BEH Weeks 9 - 12

 It has been some tiring weeks here at Brown Equine and I cannot believe that my time here is over. I apologize for my lack of posting, but time got away from me a little bit! I have had some interesting cases and some sleepless nights these last few weeks, but I have learned a lot.

Week ten started out with 13 lameness exams in one day! Twelve of those lameness exams were for one of the standard bred clients that we work with. Usually on Mondays or Tuesdays we work on their race horses and conduct lameness exams and identify the issue and treat them accordingly. The client wanted their horses to be ready for the Delvin Miller Adios Pace for the Orchids at the Meadows. The Adios is a horse race for three-year-old Standardbred colts and geldings that occurs annually at the Meadows Racetrack in Washington County, Pennsylvania. This is a final for the horses and it is a one-mile long race. During the lameness exams we can identify different issues the horse is having by having them trot in circles to the right or left and also flexing the horses limbs. You can do upper and lower limb flexion as a way to identify what is the source of lameness in a horse as well as using hoof testers. For example, when the horse is positive (has a change in the degree of lameness) to both upper and lower limb flexion in the hind limb, the suspensory ligament can be the issue. You can then clip the area and use an ultrasound to examine the suspensory ligament and look for any tears or abnormalities within it. Sometimes nerve blocks are utilized when the site or source of the pain is unclear. If you are able to block the horse out successfully and the horse is then sound upon re-examination, you have localized the pain and can therefore use other diagnostic procedures more effectively both medically and economically to identify the cause of the lameness and treat it appropriately. Being able to work with Standardbreds was not something I had envisioned for myself as a future career path and I am glad I had the opportunity to do so. This gave me the chance to experience a different career for myself and working with clients like this allows me to see that it is a definite possibility.

Later on in the week, there was a patient that came in due to a fracture at its first phalanx (P1). The horse was competing at a barrel racing contest when it fractured its P1. We took some x-rays of the patient in order to visualize the fracture and see if it could be repaired surgically. Here are some pictures of the x-rays we took:

The owner wanted to move forward with surgery, so we placed a catheter, administered the pre-anesthetics and took the horse to surgery. We had an x-ray machine in the operating room in order to take images of the procedure and confirm placement of the screws and that adequate compression was generated. The surgeon needed an extra hand and I was fortunate enough to scrub in for the surgery and hold the horse’s limb in position while he worked. I held the limb in a curled position, similar to curling a weight, for an extended period of time (sorry I didn't get any pictures of this, I had my hands full!). It was safe to say it was arm day for me, no need to go to the gym! We placed all of the screws, put a cast on the horse and put the patient in the recovery stall. The horse recovered wonderfully from anesthesia and stood up nicely. The horse did not arrive to the clinic until 5 p.m. that evening so surgery did not start until 8 p.m. The surgery lasted about 5-6 hours and recovering horses takes time. We did not leave the clinic until 4 a.m.! While it sounds tiring, it was worth it! I can honestly say there really isn’t anything like surgery. The horse is still at the hospital and recovering. The cast will not come off for another couple of weeks, which the horse is less than enthusiastic about. Before I left the horse started trying to remove parts of their cast, but to get them to stop doing that, we placed a half limb bandage above it and put paste on the outside of the bandage to deter them from eating the bandage. This proved to be effective and the horse is no longer biting at their cast. 

Here are some of the pictures taken during surgery and after we placed the cast and screws:

During week eleven a colic came in on emergency during the night. The horse was worked earlier in the day and started becoming painful. The horse began to pace, paw at the ground, get up and down and roll. When the horse came to the clinic, we ran blood work like complete blood count (CBC), Chemistry, packed cell volume and total protein (PCV/TP) and a serum amyloid A (SAA). The CBC is important because it provides information about the cells in a patients blood, which can provide vital information about the patients status. The PCV/TP is used often because it can be an indication of the horses hydration status or other disease states like malabsorption, liver disease, gastrointestinal disease or kidney disease when you compare the results of the PCV and TP together. SAA is a protein that is produced by the liver in response to inflammatory stimuli. This test can be used as a diagnostic in horses to analyze a disease state. When we ran this blood work for the horse everything came back within normal limits except for an elevated glucose, which can be due to stressful situations, like trailer rides to the hospital. When the veterinarian rectally palpated the horse, it was found to have a dorsal displacement of the large colon. This was not deemed surgical because it was due to a gas displacement, the horses blood work was normal and the vitals were within normal limits. We placed an NG tube and gave the horse fluids and electrolytes as well as mineral oil. The mineral oil was given to serve as a biomarker, rather than to help pass the feces. Once this was done the horse was given buscopan to help relax the GI tract, control the pain associated with spasmodic colic and make the patient feel more comfortable. We then administered IV fluids and walked the patient up and down hills quickly to help the patient pass feces and gas. Once this was done we withheld food in order for the bowels to evacuate the intestinal contents and make the horse more comfortable and allow the colon to return to its normal position. After multiple brisk walks and hills, the horse began to feel more comfortable. The next day the horse was palpated and the colon was no longer displaced. The horse was monitored for 24 hours and then discharged home.

