The theme of this week has been rain. We were in Michigan on Monday and Tuesday and then traveled to Ohio for Wednesday and Thursday, and we got rained on every single day. We spent the whole day on Monday looking at horses at one barn; we start by watching them move then Dr. Hill palpates the horse. Both of these things help determine what treatment the horse will get. On Monday alone we saw close to twenty horses. We started each one on the lunge line, which allows you to observe the horse's natural movement. After lunging Dr. Hill performs flexion tests; This helps to localize where the horse is sore by flexing the upper or lower limb of both the fore and hind limbs. After each flexion the horse is jogged in a straight line to see if flexing the limb has made them more lame. On Monday I was the jogger, so I got a lot of exercise! Once all the flexions have been done Dr. Hill palpates to try and feel any abnormalities in joints, tendons, and ligaments. This helps him see where the horse is hurting, and helps him choose what treatments to do. Depending on the level of lameness he may inject a joint, or use the shock wave on a tendon. If the horse needs a joint injection I do a sterile scrub of the joint; Dr. Hill does a lot of injections, so I do a lot of scrubbing. If we use the shock wave, which emits sound waves into the tissue like an ultrasound,  I have to clean the leg as if we were doing an ultrasound. The sound waves do not penetrate as well if the area is dirty, so it is important to clean the area before the treatment.
After treating more horses in Michigan on Tuesday we drove down to Ohio to look at more horses. We worked on horses at one farm in Ohio on both Wednesday and Thursday. Most of Wednesday was watching the horses get ridden, flexion tests, and palpation exams. We looked at about forty horses those two days, and saw most of them work on Wednesday. After all the tests we started treatments on the horses. I did a lot of scrubbing for injections those two days. We had all the horses we needed to treat done by about four thirty on Thursday because Dr. Hill had to catch a flight, and I drove back to Lansing. Today I have to drive to Indianapolis to meet him, and we will be looking at horses in Indiana for the next two days. He is getting the horses ready for a horse show in Ohio next week. This week has been a lot of work, but also a lot of fun. I can't wait to see the show next week!

Me scrubbing for a fetlock injection. 

Dr. Hill performing an ultrasound-guided sacroilliac joint injection. 

Week 1

My summer Equine Fellows experience began on Monday when I started working at Saginaw Valley Equine Clinic (SVEC) in Saginaw, MI.  There are three doctors in this practice – Dr. Jones who mainly does the ambulatory and critical care work, Dr. Cumper who focuses on reproduction, and Dr. Rhapson who just graduated from MSU CVM and also started working there on Monday.  It has been a very busy week but I have already learned a ton and am excited for all that I will experience this summer.

This week included some of the basics like vaccines and Coggins, but also a lot of palpating and breeding mares and embryo transfers, working on 2 foals with flexural deformities, and scoping a horse with a guttural pouch infection and another with gastric ulcers.  The most interesting case has been a 3 year old mare that came in neurologic.  The horse had reared up and flipped over on Easter Sunday, went into a seizure and once she eventually made it to her feet, was clearly neurologic.  The owners put her in a stall where she was very distressed and ended up scraping her eye along the stall wall.  When she presented to SVEC, her neurologic symptoms had much improved since the initial incident, with the remaining deficits being a drooped ear and lip, deviated muzzle, and some unsteadiness on her feet.  However, the eye is now the more concerning issue as the ulcer in her eye has penetrated through the entire cornea and the iris is prolapsed forward into the hole.  She doesn’t appear to have vision in that eye, so eventually it will need to be removed, but her neurologic status must first be improved before putting her under anesthesia due to the difficulty of the recovery. 

So, for now, we are medically treating the eye.  Dr. Jones inserted a lavage system with a pump so medication is continually being put into her eye.  She is getting an antibiotic, anti-fungal, and atropine to dilate the eye and help reduce the pain.  Systemically, she is getting Banamine (an NSAID) for the inflammation that is causing the cranial nerve deficits and vitamin E to promote nerve health.  Dexamethasone, a corticosteroid, is also effective for inflammation associated with nerve injuries, but it delays wound healing and only exacerbate the situation with the eye, hence the use of Banamine.  She will be heading home on Monday and her owners will continue her treatment there.  I am very interested to see how her condition progresses and whether or not her sight comes back.  I may be discussing the removal of her eye in the next month or two. 

That’s all for now!

