Cleveland Equine Update

I’ve learned about two interesting treatments this summer that are used to treat musculoskeletal injuries and diseases in horses.

IRAP, or Interleukin-1 Receptor Antagonist Protein, is used to treat osteoarthritis of joints. Interleukin-1 is a molecule produced by cells in damaged joints and it causes further inflammation. IRAP, when injected into joints, blocks interleukin-1 from binding its receptor, and thus helps stop the inflammatory cycle. The process used to make IRAP is interesting. First you draw a small amount of blood from the horse you wish to treat. The blood sits in a special syringe for 24 hours that has factors which stimulate monocytes in the blood to produce IRAP and other anti-inflammatory factors. Then the blood is spun to separate the cells and plasma. The plasma is divided into several doses and frozen, then once a week a dose is thawed and injected into the joint of interest. Because it is made from the horses’ own blood, the horse is very unlikely to have an allergic reaction. IRAP is a good alternative to treating joints with corticosteroids, which could eventually lead to further joint damage.

PRP, or Platelet-Rich Plasma, is most commonly used to treat tendon and ligament injuries, but can also be used in joints and other areas. Similar to IRAP it is made from the horse’s own blood, centrifuged to separate the plasma and platelets from red blood cells. The concentrated platelets are injected into the damaged tendon or ligament, where they become activated. Platelets can release a variety of growth factors which explains their usefulness in treating injuries in structures that have very little healing potential of their own. PRP can be made and injected within less than an hour, no overnight wait needed.

Jenna already mentioned Stem Cell treatments in a post from a few days ago, so I won’t explain it again but I will say it’s another great option to promote healing that is sometimes used here at Cleveland Equine. 

Time has been flying by at SVEC

I can't believe how much time has flown by since my last post. Over the last couple weeks, I have learned more than I could ever imagine! I've seen the usual lameness exams and dentals as well as numerous more interesting cases. I've helped with numerous lacerations of all different degrees, from those that could be sutured standing do those so large and on the belly that the horse was put under anesthesia to close the wounds to those that could not be salvaged and the horse was humanely euthanized.

One procedure that particularly interested me was the removal of a stifle OCD in a yearling colt. The OCD was located on the lateral aspect of the trochlear ridge of the femur. It was identified radiographically, and Dr. Williams was able to remove the OCD via arthroscopy. I scrubbed into this procedure and helped Dr. Williams by blotting and handing her instruments (A great way to learn instrument names and the appropriate way to hand off instruments). The arthroscope was inserted between the medial and middle patellar ligaments and was angled to located the OCD. A curette was used to loosen the OCD from the femur and Rongeurs were used to pull it out. I was surprised by how little trauma was made to the joint during the procedure, and that the colt was able to go home two days later.

Another procedure that I was able to scrub in on was a distal check ligament desmodomy. The procedure was performed bilaterally and was intended to help the horse create a better angle at the fetlock. A proximal check ligament desmodomy had already been performed previously, and did not create enough angle, so the second procedure was performed. During this procedure I was able to help guide the suture, hand instruments and keep the area well blotted for Dr. Williams to be able to see. 

I can't wait to see what this next week holds in store for me! Until next time...

Kaitlin

Week 4 at RREH!

Hello!

I can not believe I have just finished my 4th week at RREH, the time is flying by. I am having such a great experience and learning so much. The past two weeks we have continued with our normal routine of doing mostly broodmare stuff in the mornings and doing regular ambulatory work in the afternoons. Working consistently at the broodmare barns has been really nice for me because I can really see how much I am learning as I get faster and more efficient at treating the mares. Almost all of the foals have been born too, but we did help deliver a red bag foal last week.

