reproductive aspect of the clinic. She monitors the reproductive status of the mares at the recip mare farm and times the mares reproductive cycle to be ready for various embryo transfers as well as inseminates and scans (ultrasounds) mares to check for pregnancy. Lastly, Dr. Williams, the Board Certified Veterinary Surgeon performs the surgeries that take place. This varies from colic to arthroscopies and ovariectomies and more. She also sees office visits and is available for farm calls. 

My week began when Elaine and I arrived at the clinic for orientation and our first day on Monday. But typical to our profession, we were immediately rescheduled to go out on a farm call to relieve choke in a mammoth donkey. Dr. Jones passed an NG tube and lavaged the esophagus to relieve the choke. It was a messy first call of the day, but the choke was relieved and the donkey should do fine. 

After relieving the choke, we also took a look at some smaller donkeys that had just been rescued with extremely overgrown hooves. It will be a long process to recovery, but Dr. Jones recommended some pain prevention and the farrier will soon get to work on relieving the "elf feet."

Since our first time out, Elaine have been on separate shifts. I work 10:30 - 7 and then am on call for the entire week as well as perform treatments during the weekend. Elaine has been working the morning shift. She comes in at 7:00 and works until 3:30, but then is not required to be on call. Next week we will switch.

Throughout the week I have seen a variety of cases. I've seen stallions collected and embryos transferred from a donor mare to a recipient mare. I've assisted with lameness exams including nerve blocks and radiographs. I've helped with pre-purchase exams, which include a standard 20 radiograph study and additional radiographs performed in problem areas.

One case that interested me was a gelding that had chronic nasal discharge and had seen a couple vets before ending up at Saginaw Valley. We performed an endoscopy and Dr. Jones had a lot of trouble entering either guttural pouch, but was getting a lot of mucous on her probe whenever she tried to enter them. This prompted her to take a radiograph of the guttural pouches, where she found a large number of chondroids. Chondroids occur when there is an infection in the guttural pouch and the pus consolidates and can only be removed via surgery. Unfortunately the surgery is not only very costly, but also comes with a high risk of damaging the nerves and arteries that run through the guttural pouch, thus causing nerve damage and possibly even a fatal bleed.

Helping doctors and watch them work through a case is one of the best ways to learn. I've also gained a massive amount of experience giving treatments to various horses. From foal handling to controlling problems animals gaining experience is invaluable. It's also really helpful to actually be the one administering medication and fluids, because understanding why I'm giving a particular medication or treatment helps me to remember it in the future. One case that has caused me to gain a particularly large amount of experience was a dummy foal that came in. The foal had low IgG and elevated Creatinine, indicating failure of passive transfer and possible kidney damage. The foal was not able to get up or down on it's own and it's suckling reflex was inadequate, causing it to be at high risk for aspiration. An NG tube was placed so that the foal could be tube fed until it was able to nurse successfully on it's own. The mare was milked and the foal was fed every two hours throughout the day and night. The foal was also put in fluids to try and flush the kidneys. Maintenance fluid rate for a foal is 100 ml / kg. The foal weighed about 100 lbs (45kg), and was push on a rate of 1 1/2 x maintenance. Accounting for the milk the foal was being given, this meant that the foal was receiving 1 L of fluids every 4 hours for a total of 6 L /day. Additionally, the foal was given Ceftiofur (Naxcel) to fight off any infection. Although all these treatments required TONS of work, the investment is invaluable. The foal is doing much better. Her IgG and Creatinine are back to normal and she is now able to nurse on her own.

The other great thing about spending TONS of time in the clinic is that I was there when a mare began foaling, so I was able to watch the entire process (from a distance)! She had a normal labor with a healthy colt, and seeing the entire process is a wonderful opportunity!

I can't wait to start a new week! Thanks for reading! 

-Kaitlin