Week 1

I have finished my first week at Performance Equine. We were traveling all over Michigan this past week. I hadn't realized how big the state really was until now. Although there is a lot of driving, the cases we see are not emergencies so most days are planned around being in a certain area of Michigan. It has been nice to see different parts of the state I have lived in the past four years. I have also seen a lot of horses and a lot of lameness this past week. Lameness deals with the horse's gait, and is usually due to a problem somewhere on the leg. I have been getting used to watching different types of horses move around. I am used to watching hunter jumper horses because that is what I have ridden and competed in. Not all horses move the same, some have a faster gait, while others may be slower. This week alone I have seen Arabians, Quarter Horses, and Warmbloods; they all participate in different competitions. This is slowly making me more accustomed to looking at any horse move and helping me see abnormalities in the movement. It has also been really interesting to see what I have just learned in large animal anatomy in practice. I'm glad our last unit was limbs because they are still fresh in my mind, and as a sports medicine veterinarian you look at legs for most of your day. Therefore, knowing the anatomy of the horse leg is very helpful diagnostically. I feel this week I have learned the most about ultrasonography. I have observed Dr. Hill ultrasound numerous tendons and ligaments on the leg. On each ultrasound he has shown me what he sees to be abnormal, and understanding the anatomy helps me map it all together in my head. I've just started and I'm already learning a lot. I can't wait to share what I learn in the weeks to come. Thanks for reading!

Week 1 @ Brown Equine Hospital in Somerset, PA

Welcome readers to the 2014 Equine Summer Fellows blogging experience.  In my first week in Somerset, PA at Brown Equine Hospital (BEH) I have already seen and learned so much, and I cannot wait to see what procedures and cases my colleagues and I get to experience this summer.

This first week has been a long one, but I have been quickly reminded that working in equine medicine is exactly where I want to be.  Brown Equine Hospital is a full service hospital offering a plethora of diagnostic tools and surgical procedures.  Dr. Keith Brown is a board certified equine surgeon, and his wife, Dr. Jen Brown, specializes in equine reproduction.  Appointments of all kinds are held during normal business hours, but the clinic also offers 24/7 emergency services so there will be many late nights and tremendous learning opportunities for me this summer.  The variety of interesting cases is seemingly endless and Doctors Jen and Keith Brown, as well as BEH Intern Dr. Younkin and the BEH technicians are a wealth of information. 

I have seen a variety of procedures this week including castrations, numerous joint injections, treatment of laminitic horses, a colic work up a with medical management, and repair of a P1 (phalanx) fracture. However, the “procedure of the week” definitely had to be the ventriculocordectomy surgery (VC), of which we did 3 on Tuesday and 7 on Friday!  Horses that receive this procedure are affected by a recurrent laryngeal neuropathy called laryngeal hemiplegia.  Typically, the left side is affected, but the conditional can affect both sides to varying extents.  The recurrent laryngeal nerve innervates the dorsal cricoarytenoid muscles of the larynx, which are responsible for opening the airway while breathing. When this nerve no longer works properly, the larynx cannot open fully and can cause trouble breathing. The impact on the horse depends on the severity of the neuropathy and their intended use due to the exercise intolerance that develops.  In addition to the exercise intolerance and difficulty breathing, this condition can also cause a “roaring” noise when the horse exercises, which is a big problem for horses in many competitive fields since noise making often leads to deducted points and low placings. 

While there are several procedures that can utilized to treat laryngeal hemiplegia, the VC procedure employed by Dr. Keith Brown is a method that not only opens up the larynx allowing better air flow, but also decreases or eliminates the roaring noises associated with laryngeal hemiplegia.  During a VC, an incision is made along the underside of the horse’s neck, in the throatlatch region (just behind the larynyx).  Dr. Brown then goes through a membrane between two of the cartilages of the larynx to gain access to the inside of the airway and the majority of the procedure is visualized by an endoscope passed through the nose to the anterior aspect of the larynx.  He then removes the mucosa of the lateral ventricles and the vocal cords, which will heal with scar tissue and form a “stiffer” structure that limits collapse of the arytenoid cartilage. The surgery increases airway diameter and allows the horse to breath more easily. 

My apologies for not including any pictures with this post, but if you would like more information on laryngeal hemiplegia and the anatomy of the larynx, MSU CVM has some great information at this site: http://cvm.msu.edu/research/research-labs/equine-pulmonary-laboratory/respiratory-diseases/laryngeal-hemiplegia

In the future I will post more pictures.  Until next week, everyone!

