Brown Equine Hospital: Week Two

Week two has brought some interesting cases and some sleepless nights, that is for sure! Here are some of the highlights from this past week! 

The week started out with a patient coming for a head tilt. This patient had a head tilt towards the right side and was ataxic when walking. This horse had been scoped at a prior clinic and was diagnosed with Temporohyoid osteoarthropathy (THO) or what is also referred to as middle ear disease. THO is a proliferation of one of the surrounding joints of the hyoid apparatus called the temporohyoid joint. The hyoid apparatus is the structure that helps to suspend the voice box and the tongue from the skull and the area where it connects is called the temporohyoid joint. This proliferation of the bone surrounding the joint can lead to joint fusion. The cause of THO is not completely understood, but it is thought that it may be due to infection or inflammation from nearby structures, such as, the inner ear or guttural pouch. THO can decrease the normal range of motion and flexibility of these structures, so swallowing and head movements can be affected. If it is not treated it can cause a fracture within the attachment of the hyoid bones and can cause symptoms to worsen (ACVS 2018). In order to treat THO the doctor performed a ceratohyoidectomy. This is a surgical procedure where the surgeon removes one of the small bones in the hyoid apparatus called the ceratohyoid bone in order to decrease pressure on the hyoid apparatus to avoid future complications like fractures within the hyoid apparatus (ACVS 2018). The surgery went well and the patient recovered well. The horse still had a slight head tilt, but the surgeon informed me that it may improve over time or that it may still be there. The recovery depends on the horse and the important part of the surgery was to relieve pressure and to avoid any future complications like fractures that could cause potential nerve damage. After about three days in the hospital the patient was discharged home.

Another interesting case that presented to the clinic was an emergency that was called in during my second solo overnight shift this week. The horse was coming to the clinic due to Banamine injections that were given in the neck muscle. Banamine is a nonsteroidal anti-inflammatory drug that is used for pain relief, inflammation or fevers in horses. Banamine can be given intravenously or orally, but not in the muscle (Teixera and Valberg 2018). If it is given in the muscle it can cause muscle damage in the surrounding area. One complication that is common is Clostridial myosititis. Once the bacteria grows it can cause Clostridial myositis that can cause swelling and crunchy areas of gas under the skin where the drug was given. This can be problematic because if the infection is severe enough, bacterial toxins can be released into the bloodstream and can make the horse very sick (Teixera and Valberg 2018). When the horse arrived at the clinic the doctor used an ultrasound to identify the gas pockets under the skin and made three incisions in the affected areas in order to drain and clean the neck. The horse was then put on IV and oral antibiotics to help clear the infection. The horse is still in the hospital and being monitored.

The rest of the week was filled with lameness exams, x-rays, joint injections and patient care. I am getting better with identifying both forelimb and hindlimb lameness. Dr. Brown and Dr. Nicholson have been amazing teachers! I am slowly but surely learning where things are in the hospital, how to run various blood tests and how to interpret the results. It has been a busy and hectic week, but very rewarding! I look forward to what the next week brings! Unfortunately, I did not get any pictures this week, but hopefully I will get some for next week’s post!

References:

“Temporohyoid Osteoarthropathy.” American College of Veterinary Surgeons, American College

of Veterinary Surgeons, 2018, www.acvs.org/large-animal/temporohyoidosteoarthropathy.

Teixera, Raffa, and Stephanie Valberg. “The Risk of Administering Intramuscular Banamine.” University of Minnesota Extension, University of Minnesota, 2018, www.extension.umn.edu/agriculture/horse/health/intramuscular-banamine-risk/.