Well, these past few weeks have certainly been a blur! I moved over here in mid-May to South Elgin where the practice is located and have been working intermittently with Dr. Marshall Stevens since then. It has been intermittent only because a few days after I began working here, Dr. Stevens had a conference to attend in California hosted by Merial then last weekend was a long weekend with Memorial Day. My first week began with learning the results of a respiratory panel that was conducted on two horses that had been coughing and had fevers the day before. Fortunately they tested negative for both equine herpesvirus as well as streptococcus equi. Those can both be serious respiratory diseases that can be difficult to contain and streptococcus equi is the causative agent of strangles, which can be a terrible disease to deal with. The two horses that were tested were both positive for equine influenza virus.
That lead to me learning a great deal about equine influenza, and Dr. Stevens was great about sharing the information on the disease with the clients and barn manager and placing the barn under quarantine. One of the horses had copious bilateral mucopurulent discharge and upon ultrasound of his lungs, some abnormalities with their appearance were found so he was treated with antibiotics (SMZs) for his secondary bacterial infection. Upon followup over the past few weeks, I have learned that client compliance (in this situation, regarding the quarantine and biosecurity measures) can vary greatly and can be a major difficulty. Based on AAEP recommendations, he requested that all horses stay on the premises, that clients practice a number of standard biosecurity measures, and that all horses have their temperature taken and recorded twice daily so that the quarantine could be lifted after three weeks of normal temperatures in the barn. Fortunately despite some liberties taken by owners, the outbreak seems to have been limited to that barn and has subsided.
Dr. Stevens' practice is located in the midst of a number of training barns and large show facilities, so we have been working mainly on english performance horses in the area. As the show season continues, we will go to more horse shows and work there, but lately we have mostly been making farm calls to several stables within an hour radius for lameness exams, joint injections, and dentals. We had a break in the routine with an emergency call last week for a horse that was colicking. After a physical exam, nasogastric intubation, and a rectal exam, the horse was then sent on to a local referral hospital. There was another case last week for a show hunter that had just been shipped in to the nearby show grounds from Virginia and was lethargic and did not want to stand. His gums were sticky but his physical exam was otherwise fairly unremarkable, so we treated him for dehydration. That gave me a chance to learn about hanging the fluid bags for IV fluid administration and how to manipulate the fluid stopper and watch the catheterization of the horse. He was also treated with a bolus of electrolyte solution and his demeanor was markedly more alert by the time that we left.
My first week began with helping with a number of dental procedures on a barn of lesson and personal horses. I learned how to prepare and set up the dental equipment and which drugs are most regularly used as sedatives for many common procedures. Detomidine or xylazine are commonly used with butorphanol for the dental work, and combinations of those are commonly used for other procedures as well. I was able to restrain horses during the procedure and do cardiac assessment prior to sedation. I also learned that I really need to review the Triadian system for teeth because I completely forget that from anatomy.
So far, the vast majority of what we have done has been lameness exams and joint injections. Fortunately, I have gotten a lot of cardio in the past few days slogging around in deep sand arenas and jogging horses. It has been good to see a lot of flexion tests performed on the different joints, and I have been able to watch some of the horses trot when they are being ridden through the flexion tests. I have also gotten a great review of the different distal limb nerve blocks, from the palmar digital block to the abaxial sesamoid/basisesamoid, then low four point, etc. A few horses have also received an abaxial sesamoid block in order to have their coffin joints injected because they were known to be difficult despite sedation. I have gotten a lot of good practice lately on scrubbing the injection sites, which has been great especially for getting familiar with the locations and landmarks of the injections. The most common joints that have been injected so far have been the coffin, hock (both distal intertarsal and tarsometatarsal), and stifle. It has been really neat seeing how thin the synovial fluid can become from the inflammation, and that ultimately is a great indicator that those joints are receiving the treatment that they need.
Anyhow, I look forward to keeping you all updated and I hope that everyone is having a great summer!
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