MSU July

Hello Everyone! Its been a while since I’ve wrote last, so I figured I would give a quick update on how the last few weeks have been going here at MSU! I am back on the night shift (from 4pm-2am) and for the most part, it has been pretty quiet the days I work. We had a night last week where we got in a few emergencies. We got in a horse that was showing severe colic signs, so it went straight to surgery. The horse ended up recovering well and went home several days after surgery.

This week, we had a mare come in on emergency that was possibly showing neurologic signs and/or foundering. Once she arrived, she received a quick neurologic exam and didn’t seem to be showing those neurological signs. The mare received a full work up with a physical exam, ultrasound, and blood work. Based on what was found, it is a concern that she may have Potomac Horse Fever. From my understanding, Potomac Horse Fever (or PHF) is an acute enterocolitis. Enterocolitis is an inflammation of the intestines. The pathogen that causes this is called Neorickettsia risticii. N. risticii is carried by mayflies and thought to be picked up by horses when they are grazing fields where mayflies have died. The horse ingests the mayfly thus also ingests the N. risticii. This causes the horse to produce signs of colic, fever, and diarrhea. PHF normally starts with the horse not eating and mild depression. Then the signs progress to fever, diarrhea, and colic. Up to a third of horses with PHF can develop laminitis. These signs are similar to signs seen in other types of enterocolitis, so it is important to do some diagnostic test to see what is causing it. To make a definitive diagnosis of PHF, N. risticii needs to be identified in the horses blood or feces by doing a cell culture or PCR. For treatment of PHF oxytetracycline is normally the go to antibiotic. Treatment is more successful the sooner it is given. The horse should respond rather quickly (within 12 hours). This should include a decrease in fever, increase in appetite, attitude becoming more bright and alert, and an increase in gut sounds. If laminitis occurs, keeping the legs iced will help decrease the inflammation that cause the P3 bone to rotate. If caught early, PHF is very treatable and prognosis is good.

Also this week, we got in a few more colics. They both ended up being fecal impactions. Treatment is similar for both of them. Treatment included oral and IV fluids, electrolytes, pain medication (such as Banamine, xylazine, detomidine, butorphanol, and lidocaine). The fluids are given to hopefully get the impaction moving and the pain medications help relieve the pain that comes along with that. Other than that, I just have been helping the night technicians with treatments and feeding the horses that are patients in the hospital. That’s all for now! I’ll keep you updated if any interesting cases come in!

Source for information on PHF: Merck Manual Veterinary Manual https://www.merckvetmanual.com/digestive-system/intestinal-diseases-in-horses-and-foals/potomac-horse-fever

Littleton Equine Week 11

Week 11

Another interesting week here at LEMC! Over the weekend, I attended the AVMA Convention in Denver. It was my first AVMA convention, so I did my best to attend a variety of CE talks (from surgery on brachycephalic dogs to practicing fear free for our small animal friends.) Monday through Wednesday, I was in ICU and floating in the clinic. There were a number of colic cases, one of which was an older gelding presenting for discomfort starting the afternoon before. On rectal palpation he was found to have gas distension. Buscopan was given to decrease the gas distension to decrease his discomfort and allow a proper rectal exam, as the doctor was met with too much resistance from the distension to feel comfortable completing the rectal exam initially. The horse was tachycardic and when refluxed with a nasogastric tube, he gave up 14L of net reflux. This particular horse did not have the option to go to surgery or go to ICU for IV fluids and monitoring. Oral fluids made him more uncomfortable, so the owner was presented with the option of trocharization. The trocharization site was visualized with ultrasound in the paralumbar fossa and prepped sterily. The extension set off the end of the short term catheter used for trocharization was placed in a small bowl of water to visualize the gas leaving the intestine. He was kept for the day at the clinic for monitoring. Without any sign of improvement, euthanasia was elected for the next day.

 Another case that stands out was an older miniature horse that was extremely painful and also didn’t have a surgical option. Without signs of improvement, euthanasia was elected for. Necropsy was also elected for, revealing three hard impactions along the intestine, one of them being at the pelvic flexure.

We also had a colic that did go to surgery. In surgery, a mesenteric tear, an impaction, and a large colon displacement were found and corrected. She is recovering well now in ICU.

Mid-week, I spent some time with team surgery and was able to watch a cast change on an Andalusian mare who had lacerated her legs severely while out in pasture. She presented a few days later for discomfort with the cast change, as it’s important that she’s comfortable enough to bear weight on the cast. Thursday was also spent with Dr. Hill. She performed a gastroscopy and an exploratory abdominal surgery. The abdominal surgery revealed an extremely inflamed cecum. After she discussed her findings with the owners, euthanasia was elected for. The gastroscopy (of a different horse) revealed gastric ulcers but otherwise nothing remarkable.

