Week Two
Tuesday May 15, 2018
I started my shift by stripping two stalls to prepare them
for cleaning. Phoenix and the French donkeys went home today. A laminitis case
came in with the expectation that the mare would need to be euthanized as the
owners had found blood at the apex of her frogs. Dr. Mullen and Dr. Kurkowski
were on the case. Dr. Kurkowski assessed the mare by physical exam before cleaning her
feet and applying hoof testers to test for pain. The mare tested positive on
the soles of her feed and would not tolerate the hoof testers on her hind feet.
Her forefeet were significantly worse than her hind feet, though she was sore
and had bounding digital pulse x2 and increased digital pulses on her
hindlimbs. Her soles were bloody at the apex of the frog bilaterally in the
forelimbs. This was cause for concern that her PIII had rotated and sunk
through the sole of the hoof. She had a day-old foal who was found to be
relatively healthy. He has slight ALD varus but has plenty of time for that to
correct itself. He also has a small umbilical hernia which also may correct
itself. Dr. Hill rasped the lateral aspect of the more significantly rotated
hoof. There was some joint laxity in his fetlocks, but Dr. Hill expects that to
resolve on its own as the foal grows and strengthens naturally.
To assess how bad the laminitis was, Dr. Kurkowski and Dr. Mullen
took DP and lateral view radiographs of all four feet. None had sunk but there
was evidence of chronic laminitis and potential fracture of the tip of PIII on
the radiographs. Dr. Hill came to assess the mare and foal and came to this
conclusion upon assessing the radiographs. There was a necrotic smell coming
from both forefeet, which Dr. Hill suspects to be a part of the disease
process.
Treatment will consist of palliative care, keeping the
hooves well padded and comfortable, and therapeutic farrier work. The toes will
need to be trimmed back significantly and once the soles harden and thicken,
the necrotic tissue should be debrided. At the moment, Epsom soaks are not
recommended due to the thinness of the sole and the chance that she still could
sink and rotate if the laminae are still inflamed. Dental mold material was
used to pack her hooves and elasticon used to wrap them. The mare went home the
same day.
I spent the rest of my shift helping with treatments and
cleaning stalls. It was a day well spent.
Wednesday, May 16, 2018
Today started with tidying, throwing hay, making up meds. At
6 I did Firefly’s “treatments” which consisted of feeding, watering, mucking,
walking, and a CPDP. She was normal. I walked two other horses before an
emergency came in presenting with a fever of unknown origin. His name is Jime
(Jimmy), a QH gelding rodeo pony who runs flags.
He went straight to isolation on precautions. He no longer
has a fever but is ADR and somewhat anorexic. Bloodwork demonstrated leukopenia
and low electrolytes. The plan is to keep him on fluids until his electrolytes
are better. Dr. Sauder suspects coronavirus as she has seen a few cases of that
here.
Clinical signs of coronavirus consist of lethargy, anorexia,
and fever. Some cases also present with GI upset, however Jime did not.
Diagnosis is confirmed with PCR, electron microscopy, and virus isolation from
feces. The virus is spread fecal-oral. Some cases lead to secondary bacterial
infection, leading to death or euthanasia. Leukopenia is most commonly due to
neutropenia and lymphopenia.
Coronaviruses affect many species. There are 4 identified
variations: alpha, beta, delta, and gamma. ECoV is a betacoronavirus, more
often seen in colder months. Fevers typically exceed 102 deg. F. Symptoms clear
in 1-4 days with supportive care. ECoV has high morbidity and low mortality
rates. Horses can shed the virus in their manure for several weeks. Biosecurity
measures should be taken to prevent any herd members from contracting the
virus. Due to the leukopenia, Jime is also on a few antibiotics as preventative
measure. His owners are going to do what they can to implement biosecurity and
monitor the other horses for signs of infection.
Week 3
5/21/2018
Case: 5 y.o QH gelding presented as ADR. The farm has had
previous similar cases that ended up being enteroliths, so they requested
radiographs and gastroscopy was performed. On gastroscopy, multiple ulcers were
noted in the distal esophagas and cardiac region of the stomach. Tissue around
the margo plicatus was noted to have some fibrin adhesions and appeared
inflamed. Radiographs revealed one large enterolith and what was thought to be
a smaller second enterolith. In surgery, a double enterotomy (one at the pelvic
flexure, one at the dorsal colon to remove the HUGE enterolith) was performed. He is
now being medically managed for both the surgery and the ulcers. Being a
performance horse and living inside all the time makes for a stressful life,
which is ultimately what leads to ulceration of the stomach. He has since started
healing well and went home.
Mule: A 3 y.o mule on her way to California from Indiana
presented for severe signs of colic- thrashing and trying to roll in the
trailer. On exam she had positive reflux, distended loops of small intestine
palpated rectally, and some large intestingal thickening visualized on ultrasound.
Initially not a surgical option, she spent the night in isolation on supportive
fluids and was refluxed a few times. The next morning, owners agreed to surgery
and she went immediately. In surgery, distended loops of small intestine were
found and were unable to be emptied. Large colon was very difficult to pull out
and visualize. Once out, an enterotomy was placed in the pelvic flexure and
large intestine was emptied and lavaged. After emptying, Dr. Hill was able to
clearly palpate a thickening of the large intestine where the cecum had intussuscepted
into the large intestine. The large intestine was lavaged and the first
enterotomy was sutured closed. A second enterotomy site was prepared at the
right ventral colon. Cecum was visualized inside of the right ventral colon, it
was very dead. The cecum was dark purple and appeared to have the consistency
of liver. Dr. Hill resected as much as she could. Illeum was then taken and
attached directly to the large intestine to bypass any remains of the very dead
cecum. Once the bypass was complete, everything was closed and the mule was
brought to recovery to wake up before returning to isolation (the cause of her
colic and intussusception was unknown). She has been on intense supportive care
but still, almost a week later, is struggling. Considering that some cecum
could not be removed and she underwent cecal bypass, it is incredible that she’s
still alive and it was well known that she would become very ill before we
would start to see any signs of improvement. I’m waiting to see if she will get
to go home and if she will be able to pull through recovery after such an
intense surgery.
Case: A rescued foal presented to the clinic for respiratory
signs, dullness, and lethargy. After 1-2 weeks of treatment, he also became
colicky. After repeatedly having net reflux of several hundred mLs, his owners
elected for surgery due to his pain levels. In surgery, his GI tract appeared
normal except for mild thickening of the pyloris. Gastric bypass was performed
with no resection. He is doing well and continues to recover at the clinic.
Friday, May 25, 2018
Today was my first day in the field with Dr. French. I
watched him in several acupuncture and chiropractic appointments, a colic
surgery recheck appointment, and two lameness appointments. It was interesting
to see the sport horses that received acupuncture and chiro act as if they were
under sedation. They were sleepy, heads down, and calm. I also was able to
watch and help with a neck injection appointment. The horse had osteoarthritis
in several cervical vertebrae and had the injections performed to help him be
more comfortable and continue performing (jumping).
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