NJ Equine Clinic - Last Week!

We lost power this week and it was all hands on deck as we worked to get water to the horses not only in the hospital, but out in the fields as well. There was a crazy ~10 minute storm with high winds that caused many towns in NJ to lose power. Other than a limited supply through generator, our power was out from Monday night to Thursday afternoon— but that didn’t stop us from seeing appointments! 

We saw an epiglottic entrapment in which the aryepiglottic fold (a normal part of larynx anatomy) envelops the epiglottis, potentially leading to poor racing performance. The entrapment is diagnosed by endoscope and in this case the aryepiglottic fold was transected to free the epiglottis.

Case Highlight: EOTRH

Equine Odontoclastic Tooth Resorption and Hypercementosis (EOTRH) is a syndrome most commonly seen in older horses that results in resorptive lesions of the incisors and canine teeth.  EOTRH is typically diagnosed through radiographs but the pathophysiology of the disease is currently unknown. The only current treatment that exists is to extract the affected teeth.

Affected teeth are extracted due to tooth loosening and associated pain. Loose teeth can fracture off as in the case of this patient. Many horses actually do much better once the teeth have been extracted as they can go back to eating/being horses without feeling pain.

Thank you to everyone who read these posts and followed along during my time at New Jersey Equine Clinic!

A special thank you to the nurse staff at NJEC - Melissa, Alisha, and Danielle for letting us get in their way and sometimes take over, Dr. Leahy for her Spartan camaraderie and life lessons and lastly Dr. Smith for being ever so willing to answer questions and keep us on our toes while dishing out questions. I am so truly thankful for the experience and am forever grateful to have been taken in having had mostly small animal experience. Thank you for remembering what it was like to be a student and for giving me a chance in equine med. I can’t wait to share all of my acquired knowledge! 

Lastly, a million thank you's to Dr. Rashmir and Dr. Schott of MSU who without their support this invaluable experience would have never happened. 

Happy Summer Everyone! Off to our next adventure! 

Stefany Gomez 

MSU CVM 2021

A grab bag of cases at Littleton Equine

Hello all,
My time at Littleton Equine Medical Center is coming to a close. It's been a great summer learning in the ICU and meeting some amazing doctors, technicians, and fellow vet students from around the country. If you are an MSU CVM student thinking about applying for this position, please reach out to chat with me (denneyk1@msu.edu).
I thought I would wrap up my blog posts with a grab bag of unusual cases we have seen the last week or so.
In mid May a yearly Arabian presented to our emergency service for a hemoabdomen following a routine castration. Although I hadn't arrived at Littleton yet to watch this case work up, the doctors ran diagnostic blood work and gave the gelding a plasma transfusion. He did not improve enough with the transfusion, so the next day he was given whole blood and the clinical team started to investigate the reason for his hemorrhaging. Suspecting a possible coagulation issue, a coag panel was sent off. The results showed that this gelding had a defect in factor 8, a rare issue in horses. Factor 8 is part of the intrinsic pathway of the coagulation cascade, which meant his PTT time was elevated. He was diagnosed with hemophilia A. After the blood transfusion, the doctors were able to get his hemorrhage under control. The diagnosis was explained to the owners and he was sent home with instructions to watch him carefully and return to the clinic if he sustained any trauma because he would not be able to clot properly. This week our favorite little Arabian gelding returned with a hematoma the size of a basketball above his tuber sacrale. He had been frolicking in the pasture and took a spill into a T-post. The trauma caused him to hemorrhage and form the hematoma. He has remained in the clinic for close monitoring this week. The hematoma does not appear to be changing in size and he doesn't appear to be continually losing blood. We have closely monitored his mucous membranes, CRT, and heart rate on an hourly basis to assess if he is losing blood. The hemotoma was ultrasounded to confirm it was in fact blood filled. This current plan is to go home on stall rest until the hemotoma resolves and to remove as many dangerous items from his pasture as possible. Although our surgeon wasn't thrilled about the idea of having to take a hemophiliac horse to surgery, we discussed the safest ways to do that if it had to happen. One note our internal med doctor made was that vasopressin stimulates the release of more factor 8, which it is an expensive medication, but would be helpful to control bleeding in this case if surgery was necessary. Luckily, this guy doesn't currently need to go to surgery.