The other things we have done are castrations, neurectomys, joint injections, chiropractic visits, x-rays, ultrasounds, lameness evaluations. dentistry, and lacerations. The laceration to the eye we saw two weeks ago healed beautifully and it was hard to tell he had ever ripped it open. We have also seen several babies born with low IgG so we run them a liter of plasma from plasma donors. Another interesting case we saw was a horse who had trouble urinating and found out that he had cancerous tissue lining his urethra so we amputated part of his penis off. This being my fourth week, I have really enjoyed going on calls to do rechecks so see how well the horses we treated were recovering. The foal that we casted awhile back straightened its fetlock out so well you can't even tell it was contracted at birth. We have also looked at several colics and removed a screw and wire from a foal who had surgery to put them in. That case was cool because Jackie had been in surgery to put the screw in and told me all about it and then I was able to see it post surgery and then how they take the screw out.

Outside of clinic hours, I have been able to watch American Pharoah do his morning workouts at Churchill Downs and then this past weekend I traveled to New York to watch him win the Triple Crown. It was an amazing experience.



That is all I have for now! I look forward to sharing more with you in the next few weeks!

Hello from Equine Athlete North Texas

Hey everyone! This summer I'm down in Texas with  Dr. Ty Wallis at Equine Athlete Veterinary Services. They were formerly Performance Equine South, so my experience so far has been similar to last year. Dr. Wallis also works primarily with Arabian show horses and follows the show circuit. We were just at a show in Fort Worth Texas, and now we are at the Region 10 show in Minnesota. Before the shows we were prepping horses, getting them show ready. We had a few cases that Dr. Wallis used stem cell therapy on. In order to do this he had to liposuction fat from the tail head to obtain stem cells. Once he obtains enough fat there are processing steps he does to get the stem cells isolated. I then blocked the limb that was being injected, and Dr. Wallis did an ultrasound guided injection of the stem cells. We did all of this at the farm, and I thought it was really great that we were able to do it that way. The other calls were the usual lameness exams and joint injections. I helped flex the horses being assessed and scrub the joints we were treating. The last show went well, we had a few colics that turned out well. I'm hoping that the show this week runs just as smoothly! That all for now, hope everyone is enjoying their summer!

Jenna

Hello from Clinton Vet!

Hey guys!

Signing in from St. Johns, MI. I am finished with my first 6 weeks, which is absolutely crazy; the time has flown by! So I also have a lot to fill in on. I've worked primarily with one vet, Dr. Cynthia Trombley, who has been wonderful, however all of the vets at the clinic have been so more than welcoming. I have had the chance to learn and experience a multitude of cases and situations.

There's been the usual spring frenzy of everyone calling in for vaccinations and checking/floating teeth, so that has entertained a lot of our time, but we have been able to round out the diversity as well. Our schedule is generally fairly consistent, and we have the opportunity to come down to MSU's Horse Teaching and Research Barn Mondays, Wednesdays and Fridays, if needed. Dr. Trombley works directly with Paula, the manager there, for facilitating the breeding program and making sure everything is staying on track and up to par. This generally consists of a morning full of ultrasounds, palpations, checking up on the new foals, etc. Everything has been really smooth, though we have had to make sure that a handful of the newborns are alright. We've just drawn some blood for IgG tests, determining that their antibody levels from mom's colostrum is adequate enough for their health and well-being. We had to administer IV plasma to one foal because his levels were too low. He ended up great over the course of the next day or two, so all good! We also saw a foal (not associated with MSU) who was acting weird about his umbilicus, and it was determined that he had a patent urachus. The owners noticed that at times he had two streams of urine, and it was really sensitive to the touch for him. It was confirmed, and we performed an ultrasound just to make sure that there was no ascending infections starting, and he was clear. There were a few different approaches that were discussed, either letting it ride out with some cleaning and observation, try using silver nitrate to cauterize, or even taking him down to MSU for a procedure to make sure it was fully closed and sealed. They ultimately decided to continue with what they were doing so he was left with some antibiotics and a regimen for consistent cleaning of the area, and heard a week or two later that he was doing great! We've seen him since then, and he's closed up well, and no signs of any other problems. It's been all encompassing with breeding topics; from the babies to retained placentas, shipped semen to live covers, we've been all across the board. With all of these opportunities, I've been able to learn and touch up on a TON of breeding, cycles, and pregnancy facts so that has been really helpful!

