Weeks 10-12 at Stevens Equine

There have certainly been some interesting cases in my last few weeks at Stevens Equine.  Most of the cases have been the usual lameness exams but there has also been some dental work, colics, and a choke.  The choke resolved well after the horse was sedated and a nasogastric tube was passed.  The obstruction was disintegrated by repeatedly lavaging it with water.  I could see why aspiration pneumonia is a common secondary problem with it, but the horse recovered well and without complications.  We also saw another horse at the show prior to the choke that likely had an esophageal stricture because while it ate, its neck would become ventrally distended just cranial to where it joined its chest.  It had not been a problem for the horse, but Dr. Stevens recommended feeding it many small meals throughout the day and keeping an eye on it.

Another interesting case that we have been treating is a retired show horse that had a bout of laminitis earlier in the summer.  She has been treated with supportive care and kept on stall rest, and has been shod therapeutically with the addition of equi-pak and a pad.  Oddly, she foundered more severely in her hind feet.  We re-checked her again last week and found that she had developed an abscess in her right hind hoof just under the pedal bone.  Furthermore, radiographs revealed that she had some osteomyelitis of her distal P3.

Rather than euthanizing her, the owners elected to have the affected area opened and debrided through a heavily sedated standing procedure.  So, after performing a high four point nerve block and an intravenous regional perfusion with amikacin, the sole was opened and the nonviable tissues were debrided.  The site was lavaged thoroughly then packed with pivodone-soaked gauze and the distal limb was wrapped with a pressure wrap.  As of when I left on Saturday, she was receiving daily regional perfusions with amikacin with bandage changes and was going to have a hospital plate placed on the hoof that day.

Jamshidi needle, 20 cc syringe pre-loaded with sodium

heparin, and scalpel blade for stab incision

One other very interesting case was one that I have written about earlier.  That horse presented for lameness and after a thorough lameness exam, ultrasound revealed that his pain likely stemmed from an old injury of the DDFT that had mineralization within the lesion.  The injury was treated with shockwave therapy then stem cells were harvested from the horse to place in the affected region.  I have never seen stem cell collection prior to that, so it was very interesting to watch.

Common places to harvest stem cells from include from adipose tissue deposits around the tail head as well as marrow from the ilium or sternum.  Dr. Stevens usually collects them from the sternum, as slight scarring is possible.  First, the sternum was viewed via ultrasound to gain visualization of the individual sternebrae.  The horse was then sedated and the area was clipped and scrubbed.  The area between the point of the elbows to approximately 4 cm caudally was blocked with carbocaine.

Placement of local anesthetic (Carbocaine)

Stab incision made over sternebrae

After the region was anesthetized, a stab incision was made through the skin and underlying tissues and a Jamshidi needle was placed into the sternum.  A Jamshidi needle is basically a bore, and is an 11 gauge 4” needle that penetrates the sternebrae when it is rotated.  A syringe that is pre-loaded with heparin is then attached to the Jamshidi needle and 8-10 ml of marrow is aspirated.  The needle was then removed and the incision was closed with skin staples.  A blood sample was also collected for the cryopreservation of stem cells.  The procedure went very smoothly, then we packed the collection with ice and shipped it overnight to Advanced Regenerative Therapies.  There, the cells are processed and expanded, then the expanded stem cells are returned to be injected in the site of injury.

About 10 days later, the stem cells were returned and were placed via ultrasound-guided injection into the tendon.  It is a very precise procedure, and we had difficulty because this horse tends to sway when he is sedated.  Ultimately, the placement was successful and hopefully the horse recovers well and returns to competition.

Jamshidi needle placed for marrow collection

Syringe attached to Jamshidi needle and aspirated

Ultimately, I cannot believe that this summer is almost over already!  I have learned a tremendous amount through this experience and would like to thank Dr. Stevens and Christy for everything that they have done as well as Dr. Schott for giving us all the opportunity to expand our learning through this program.

12th and Final week at RREH in Ambulatory

It's crazy how things slip away from you when everybody wants a bit of your time.

Sunday was a pretty relaxed day. I watched Netflix, read, and got a couple things from the store.

Monday was strange. I started with Dr. Friend. We saw a bunch of repro stuff. I learned to write a health certification. We saw an old horse for an ADR. It seemed he may have had a bit of laminitis. We saw a metabolically challenged horsey. The tech and I got to float some teeth. I went with Jordan to do a Coggins on a rotten horse and dig out an abscess on a pony.

Tuesday, I rode with Dr. Heath Soignier. He started a whole lot later than I was used to. He told me all about his family and his route to where he is now. We rechecked a pneumonia foal. I saw a different way of doing the lung scan. We drew a couple Coggins. I was surprised that he handed me the materials without asking a million questions. We looked at a puncture wound in an older foal. That was another experience for me to see a different way of doing things. We also saw a conformationally challenged foal and a cellulitis mare. We were done just after noon. I was surprised that he asked me to come back out with him at Thursday.

Wednesday was fun. I started at the clinic picking up stuff for Jordan. We started by rechecking a mini donkey eye. We floated some pretty bad teeth at the Horse Park. We did a couple regularly repro stops before meeting up with Dr. Friend at his farm to do some more teeth.

Thursday was interesting. I started the morning with Dr. Soignier. We palpated two mares. We retook some radiographs for the stallion that bit Dr. Soignier on Monday. We looked at an abscess and rechecked the foal with the puncture wound. After he was done, I hung around the clinic to wait for Dr. Friend. He had a chiropractic appointment at the clinic at 2. The people were from Richmond, IN. It was interesting to see the full workup instead of the barn version.

