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.
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