Friday was spent with Dr. Dunbar. She performed extraction of 109, which was really interesting to watch. The horse needs 209 extracted as well, but that will be done on a different day. The tooth came out in two big pieces and two small ones. Sclerosis was noted at the tooth root on radiographs, so he’ll definitely be feeling better after having those two teeth removed. We also did some primary care- vaccines and physical exams. After the primary care visit, a quarter horse mare was brought to us for a pre-purchase exam. She was fairly lame in front and behind on flexion. Her feet were radiographed and the findings were discussed with the owners. It was determined that they would have her shod and she would be given the chance to adjust and become more comfortable before a sale decision was made. Our final visit was for vaccines of a yearling. The vaccine visits were a welcome change for me after the unfortunate cases that I’d seen earlier in the week. Before our day was done, we were able to peek in on Dr. Hill’s maxillary flap surgery and extraction of a broken 109.

Thanks for reading!

Littleton Equine Week 10

Week 10

 This week brought quite a few interesting cases! Early in the week, a gelding in his teens presented for incontinence- steady dripping of urine but not actually urinating. He was sedated, palpated, and ultrasounded. Ultrasound demonstrated a urolith and it was determined that he would need surgery to remove it as soon as possible. Dr. Hill wasn’t sure if he was passing his small urine dribble because the urethra had torn and some urine was escaping, or if the urolith had not completely blocked the urethra at that time. The horse remained standing for surgery and a temporary perineal urethrostomy was created to remove the stone. During the surgery, a large stream of urine was released from the site of the opening. On recheck the next day, the surgical site looked good, but when a scope was passed into the bladder, the bladder looked very irritated. Ultrasound confirmed that the bladder was very full. He was returned to his stall and after urinating, he was put on a bolus of fluids to encourage urination. Concerns at this point are that the bladder may have been stretched beyond repair and that the kidneys may have suffered some damage, as their values on bloodwork hadn’t come down as much as they should have 12 hours post-op. The stone was also rough and crumbled when it was being extracted, a portion of it was also adhered to the wall of the urethra. This raises the concern that when the urethra heals that it may form excessive scar tissue in a circumferential pattern and prevent urine flow. Should that happen, the horse would need a permanent perineal urethrostomy. Given some time to heal, we will have a better idea of prognosis and return to full urinary function.

Another interesting case from this week was an older gelding who presented for evaluation to remove a cancerous eye. There was not enough healthy tissue around the eyelids to suture the eye closed prior to removal, so it was clamped with hemostats and then routinely removed. He seems to be doing well post-op.

This week also brought a young mare with a laceration on her left lateral pastern. The wound was cleaned, probed, and radiographed to assess whether it had affected any synovial structures. The pastern joint was also distended with saline (and a small amount of amikacin) to assess whether the laceration had specifically entered the joint. Thankfully, the laceration did not affect synovial structures, but radiographs incidentally demonstrated a bone chip in the fetlock that can be removed arthroscopically. Surgical options for the bone chip will be discussed with the owner.

Friday, I went with Dr. Lori in the field. We saw suture removal, lameness rechecks, coffin and stifle injections, and a few pre-purchase exams. It’s always interesting to see how the different clinicians will perform the same task, there’s always something new to learn!

Littleton Equine Week 9

Hello Hello! The last few weeks have been amazing! It's been a whirlwind of activity, but we're in a bit of a lull today so I had time to write about what I've been up to.

Week 9

We had a draft gelding come into the clinic this week as “ADR”. He had 104 fever but was BAR on presentation. He was a colic patient a while ago. He also had a partially thrombosed jugular vein which was thick, but not warm on palpation. He was worked up with gastroscopy and ultrasound, as we weren’t sure exactly what was causing him discomfort. U/S indicated cellulitis just proximal to his left carpus. He responded well to therapy and was supposed to go home but had an episode of going down and struggling to get up. Post- struggle, he had acute preputial swelling- firm and cool to the touch. At this point he was acting extremely painful, very unlike him. Ultrasound and his continuous swelling indicated hemorrhage. He’s able to place his left hind, but was knuckling over. Possible for pelvic Fx of tuber ischii given the swelling location- could have happened when he lay down and tried to get up. Very difficult to image due to his large size and the significant swelling. Plan at the moment is to monitor.

Thursday was spent at horse park. I jogged for a couple of quick lameness exams and watched a jumper class in the international ring.

Friday I was with Dr. Toll. We saw a variety of cases, including a couple of wound evaluations, an emergency colic, and health certificates. Of particular interest was a middle-aged Peruvian Paso brood mare. She had severely overgrown hooves and was laminitic. She had a body condition score of maybe a 2/9. On her left front, she had a wound that extended from carpus to fetlock. It appeared to be from being chewed on by the horse (and then by flies.) The wound had been bandaged 5 days prior. The bandage was removed, the wound cleaned with nolvosan/water, and a new bandage was applied. The horse was given IM antibiotics and IM vitamin B12 to increase appetite. Dr. Toll is working with the owner to get the mare’s feet trimmed and resolve the laminitis, and also to de-worm the horse as she believes the wound is being affected by a heavy parasite load. The horse has never been de-wormed. This case emphasized the importance of client communication and education, and meeting clients “where they’re at” to work with them in the best interest of the animals.