Along with the breeding, we've seen some pretty incredible mouths as well. And not necessarily in a good way. We've seen some of those last molars at about 2 inches long grinding down the gums of the lower jaws, many a cheek ulcers, and have pulled a handful of rotten, loose teeth as well. While these are all good consistent maintenance practices to take care of and resolve, we have been able to see the extremes of both ends of this industry. We were called out to a property on a concerned neighbor's request, also soliciting animal control's help. While I obviously won't disclose details, it was really fascinating to see the opposite side of this world, the part that we don't always like to think exists. The drama that unfolded between officer, vet, owner and boarder was all very intricate. It came down to a bit of neglect issue and some miscommunication, but the owner started up on the right path for taking care of them and hopefully getting them to a full and healthy weight and lifestyle. Yet, it's quite an uphill battle, given an older horse, bad teeth, poor quality hay and a fecal sample of approximately 740 stronglye eggs. It'll take a while, but at least now the issue has been addressed..! It just goes to show the brevity and responsibility we have and will have as veterinarians, to truly affect these animals' lives in a positive way. I wouldn't say it was the best situation, but certainly encouraging to know that we can and will make a difference. This also has taught me that no matter the circumstances, no matter what conclusions we might draw in our heads about the owners or the animal's situation, it is still necessary to present every option possible. You never know what goes on behind the scenes. Some people will surprise you, and although the money might flow a little bit freer with the million dollar horses, the everyday pasture pet might make a run for that money just as strongly. I'm definitely learning to appreciate the other, intangible lessons that this time has revealed. I could go on and on, but I will sign off for now, and be back soon. Excited to see what these last weeks will bring!

Thanks everyone,
Taylor Alton

Weeks 2 and 3 at Littleton Equine

Hello everyone!
I am learning a lot working in ICU as well as assisting with appointments, emergencies, and surgeries. One surgery Dr. Devine did last week was an enucleation on a paint horse. This horse, like many others with a large amount of white on its face, developed a squamous cell carcinoma on its upper eyelid. A previous resection and chemotherapy treatments was attempted without success. The only option left was to remove the whole eyeball so the tumor could be removed with good margins.

We had a Friesian come in Memorial Day weekend. This poor boy has had a long few weeks. He was imported from the Netherlands. After his quarantine in Los Angeles, he was shipped to Denver to be with his new owner. When he arrived in Colorado, he stepped off the trailer with nasal discharge and a fever. Shipping fever(pleuropneumonia) occurs during increased stress and decreased air quality inside a trailer. Unfortunately for this guy he also had a colon torsion that required surgery when he arrived at LEqMC. As if this poor guy hadn't been through enough, during his recovery he developed post-op ileus, a fever, and diarrhea. This required the doctors to pass a nasogastric tube and we got 14L of fluid off his stomach. We like to see net reflux under 2L so this is an extremely large amount of fluid! This guy was really good at hiding his pain, because he had minimal increases in his heart rate with that large amount of fluid in his stomach. He was started on a Lidocaine CRI which has been suggested to help sluggish small intestines in horses with post-op ileus. Food was eventually slowly introduced which he loved. I'm so happy to say he is doing extremely well now and will be going home this weekend to continue his recovery! 

Dr. Duff and Dr. Murray performed acupuncture on him during his recovery for some sore muscles. He was not a fan of his muzzle preventing him from eating. He even chewed one apart during his stay! He is a hospital favorite and loves to snuggle with everyone and beg for treats :) 

On Saturday we had 2 colics come in for treatment. One was admitted for IV fluids to treat an impaction and went home a few days later feeling great! 

Unfortunately we could not control the pain in the other horse. This mare had a colic surgery for a strangulating lipoma a couple years ago. This time she had about 5 doses of sedation and analgesia without any relief. The owners elected human euthanasia and requested a necropsy. I assisted Dr. Duff with the necropsy. We found that she had a displaced colon that was about to be a torsion, multiple adhesions in her small intestines from her previous surgery, and a partial torsion of her ileum where in entered the cecum.  Multiple sections of her intestinal mucosa was purple due to decreased blood flow. This was a great anatomy refresher! It's always great to apply things you learn in school. I appreciate the things I learned from this mare. 

