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.
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