We also went to an animal rescue that has recently had problems with respiratory disease. A few horses have come up strangles positive and given the nature of the facility management (waste removal and feeding practices), Dr. Toll believes that the disease may have been spread to several paddocks unintentionally. It was very interesting watching Dr. Toll and the barn/paddock manager work to come up with biosecurity measurements to contain the disease as best as possible. It was determined that healthy horses would be vaccinated and that all horses would need to be temped every day until the disease was under control. Potential adopters would need to be notified of the problem on the property as well.

Week 2 at East West Equine

Hello,
I just wrapped up my second week at East West Equine Sports Medicine. I am loving it so far! I have had a blast in beautiful Traverse City. We did more lameness exams this week, which are pretty similar to what I described in last weeks post. We did see some unique cases and I got to help Dr. Bidwell with acupuncture.
Horses colicing is not uncommon at the show. Colic is a general term for any abdominal discomfort a horse experiences. Colic's can have many causes, ranging from an impaction of feed material, gas colic, sand colic, strangulation of the gut, entrapment of the gut, or even when the gut ruptures. When Dr. Peters is called to respond to a colic situation he takes the horses temperature, listens to gut sounds (borborygmi is the fancy word for gut sounds and is wonderful for Scrabble), and gets a history of feed and medications from the owner. He will then do a rectal exam on the horse to feel for dissented loops of small intestine, to feel if the colon is caught between the kidney and spleen (a nephrosplenic entrapment), or to see if he can feel an impaction in the cecum or colon. He will usually also pass a nasogastric tube into the stomach to see if the horse will reflux. Depending on what he finds on the physical exam, the patient is either determined to be a medical colic or a surgical colic. If the horse needs surgery, then they will be shipped to my friends at Michigan State (about a 3.5 hour trail ride from TC). If they are a colic that can be treated at the show, we will give them NSAID (usually Banamine) for pain management, IV fluids, and sometimes fluids and electrolytes via the nasogastric tube. We have seen a few colics this week, one that did well with surgery at MSU and one that responded wonderfully to medical treatment at the show.
This week I also got to help Dr. Peters "float" a patients teeth. Floating is doing a comprehensive dental exam on a horse. Horses upper jaw (maxilla) is wider then their lower jaw (mandible) and they grind their feedstuffs by chewing laterally (side to side). Horse dentition is unique because their teeth grow continually. Because of how they chew and their teeth constantly growing, they can get "points" on their teeth. These points are painful and can impact how well they are able to eat. Dr. Peters will sedate the horse (usually with Xylazine and Dormosedan). He will then feel for points and unevenness of the patients teeth. After he finds the points he will use large files to file them off until everything is on an even plane again. This makes it much more comfortable for the horse to eat and improves their quality of life.
During the show the horses are all kept in stalls. They are big beasts and they can get bored in their stalls, so they occasionally get turned out into small paddocks. The weather has been a little cooler in TC and some of the geldings have been feeling spunky. One pony got his leg lodged in a round pen panel while trying to escape to go visit his neighbor. The owner called us to treat a laceration on his hind left leg. He had a 5 inch laceration on the lateral (outside) part of his cannon bone and a 1.5 inch laceration on the medial side of his cannon bone. The lateral laceration wasn't full thickness, so we just scrubbed it and then wrapped it. The medial laceration was a full thickness cut, so we scrubbed it and Dr. Peters put 2 staples in it.
Those were some of the unique cases that I have gotten to see this past week. I love the scope of equine medicine that I get to see here. One of the most interesting treatments I've seen so far has been acupuncture. Dr. Bidwell is a certified animal acupuncturist trained in traditional Eastern medicine. She sees anywhere from 5-30 patients every day. She starts her exam by doing a scan. She uses a blunt object, usually a needle cap, to apply moderate pressure to association points on the horses to see where they are sore. After she scans them, she will then give them a massage, stretch them and then start placing needles. The needles range in length from 0.5 inches to 2.5 inches. She places the needles in appropriate locations based on her Eastern medicine trying. The needles help to stimulate nerves and increase the flow of energy (Chi). Many of the hunters and jumpers at the show have similar sorenesses because they are doing similar jobs. They are commonly sore in their feet, neck, lower back, and sacroiliac region. After placing needles, Dr. Bidwell will sometimes attach a small machine that passes an electric current through the needles (this is called electroacupuncture). The electric current helps to stimulate the muscles and nerves more than just the needle itself. She will then use a cold laser in various locations to increase healing and help with pain relief. Most horses very much enjoy their acupuncture. They will lick and chew, which are signs of relaxation. Acupuncture is an amazing treatment for these athletes because it is non invasive, has minimal negative side effects, brings them pain relief, and treats the horse as a whole. It also opens up wonderful and interesting conversations with owners, grooms, and trainers.
I'm sad to see week 2 at East West Equine go so quickly, but I am enjoying every minute. I am so grateful for this amazing opportunity to work with world class veterinarians. My shout out this week goes to Dr. Peters for busting out a Harry Potter wand and casting a spell to "repair minor injuries" on our laceration pony. The days are long here and we have to find ways to laugh and relax and Dr. Peters did just that with his amazing wizardry.
Thanks for following along :)

