Surgery at Rood and Riddle Equine Hospital

 

 

Hello again from the great Bluegrass state! The last two weeks have been pretty full, and I apologize for my blog absence. Hopefully this week I’ll be able to get in 2 blogs for y’all!

On any given day here at RREH, we see as many as 20-25 surgeries a day. We are fortunate to have the staff capabilities, as well as multiple boarded surgeons, to be able to drop and complete as many as 3-4 surgeries or anesthetized procedures at one time. If you have never seen an equine surgery from start to finish, you may or may not realize how much of a production the whole process is, and how skilled of a team it takes to get a horse safely in, through, and out of surgery. At RREH, the team may consist of 3 surgery technicians (it takes that many bodies alone to get the horse from standing to recumbent, but usually only 1 actually “techs” the surgery), an anesthetist (usually a trained RVT/LVT or an anesthesia intern), a surgical intern, the surgeon himself, and a team of 2-3 recovery guys.

Currently, we are in the middle of “weanling and yearling” season, meaning that many of our surgeries are done on yearlings (>1 yr of age) or weanlings (usually <6 mos age) to correct minor to moderate angular limb deformities prior to the major fall thoroughbred sales. The main ones, which comprise maybe 50-75% of our daily caseload , include:

1. transcutaneous periosteal transection (“periosteal stripping”): A basic “outpatient” procedure that is done to correct angular limb deformities in younger foals, a.k.a. the weanlings. This procedure is done in an effort to encourage accelerated long bone growth on the concave side of the bone. These can be done in both the carpi (“ front knees”) and fetlocks (“ankles”).

2. transphyseal screws: Again, another basic “outpatient” procedure that is done in both weanlings and yearlings in an effort to retard long bone growth on only the convex side of the bone. The screw is placed in an diagonal fashion through the growth plate, and essentially slow the growth on that side while allowing the other to “catch up”. These can be done in both the carpi and fetlocks as well.

3. transphyseal screw removals: The reverse of #2 – once the long bone has corrected itself, the screws have to be taken out in order to not “overcorrect” and cause a deformity in the opposite direction.

4. joint arthroscopies: These surgeries usually require at least an overnight stay at the hospital and are most commonly done on mature yearlings or current adult racehorses. The most common joints that are “scoped” tend to be the stifles, hocks, and fetlocks, but occasionally we see a carpus or two that require arthroscopic evaluation. The most common reason that we scope joints are to remove osteochondral fragments (“chips”), to resurface the joint cartilage following damage, to remove osteochondral lesions (OCD), or to remove subchondral cystic lesions (“bone cysts”). The goal of these procedures is to eliminate a source of pain in the joint or to prevent severe arthritis from developing because of an existing lesion. These procedures are minimally invasive and involve the use of a camera and light source inserted into the joint pouch itself by means of a trocar and cannula. These instruments allow the surgeon to see the joint on a TV screen and operate based off of that image.

Some of the other surgeries we’ve seen in the last week have been tie-backs (arytenoid chondroplasty and arytenoidectomy), cryptorchid castrations, arthrodesis, more Basket surgeries, and long bone fracture repairs. Hopefully I’ll be able to get some pictures of these and other surgeries for you in the future, but for now, I’ll leave you with some images from my trail runs. Again, I am so blessed to be in a place that values its equine industry, and has so many rolling hills and green pastures! Once surgeries slow down and I can head out on farm calls, I’ll post some farm pictures for you.

 Runs on the Legacy Trail in Lexington, KY

 

The entire city is gearing up for the Belmont this weekend, and that may be the topic of my next post – so stay tuned. Best of luck to all of the amazing athletes running this weekend!

Look closely - you'll see my double rainbow!

Week Two in Somerset

After jumping head first into a busy week when I first arrived, my second week was more manageable. I was surprised how quickly I settled in to the routine and how well I am fitting in here. It is all thanks to the people I work with; they made me feel right at home. This week, we said goodbye to Dr. Jason Dickey as he has completed his internship year and has accepted a position in Ohio. Dr. Keith Brown also turned 40 this week, so we had two things to celebrate. On Wednesday, we took the afternoon off and threw a party at the clinic for them. It was nice to relax with good food and good company.

Since Dr. Dickey left, I have taken over most of his responsibilities. I start of in the morning by performing short physical exams on all of the in-patient horses and helping the technicians administer morning medications. Most medications are antibiotics or pain meds given orally or intravenously through a catheter. The rest of my day is spent assisting the veterinarians during appointments and surgeries. Assisting can mean anything from restraining, sedating, and drawing blood to shooting radiographs and scanning the plates. I still need a lot of practice shooting radiographs (it took me seven tries to get an acceptable navicular skyline), but everyone assures me that I am getting better.  I am also getting really good at pulling blood and giving IV sedation. At this rate, I will be a pro by the end of the summer!

