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!
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