Best,
Kaity

Cleveland Equine Clinic Week 10

This was a fun week 😊 The owners of the foal with rhodococcus were having difficulty administering the prescribed antibiotics, and the foal’s abscess had become a very prominent swelling. We went to the farm and, after a recheck ultrasound of the affected region, laid the foal down on four bales of hay that were covered with a sheet. The vet sedated him with dorm and xylazine, but said that in younger foals you can lay them down on xylazine alone. Two techs held the foal while I scrubbed the elbow with betadine scrub. The vet then lanced the area with a scalpel blade. The amount of discharge was remarkable, and a culture and sensitivity was taken while the abscess drained. We also flushed the space with a LRS and dilute betadine solution. The space was closed, but included a penrose drain so that the abscessed region could continue to drain. Because dormosedan was used as part of the sedation, it took longer for the foal to wake up than if only xylazine had been used. Once he was up we thoroughly washed anywhere the pus had touched the foal. I created the scrubs, because I had not had any contact with the drainage and could therefore reach into the bucket that is used for any scrubbing we do, and handed them to one of the techs that had been holding the patient. Attention to sterility was very important because of the infectious nature of rhodococcus. Immune competent humans are generally not susceptible, but we had to be careful not to spread the bacteria to any farms we were visiting throughout the day, especially because it can persist in the environment. We recommended the owner use a watering can to sprinkle a bleach solution over the arena where we had done the procedure. The scrub bucket was coated with betadine and any trays or carts used were soaked with alcohol and wiped down. We squirted the bottoms of our shoes with alcohol and wiped down the sides and tops with Clorox wipes. Everyone cleaned their hands and arms with betadine scrub. All trash was put it a bag that was disposed of on the farm – not brought with us in the truck. The foal is still on the antibiotics rifampin and azithromycin and will hopefully start improving now that the abscess has been drained! The vet concluded that this abscess was likely not a result of the foal’s previous fetlock wound, and instead was a result of where a different infection had settled and was subsequently walled off.

I removed the stitches from a wound that I helped treat on a nighttime emergency call a few weeks ago. Below are the before and after images. The wound had very clean edges, and while deep, thankfully did not perforate the jugular. The vet did not have to debride any dead tissue, but did scrape the edges of the wound to make them bleed before suturing (healthy, viable tissue bleeds). Suturing went well and the healed skin looks good!

The choke horse in the clinic was still very finicky about drinking through last weekend. The clinic bought her gallon jugs of water, hoping it would be more enticing to her than our clinic water.  Though she still wasn’t drinking the amount that would be preferred, she went home with instructions to keep an eye on her water consumption because her esophageal ulcers had healed.

Two of the vets in the clinic do a lot of racehorse work and take turns spending one day a week in West Virginia. I went with one this week and got to look at a lot of endoscopes (I got to try passing one too, but had a hard time getting the scope in the correct meatus). Seeing so many in a row allowed me to compare variations of normal and different grades of pharyngitis. For the horses with pharyngitis the vet prescribes an antibiotic (preferably doxycycline), 10mg dexamethasone every other day for 6 doses, and a solution at the clinic called Solution B (liquid furosine, sulfadiazine, DMSO and dexamethasone) for 10 days. Endoscopes are often performed if the owner is noticing a breathing noise or trouble breathing. Arytenoid issues can cause a roar, but a flipping of the soft palate usually does not result in a sound aside from a quiet, expiratory gurgle. Working with the racehorses is unique because you have the added element of race track drug testing regulations to consider when creating treatment plans.

I’ll talk to you all next week!

MSU CVM Weeks 8, 9, and 10

Greetings again from the MSU Large Animal Hospital! I am sorry for the delay in creating this post, things have gotten busy the last few weeks. Since returning from AAEP Summer Focus, I have been on the day shift at the hospital. In addition to helping out with hourly treatments on in-patients, I have been able to assist with some out-patient procedures and observe surgeries. We have had a few weeks of very hot weather (often in the 90s), and have seen many horses with colic.