We also had a couple of horses come in for ventral cordectomies (VC). These horses were experiencing exercise intolerance and we scoped the horses to see if they were paralyzed or not. The horses were both experiencing left recurrent laryngeal paralysis and needed to undergo the VC procedure. The area was clipped, scrubbed and blocked. We utilized the scope and placed it through the patients nasal passage in order to adequately visualize the area while the surgeon removed the saccules and vocal cords of the horse. The patients recovered well and were sent home the next day.

Then we had a horse come that was three legged lame. This means that the horse was only functional on three legs. It would hop instead of putting weight on its front right leg. We took the bandage off of the horses hoof and found that the horse had an abscess that burst through the toe of the hoof and was infected. This was causing the horse a significant amount of pain. In order to debride the area the surgeon decided to use medical maggots. Medical maggots are disinfected maggots used to debride wounds and clear infected tissue without harming healthy tissue. The maggots are applied to the area and bandaged so that the maggots stay in the wound and do not migrate away from the affected area. After about 3-4 days the wound is re-checked and additional maggots are placed if needed. In addition to the maggots we consulted with the Ferrier in order to see what we could do to make the horse more comfortable. When we walked the horse, it would put weight through the front right hoof when going up and down hill. When she would go back towards the barn, she would begin to limp again. The slope of the hill was causing her to be uncomfortable on the lateral portion of her hoof. This meant that she would be more comfortable with a wedged shoe that was placed on the lateral aspect of her hoof. To help the Ferrier trim their feet we took x-rays to show him how far he could trim the horses feet. We also ordered easy riders to help her be more comfortable and provide support to the other hoof. The horse stayed at the hospital until the maggots were gone and was discharged home. 

Another horse came for a lameness exam and before the exam even begun the horse's hind legs looked like it was dragging and it would sometimes even kick out. (For my fellow first years, it looked almost exactly like the video Dr. Manfredi showed in the Stifle lectures). This horse had a locking patella. In order to fix this problem the doctor decided to fix it surgically by doing a medial patella ligament splitting on both legs. What the procedure involves is cleaning the area, anesthetizing the horse as well as applying local anesthetics to the area. Once this is done the surgeon takes a blade and makes about three punctures with a scalpel blade in order to make the medial patella ligament thickened and enlarged. This helps to make it less likely that the medial patella ligament will get suck over the stifle and allows the ligament to be more fixed in space. This will help make movement for the horse easier and will decrease the instances of the horse dragging its toe and kicking out. 

I was able to go out to one of the neighboring farms with the vet techs to shock wave a couple of horses. I was able to bring the machine with us in order to shock the horses suspensory ligaments and hocks. This was done on some racing horses in order to help stimulate healing in affected areas. I even had a helper with me (pictured below)! Normally you would do a lameness exam first before doing shock wave therapy, but these horses had already had lameness exams before and were in the middle of their treatment cycle.

Over these past four weeks I have been able to gain more experience placing IV catheters, administering IV medications, taking x-rays, working up colics, performing PD and abaxial nerve blocks, palpating for injecting joints, prepping and recovering horses from surgery. In between the appointments and surgeries I have been able to help with inpatient care and gain more experience with charting for patients as well as learning how to calculate dosages for patients.

I cannot believe that the 12 weeks for this fellowship is already over. It is a bitter sweet ending to be honest. I have had long days and many sleep deprived nights, but I would not change it because it has taught me many things about the profession and myself. It has allowed me to get a small glimpse at what an internship is like and if I am up for the task. It has shown me what vet med is really like and what kind of veterinarian I want to become. 

I had two goals when I started this job: to work hard and learn as much as I could about equine medicine. I believe that I accomplished said goals, granted I still have more to learn about equine medicine, but I believe that I am off to a good start. I cannot thank the staff at Brown Equine enough for everything they have taught me and done for me this summer. I am forever grateful for all of the hands on learning opportunities that I was afforded here. Because of them I feel more prepared for clinics and I am more confident in my abilities. Thank you again for all of your help, I will miss you guys! 

Until next time!

Shelbe