Friday was bittersweet. They said the day was all about me. I got to do just about everything I was able. I was given the opportunity to choose whatever place I wanted for lunch. I had Dr. Friend pick me an Italian restaurant. It was very good even though it took forever. I say my thank yous and gave my gifts. I had a little nap before packing up my things and heading home.


This was a fantastic experience!

Clinton Week 7 and 8

Hello everyone, sorry for the delayed post, I was needed at home immediately after completing my time at Clinton and have not had time since.

Week 7 seemed to be a week for eye problems. Even the horses being seen for other appointments had eye problems. It is just that time when horses are outside more and can find more trouble to get into or their owners notice a vision problem that wasn't apparent before.

One of the first appointments we went to the owners had noticed that their horse seemed to be bumping into things in his paddock frequently. He also seemed to become easily disoriented and would panick in an area when he didn't realize where he was. Upon opthalmic exam, the horse had lost all vision in his left eye, He no longer had a pupillary light reflex for that eye. The right eye was very clouded with cataract progressing, though there was evidence he still had some vision in the eye. There was no sign of any ulceration. Unfortunately there was not much to be done to help the horse. A triple antibiotic with corticosteriods was perscribed for the right eye as a trail to see if it helped him at all. Other suggestions for the owner were to narrow the pasture areas he had access to and keep them clean of debris. Putting a bell on one of the other animals that the horse is a buddy with so he has someone to follow. The owner was very willing to try anything she could to make life easier for her horse.

We also had a horse brought into the clinic for an eye removal, also known as an enucleation. The horse had previously had trauma to the eye that had resulted in loss of vision. Recently, the horse had been sold and the new owner decided she wanted the eye removed. I was allowed to help place the nerve blocks around the eye socket and to the surrounding nerves. I learned quickly the difficulties of pushing larger volumes through a small gauge needle, sometimes ending up with more carbocaine outside the area than in it. I scrubbed in on the surgery to help hold instraments and pull tissues out of the way. Eye removals are not the most neat of procedures. They tend to bleed a lot and there is a large bulk of tissue that simple needs cut away and pulled out. That and the large optic nerve needs cut. It is not a good one for the squimish to observe. After everything has been removed, a suture pattern is placed to prevent the overlying tissues from sinking in as much and surrounding tissue is pulled down and sutured together to cover the hole that has been created. It amazes me for all that is involved, this procedure can be done standing with sedation. Once the surgery was done, we cut into the eye that was removed. The whole eye was very shrunken and the inner chambers were full of old, blackened blood. This horse was much better off with the eye removed.

Another of our eye cases that week, was a mare that was brouth in for a vaginal exam, not an eye. The owner had noticed thick, nasty vulvar discharge shortly after the mare had been bred. She did not concieve and upon exam she no longer had discharge. There was a reddened area in her vagina but it appeared to be healing nicely. However, when talking with client, Dr. Trombley noticed that one eye looked slightly swollen and painful. The owner said that she had noticed that the day before. Staining the eye revealed a corneal ulcer. Atropine and a triple antibiotic were perscribed. In this case there were no corticosteriods included in the ointments because they inhibit ulcer healing.

Eyes are always interesting to treat. They can be very fraustrating to get to heal and there is such a wide variety of treatments that can be tried. Always check the eyes, you never know what you will find.

Week 8 was the end of my fellowship with Clinton. It certainly went by faster than I expected. The last week was fairly quiet. We had a lot of appointments that were just giving vaccine boosters and doing health certificates and coggins as many clients were getting ready for fair. We also had a handful of later pregnancy checks on mares we had seen earlier in the summer. For the most part, all the mares were doing well and maintaing their pregnacies.

Aside from that, we floated a number of horses teeth. A couple of clients were willing to let me do the main floating and then have Dr. Trombley go over it to show me where I need had missed. It was a great learning experience. It takes a while to get used to the amount of pressure and the angles you need to hold the different files at in order to wear the teeth the way you want. I was starting to get it but I will need a lot more practice before I feel confident in what I can do. We had a number of horses with very bad mouths. There were lots of caudal hooks, ramps, bad steps, and transverse ridges, all of which were impeding the proper chewing motion. One horse stuck out. he had one of his molars that was displaced to the inside of his mouth about 1/2 of an inch from the rest of his teeth. We are not sure if that is where the tooth erupted or if something happened that pushed the tooth to that spot. Only about half of the tooth had any contact with the teeth below. The part that was not in contact had formed a sharp, long point (over an inch!) that was piercing down into his tongue. It had to be very painful for the horse and was causing him to toss his head when ridden. It will take a couple, more frequent floats to improve his mouth entirely, but at least the tooth was taken down enough to stop jabbing his tongue.

We also had one lameness exam that was a little fraustrating. The horse was intermittenly noted to be very stiff and sore but not consistently. It was also noticed that she seemed to be tripping more in during lessons. Of course the day of the exam the horse was moving normally. She did not react to flexion tests but she was slightly sore to hoof testers. The owner elected to have us take x-rays of the front hooves to check for navicular disease. On the x-rays there was no hard evidence of navicular, but the pasturn angle was broken back. Recommendations were made to have the farrier change the angles he was trimming on and see if that would improve the horse's comfort level.

My time at Clinton has flown by and it has been a great learning experience. I learned more about breeding and pregnacy exams than I ever expected. It was great to live the day to day life of an ambulatory equine vet. Sometimes it is slow and you have to be creative on what to do in between appointments, including helping the office staff with their work. Other days it is one appointment after another and it doesn't seem you have enough time in the day to get to everyone. The varitey of people that you meet is amazing. It is so nice to be able to build a relationship with the clients because you see them on a more regular basis. You truly get to know them much better than if you work at a referal hospital and they appreciate what you do. This summer has made me more proud of the career I am pursuing and excited for what is to come in the future.