We had another baby come in for increased respirations. This little guy was a cute little Hanoverian. His vital signs, blood work and radiographs continually showed no abnormalities during his stay. Dr. Murray believes this foal had idiopathic tachypnea. This condition is believed to be related to a dysfunction of thermoregulation. 

Last weekend I visited Garden of the Gods in Colorado Springs to do some hiking. I am in love with the mountains :)

Equine Analysis Systems-An Alternative Veterinary Experience in Midway, KY

Hello from the most beautiful place on Earth! Somehow 4 weeks of this experience have gone by  without a peep from me, so there is a lot for me to catch you all up on!! My placement at Equine Analysis Systems is a bit different than your typical veterinary clinic. In our office you won't find needles, syringes, bute, xylazine, or any of those other equine vet essentials. Instead, what you will find is computers, ultrasound machines, cameras, and some of the smartest researchers outside of the university. For a full company description, please visit www.equineanalysis.com, but in short EAS is a performance prediction company that has developed its own proprietory and patented technologies for assessing Thoroughbred racehorse conformation, breathing ability, metabolic response, cardiac competence and many other aspects that play a role in the success of a racehorse. As a consulting company, we are employed by farms, owners, and perspective buyers to assess horses on the farm, at the yearling and 2-year-old sales, and at the track. Much of the job description is to fully understand the concept of confidentiality, as the results of the tests can mean the difference between buying, selling or keeping animals worth hundreds of thousands of dollars. Therefore, I apologize that I won't be able to post any pictures of the farms or horses I visit, but our client list is as confidential as the data collected. So what the heck am I doing at a place that doesn't practice veterinary medicine?? Well, the short of the story is we have 3 veterinarians on staff who DO practice their veterinary skills, just outside of the traditional idea of "medicine." Our veterinarians are very skilled at ultrasounding hearts and working with clients to make the best decisions for their horses. It is our goal to help the horse by first helping the horseman. My main goals here in Kentucky are to get a thorough understanding of the ins and outs of the Thoroughbred industry, and to conduct research that may help the company, its clients, and potentially the Thoroughbred industry. Stay tuned for more information on my research when it becomes publicly sharable. My boss, Dr. David Lambert, is a wonderfully encouraging person, and has aspired to help me create a paper that is publishable and presentable at MSU CVM's Phi Zeta Day this next year. We aim for the moon here in Midway!

As for the daily activities at EAS...My first week here involved riding along to many of the farms around Lexington and the surrounding area, observing as the vets ultrasounded hearts and took photos to be analyzed by our conformation analysis software, FotoSelect. After only 4 days in Kentucky, we took off for Maryland, to the Fasig-Tipton Midlantic 2-year-olds in training sale. It was a long, beautiful drive through West Virginia, and was not without adventure! We stopped at a barbeque place in WV where lunch included a cupcake dipped in funnel cake mix, deep fried, and covered in ice cream and caramel sauce! (and then I enjoyed a sugar-coma while Dr. Rainbow drove!) In Maryland, we stopped at Dr. Rainbow's uncle's house, which was right on a mountain and had a view all the way to Baltimore. On the way home, pulling a tractor, we ran out of gas. Yup, that's right, 1.5 vets in the truck and we ran our of gas. Thankfully, fumes and weight from the tractor pushing us down hill, got us to a gas station. I think I've had enough West Virginia adventure for a while! So about Maryland...what a culture shock! The first thing that takes some getting used to is the sheer value of the animals presented. The top selling horse went for $1.25 million (and yes I got to touch her!) We were just in time for the Preakness, but as most of you know, it rained. That's not the right word, it poured. An entire lake fell from the sky. So my coworkers and I watched the race from the safety of a restaurant and were very grateful that we did. Now that I am back in Kentucky, I have been researching, analyzing data, and becoming very good friends with Microsoft Excel and statistics. It may seem boring, but every day I chip away at the puzzle a little more and move closer to some truly effective results. Stay tuned for more information on my research, and hopefully some pictures of this wonderful little town! Cheers!
-Nicole King