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.

Week 9 at Stevens Equine

Hello again from South Elgin!  Well, last week was a very busy week!  We did some lameness exams, lameness progress exams, and ultrasounded some limbs, then Dr. Stevens debrided and sutured a mare’s torn nares that had been previously repaired by another vet but was infected and healing poorly.  I learned that because her alar cartilage was involved in the tear, the lack of vascularity of that tissue may prevent it from healing with complete apposition.  We should know within the next week how it will turn out.  He also removed the last abdominal bandage from a horse that had had colic surgery a month prior to that, and it was helpful to hear the continued recommendations for post-op recovery before she transitions back into work.

I also saw another horse with neck and back soreness have its cervical facets injected at C4-5, C5-6, and C6-7 and also have its epaxial musculature injected.  Those are always interesting to watch, but it is difficult holding the horse well for the cervical intra-articular injections because the neck positioning is very important and the horse’s head isn’t light by any means!  It’s really interesting to see the ultrasound-guided injections though.

Another unique case was a horse that we did a lameness exam on then examined the affected limb with ultrasound.  Dr. Stevens then found mineralization within the deep digital flexor tendon.  It was interesting to learn that due to the presence of the mineralization that it must have previously damaged the tendon and had re-injured it.  It looked unique on the ultrasound screen because the mineralization was casting a shadow, which was really interesting to see in that location.

On Saturday, we used a shockwave machine to treat some high-level performance horses that had back pain and/or were recovering from distal limb injuries.  I remember seeing it used once when I was in undergrad, but I enjoyed seeing it again then reading up on how it works and why it is used.  It is also called extracorporeal shockwave therapy, and basically the shockwave machine generates a mechanical pulse that travels into the tissue.  It is commonly used to treat orthopedic conditions in horses, and works by introducing microtrauma into the region to help promote healing by stimulating inflammatory and catabolic processes as well as angiogenesis and neurogenesis.  I also learned that horses are commonly sedated for the procedure, but these horses had had it done previously and stood well for it.  I recommend earplugs though because it’s fairly loud!

On a sad note, today was the first time that I have seen a horse euthanized.  It was a very old horse that had been suffering from severe hoof abscesses that had not responded well to treatment over the course of several weeks and had begun to deform the hoof.  There was also some separation at the white line, which suggested that the horse may have also had laminitis.  Due to the horse’s advanced age, the horse’s poor response to treatment, and a poor prognosis due to the severity of the condition, the owner elected to have her horse euthanized.  Dr. Stevens allowed me to place the IV catheter, and the procedure went quite smoothly.  Overall it was a sad day, but a great learning experience that makes me appreciate how veterinarians can provide such a service to humanely end an animal’s suffering.  I look forward to what I will continue to learn over my last few weeks here!

Weeks 6, 7, and 8 in Ambulatory at Rood and Riddle

     Whew! I didn't realize how long it had been since I posted! I've seen a lot in the last 3 weeks. I'll try to keep it short and sweet. It's amazing how many externs want to ride with Drs. Friend and Kiviniemi- Moore! I picked one up on my way out to meet Jordan just about every day of these past 3 weeks.

Week 6--

   Sunday was Father's Day! I was lucky enough to be able to make a quick trip home to surprise my boyfriend. His dachshund got into something and was covered in hives by noon, so I had to help communicate with a good friend who happens to be a small animal vet to get the pup started on some steroids. I headed back much later than I had originally planned, but overall a good visit.

     Monday, I was basically dead on my feet. I got to do a couple injections and uterine lavages. We did a placenta exam. I love those. Pretty typical day.

     Tuesday, we did a lot of repro work, as usual. We did several lavages and ultrasounds. We treated a uterine yeast infection and scanned some coughing foals. While doing a basic exam so a client could increase his insurance on a horse, we found a second degree AV block. It was interesting to find and hear Jordan explain it to the client to help him realize it wasn't a big deal. 

     Wednesday morning went by very quickly with a bunch of repro work with Jordan. We met up with Dr. Friend to tag team a bunch of floats at a big barn. I left with Friend to go see some lamenesses. The first turned out to be bilateral forelimb lameness most likely from new shoes. (After doing a couple blocks.) The second was a chronically lame Saddlebred. It was not the first time this horse had been seen and was once again recommended to have the hoof manipulated to help a club foot mechanical lameness. The client opted not to inject the joints so she could show the next day. We finished the day out at Friend's farm. He let me palpate my first mare! It was a great experience, but I was definitely using the ultrasound to find things instead of my hand. It all felt like squishy stuff. I was able to find the body of the uterus, but that was about it. After a bit, I found the 14 day pregnancy.