Probably the most exciting aspect of this week was that I got to scrub in on another surgery. This week, it was a bilateral palmar digital neurectomy. Neurectomies are fairly common surgeries as a last resort for horses with hoof pain that does not respond to special shoeing or joint injections. During the surgery, I accidentally contaminated myself (major whoops), but Latasha the technician on anesthesia came to my rescue with a new set of sterile gloves.  Besides that, the hardest part for me was identifying each instrument Dr. Brown needed and quickly giving it to him (apparently my hand-off needs a lot of work.) I hope I get a lot more opportunities to improve.
Here is a mini virtual tour for those interested in what Brown Equine Hospital looks like:

Work-up area, Stocks, and Lower Barn for the critical patients

Preparation Room and Recovery Stall of the surgery suite

             

Surgery Table and Room

Upper Barns- outside and in

Hello from OHIO!

            I have worked for about three weeks at the wonderful Cleveland Equine Clinic! I have started to get into the routine of the clinic and really love working with all of the staff! My days tend to start at about 8:00 am at the clinic, where I then either begin assisting the doctor with in-hospital appointments or, more often, I hit the road with one of the other doctors. My day continues until all the appointments and patients are taken care of for the day.

It is breeding season here, so I have been able to see a lot of repro ultrasounds, inseminations, and even semen collection. The amount of work and time that both the vets and owners spend trying to get these mares pregnant is quite impressive!

I have also been able to see several lameness exams. We start by palpating the entire horse, followed by a motion exam which includes walking, trotting, circling, lunging, and flexion tests. After this, the doctor may follow up with nerve blocking and retesting, radiographs, or ultrasound. I have been lucky enough to actually see a standing MRI done on a horse’s foot. The MRI takes several hours and definitely takes a trained eye to notice subtle changes. It was certainly an excellent anatomy review for me!

Colorado, Week Three!

Hey everyone! After 3 weeks at Littleton, I’m starting to feel like I know my way around now. I’ve been helping with a lot of the regular treatments, which occur every three hours throughout the day. It’s been really nice to develop confidence in my ability to take vitals such as heart rates, assessing gut sounds and mucous membranes, and feeling for digital pulses. So many of these skills are easy to learn about in class, but the only way to get good at them is to practice doing it every day.

The majority of the cases we see in the ICU are emergency colics. One case that was particularly interesting to me last week was a horse that had been brought in right at the start of my shift on Tuesday because of moderate discomfort. He was worked up by an intern doctor, who determined by ultrasound that he had a nephrosplenic entrapment. The nephrosplenic ligament connects the spleen to the left kidney, and for reasons that are not well understood, the colon can displace from its normal position on the abdominal floor and become lodged over this ligament. This can become problematic because intestinal contents cannot move past this point, causing the colon to distend, which can be incredibly painful.

After his condition was diagnosed, our first goal was to treat him medically, which is both less expensive and less invasive than surgery. The common treatment for a nephrosplenic entrapment is to give phenylephrine, which causes the spleen to contract and shrink in size. The hope is that this combined with trotting will help the colon slip down from the nephrosplenic space. While initially this seemed to help, after a few hours on intravenous fluids he quickly became dramatically painful. At about 7 pm he was taken into surgery and I was able to sit in and watch. I love watching surgery because it really helps solidify my understanding of anatomic relationship of different structures. What I wasn’t expecting was to be quizzed on all of it by Dr. Toppin! Definitely a reminder that I need to hit the books! This particular horse came through the surgery very well and is still recovering in the ICU barn. I have really enjoyed following his case from the first moment.

In addition to all of the horses, I was able to take some free time this weekend to explore Boulder with a co-worker from the clinic. We went on a long, steep hike (seriously, the altitude here is pretty killer!) in the flatirons to one of Colorado’s few natural arches. Afterwards we explored downtown shopping and spent a few hours at a rooftop bar. Every new place I go in Colorado, I fall in love with the state a little bit more. I’ve only been here for three weeks and I’m already wishing I could stay.

‘Til next week!

Kiva

Hello from Somerset

Hello from Somerset, Pennsylvania! Somerset is a cute little town in the beautiful Laurel Highlands. I was pleasantly surprised to find that I would be surrounded by such a gorgeous landscape this summer. I hope to take advantage of some of the many hiking trails in the hills in my limited free time.

After a very busy week, I already feel right at home here at the clinic. Brown Equine Hospital is a small referral hospital that currently staffs four veterinarians. Dr. Keith Brown is the practice owner and a board certified surgeon. Dr. Jennifer Brown focuses primarily on breeding management and artificial insemination. Dr. Travis Tull, also a board certified surgeon, is the doctor on call for emergencies. Dr. Jason Dickey, the veterinary intern, has worked the hardest and the longest this past week. A slew of great veterinary technicians keep the clinic running smoothly around the clock. Everyone has been so friendly, going out of their way to teach me new things.

This week has been jam packed with a variety of different cases. I have gotten to try my eye at detecting lameness and learned to shoot radiographs. I also helped prep for and stood in on several surgeries, including a joint arthroscopy, a periosteal strip, and several castrations. I actually got to scrub in and assist on a cryptorchid castration, which was very exciting.

