Equine Athlete: Week 4

Show prep, show prep, show prep.  That was the theme of the week as we pushed to prepare horses for the two regional shows at the end of June.  Region 13 in Springfield, Ohio and Region 14 in Lexington, Kentucky.  Regional shows provide opportunities for horses to prove themselves on the road to the National shows coming at the end of the show season.  But, in order to get there, the horses must perform at their best throughout the Regional weeks.  So, we spent the last week traveling to many farms to prepare horses for both shows.

A day of show prep begins with a long list of horses.  We will fetch the horse and lunge them for the doctors to evaluate their movement.  Then, handle them as we work through flexion tests in order isolate the source of any lameness.  If locating the source is difficult we will go through and block certain regions and reevaluate.  Blocking a region of the leg is performed by essentially numbing the nerve supplying sensation to the intended area.  A lot of the blocks we perform are for the distal limb and foot.  Common blocks include the palmar digital or PD block that numbs the heel and sole of the foot.  Moving up the leg we can block the entire foot and back of the pastern with an abaxial sesamoid block.  As you move further up the leg you can block out more and more area in an attempt to find the source of the pain.  You want to start low and work up to prevent masking problems that are below the area that you block.  

Image 1. Dr. Hill injecting a hip

Once all of the horses are looked over, the doctors will sit down with the trainer and discuss treatment plans for those who need it.  That is when the real fun begins!  A lot of the treatments we do on farm are joint injections.  Intra-articular, or IA, injections go directly into the joint capsule to deliver the desired medication.  The most commonly injected joints are fetlocks, hocks, and stifles.  But it is not unheard of to inject the sacro-iliac joint (SI), hip, or shoulder.  This week we did a few SI joints and a hip (an injection I had never seen before) (Image 1).  Both the SI and hip injections are ultrasound guided to ensure that the medication is delivered to the desired location.

Image 2. Preparing to inject fetlocks

In order to inject a joint you must ensure that the region is extremely clean and that the horse is properly sedated to ensure a smooth procedure.  We begin by scrubbing the joint with a Chlorohexidine scrub that we alternate scrubbing and rinsing with a Chlorohexidine solution (Image 2).  We scrub and rinse until the area is properly cleaned and then let the final scrub sit until just before we are ready.  Although this process may sound tedious, it is a small and necessary sacrifice to prevent a possibly infection from occurring.  Not only can an infected joint cause soreness and increased lameness.  But, it will also cause irreparable damage to the joint and surrounding tissues.  Thus, we stress a proper scrub technique.

Once the area is prepared Dr. Hill or Dr. O'Cull will perform the injection.  There are many substances that can be injected, depending on the desired effect.  Corticosterioids such as Vetalog (triamcinolone) can aid in the reduction of inflammation within the joint.  Hylaronic Acid (HA) will be injected to supplement the HA naturally occurring in the joint and help increase lubrication.  Other injectibles include IRAP and antibiotics.  Most practitioners will use a combination of these substances, which is how Dr. Hill and Dr. O'Cull practice.  Studies have shown positive results for a variety of IA injectibles.  Therefore, as long as you maintain proper technique IA injections can prove to be extremely beneficial.

I can't wait to experience the excitement of Regionals and am excited to learn even more from these fantastic veterinarians.  I have already learned so much in the few short weeks that I have been with them.  Stay tuned for updates from the Regional shows and beyond.