     Thursday was another typical repro day. We had a bit of complication trying to collect a young stallion who had gotten a taste of live cover. He was not pleased with the artificial any more. Later, we met up with Friend to do some more floats.On the way to our last farm of the day, a tornado warning came across the radio. The poor English extern was beside herself. It didn't get too bad where we were. We ended up doing the last palpation in the old tobacco barn with the warning still out. Jordan and I rather enjoyed the end of the day because we both enjoy storms. 

     Friday was another heavy repro day. We did a lot of uterine lavages. We got to do 2 new foal and placenta exams. We did a couple yearling radiographs. We stopped by the Horse Park so Jordan could be filled in on what exactly she was supposed to do over the weekend. I finished my day with some food with the externs. The ones I have driven were so thankful that I has swung through to pick them up. 

     Saturday was an interesting day with Dr. Friend. Our first stop had a ton of lavages. He had Jordan meet us there to make it go a little more quickly. I felt like a chicken with my head cut off trying to help them both at the same time. They both did radiographs on a foal while I put away all the repro equipment. Next, we stopped at his house. I have now met most of the family. I have yet to meet the youngest of his children. We took 2 of the children to transport some horses. Then, we went to see a new foal. Thankfully, the mare had finally passed her placenta so we didn't have to deal with that. One of the clients held a cookout for a group of the vets. I was honored with an invitation. The food and discussion we wonderful!

Week 7--

     Sunday was my day off to get some of my own things done. 

     Monday was an early start with Dr. Friend. The emergencies he went to over the weekend took a hit on the supplies. We were running really low on a lot of things.Thankfully, we didn't have very many lavages because we ran out of fluids within the first hour or two. Dr. Friend guided me in my first hock injection on one of his horses. I am so thankful to be able to have these experiences. At his farm, we looked at a lame horse who turned out to have an abscess. We got it drained and packed.

     Tuesday, we had a full truck. We saw lots of repro in the morning and more dentals around noon. Our final stop ended up being more than planned. The popped splint bone turned out to be a boney bump on the front of the cannon bone that we injected just the same. Another horse was re-evaluated after healing a splint. The third was a mare who was acting studly. On palpation and ultrasound, Dr. Friend found a softball size granulosa cell tumor. Then he went back to the clinic for a partner meeting and the help went to his farm. We repacked the hoof we drained yesterday. 

     Wednesday, I was back with Jordan and an extern. We did a bunch of repro- bred a few mares and lavaged a few. We did several vaccines and one dental. 

     Thursday was relatively unexciting. We did mostly repro work- scans and lavages. The day ended with a euthanasia recommendation for a horse Jordan had been seeing since Sunday for diarrhea. They had called her out as an emergency saying the horse had already been having diarrhea for 8 days. They didn't have the money to send him to the clinic. We left hoping the guy was able to give the horse a quick and painless end. 

     Friday was a short day with Dr. Friend. He was trying to have a 4 day weekend for the holiday. We only had 2 stops for some routine repro work. He went home to get the family ready to go to Virginia for a vaulting competition. I took the labs and lavage tubes back to the clinic. The other help went to change the foot pack again. It was strange to get home so early. I had plenty of time to cuddle with the pup and take a nap before anyone got back from work.

Week 8-- I felt a little bit like a slacker this week.

     Tuesday was a very early start coming back from the holiday. It was a very typical repro day. We did a lot of scans and several lavages. Our last stop of the day was to look at a foal with a busted eye lid. Jordan placed a couple of sutures to make him look pretty and off we went. No severe damage. One of the country roads we take had been lined with little flags in celebration of the 4th. It was really cool to see them all. The picture isn't the best representation, but there was a flag on both sides of the road every 10 feet or so for a 5 mile stretch of the road. So cool to see something so patriotic!

     Wednesday was another standard repro day. We went to see a horse that had been coughing a little bit every couple of days. Jordan started him on some steroids to get any inflammation in his airway down. It seemed to be an allergy case. Toward the end of the day, we saw an eye injury that appears to be a rupture of the eye. Jordan suggested that they see Rood and Riddle's ophthalmologist, but they didn't have that much money to spend. The next best suggestion was to remove the eye in the field as a teaching procedure. They are discussing and deciding what to do next.

     Thursday, my family came into town on their way home from Gatlinburg. I took the day off to spend some time with them.