An interesting case that presented for evaluation was a 20 year old Morgan gelding with prominent swelling of a hind limb and accompanying lameness. He was non-weight bearing on the limb and had pitting edema, pain on palpation and the limb was very warm. Differentials included dermatitis and cellulitis, and joint infections and fracture. An ultrasound was conducted to check the subcutaneous tissue. Radiographs were performed to rule out fracture, and blood work was submitted to check fibrinogen elevation and white blood cell changes. The results of testing indicated that the horse had cellulitis in the limb. Broad spectrum antibiotics (SMZs) were started, and Banamine was given to control inflammation. A sweat of nitrofurazone and DMSO was also applied to the limb to draw out the fluid, and a bandage was applied. The gelding was walked several times per day as his comfort level allowed, and the sweat bandage was changed daily. He steadily progressed and became more sound, and the swelling continued to resolve. This was a great case with a great outcome!

Another interesting case was a Holstein cow that presented for dystocia. During the exam, it was determined that the calf was likely still viable, but was too large for the cow to deliver on her own. After a short time of trying to pull the calf manually, we proceeded to the operating room for a Cesarean section. The surgery was uneventful, and a large bull calf was delivered. Often calves delivered via C-section require some resuscitation, but this guy was lively.

Unfortunately, the Belgian foal that I wrote about in my last post returned to the hospital. She had been doing well at home, when the owner found her lateral and obtunded. The owner thought she may have been kicked in the head by another horse in the pasture. There were abrasions on her head, but they were more consistent with damage due to seizure activity than due to trauma like a kick. Skull radiographs were unremarkable. She was started on IV fluids, and a nasogastric tube was placed for feeding purposes, and IV antibiotics were started. The foal soon developed seizure activity, and was placed on a Midazolam CRI. Despite this, she continued to have breakthrough seizures and required IV diazepam to control those. When her seizures did not resolve and became more difficult to control, and the prognosis for the foal's recovery was poor, the owners elected for humane euthanasia. Due to the seizure activity, the doctors suspect that the foal may have had Tyzzer's disease. Liver biopsies and a necropsy were performed. I actually got to take a few liver biopsies myself.  On gross necropsy, a subdural bleed was found, consistent with head trauma. However, it is not known if that is due to truly being kicked in the head, or if the bleed was due to head trauma from seizures. Lesions on the liver were also found during the necropsy, and were submitted to histopathology. Those results are not yet available, but will confirm or rule out Tyzzer's disease.

Another foal came in last week. The owner's indicated that it was an embryo transfer foal, and that it was 30 days premature. The foal was surprisingly bright and feisty for being so premature. Luckily, the foal's lungs and joints were mature, which are the biggest concerns with premature foals. However, because the foal was premature, the mare had not yet begun to produce colostrum, and therefore the foal did not receive antibiodies via nursing. This leaves the foal at a very high risk for infection, because foals get their early immune system from colostrum. Therefore, the foal was given a plasma transfusion which contains the necessary antibodies to protect the foal from infection until they begin to produce their own. I was tasked with monitoring the foal during the transfusion. I had done plasma transfusions on dogs before when I worked at an emergency clinic, but this was my first transfusion on a horse. Vitals have to be monitored every 5 minutes during a transfusion, to watch for signs of a hypersensitivity reaction. However, the foal did great, and went home a few days later.

This summer has flew by! I can't believe that July is half over, and I will be back in class in a little over a month.

Week 1 with East West Equine Sports Medicine

Hello everyone,
My name is Kaity Denney and I am a rising second year at MSU CVM. I am so excited to be an Equine Summer Fellow this summer!

I am spending 4 weeks in Traverse City, MI with East West Equine Sports Medicine. There are 3 doctors on staff, Dr's Duncan Peters, Lori Bidwell, and Matt LeShaw. I just finished up my first week working with them. They are the official vets for the Great Lakes Equestrian Festival, which is a hunter-jumper show. I work Monday-Saturday with them, from roughly 8 am until 9 pm. The doctors also respond to various emergencies during the night. My experience so far has been rewarding and enjoyable. Although we work long hours, the time really does fly by because we are incredibly busy and I am learning so much.

All of the patients are sports horses, so we do a ton of lameness exams. Each lameness exam consists of watching the horse walk and trot in a figure 8, on a straight line, and then usually on a lunge line. Then the doctor flexes one joint and then watches the horse trot off to see if the flexion exacerbated the lameness. The doctor will use hoof testers on each foot to apply pressure to try and see if they can find a spot that the horse is sensitive on. After the doctor has localized the lameness to one leg, they will them use a nerve block to find which part of the leg the lameness is in. The blocks start at the lower leg and then the doctor will block further up as they go. The doctors use mepivacaine (which is similar to lidocaine) as a local anesthetic. They will inject the nerve, let the horse hang out for about 5 minutes (the time it takes for the drug to take effect) and then will poke the area with a pen to make sure the block worked. Then we watch the horse trot again. If the lameness is better than the doctor knows that region is where the pain is and can treat appropriately. I have learned that if there is a sudden lameness, then you want to watch the horse trot, but do not block it before you take x-rays. This is because if you block the nerve and their is a fracture and you make the horse trot they will sometimes fracture it more.