Final Times at Cleveland Equine

I have finished at Cleveland Equine Clinic, and I have had the most amazing summer experience.  This last week was pretty great.  I was able to see and assist with a mass removal on a horse's upper eyelid.  This was more of a debulking procedure as the mass was quite involved in the surrounding tissue, and complete removal of the mass would have resulted in damage to the eye. A penrose drain was placed because after debulking there was a significant amount of empty space, and we did not want fluid or infection to pool in the area.   There was also a smaller mass over the facial crest. The doctor removed that but then let me do my first suturing!!!  I did 3 simple interrupted sutures to close that incision. After 4 days the drain was removed and sutures were removed after 10-12.  Histopath on the masses revealed they were sarcoids.   We have seen a lot of sarcoids this summer. They are a benign skin tumor.  They are benign, however their location can lead to pain or other problems.  This sarcoid was large and on the upper eyelid, and was pressing on the horse's eye. It also kept the eye from closing completely which leads to increase risk of eye trauma and ulceration. 

There was also a colic that came into the clinic.  It's history is long an convoluted.  The horse may or may not have had bastard strangles--they found an abdominal abscess on rectal palpation 2weeks prior. The horse was treated with excede (ceftiofur).  The abscess could not be palpated at this visit, however there were thickened small intestines. He came in with a heart rate of 52, but an arrhythmia, and a grade 6/6 heart murmur.  We passed an NG tube and before entering the stomach got spontaneous reflux.  In total 6 gallons were refluxed from the horse.  We left the NG tube in place so he could be refluxed as needed throughout the night. After we got this huge volume off his stomach, we re-listened to his heart and the murmur was gone and arrhythmia had lessened.   In the morning he was placed on IV fluids. An ultrasound exam was done.  Enlarged liver was noted, along with ileus throughout the small intestine.  He was refluxed throughout the day without any significant improvement.  At the end of the day the decision was made by the owners to euthanize him.  This was an interesting case in terms of how to handle difficult cases and client communication.

I have had the best learning experience this summer and thank all at Cleveland Equine Clinic for the opportunities they have granted me. Each and every veterinarian at CEC has been a pleasure to work with and they have all been wonderful teachers. I also would like to thank Dr. Schott in his work to keep the Equine fellows program running.  This has been a once in a lifetime experience and I hope to incorporate all of the wisdom and education from it into my practice as an equine veterinarian.
Thank you ALL for an amazing summer!!!    Now back to school in 3 weeks!

Past few weeks at Littleton Equine

Hello all!

Greetings, sorry for the lack of posts lately, things have been busy. It is very weird coming to the end of this summer, I'm sure it's a mutual feeling all around, but it's been a pretty incredible few months!

Things have been very busy here, I guess June was a record-breaking month for them here. My weeks have been fairly consistent as well, with some fun surgery days, ICU going from a full barn to a bit of a slow down, and being able to go ambulatory as well as to the Horse Park for the shows.  With the busyness has brought some diversity, so I've been able to see a handful of really cool cases.

This was one case I went to with Dr. Senn, one of the former interns from last year. The owner noticed this in the morning, and was rightfully a little concerned..! Upon arrival, he, Hot Shot, was fairly calm and alert, but clearly this was very painful. It was a long process of trying to diagnose, clean, and prep just to even get a feeling for just what the damage was. We were obviously worried about any brain damage or communication into the local sinuses. The same side nostril had some blood coming from it, so that led to a little more caution as well. Once Dr. Senn was able to get a probe in there and feel around, trying to see just how deep it was. He wasn't the biggest fan of all of this, and to add insult to injury, upon normal administration of PPG IM, he had a pretty severe reaction. Thankfully no one was injured, including Hot Shot. We finally got him settled down, and were able to take some radiographs of the area. A big concern is not just the depth, but the interaction with the eye itself. He didn't have much of a menace response, and his globe was already starting to get cloudy. After all that, we eventually got him stitched up, leaving a slight opening at the bottom to allow for any drainage.

Two weeks later, we returned for his recheck, and the wound itself looked really great. I forgot to grab a picture of the after, but the site was clean, and healed beautifully. That was a relief, however, we were still concerned with the eye. Again, no menace was elicited, and he wanted to keep it closed constantly. Dr, Mullen, the Internist, came to the appointment as well, and was able to stain the eye, which had no uptake; take an IOP, which was surprisingly within normal limits; as well as ultrasound, which found some slight retinal detachment. Unfortunately, this doesn't bode extremely well, however if they do choose to remove his eye, they think that he could do just fine, seeing as it wasn't causing him too much pain anymore. Dr. Mullen said she would discuss it with an ophthalmologist and go from there on any further options. 

There's also been the multitude of arthroscopes, athrodeses, and more than enough colic surgeries. The Summer Show Series out at the Colorado Horse Park ended 2 weekends ago, and they were all a steady stream of lameness exams, pre-purchases, radiographs, joint injections, and miscellaneous patients. 

This was an interesting case, the horse had been having some soreness and pain up around his head and poll, thinking maybe something was out of place potentially. He had chiropractic work done, and some rest, but nothing was seeming to work. This rad taken shows some interesting mineralization or metal potentially up near his pole, caudal to his ears. It was quite the mystery, and I'm not even entirely sure how he's been doing since then. 

There were a handful that did have to come in to the hospital for colic surgeries, I think week 6 out there had 3 over the weekend. I was asked to forego my final weekend out at the shows to stay here and help with ICU, as it was getting a little packed..! Thankfully since then, it has calmed down a bit. 