The case that has consumed the most of my time this week has been a miniature foal that came in Tuesday afternoon. The filly’s mother had died the night before and she was combating both failure of passive transfer and hypoglycemia. She was treated with a dextrose drip and plasma transfusion. She has needed constant monitoring and I took my turn with her Tuesday night. She looked to be doing better by Wednesday morning, taking fieldtrips up and down the barn isle. Unfortunately, she took a turn for the worst on Friday and now she is just barely hanging on. She has been a rather sobering reminder that sometimes, you can do everything right and still not make a difference.

I am still extremely excited for what the next nine weeks will bring. I can already tell that this will be a fantastic experience. I can’t wait to get started again tomorrow.

Summer in Lexington, KY

Greetings to everyone from Lexington, KY!

My name is Megan, and I am working for the summer as a surgery technician at Rood and Riddle Equine Hospital. This hospital employs over 50 veterinarians, and currently has approximately 10 interns (both rotating and ambulatory) and 2 residents. RREH serves just about every type of horse you can imagine, but as you might guess, we see quite a few racing thoroughbreds from this great Bluegrass state. The hospital provides services in internal medicine, podiatry, surgery, radiology, neurology, theriogenology, regenerative medicine… really, almost any equine medical service you might ever need. Thus, even in the few short days that I have been here, I have been exposed to many new techniques and services that are rarely offered elsewhere.

For instance, today Drs. Steve Reed (neurology) and Brett Woodie (surgery) performed a “basket” surgery on a show Hackney pony. What is a “basket” surgery, you ask? This procedure was developed at Washington State’s CVM in order to stabilize vertebral bodies that are injured, arthritic, etc. and are causing damage and functional impairment to the spinal cord itself. It involves fusing two adjacent vertebral bodies by means of an implant, specifically in this case, a Cloward Bagby Basket or a Seattle Slew implant.

This surgery aims to correct cervical stenotic myelopathy, a.k.a. Wobbler’s Syndrome, a condition in which the vertebral canal impinges on the spinal cord, especially when the neck is flexed, causing the horse to become ataxic (exhibit abnormal gaits), and lose motor and sensory coordination in its limbs. The most common reasons that this condition occurs include cervical vertebral stenosis (the canal or points along the canal may be too narrow for the spinal cord to pass through), cervical vertebral malformation (deformities of the vertebral bodies or the canal itself), or osteoarthropathy/degenerative joint disease affecting the articulating surfaces of the vertebrae.

Here’s a fun fact about basket surgeries: one of the first successful basket surgeries was done on none other than Seattle Slew, the 1977 Triple Crown winner, in 2002. His owners began a fund through the Washington State CVM to promote equine spinal cord research.

Enough with the veterinary jargon… I will probably say this in every blog, but I feel so blessed to be in such a beautiful city that truly values its equine industry. Lexington is truly one of the meccas of the horse world - if you are an equine enthusiast and have never visited, I highly encourage it! Hopefully I will be able to share some photos of the big, fancy farms, the rolling hills, and the Horse Park in the next few blogs, but I will leave you with this for now: 

This is a statue of the legendary Man O' War at the entrance to the Kentucky Horse Park. (http://kyhorsepark.com/)

The first two weeks in Colorado

Hi I’m Kiva, a third year veterinary student. Thanks to this amazing opportunity through the Equine Fellows Program at Michigan State, I get to spend my summer at the Littleton Equine Medical Center near Denver, Colorado. I have a long background with horses and have been riding for most of my life, but over the last few years I have questioned whether equine medicine is where I want to go with my career. This will be my first experience with an equine vet clinic that is this large and advanced, and I’m really excited to get back into equine medicine!

It was a whirlwind trip driving out here and getting settled in. Starting at any new place can be overwhelming, let alone a clinic that staffs 17 veterinarians! The clinic is beautiful and laid out over several buildings with the Rocky Mountains looming to the west. My position at the clinic is as an Intensive Care Unit assistant. The ICU is staffed by veterinary technicians 24/7, with round the clock treatments. I’ve been really impressed so far by all of the protocols that are in place to protect the sick horses in the ICU barn, as well as any other horse coming on the property. I’m still amazed that a clinic so large can function so seamlessly, especially when we are all in different buildings.

Everyone I work with has been really friendly, which I’m starting to discover is true of just about everyone I’ve met in Denver.  I’ve been in the city for 2 weeks, and I’m falling in love with it quickly. Because of the large number of veterinary student externs coming through the clinic this summer, I was unable to live on site like the previous fellow. While initially I was disappointed that I couldn’t be close to the action at the clinic, I was able to find an apartment within walking distance from downtown Denver, which has turned out to be awesome! Since I’ve been here I’ve gotten to explore some of Denver’s parks, farmers markets, and night life. I’ve been up hiking in the mountains, which I plan to do much more of.

That’s all for now, stay posted for more details about the clinic and what all the cool stuff I’m seeing and doing!