Week 2 at Littleton

Happy Memorial Day from Littleton!

This was another busy week, but full of a lot of interesting cases. We started out our week with our Monday Morning Meeting going over ophthalmology from Dr. Lori, and got a good refresher on some of the most common problems we might run into as equine veterinarians. We also had an interesting Journal Club session with the interns on Tuesday, going over a paper on the differences of using triamcinolone, a steroid, for joint injections vs triamcinolone and hyaluronic acid (HA), which is a really common combination to use. The study found that the combination didn't provide any significant improvements or added benefits than just the steroid alone. There were some simple flaws with the set up of the study, in that this couldn't really be a blind test, as the two cannot be combined in a single injection. Another problem we discussed was the lack of vet assessment 3 months post-treatment, it was just a simple questionnaire/phone call discussion about the owners' perceptions of their horse. This can lead to some obvious subjectivity, so we thought that it could lend better in future studies to have consistent evaluation throughout. Yet, it was thought provoking, seeing as a lot of owners ask about the injections and the added benefits of combining the two or not, as well as the added cost, so it was interesting to get to work through some of the pros and cons. I think the overall consensus was to still offer the two, and just explain to the owners the effects or results that have been potentially found.

As far as other cases from the week, the surgery suite was fairly busy. We had a 1 1/2 month old foal in for a transphyseal bridging for the treatment of his severe angular limb deformity (ALD). There was about an 18 degree carpal valgus deviation so the bridges were placed laterally to stunt the growth on the outside, and all the medial aspects to catch up a bit. They will go in and remove those once the legs appear straightened out, or else it can lead to an over-correction. There were also a couple arthroscopies as well.
A horse that has been with us for about a week and a half who presented as a choke, has had a few more scopes to try to figure out what to do and what's going on in this poor guy's larynx. He initially had a tracheostomy performed, and has been on tubed electrolytes/fluids, as every time he went to eat he was still having food coming back out his nose. He finally has been able to move to some mashes and wet down hay, slowly working back to normal food. On one of the early scopes, it was debated if he had an entrapped epiglottis, and action needed to be taken. He eventually had a laser vocal cordectomy done, and while it wasn't wholly successful, it has shown improvements, albeit slowly. The epiglottis is going through a bit of a necrotic and swollen phase, but will eventually slough off and lead to restoration of his airway, hopefully. He's hanging in there though!

Another fun case was a 10yo QH barrel racer who came in with some lameness issues. The previous rads from the referring DVM showed some fusion in his hocks, mostly on the left side, in the DIP joint. It was decided that both would be injected though. Once some flexion tests were done, there was revealed some soreness on the front end as well, around the navicular areas on both fronts. Dr. French decided to get some radiographs of his front feet, just to make sure, and on his right front, there showed a definite fracture of the navicular bone! It did look older/more chronic just based on the fact that there was remodeling already happening. Yet, just to cover all the bases, the coffin joint got injected as well. The horse received os-phos too, on top of it all, in order to help with some/any bone bruising or edema present. It will be interesting to hear how he does with this further treatment.

Finally, I went out into the field on Friday with Dr. Senn for a facial laceration repair. Thankfully, this big old 6yo TB sweetheart must've just done it, as it was fresh and still bleeding. We knew that was a good sign at least. After a load of antibiotics, cleaning it up and lavaging it out, there were no distinguished pockets anywhere, again, a great sign. So, keeping our sterile field, Dr. Senn sutured him all up, a couple vertical mattresses for tension/support and some simple interrupteds to close it all up. She debated to leave a little triangle for drainage, but in the end closed it up, allowing some space for drainage, but wanting to avoid any further potential infection. All was well!

Also, this weekend I had the chance to host one of my classmates, Lauren Lauwers, out in Denver! It was a lot of fun, and was really nice to have the ability to get out a bit and experience some of what Colorado has to offer. I hope everyone had a great weekend and look forward to another exciting week!

Taylor