This summer we have also seen a few horses with severe ulcers. One of the most effective ways to treat them is with an SPL (sub palpebral lavage system). This is where a medication diffusing device is placed under the eyelid and a line is run up the horses mane. Most horses do not respond well to having eye medication placed daily, so an SPL helps to deliver medications in a safe and reliable manner. We usually give "ulcer mix" which has gentamicin, +/- atropine, artificial tears, and acetylcysteine. We also give serum via the SPL to help with the healing process. I had never seen an SPL before coming to Littleton, so it has been fascinating to watch the placement of them and how well they help to heal ulcers.

My last interesting case for this week was a mule who came in for a ovariohysterectomy (spay). This isn't commonly done in horses because their heat cycles are controlled well with hormonal medications like Regumate, but this mule had severe behavioral issues and the concern was that they were stemming from hormonal issues due to a possible ovarian tumor. On ultrasound the left ovary was considerably larger than the right and was anovulatory. The concern was that this mule had a granulosa cell tumor (GCT) producing testosterone in her ovaries that was leading to her behavioral issues. The ovaries were removed via laparoscopic surgery and we will wait to see if the behavioral issues resolve. One way to test for GCT's is with an AMH and testosterone test. Her's was negative, but our surgeon has had that happen in the past and send the ovary in for histopath and it was in fact a GCT. This was another unusual case that was very cool to watch unfold.

It has been a roller coaster of a summer here in CO. I am very grateful for this opportunity and for all I have learned and the amazing folks I have met. Please always feel free to reach out if you have any questions.

All the best,
Kaity

A Field Necropsy - CEC

Hello again! This past week we had a case that turned into an amazing learning opportunity. We were called out to evaluate a pony that had a history of founder. When we arrived, you could tell from a distance that the pony was having trouble breathing.

This is what we found on our physical exam:

Heart Rate: 80 beats per minute
Respiratory Rate: 100 breaths per minute
Mucous Membranes: Brick red with a toxic line
Capillary Refill Time: Prolonged
Digital Pulses: Within normal limits
Abdomen: Extremely distended

The pony did not act sore on his feet. When we lifted his feet, he was not reluctant to put weight on the opposite front foot. A lot of horses with founder would be resistant to this due to how painful their front feet can get. Additionally, he was not standing in a way that would shift weight off of his front feet. We were unable to do rectal palpation due to his size.

Unfortunately, due to the pony's poor condition and old age, the owner elected to humanely euthanize the pony. However, she agreed to let me ultrasound and then necropsy the pony for learning purposes. It was extremely kind for her to allow me to do this.

The ultrasound yielded some additional information. When scanning the lungs, we saw "comet tails." This suggests that there is some level of disturbance on the outside pleural surface of the lungs. Dr. Sarah Varnell was concerned that there may be fluid in the thoracic cavity as well because of the scan, which could have been contributing to his labored breathing. We did see some nodules on the spleen and there was decreased motility of the small intestines. We weren't able to do the best abdominal scan, because we only had a tendon ultrasound probe on the truck. But we did the best that we could with what we had!

It was great to get the opportunity to match the ultrasound findings to the necropsy findings. When we opened him up, immediately we noticed that the ventral colon was extremely distended. The vasculature of the intestines and stomach was also incredibly distended. The lymphatics of the mesentery were also so engorged that we initially thought that the abdomen had parasites in it! At the hilus of the mesentery, the blood vessels and lymphatics were so distended that when you reached your hand into the abdomen, they felt like ropes. There was indeed fluid sitting around the lungs and hemorrhagic fluid in the abdomen as well. The small intestines were abnormally colored. There were in fact nodules on the spleen and also on the kidney. The liver lobes were rounded. Although there was a lipoma, it was not of any concern for intestinal strangulation.

While we did not come up with a definitive diagnosis because no samples were sent off for histopathology, Dr. Varnell was suspicious of lymphoma given the pony's age and necropsy findings. This case was truly incredible. To get to work up a horse, perform ultrasound diagnostics, and then compare those findings to the necropsy is an experience I will never forget. I am very humbled to have had this opportunity and that the owner values student education so much.