This horse came in for a recurring dental issue as well as some concern about the sinuses. This horse has previously had 108 removed I believe, and there was a bit of infection, and it apparently kept draining from the site for over a month. Dr, Dunbar, the tooth expert, as well as Dr. Devine, our surgeon both tackled this case together. Dr. Dunbar went in orally through her mouth and removed 109, which was the primary reason for the procedure. Yet, when the sinus flap was opened, it showed that the entire right side of this horse's face/sinuses was filled with a caseuous exudate. Very pleasant smelling too.. Thus began a massive lavage and cleared it all out. A film was shot, and there revealed some cyst-like structure in the same region as well. It was quite perplexing just because there was no localized swelling and when Dr. Dunbar probed from within the mouth, there was really no opening to go through. It was decided to just totally flush it, take care of the tooth, close her up and see how it heals, coming back to rads later down the road. She recovered great, and as far as I know, there have been no further problems. 

Two weeks ago, we had another interesting case. A broodmare was in to be re-bred, however she came into surgery for a urethral extension. The mare was so sunken back cranially, that her uterus would just fill with urine. A rubber catheter was used as the temporary line, and it was an intricate process of making sure it would stay in as well as not doing too much damage to the structures involved. This mare was about 22 years old, and was a little bit of a poor doer, so the topic of even breeding her in the first place came up. It was a good learning experience to understand that even though we as a veterinarian may not think it's best to breed this mare or that stallion, and can convey that to a client, but at the end of the day, unless truly critical, that decision isn't ours to make. 

Last week also brought in a 4 year old TB with a rough history of some hock effusion and intermittent lameness. 

He had an arthoscopy to basically get a diagnostic game plan for the future, and even Dr. Devine mentioned that this might possibly be the largest hock he's ever seen..! Once he was in there, it was a mess. A lot of shredded cartilage, and even removed a couple of these bone chips. The prognosis was not great for this horse to return/aim for a full athletic career, and it is really unfortunate just given he's so young. Hopefully he is now much more comfortable though. 

Another fun case was a horse that I have previously mentioned on this blog post. Russel, a horse that presented as a choke, stayed at the hospital for a while, with a temporary trach, and an eventual diagnosis of DDSP. They went in and lasered it, but after he went home, apparently he was not improving like we wanted. So, he arrived back for another visit, this time for a permanent trach. 

Everything went smoothly and he was now equipped with a much improved breathing capacity. He recovered really well, and apart from the expected swelling around the site, everything looked great for him and he was able to go home. The only true concern for the owner was his lack of vocalization anymore! He was an incredibly sweet horse. 

This past week/weekend also brought Colorado the National Junior and Young Riders Championship. I partook on the festivities on Saturday, the major cross country day. Being an FEI regulated event, the security and rules were much more strongly enforced. It was exciting to see just exactly how this ran, being extremely interested in that level of competition and veterinary care. I helped out with the One Star horses in the morning to start, in the holding box after they ran. It was very similar to the rush that happens at Richland, if anyone has been there. I helped Dr. Toll, who has been at this event since 1998, with the TPR's and rechecks of these horses. Then, we proceeded back up to the main area where I helped Dr. Christakos administer some IV fluids for a few horses. Most teams brought their own vets, so we had less to administer than expected, which was very welcomed. The trouble with FEI events is the lack of ability to use any drugs, sedation, blocks, etc. so placing a catheter is made a lot more interesting. There was only one horse that fell on the cross country course and it was only a slight abrasion, road rash basically, so everything and everyone stayed very safe. We had a chance to watch the stadium jumping at the end of the day, and again thankfully no injuries, just an exciting run! 

I can't believe I'm coming to the end of this awesome experience, but here's to a great final week and finishing out my time here in Littleton! Hope you all are having wonderful summers from here on out as well! 

-Taylor Alton

Rood and Riddle Ambulatory!! Weeks 9, 10, and 11

Time has flown by this summer! I can't believe it's been another 3 weeks already! It's kinda sad to think that I only have a few days left; on the other hand, it's exciting that I'll get to spend some time with family and friends soon!

Week 9:
     Sunday was a day off to get laundry and errands done.
     Monday was a strange day. I started the day with Dr. Jordan Kiviniemi-Moore but quickly switched over to Dr. Friend. The first few stops were mostly reproduction work. Dr. Friend injected a tendon sheath and a wind puff at our last official stop. Then we went to his farm. One of his horses had advanced moon blindness. We got to help with an enucleation procedure on it. I placed and sutured in a long-term catheter before we started. I helped tech the procedure. After we were done I got to dissect the eye. The lens had been ventrally luxated and was starting to break down. Right before we left, I got to tube another horse just for fun. It was a good day!
     Tuesday was a pretty short day with Jordan. We did a fair amount of ultrasounding and lavaging. We changed the bandage from Friday's enucleation. The day ended with breeding 2 mares. That left me with time to finish my last blog post.
     Wednesday was closer to normal length.  I rode with Jordan again.We checked and lavaged several mares. We did a pneumonia recheck on a foal. We did some recheck radiographs on a foal with a wing fracture. Jordan suggested that he get bar shoes to help reduce the motion in the hoof, so it could heal better. We took some radiographs of a foundered pony and a very arthritic pony. I pulled blood for a Coggins while Jordan looked an a potential hoof abscess. We scanned and bred a couple mares at our next stop. We finished the day looking at a horse that looked like it had been kicked in the side of the face. It didn't have any outward damage, just edema. He got a blast of anti-inflammatory agents.
     Thursday was a pretty standard day of reproduction work. One of our last stops was interesting because no one spoke much English. They had to call their daughter several times to help with the language barrier. It was very difficult to figure out what was going on and decide how to help the horse. We ended up wrapping a leg and leaving them with materials to rewrap it the next day as well as antibiotics and Banamine. I can't remember what the complaint was though.
     Friday ended up being a much longer day that the last few. I met with Jordan in the morning. We had to go to a couple of Friend's stops with him because his truck was still in the shop and he didn't have very many of his things. Those we mostly repro stops. We finally got started on Jordan's schedule 2 hours later than planned. The rest of the day was pretty routine. We saw a horse with a very sore back. He was suggested more time off. We saw an infection in the ear pinna of a horse. That was strange. It looked like there may have been some sort of wound that got infected. The owners had been treating with penicillin for a while. We also saw an ADR that ended up with extremely high eosinophils.
     Saturday was a day off. Friend was going up to Michigan for a family vacation for all of next week. Hopefully things don't get too crazy.