The doctors also use a handy dandy portable digital radiography unit to check for any bone issues in the legs like arthritis, bone spurs, or fractures. They also use a portable ultrasound to check for soft tissue damage. I have gotten to help with x-rays and ultrasounds. Dr. Peters is an amazing teacher and walks me through what the gray blobs on the ultrasound are and shows me the difference between normal and abnormal.

The most common issues that I have seen so far have been front leg issues including front fetlock (similar to the human ankle) issues, abscesses in the hoof, coffin bone (similar to the bone in the tip of the human finger) fractures, and tendon/ligament damage.

Many of these issues are treated with rest, NSAIDs for pain and anti-inflammation, and steroids to decrease inflammation. The doctors also recommend horses go to equine rehabilitation centers to strength weak muscle groups to try and prevent further damage.

I have had any amazing first week learning all about hunter-jumpers, horse show life, and equine sports medicine. I have more stories to tell, but I will save those for next week so my posts aren't too long. I am so grateful for the doctors and staff at East West Equine Sports Medicine for their patience with me while I learn. Also shout out to Dr. Bidwell for all of the burritos she has bought me to keep me going during the long days. Until next week :)

Kaity

P.S. My advice if working with Equine Sports Medicine vets is to wear tons of sunscreen and always have chapstick with you.

Cleveland Equine Weeks 7-9

The summer rush is starting to slow down a little here, but there have been some cool unique cases the past few weeks. Beanie, the horse with the melting corneal ulcer, has gone home after an enucleation. She was transferred to Ohio State to be evaluated for a surgery, but they determined the cornea could not be healed based on the condition of her eye. OSU sent her back to us with an adjusted treatment plan, but agreed with the doctors here that the prognosis for sight and the eye itself were both grave. She may not be used for her intended purpose of jumping because her depth perception will be off now, but otherwise she is a much happier horse!

There is a new case staying in the hospital that presented for choking. The choke was very difficult to resolve. The general method is to tube and lavage, making sure the horse has its head down to prevent aspiration. For this case, the veterinarian had to use the probe from the gastroscope to help break up the obstruction, which turned out to be about 5cm long! I was not there for the original diagnostics and treatments, but have been helping administer her daily medications. The mare refused to drink for about a week, but the original gastroscope had shown some severe esophageal ulcers. To avoid irritating the already damaged esophagus we have been tubing her with a pony sized tube. She is currently on ranitidine, metronidazole and sucralfate twice a day. The ranitidine and antibiotic can be given through the tube along with water and electrolytes, but the sucralfate is always syringed into her mouth so that it can help the esophageal ulcers. When we were having trouble getting her to eat or drink, one of the doctors looked in her mouth and removed a loose cheek tooth and put in a dental plug. She is still occasionally quidding her grass, but this is likely due to an overly smooth occlusal surface (not terribly uncommon for a 28 year old) that makes grinding difficult. Just today, over one week past admission to the hospital, she drank on her own. This was after we syringed some salt water into her mouth, a trick one of the vets will sometimes use to get colic patients to drink. Hopefully she will continue to drink on her own and can go home soon.

Another dental case stemmed from a somewhat bizarre situation. A client called because her horse had knocked his tooth out, root and all. We rarely have the advantage of knowing what happens in wound cases, but in this instance the client saw the incident occur. Her horse was startled while he was poking his head out of his stall. Upon pulling his head in he smacked it against the metal bars of his door and the tooth fell out. When I went with the vet who focuses on teeth (after the on-call veterinarian had stopped by the night before) we performed skull radiographs to confirm that a few small fragments she thought she could feel remained in the socket. It took a lot patience, but she was able to remove the fragments. It was important to move slowly and not fragment the remaining pieces even further.

An inpatient case from last week involved a foal that was lame, supposedly as a result of the wound on his left front fetlock. The wound was treated but another doctor at the practice then noticed that the elbow region was more swollen and hypothesized that the leg swelling was extending distally from an issue in the proximal limb, not the other way around. We ultrasounded and discovered an abscess! You can distinguish an abscess from a vessel on ultrasound because an abscess will remain circular on cross section and sagittal view, whereas a vessel will elongate when taken out of cross section. Because of its proximity to large vessels and the numerous layers of muscle over the abscess, the vet decided not to drain it. A culture was taken after it did not shrink for a couple days, and another vet ultrasounded the foal’s lungs under the suspicion that it may be a rhodococcus equi infection. The culture came back positive for rhodococcus, and the vet did notice some irregularity along the lung viscera. The foal was managed in the clinic for a few more days and then sent home on antibiotics.