Images:

Heart and Lungs

Spleen with nodules

Abnormally colored small intestine

Spleen with irregular consistency

Distended stomach vasculature with adjacent lipomas

Distended vasculature and lymphatics

Distended colon

Vessels that resembled "ropes"

Colic craziness at Littleton Equine

Hello all,
I hope summer is treating you well. It has been so busy here at the clinic lately. Our ICU is full and most of the cases are colics. I thought I'd give a brief overview of what colic means and how we address it. 
Horses colicing has been a very common occurrence this summer. 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. To work up a colic we start with a basic physical exam including:  temperature, listening to gut sounds, check mucous membranes and CRT, feel digital pulse, and get a heart and respiratory rate. We will also get a history of feed and medications from the owner. Then we 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 we can feel an impaction in the cecum or colon. We then pass a nasogastric tube into the stomach to see if the horse will reflux. Each patient will also be ultrasounded to help assess what type of colic is occurring (can you see the kidney and spleen, are there dilated loops of SI, ect). We will also run a CBC, chem, and lactate on the patients. A very helpful piece of blood work is the lactate. Lactate is a byproduct of anaerobic metabolism, so if the lactate is high it indicates something is depleted of oxygen, and commonly with colics it is due to strangulated/dying gut. Depending on what we finds on the physical exam and with diagnostics, the patient is either determined to be a medical colic or a surgical colic. If the horse needs surgery, then they will head up to the clinic to our surgeons. If they are a colic that can be treated medically, we will give them NSAID for pain management, start then on a Lidocaine CRI for pain and to increase GI motility, IV fluids, and sedation. If the patient continues to be painful, we can add in additional medication like Buscopan, more intense pain meds, and more effective prokinetics. If the patients pain can not be controlled, then we either have to go to surgery or we have to euthanize. This week I got to see a colic surgery which was a large colon torsion. Unfortunately the torsion had cut off enough of the blood supply to the colon that is was too compromised and the prognosis for the patient was not good. We ended up euthanizing on the table. It was a sad case, but the owners felt that they had truly done everything they could for their horse and were very kind and thankful to us. One of our clinicians like to say that a little over half of colics with resolve on their own, 30% need some sort of meds and basic care, and around 15% need surgery. Working in the ICU we see so many really sick ponies that I have to keep in my mind those numbers because it is nice to know that many more horses are still out in the world happy and healthy. Please let me know if you have any questions (denneyk1@msu.edu). 

Thanks for following along :)

NJ Equine Clinic Week 5

This week we went on a farm call to see a horse with recurrent airway obstruction (RAO), or “heaves.” RAO is an inflammatory condition of the lower airways and is thought to be caused by inhaled antigens such as dust from food and bedding. Clinically, you could see coughing, exercise intolerance, increased respiratory rate and effort, flared nostrils and a double expiratory effort resulting in the characteristic “heaves line.” The most effective treatment for RAO is environmental change! 

Case Highlight: Rhodococcus equi

A foal presented with a swollen stifle, no fever, and no loud moist crackles upon listening to its lungs. This foal was currently being treated medically, but treatment did not appear to be working. If you look at the x-ray, you can see darker areas on the patella as well as the trochlear ridge of the femur, in this case indicating bone lysis. The U/S also revealed gas bubbles under the skin, another sign of bacterial infection. 

What could be the possible cause? Rhodococcus equi is a bacteria that is the most serious cause, although not the most common cause, of pneumonia in foals 1-6 months of age. Besides pneumonia, foals can also present with gastrointestinal issues and/or joint swelling. Rhodococcus equi is difficult to manage as it is ubiquitous in the soil and is also seen in the feces of horses and ruminants, thus providing vehicles for passive carriage. 

Our foal presented with joint swelling and thus was taken to surgery to have the stifle flushed and some of the loose bone around the patella and femur debrided. A sample was taken for culture.

Lots of birthdays this week! My mother, Tundra and I all got a little older (and hopefully wiser!) this week. Happy Birthday to Us! 

Hope you’re all having a lovely summer, time is flying!

NJ Equine Clinic Week 4

This week an arytenoidectomy was performed on a horse that had previously had a tie-back procedure (see week one to read about tie-back’s!) years ago and the surgery unfortunately was no longer producing effective results in that horse. An arytenoidectomy involves removal of all or a portion of the non-functioning arytenoid cartilage. A tracheostomy tube was placed beforehand in order to assist the horse with breathing during the procedure.

We also saw a horse with “kissing spines,” which is the term used to describe fused dorsal spinous processes. This finding has to be taken in a clinical context as for some horses kissing spines are very painful whereas other horses don’t seem to be too bothered. Kissing spines are found most often in Thoroughbreds, Quarter Horses, and Warmbloods.

The clinic’s hyperbaric chamber got used frequently this week as we are currently in the process of treating a horse with exercise induced pulmonary hemorrhage (EIPH). EIPH is thought to occur due to the intensity of the exercise performed by racehorses and increased pulmonary arterial pressure. The hyperbaric oxygen chamber works by increasing the amount of oxygen dissolved in the plasma. In terms of EIPH, decreased bleeding seen on endoscopy and improved performance on the track have been noted after treatment. 