Week 10:
     Sunday was another day off. I ran some errands and found a laundromat since the girls across the driveway were both working. I forgot to work on this though.
     Monday was an interesting day. We saw a lot of reproduction stuff but also 2 hoof issues. The first was an abscess that popped with hoof testers. The second was a nail that had stabbed horizontally into the frog. We scanned a couple foals for pneumonia rechecks. Both had improved but needed to stay on antibiotics for a little longer to finish clearing up the abscesses. We pulled blood for several Coggins tests. We collected a stallion. We finished up the day post-breed lavaging a mare we had bred in the morning.
     Tuesday was a bit crazy. We were all over the place. We saw a couple of our normal stops, but we had a lot of sporadic stuff as well. We met a mare with a very interesting story. She temporarily moved to one of our daily stops for treatments. We took some staples out of a healed up knee wound. We looked at a little pony mare that had been in a fight and got her vulva and vestibule wounded. Jordan passed a urinary catheter to make sure the urethra was not involved. We looked at a deep digital flexor tendon strain. We ended the day with several dentals, vaccinations, and Coggins.
     Wednesday was oddly short for a weekday with one doctor on vacation. We started with reproduction work and more dentals before the day got to its full heat. We had a couple more repro stops before we went to look at an eye. The poor old guy was blind. He had an ulcer under his lower eye lid. It seemed like he most likely ran into a low-hanging branch on one of the trees in his pasture.
     Thursday was awful! Jordan volunteered to check a mare that was in the clinic for frozen semen a couple hours before we were planning to meet. She ended up having to do a foal exam too because the foal with the aforementioned mare had developed a fever and diarrhea since coming into the clinic. All of that took much longer than expected, so she pushed our meeting time back a little. Our first stop was routine repro. We came back to the north end of town to do more repro and dentals. Between the repro and dentals, we got a call from the clinic for a red bag on the south side. Thankfully, the clients got the red bag handled before Jordan called them directly. The down side was that as soon as we finished the dentals we had to go back to the south side for those clients instead of finishing our northern stops. The foal was super cute though! I spent the majority of the time there helping him stand and trying to help him find the milk. He was a little dysmature with his domed head and floppy limbs. The placenta was such a mess that we couldn't tell whether or not it was all there. It ended up being good that Jordan gloved up and went in to check. The mare had several decent sized chunks left in there. We ran a couple liters of saline through her uterus after Jordan got done feeling around and peeling off what she found. We used the Madigan foal squeeze to restrain the foal to get some blood for testing. He's definitely a feisty little guy. After being with them for 3 hours, we headed back to finish our northern repro stops.
     Friday was a long day. Our first stop was pregnancy checks. Unfortunately, there were no babies to be found. We checked on the new foal from yesterday and did another lavage on the mare to rinse some more placenta out. We had a couple more repro stops. Then we saw a horse with possible kissing spine. We took some radiographs to see for sure. He was definitely not happy about pressure on his back. At 6 pm, we finally made it out to Friend's farm to check on some of the horses out there. One had been making some strange noises in the morning but wasn't doing it anymore. We took a blood sample to check for Thumps. Another had a heel bulb bruise. I got to do a lateral PD nerve block to be sure there wasn't anything else going on. The other vet student did the medial PD block. Another had a snotty nose. While we were trying to catch the third, we found a calf stuck in the mud. After we finished with the horses, we went to pull him out. Unfortunately, it had started raining and I got stuck. It took longer to get me out than the calf. Once I was free, the rain stopped. We found the calf hiding in the high weeds and took him over to the herd. None of the cows were interested in taking him, so we took him up to the barn to be a bottle baby. There was already another orphaned calf up there with spider calf syndrome.














     Saturday was a day off. I ended up going home because one of my best friends was going to be euthanizing her puppy with a congenital kidney malformation. He got 77 more days with dialysis, but his body was getting worse.


