A Pony's Tale - Cleveland Equine Clinic

My favorite case of the week involves a schooling pony at a local farm. He came in from the pasture one morning so lame that he could barely walk. We did a full lameness work up which typically involves palpating the joints and tendons, evaluating movement, and taking radiographs. On palpation, there was a lot of pressure in the middle joint of the knee. My mentor suspected a fracture due to how lame the pony was at the time. We took radiographs and to our surprise, there was no fracture to be seen! 

Our next step was to tap the joint and see what the joint fluid looked like. Normal joint fluid should be clear and colorless. This pony's joint fluid was opaque and dark brown/red in color. We collected the fluid so that we could analyze it back at the clinic and injected an antibiotic, called Amikacin, directly into the joint. The owners of the pony were unable to provide the care needed due to the extent of the infection in the joint. However, the clinic owner and owner of the horse have a great relationship. We took the pony on as a charity case and brought him back to the clinic for treatment! 

Upon joint fluid analysis, there was a high white cell count, indicating that there was indeed an infection in the joint just as we had suspected. We decided to do an alternating schedule of procedures on the knee. The first night, the intern and I flushed the joint and then performed a regional limb perfusion. This regional limb perfusion involved putting a tourniquet on the leg in two places, one above the knee and one below. We then gave a high concentration of antibiotics into the vein near the knee. We left the tourniquets on for several minutes so that the antibiotics could absorb into the surrounding tissues and joint. This provides a strong and local source of antibiotics to help with the infection. It was a great learning experience for us both. The pony stayed in the hospital for about a week. We alternated flushing the joint and performing regional limb perfusions daily. 

Additionally, he was on Banamine for pain relief and systemic antibiotics. We took more radiographs after a couple of days in the hospital to make sure that there weren't any significant bony changes that can occur due to the infection in the knee. In a few short days, the lameness had significantly improved and the joint fluid was looking more like it should. At the end of the week, he was discharged and sent back to his farm to greet the next group of camp kids. It was truly an amazing chance to learn how to do regional limb perfusions and joint flushes. And best of all, there was a happy ending for the pony! This is just one of the many examples of how this clinic truly cares about student learning. Until next time! 

Liz Ritchie