That’s all for now! This week was Danielle’s last week at the clinic. Best of luck in small animal world, I know you’re going to be great! We’ll miss you! 

Dentals for Days - CEC

Hello again! My latest summer adventure has been doing a dental. One of the technicians here at the clinic needed a dental done on her horse and allowed me to practice the technique! I was the official "doctor" on the case and helping me with the dental was Dr. Lauren Fischer from the Cleveland Equine Clinic. Dr. Fischer had walked me through dentals exams in previous cases, but this was my first time doing the float.

I am now comfortable aging young horses by their teeth, distinguishing between deciduous and permanent teeth, and identifying some abnormalities in the mouth such as ramps, infundibular carries, and steps. A ramp is where just the edge of one tooth is taller than the rest of the tooth and forms a "bridge" between the two teeth. Horses have teeth made up of several layers. In the center of horse teeth, there are layers of enamel and cementum that form invaginations on the surface that horses use to grind food. Infundibular caries commonly form when there isn't enough cementum produced, which causes the center of the tooth to decay. A step is when one entire tooth is taller than the surrounding teeth. This can happen if the horse is not chewing food properly and that tooth doesn't wear down with the rest of the teeth.

My exam started with a full physical exam to make sure that the horse could handle being sedated. When the horse was sedated, I palpated the temporomandibular joint and both jaw lines to make sure that there weren't any abnormalities. Then I placed a speculum in the mouth so that the mouth was held open for my oral exam and float. Putting the speculum in the mouth is similar to asking the horse to take a bit. Before looking in the mouth I washed it out with some diluted chlorhexidine solution to remove any food that may be in the cheeks.

The oral exam starts by simply looking in the mouth. I am looking for things such as impacted food, callouses on the cheeks, sharp points, steps, ramps, and fractured teeth. There were some callouses on the cheeks, indicating that the teeth had formed some sharp edges and were cutting the cheeks. The next step was to reach my hand into the mouth and feel the edges of the teeth. This horse's teeth had moderate points on them. I then used a pick to feel for gaps in the teeth. The last part of my exam was to use a mirror to observe the grinding, or occlusal, portion of the teeth. Everything looked as it should and we were ready for the power tools!

Using the float was definitely an experience. You have to be able to use the float in your dominant and non-dominant hand. Keeping the correct amount of pressure on the teeth was difficult to do. It's also really easy to bump the incisors or accidentally "stick" the float to the magnetic light. All of these little bumps affect the cooperation of the patient. However, I got through it and Dr. Fischer only had to touch up a couple of the back teeth! It was an incredible opportunity to have gotten to perform a dental from start to finish. I'm feeling more confident about my dental exam each time I help with a dental and could not be more excited about these new clinical skills! Until next time!

Liz Ritchie

NJ Equine Clinic Week 3

Happy Independence Day! We were off for the fourth of July on Thursday and it was a nice break to have during the week. While no appointments were scheduled, the doctor’s will see emergencies on holidays if the need should arise. 

This week we worked up many lameness cases. Lameness can arise for various reasons and the source of the lameness can be anywhere from a horses’ hooves all the way up to its shoulders and neck. Two helpful tricks for detecting lameness in a horse include:

  front leg lameness - watch for a head bob! When the horse’s head is down, that means it is shifting most of its weight on to the “sound,” i.e. good leg.

  hind leg lameness - watch for a hip hike! This tends to be a little trickier than watching for a head bob but typically the side of the hip that is hiked higher than the normal plane of the hip will point you towards the lame leg. 

Practice (and lovely doctors who tell you if your guess was right or not) is key!

Additionally, we saw a horse that presented with an ethmoid hematoma. Ethmoid hematomas occur in nasal passages as well as paranasal sinuses of horses. While ethmoid hematomas are not neoplastic, they have the potential to become large masses and can lead to reduced airflow. Clinically, you would most likely see intermittent blood coming out of one nostril. In this case, formalin was injected into the mass in order to cause it to regress.

Case Highlight: Bone chip + subchondral bone injury

Bone chips, or osteochondral fragments, are thought to occur from trauma due to hyperextension. They are quite literally pieces of bone that have chipped off from the originating bone and can potentially lead to osteoarthritis and/or other problems. On the other hand, injury to the subchondral bone, or “bone bruising,” can put horses at a higher risk for fractures. In this case, a screw was placed in order to prevent a potential fracture while the chip was removed arthroscopically. 

Cheers to the smell of hay, summer nights, barbecues, and strolls on the beach.

- Stefany G