While GastroGard is commonly used to treat gastric ulcers, we recently treated a patient known to have ulcers with injectable omeprazole. It was a cheaper option and more convenient (once a week treatments instead of daily) for the owner. The patient was gastroscoped at the beginning of treatment and this past week after a little over a month of treatment and the ulcers had subsided almost completely! It was exciting to try a new product and be able to evaluate its efficacy.

A neurologic horse I have seen a few times poses an interesting debate. This horse was put on medication for EPM, but then tested negative. When taken off the EPM meds she became much more neurologic. The vet radiographed the horse's neck and found some moderate bony lesions that could be responsible for neurologic signs. The mare was put back on EPM meds, anti-inflammatories (isoxuprine and equioxx) and scheduled for an acupuncture appointment with another vet at Cleveland Equine. When we rechecked the horse her neurologic sings were significantly improved. It’s hard to know what exactly is helping this horse. While EPM antibody testing can have false positives, this horse tested negative. Still, the EPM meds seem to help despite the neck lesion being the most likely cause of the neurologic issue. Aside from a blood titer you can also test for EPM via CSF (though this is a more involved procedure than a blood titer), therapeutic diagnostics or from a necropsy.

I’ve had the chance to do more during the diagnostic process and treatments. I performed a PDN nerve block on a horse. I have watched so many at this point that I was really excited to try one for myself! I palpated the palmar digital nerve and injected about 5cc of carbocaine into the medial and lateral side. I’ve also gotten more practice with radiographs, both taking and holding the plate. Some of the vets have started letting me record the findings I see before they go through them which is incredibly helpful for focusing on what normal looks like for each view.

It’s hard to summarize the best cases over multiple weeks, and I apologize for not posting more consistently. I’m a little sad to realize I only have three weeks left here at Cleveland Equine. I can’t wait to see what I learn in my last few weeks, and I’ll do my best to share with you the highlights!

Brown Equine Hospital: Week 8

Well time is flying when you are having fun! I cannot believe it has been 8 weeks already! It seems like I got here only yesterday. This week was very busy and I will try to provide the highlights as usual! 

We had two horses come in for a condylar fracture repairs. One horse had a condylar fracture on the third metacarpal bone, while the other horse had a condylar fracture on the third metatarsal bone. In order to fix the fractures, we needed to place two screws and a plate in each horse in order help the areas heal. The danger with any recovery or surgery is fracture to a leg, so both the induction and recovery was slightly more stressful because a fracture was already present! Both horses went down smoothly and surgery went very well. I was able to scrub in during one of the procedures and assist the surgeon by lavaging the area, blotting and retracting tissue. The horses got up in one try and stayed on their feet very nicely. Here are some pictures of the metatarsal fracture and the repair (I didn’t get a chance to take a picture of the metacarpal fracture):

Two days later one of the horses was showing signs of colic. They were pawing at the ground, circling, getting up and down and were very uncomfortable. I was working that day and called the veterinarian on call. We began to bolus 10 liters of fluids, hoping that would help make the patient more comfortable and help treat the colic medically, rather than surgically. After this was done the horse was still uncomfortable so xylazine and detomidine was administered to help alleviate the pain while the veterinarian could drive in to rectally palpate the horse. The horse was found to have a substantial cecal impaction and needed surgery right away. Other staff members were called in to help with anesthesia and the horse was prepped for surgery. The cecum was identified and an enterotomy was performed. The cecum was flushed in order to remove the impaction. Once the surgery was over, the horse recovered nicely and has been monitored for gastrointestinal sounds in all four quadrants as well as bowel movements. The horse has been slowly introduced to food and has been steadily recovering. The horse is still not out of the woods yet, but is making a steady recovery. The other horse recovered smoothly following surgery and was discharged home.

Another horse presented to the clinic for roaring. We passed a scope and identified the paralyzed side. The surgeon performed a ventral cordectomy (VC) and the horse was discharged home two days later.

Another horse presented to the clinic for roaring as well. The horse had a VC done in March and needed to be re-evaluated. When the scope was passed the horse had a pea-sized hole to breathe through. The horse had an iatrogenic glottis stenosis. The surgeon used the endoscope to guide the procedure and made an incision ventral to the glottis. They removed the tissue and helped the horse to breathe better. The horse was discharged home the following day.

A racehorse presented to the clinic for exercise intolerance. A lameness exam was done in order to see if it was due to any soreness issues. There was nothing remarkable with the lameness so a scope was passed through their nose in order to visualize their larynx to see if the horse was suffering from laryngeal paralysis. It was found that the horse had an entrapped epiglottis. This is when aryepiglottic fold envelops the apex and lateral margins of the epiglottis. A endoscope was used to guide the procedure and the horse recovered well and was discharged home.

Its hard to believe I have been here for 8 weeks already. I look forward to what these last few weeks will bring me. 