     Friday started out like any other day with a lot of repro. We did several scans and lavages. We re-scanned a few foals that had been on antibiotics for pneumonias. We looked at a horse with cellulitis and gave an anti-inflammatory blast. One of the last things for the day was doing the enucleation! 

Here is a before picture of the eye... She was definitely in rough shape. During the surgery, we were able to confirm that she had a laceration causing her eye to partially rupture. The owners believe she cut herself on a nail after a fence board had been pulled off.

This is an after picture of the bandage. I got the privilege of drawing on the good luck eye. I will try to get a good picture after the incision has healed up. 

  

 
We finished the day looking at another eye that seems to have been bumped on something. We didn't see any damage, just swelling of the eyelids.

     Saturday, I rode with Dr. Friend. We only had a few routine repro stops and a couple mares to breed. It was a rather short vet day. After running some errands, I got home and took a much longer nap than intended. I woke up long enough to eat some dinner before going to bed for the night.

    

Clinton Week 4 and 5

The past couple of weeks have involved a couple of firsts for me.

For one, I injected my first joint on a live horse. We were at an appointment for a horse with chronic hock issues. The right side was worse than left. Under Dr. Trombley's guidance, I was allowed to perform the injections of the left hock. I attempted to inject the distal intertarsal joint from the medial aspect below the cunean tendon and the tarsal metatarsal joint from the lateral aspect just above the head of the splint. In both cases, I demonstrated where I needed to place the needle, scrubed the injections sites and was sucessful.

A second first was performing a uterine antibiotic infusion. A couple weeks ago, Dr. Trombley had breed a mare. She did not take and was pooling fluid in her uterus. After a few uterine flushes failed to eliminate the fluid, the decision was made to treat with a local infusion of antibiotics. I was allowed to carefully rectal the mare to visualize the remaining fluid by ultrasound. Afterwards, Dr. Trombley guided me in how to keep my equipement sterile for this procedure by myself and on placement inside the mare. I had trouble locating the opening to the cervix during my attempt. I kept ending up on top of it instead entering. Dr. Trombley ended up taking over to place the pipette then allowed me to feel where it was going. It was a good learning tool. I definitely need more experience palpating.

I also got some experience with the complications of field surgeries during to different mass removals. The first was the removal of what appears to be a fibroma from near the point of the shoulder. The mass was a firm rounded ball that was not firmly adheared to the muscle and lacked a blood supply. The removal itself was uncomplicated, with the exception that it was more adheared to the skin than expected. It was more difficult to manage the people. Clients and their children do not always understand what needs done during a field surgery and what rules need to be followed while the doctor is working. This time, this resulted in the contamination of part of the surgery pack. It was a lesson to me not only to pay attention to what your patient is doing, but also of what the clients are up to while you work. It is a good idea to make it clear to them before getting started what they are not allowed to touch or do until the procedure is finished.

The second mass removal come with it's own set of masses. The horse had a mass just lateral to its rectum. Previously the mass had been treated with topical steroids and oral antibiotics. At that time it had completely regressed. A bunch biopsy had been taken and revealed a granuloma. Recently, the mass returned and the decision was made to remove it. Sterility was one issue encounted during the surgery. The tail was wrapped and tied to the side but it kept working its way loose. There was always an eminent risk of the horse defacating, which thankfully never happened. Oh and the barn cats were running through the rafters, showering us with hay. It was certainly a surgery where the scrub needed to be kept close at hand. Another issue was lighting. The barn was very dim and the head lamp was not working. We improvised and had me hold a flashlight and direct as best I could at the surgery site without getting in the way. Stocks also would have been helpful for this surgery, because the horse kept moving from side to side trying to keep his balance while sedated and the floor had become slick after the incision bled. At one point I was holding up the flashlight in one direction and pulling the tail away with my other hand while trying not to slip. Regardless, we completed the surgery and got the sutures placed without major incident. Upon cutting into the mass, we found a sharp demarcation in color and texture that was concerning. The mass has been sent for furthur evaluation.

One other interesting case was a foal with a laceration near its eye. We were called to the farm for an eyelid laceration. It was not known what the foal had caught itself on. Upon inspection, it was found that the eyelid margin was intact and the laceration was slightly below the lid. The eye was not involved. The foal had however torn about 1/2 inch V-shaped flap that was a little deeper that expected. The foal was sedated, a deep suture was placed to help hold the tissue better then the flap was tacted down using absorbable suture and a buried pattern to help prevent sutures getting caught if the foal rubs. The margins came together well and the laceration should heal well.

The variety of cases and complications that come with field work are certainly keeping me on my toes.