After two hectic weeks at the Regional shows we all took a day to recover over the 4th of July holiday. Then it was back to work catching up on local patients and beginning preparation for Youth Nationals. There have been many opportunities to see and learn new things over the past few weeks. The doctors have been fantastic teachers and are always willing to talk me through the procedures that they are doing. We have gotten to see some fun things over the past two weeks.
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| Regional limb perfusion |
It all kicked off with a regional limb perfusion. I have heard of the procedure but was excited to be part of one. Regional limb perfusion (RLP) is often used in large animals to deliver medication or antibiotics to specific areas versus systemic administration. More recently RLP has been used to deliver stem cells to areas with tendon or ligament injuries. The Quarter Horse gelding was perfused with mesenchymal stem cells in order to help in the healing of a chronic injury to the suspensory branches. Mesenchymal stem cells have been shown to increase the rate of healing in tendon and ligament injuries. It is believed that the properties of stem cells draw mediators and cells to the injured area to promote healing. In order to perform the RLP Dr. Hill placed a tourniquet distal to the carpus and perfused via the lateral palmar digital vein. We then left the tourniquet on for 30 minutes under a wrap over the injection site. When the treatment was complete we wrapped the leg with a pressure wrap and administered some banamine. Hopefully this procedure can offer our patient some relief.
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| Dr. Hill performing an ultrasound exam |
At one of our next stops we got to follow up with a horse that had damaged its suspensory ligament. Before this summer I had very little experience with ultrasonography beyond reproductive imaging. Dr. Hill has been a fantastic instructor and has kindly walked me through his exams. This particular case involved a gelding that became acutely lame at a horse show earlier this season. He had a history of suspensory soreness but always responded to shockwave therapy, icing, and other management practices. He was given time off prior to the show season in order to rest the area and prevent major injury. Unfortunately, a bad step off of the trailer had the farm calling Dr. Hill. Upon exam we were able to pinpoint the area of acute soreness in the lateral branch of the suspensory ligament. Ultrasound examination revealed significant edema within the branch. The farm was instructed to rest the horse in its stall for 30 days with daily icing. When we were next out at the farm we performed a follow-up exam. It was great to see the side-by side comparison of the injury. Healing was easily visible between the images and the horse was cleared for two weeks of hand-walking and a slow return to work. Before we left we shock-waved the area to kick-start further healing. We will be back to re-examine the horse and hope to see even further correction.
The level of care, from farm to show ring, that is offered at Equine Athlete has provided me a full circle view of this kind of equine medicine. It is a unique opportunity to be able to follow cases throughout my internship and learn, not only about diagnostics, but treatment and long term management of various ailments. I am very fortunate to have been given this opportunity and look forward to my final month with the Equine Athlete team.
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