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