Clinton Vet Service: Week 5

Well, that's a wrap!  I apologize for the delay in writing this final entry.  Between the Fourth of July holiday, and my inability to quite put into words my final week with Clinton Vet, this post is a touch tardy.  Words cannot describe how grateful I am for the wonderful experiences I have had over the last month and a half.  Without clinics like Clinton, programs like MSU's Equine Fellows, or sponsors like Zoetis, experiences like the one I have had would be impossible.  I learned more than I ever could write and continued to build my relationship with a fantastic clinic and their clients.  But, above all else I continued to perfect valuable skills that will serve me throughout my veterinary career.  I am sad that my time with Clinton Vet is over, but am so glad to have had the opportunity to continue learning from them.

My last week was nothing short of amazing.  We started off quite busy with full days Monday and Tuesday driving all over Mid-Michigan for a variety of calls.  We saw everything from lamenesses, floats, sick horses, and reproductive calls.  It was encouraging to get to do some followup calls for cases we have been working on since I started.  Even more exciting was the positive pregnancy checks we had for a few of the mares I have gotten to work closely with.  Mid-way through the week we got a surprise inpatient at the clinic.  A newborn foal with contracted forelimbs.  It is not uncommon for foals to be contracted and is caused by their flexor tendons being too tight/short when they are born.  Without intervention it is unlikely that the foal will be able to stand and nurse properly.

The colt, affectionately nick-named Forrest, needed immediate assistance.  I was impressed by the entire team coming out to help! Even after a long day of work almost every staff member returned to the clinic to begin treatment.  The typical treatment for contracted limbs is Oxytetracycline, a broad-spectrum antibiotic.  It is unclear what properties of this drug encourage the relaxation of the tendons, but typically the limbs will straighten after 24-48 hours of treatment.  Concurrently, splints can be placed to encourage straightening.  Though it is imperative that they are not left on indefinitely, or the foal will become dependent upon their support.

Drinking like a big kid at 3 am!

Unfortunately, contracted limbs were not Forrest's only hurdles.  He did not have a strong suckle reflex, a common finding in "dummy" foals.  Even with the support of three staff members and guidance towards his mothers teats, he couldn't latch on to nurse.  This meant that he needed round the clock care in order to receive proper nutrition.  Dr. Lindsay (the main doctor on the case, who first saw the foal that morning) had successfully milked the mare and fed Forrest via syringe a few times throughout the day.  But, it was evident that he needed treatment every two hours throughout the night.  Thankfully, there was no shortage of volunteers and Dr. Cynthia, Michelle (who lives nearby), and I divided up shifts and began a long night of treating the foal.  At first, it was a two person job to milk the mare and feed Forrest.  As the night wore on we were able to get a system down that required only one person.  Since he didn't want to suckle well it became evident that we risked aspiration pneumonia using the syringe method.  This can be a serious complication of hand-fed foals if you are not careful.  So, at three in the morning Dr. Cynthia and I attempted to train him to a bucket for drinking.  It took some creativity, but eventually he took to it like a champ!  The rest of the night was uneventful and he even began to stand more easily on his own.

Look at that handsome little colt

Nursing on his own!

The next morning Forrest continued to improve but still needed regular care.  We had a good system down for feeding and he received his second dose of Oxytet.  Periodically, we would work his limbs to help them stretch straight and aid him in getting up and walking.  This round the clock care continued for another day or two before significant improvement was noted.  Finally, his tendons relaxed significantly and he began nursing on his own!  Throughout this process, his dam was a star.  Many of these cases outcomes are contingent upon the mare continuing to help care for the foal.  It is one thing to have to hand rear a foal for a few days, but taking on a rejected or orphaned foal is a whole different story.  Thankfully, the mare remained calm, easy to handle, and milked extremely well while we had to.  The most recent update I have heard is that they are both home and thriving.  I can only hope that the rocky start is the end of the trials for this spunky little colt.

Working with Forrest was one of the highlights of my time with Clinton.  Getting to help with his round the clock care was a great learning opportunity and really improved my skills with foals and nursing mares.  But, what shines above all else are the people.  The staff at Clinton Vet is unlike any I have worked with before.  They are a family and work extremely well as a team.  Even during the toughest times they are quick to lighten the mood when they can and are always having fun.  I don't think I ever walked into the clinic and didn't find a reason to smile or laugh with whoever was around.  Having a good team is a pivotal part in running a successful clinic and Clinton has that mastered.  I am sad to be done, but will forever be grateful for all they have taught me.  Thank you for following along on my adventure and thank you to Clinton Vet and Dr. Cynthia for hosting me!


Some pictures that haven't fit into other posts (but further prove how much fun was had by all!) :

Always a sense of humor at Clinton!

Baby bunnies at a call

Sally: the clinic manager

No chicks were harmed in the taking of this photo

The newest addition

Peanut gallery sleeping on the job while we float teeth