Week 11:
     Sunday was a decent day. I had a date day with my boyfriend and got confirmation of the end of a life before heading back to Lexington.
     The meeting time for Monday morning kept changing. I barely woke up in time to make it. A mare on the clock for frozen semen was not cooperating and had to be checked early. Thankfully she had ovulated by the time we got there. It was almost worth getting up early to see the sunrise over that farm. We had to meet up with Friend again because his ultrasound is still out for repair and he didn't have a loaner. After all that, our day was pretty normal. We did a lot of repro and scanned a coughing foal. I brought the labs back so Jordan could take her Pilot to get the brakes fixed. I went out to Friend's farm to do some more learning on his horses. I tubed a horse again. I started taking the sutures out of the enucleation we did out there 2 weeks ago. I got to do a PD on a hind limb, which I think is much more difficult than the front. I got to palpate one of the old, retired brood mares. Her uterus is so saggy I can't hardly tell what I'm feeling at all. I think I found her right kidney and her spleen though.
     Tuesday, I was back with Jordan. We did a bunch of pregnancy checks. We did a lameness exam and injected both hocks. I got to do one of the injections. I grazed the saphenous vein just a tad. This time I was coming from the same side of the body. When I did one previously with Dr. Friend, I came across from the other side of the horse. I think I like that a little better, but it wasn't practical with this particular horse. He was very kicky. At the next stop, we lavaged a mare that went to the clinic with a dystocia on Friday night. The baby is gigantic! Jordan found a couple more pieces of placenta still hanging out in her uterus. We ran a bunch of saline into her as well. We ended the day taking the sutures out of the client enucleation we did about 2 and a half weeks ago.
     Wednesday was another strange day with Jordan. Friend's loaner ultrasound went out, so we had to bail him out first thing. We flushed and scanned a couple of mares with him. Jordan and I left while the others were running plasma to and tubing colostrum to a newborn. We did some more repro and looked at some eyes.
     Thursday was awesome! We all started the morning together since Friend still didn't have a working ultrasound. We did some scans, some lavages, and a breeding. We also tubed a foal to get some mineral oil. He has been having trouble defecating for a while, so he has gotten intermittent tubings for mineral oil. I went with Friend to his next stop. He took a screw out of a knee. We did one more palpation before we went to his farm. He had taken in an elderly horse for the purpose of education a couple of months ago. We had been poking, tubing, and palping her throughout the summer. This was her last day. She dealt with one more round of tubing and palpations before I put her catheter in and she was euthanized.  One my turn palpating, I was able to find both ovaries, but I still couldn't find her saggy uterus. Jordan did a tracheotomy. We dissected her neck to see the relationship of the jugular and carotid artery. We did an enucleation. We dissected at least one of each type of joint in her legs. She was riddled with arthritis. We trocharized her cecum. We made a paralumbar incision and took out an ovary. Then we opened her all the way up to the sternum. We pulled out a bunch of her intestines to find her uterus and a kidney. We had so much fun and learn and reviewed a lot!
     Friday, I rode with Dr. Friend. We had several of the normal repro stops. We microchipped a foal and examined it after reports of coughing. We went out to his farm. It was the other vet student's last day. Both of us got to float one horse's teeth before he left for a man weekend.
     Saturday has been mostly a lazy day. I have gotten my laundry done and now I can check this off my to-do list.

I still can't believe this wonderful experience is almost over. I'm the only person left on the property. The girls across the driveway have all moved out. The other student who has been working in surgery left this morning. I suppose I'll have to be packing up soon.

Week 9, 10, 11 @Cleveland Equine

There has been so much going on these past few weeks.  We are just starting to slow down a little bit the past week (which is a good thing as it has been 96 degrees out with really high humidity). 
I have seen and helped with many interesting things lately.  Here are just a few.
We did a myectomy on a TB racehorse with soft palate displacement.  This includes removal of parts of the sternothyroideus and sternothyroid muscles.  This inhibits retraction of the larynx, which in turn inhibits soft palate displacement. It is about 60-65% successful. The surgery is done by laying the horse down with ket-midazolam. Making an incision on ventral midline under the throat latch.  removing the muscles and cutting out a piece of each.

I observed one of the Dr.s give a presentation about strangles to a barn that has an unconfirmed case resembling bastard strangles.  She spoke to the barn because people were starting to worry for their own horses, but did not have adequate information about the patient or strangles in general.  In this horse's case, he had been sick.  He showed colic like symptoms and was rectaled- this revealed an internal abdominal abscess, it was walled off but was painful to touch.  This caused bastard strangles to be a differential.  And because of this the barn started to panic.  However it should be noted that the testing was inconclusive.  This horse had been vaccinated for strangles. The vaccine is a modified live vaccine (MLV) meaning that you are essentially giving the horse a small taste of the virus.  Similar to the human flu vaccine, you can get sick from the vaccine.  So it is possible that he is sick and his test results are due to his vaccination, or he could be legitimately infected.   It was really interesting to learn how to handle situations such as these where people who don't own the horse are wanting confidential patient information.  In this case the owners of the horse decided to share all the information with their co-boarders at the barn.  I learned a lot about strangles from the presentation made at the barn meeting.  Client communication is key in general, but especially in cases such as these.   Two horse owners decided to test their horse for strangles.  They need 3 negative tests to confidently call the horse negative for strangles.  The test is a PCR and culture of a nasal flush. 

This past Friday was a great experience as I was able to help a Dr perform a uterine biopsy on a troublesome mare.  She has been infused with timentin twice this breeding season. She has a perianal tear causing her to be a wind-sucker--a temporary caslicks was placed with staples until we can repair her permanently.  She had what looked to be a resorbing vesicle when we previously checked her a week ago.  So it was decided to perform a uterine biopsy to grade her uterus and assign a probability of carrying a foal to term.  I learned that there are no nerve endings in the uterus so we did not need to block anything in order to biopsy her endometrium.  We placed the samples in formalin and will be sending them to OSU for evaluation. We also took samples for cytology and a culture.  These will help us gain a more complete picture of her uterine environment.  She has had 10 foals, and has gone through many uterine infections, so we are wondering how suitable her uterus will really be to carry a foal to term.  I am very interested to see the results of this. 

I helped with a neurectomy on a horse that was previously MRI'ed.  It is a relatively simple procedure.  Removing the palmar digital nerve, is done standing under sedation.  A PDN block is also performed to remove sensation when incision is made and the nerve is cut.  You must be careful to ensure you are cutting the nerve and not the vein or artery that course nearby.  Once the nerve has been located, the distal portion was cut.  Then vetalog (triamcinolone--a steroid) is injected internueronally in the proximal portion.  Then the proximal portion is cut, this leaves you with about a one inch portion of nerve that has been completely removed.  The vetalog will help to inhibit nerve regeneration or neuroma formation.  The incision is then closed with simple interrupted pattern.