The downfalls of routine

I have learned through my experience as an Equine Fellow that one of the most important qualities in equine field work is to be flexible. Although there may be a full schedule booked in the evening, the following morning can bring different emergencies that tend to shift around that entire schedule.

It is easy to get frustrated, but it is important that emergencies are just that: unplanned. I feel like that is one of the perks of equine medicine. I love experiencing a variety of different cases that aren’t typical of the routine visit. So far this summer, I have seen several different cases of foot abscesses. These calls have turned into guessing games on the drive. What caused this acute lameness? Is it going to be a case of laminitis, a fracture, an embedded nail, or an abscess?

I’ve learned that you need be interested in these different emergencies that are thrown in your direction instead of being so caught up in a routine schedule.

Wrapping It Up Ohio

I have finished up my twelve weeks at the Cleveland Equine Clinic. The time simply flew by! I could not have asked for a better summer experience. All the staff, technicians, and veterinarians were so hardworking and knowledgeable it was truly impressive. I was able to see such a variety, from breeds of horses, to internal medicine disease, to wounds, and to routine care. Within the last few days, I assisted with a tongue laceration (the rostral 1/3 of the tongue was literally hanging on by less than a half inch), worked up a horse with a severe pelvic fracture (initially the appointment was for a suspected abscess), worked up various lameness cases, pin-fired a horse, and assisted in an entire day of tie-back and sacculectomy surgeries. I certainly feel that I am ready or at least more prepared for entering clinics this next spring. At the suggestion of one of the vets, I've compiled at list of commonly used drugs, dosages, with quick reference info that I plan on using for equine clinics. I also think that my horse handling skills have improved. Although I have always been a horse person, there is an art form to restraining a horse for an exam or a particular procedure. I definitely feel more confident at performing flexion tests, diagnosing subtle lameness, doing a routine physical exams, and performing leg, back, and neck palpations. This program has given me an excellent look into what it will be like to work in 'real-world' equine practice.

For anyone interested in this program, I cannot say enough good things about it. For my program in particular, I think as long as you are willing to work hard, learn quickly, and go with the changes, it can be an invaluable experience!

Farewell to Somerset

Well, it has finally sunk in that my time with the MSU Equine Summer Fellowship Program and Brown Equine Hospital has come to an end. I could not have imagined a better experience and I would do it all over again in a heartbeat. The vets and techs at Brown Equine Hospital taught me so much and were so supportive, I could not ask for a better group of people to work with. I was very sad to say goodbye, but I left with many fond memories. So here it is, my final blog post:

Something must have been in the air this week, because we received four emergency colic cases in less than three days. The first to be brought in was a draft horse that had been off feed since the night before. From the abdominal ultrasound and rectal exam, Dr. Brown diagnosed him with anterior enteritis, or inflammation of the duodenum and/or jejunum. Since anesthetizing draft horses carries an even higher risk than other horses, Dr. Brown wanted to keep this gelding off the table at all costs. We started by passing a nasogastric tube to reflux every few hours and administering IV fluids with a lidocaine drip. The draft horse took a turn for the worst a couple days into treatment, refluxing up to 30 liters and going into acute renal failure. We increased the frequency of refluxing and started to bolus the IV fluids. Remarkably, the gelding pulled through and is now recovering well. We stopped refluxing completely and have started weaning him back onto solid food.

The second colic that came in was a part-Standardbred that had been acting uncomfortable for a couple days. As it turned out, this gelding also had anterior enteritis and we started him on the same treatment regimen as the draft horse. Unfortunately, our refluxing did not keep pace with the fluid backing up into his stomach. About 48 hours after being admitted, we passed a tube, but we got negative net reflux. Suspicious, Dr. Brown performed another ultrasound and belly tap. The results showed excessive fluid (reflux) surrounding the intestines, revealing that the gelding’s stomach had ruptured. Sadly, we had to put the horse down. It is surprising how such similar cases, treated the same, can end so differently.

The last two cases were also treated medically. An impaction and a right dorsal displacement were resolved with IV fluids and fasting. Both horses were slowly reintroduced to solid food and were sent home within two days of being admitted. I had always thought that all colic cases that were referred went to surgery. Much to my surprise, however, the vast majority of the colic cases we saw this summer were treated and resolved medically. Another surprise was how many of the horses that came in for colic went home healthy; it was nice to discover that colic is not a death sentence.

To end, here are a few photos of some of my favorite moments working at Brown Equine Hospital:

Repro work with Dr. Jen Brown

Surgery with Dr. Keith Brown

Scoping with Dr. Travis Tull