I have enjoyed being able to help where I can with these procedures and getting a first hand look into how to perform them.  I only have one more week left with CEC, we'll see what I learn this coming week!  I always enjoy riding along with the different doctors, as they each have their own differences in how they might treat the same case.  Learning a variety from each of them has helped to guide my understanding and how I might treat each of these cases when I see them in a few years. 

EAS Weeks 7-9

Hello Again!

Sorry for the delay in posts. I was without internet for a few days and my parents came to town so I was finally able to go to all of the tourist spots.

We went to Keeneland racetrack which is the most beautiful racetrack I have ever seen! It has such a different vibe than Churchill Downs. I think it is important to visit both tracks as you get a different experience from each. Keeneland also has it's legendary track kitchen where you can grab breakfast while watching the horses workout in the mornings. I took a picture of the iconic jockey statues and of course hit up the giftshop.

 Afterwards, we went on a tour at the Winstar stallion barn. My parents don't know much about the racing industry so they were amazed by how grand the stallion barn was. It looks like a mansion from the outside and is the cleanest barn I have ever been in. The stallions are also pretty awe inspiring to look at! They brought out Tiznow for us to look at and then we got to see the other 21 stallions in their stalls and learn all about their racing history. Of course, everybody on the tour couldn't wait to snap a shot of Pioneerofthenile who sired last year's triple crown winner American Pharoah! All of the tours to see American Pharoah have been sold out all summer so meeting his sire is the next best thing. We also got to see the breeding shed, where the stallions breed up to 3 times a day during the breeding season. It is definitely a tour I would recommend going on if you are ever in the area.

Winstar Stallion Barn

Tiznow

Buffalo Trace Bourbon Barrels

You can't come to Kentucky without going on at least one bourbon tour so I took my parents to the Buffalo Trace distillery in Frankfort. There is a lot of history at this distillery since it's located in the state's capital. They even have a ghost tour once a week in the evening where they tell stories of all the ghosts that supposedly hang around. We didn't do that tour this time but it's on my to-do list for future visits.

I am still traveling up to Churchill 2 to 3 times a week to collect data for my summer project. We now have data on 42 horses and 16 of them have double data sets. Our goal was to get 50 horses by the end of the summer so we are almost there! At the beginning of the summer there were mostly 3 yr olds in training but now there are more 2 yr olds that are starting to train. Testing the 2 yr olds is slightly different than the 3 yr olds. Since many of the 2 yr old haven't raced yet, we use our results to help predict how they will run, whereas with the 3 yr olds we compare our results to their current race record. Having an idea of how the horse will perform before it's ever run, makes it twice as exiting to watch their first race and root for them! Since we have quite a few double data sets now, I have also started to evaluate the wind test on it's repeatability. I look at the results from both wind tests on the same horse and see if they match up as expected. There was a professional photographer out at the track who snapped a few photos of the some of the horses wearing our wind test hoods in action. I think the horses look like super heroes when they wear them!

On days that we don't go to the track I'm either at the office analyzing the data or traveling to other local farms. I've gotten to see a vast array of the farms here from ones established within the last decade to ones that have been around for 100 years. They are all beautiful and unique in their own way. The Fasig-Tipton yearling sale was here in town last week so I got to go to that as well. I had been to Thorough bred sales in the past but none were this large. Our team was kept pretty assisting buyers with which horses to purchase. When a buyer is interested in a particular horse the team would perform a heart scan and conformational analysis on it and report back to the buyer. I got to practice doing a heart scan which is much harder than it looks. It definitely takes lots of practice to get used to maneuvering the ultrasound probe. Luckily, I had a good colt who was very patient with me and stood still for a long time.

I have 3 more weeks left of my fellowship and will be using most of that time to wrap up my part in the summer track testing project. I'll probably be up at the track a lot gathering more data and will hopefully be able to finish my study on the repeatability of the wind test. This summer really flew by but I guess that's what happens when you're kept busy and having fun!

Clinton Week 6

It is clear that the season is changing as you watch the shift in cases. Breeding has basically come to a close and now pregnancy checks with longer intervals between checks have started. Few calls are coming in for vaccines. Now the cases seem to be more colics, Potomic horse fever and lameness.

This week brought cases that were more puzzling than the routine. On one call, we saw a horse with boney proliferation in between his eyes. The lump ran in a line, following skull suture in that area. The owner believed the horse was either kicked or hit its head on something about a month ago. The horse was never painful but the owner became concerned that the lump had continued to spread and was now close to the eyes and one eye was tearing more than normal. We took radiographs of the head. The boney proliferation was clear but the frontal sinuses were not involved. After a consult with MSU, it has been determined that the horse likely has suture line periostitis, also known as horns. This condition was likely caused by trauma/fracture of the area and the body overresponded to heal itself. It should eventually stop growing and cause no issues except cosmetically.

Another case we say was horse with a wound over the medial aspect of its carpus. The owner and trainer were concerned that the horse may have a bone chip because he sometimes interfered with himself when working. No chips were evident on radiographs. On ultrasound there was some debrie evident in the area. The horse was referred for arthroscopy.

One of the lamenesses we say seemed to have a lot going on. The horse had been slightly off for awhile. The trainer said the horse seemed disconnected in his movements undersaddle and had a hard time backing. He had also recently become more resistent to bending. When we examined the horse, he was sore over his back, responded to the spavin test on his right hock, had muscle atrophy over his right hip and his left shoulder appeared set forward. On flexions, the lameness became more pronounced after flexion of the hocks. The horse also was weak in the hind end to a tail pull and did not seem to know where his feet were when backed or pulled in a tight circle. X-rays of the hocks were inconclusive, with only subtle change noted. blood was drawn and sent for a variety of tests, including EPM and vitamin E and selenium. The EPM test come back negative and selenium was within an acceptable level. However, the vitamin E was critically low. Vitamin E deficency has been shown to produce some neuromuscular signs. The recommendation right now is to supplement the vitamin E and possibly have the horse adjusted by a chiropractor and see if he improves.

Another interesting case was a horse that the presenting complaint was not drinking enough and was dragging his back feet. On presentation the horse was eating well and mildly dehydrated. He had symmetrical atrophy of his hindquarters and was sore to papation, especially in the sacroilliac region. He also had a fever of 102. His symptoms did not seem to fit well into just one problem. He was given banamine and started on SMZ's. His fever responded and he has improved. Bloodwork was suggestive of an infection but the etiology is not know. A chiropractor was recomended to help with his back pain.

Vet med certainly is a puzzle and sometimes you really have to work to find the pieces that fit together well enough to give you an answer.

Equine Athlete Week 9!

Hey everyone!

Signing in here from Arabian Youth Nationals in Oklahoma City! It's currently 7:54 am and already 85 degrees. The forecast is between 97-103 degrees for the next 2 weeks I'll be out here. Pretty HOT! The last two weeks has been mostly driving around to different states in the midwest preparing all the horses for this show. In preparation we have done lots of joint injections, either with steroids, IRap or PRP depending on the particular case. We have also performed shock wave and laser therapy to try and promote blood flow and healing in areas of chronic injury or pain. I have also watched Dr. Hill and Dr. O'Cull perform mesotheraph to desensitize the nerve endings in muscle areas that are extra sensitive. A few areas that we have done are the neck and the epaxial muscles over the thoracolumbar region. 

During the last few days of horses arriving at the show we have had to deal with a lot of respiratory cases related to shipping fever. Most of these horses shipped in from a minimum of an hour away to a max of over 20 hours. I have become accustomed to the work up of these cases, starting with a complete physical exam and then usually ultrasound to determine if there is any consolidation in the lungs. Depending on the case and the degree of dehydration of these horses we then usually place a temporary catheter and run fluids and start the horses on a round of antibiotics and banamine. I've really enjoyed working with some medical cases, it's been a nice refresher and change from the lameness cases.  I have been administering all of the IV medications as well as placing most of the catheters; I love the practice! 

I'm in for another exciting two weeks of showing! Until next time..

Alex 

Weeks 9 and 10 at RREH Surgery

Weeks 9 and 10

Weeks 9 and 10 were phenomenal in surgery! Knowing the routine has helped me relax and enjoy the medicine aspect of it all. As a major bonus I’ve been able to shadow anesthesia for a few cases and I’ve learned to place arterial lines, hook up fluids and an EKG, intubate a horse, run a blood gas and place an IV catheter. It’s helped me realize that equine anesthesia is exactly what I want to do for the rest of my life!

One of the interesting cases we had in week 9 was a draft horse that had a hind leg abscess that had been developing for a long time. The goal of anesthetizing the horse was to drain the abscess and debride the area so that the wound could heal properly. The horse was also painful because it had a cracked hoof that had its own draining abscess. The pain involved with these two wounds is too much to warrant treatment while the horse is awake; hence the necessity of general anesthesia. Dropping a painful draft horse is a dangerous process and there’s no getting around it. We simply don’t have the strength to force a horse that big to move where we want it to if it doesn’t want to. Thus, the primary goal of inducing this horse for anesthesia was that no one get hurt. We do our best to guide the horse to the ground once it has been induced and we keep our eye out for one another so that we can push the horse away from anyone it’s falling towards. Luckily this horse was induced smoothly and no one got hurt!Luckily this is most often how it goes. We hoisted the horse onto one of the colic tables with extra support added because of the sheer size of the patient. Because abscesses are inherently non-sterile and the wound wasn’t in danger of contaminating a nearby joint, the procedure was completed in the transfer area between the drop stalls and the surgery rooms. I wasn’t the primary technician on the surgery and the hoof abscess wasn’t a part of the surgery either so I spent the surgery cleaning out the hoof as best I could with sterile saline and gauze. The surgeon was able to drain and debride the abscess and the horse recovered well! 

The abscess that required surgical attention.

The hoof abscess before I cleaned it out.

Another exciting case was when I came in after normal work hours to help tech a colic. The horse was painful before coming to the clinic but began its visit with a colic workup that was ultimately non-surgical in nature. Within an hour of leaving for its stall, the horse was extremely painful and trying to throw itself on the ground. Thus it was destined for surgery! As it was an older horse, and with few findings on the workup to denote anything else, the most likely cause of the abdominal pain was a lipoma (a fatty tumor that wraps around the intestine and constricts it, which becomes more likely with age). It was an interesting and exciting experience, being only one of two technicians in the clinic to help with the surgery (the other was an intern who was the primary technician on call-it was her first time acting as tech, and I had offered to help her out). Opening the room, preparing gowns and gloves, running blood gases, grabbing instruments and suture was all up to just us. It felt good to be there and make a difference for the horse! The horse did end up having multiple lipomas that had constricted its intestines, but luckily color returned to the affected intestines as the surgery went on. Once the lipomas were removed, the surgeon was able to close the incision knowing that the problem was fixed. We brought the horse to recovery and two interns helped to recover the horse while the tech and I cleaned the rooms, transfer area, and all the instruments we used during the surgery. Quite a job for two! It felt great to know that we helped this horse through a colic to recovery though. All in a nights work.

The lipomas that were removed.

Other interesting cases included an eyelid laceration and a groin laceration that took a long time to fix!

The eyelid laceration.

The groin laceration.