Dr. Denise Gorondy
The job of an equine veterinarian is so dynamic. As far as jobs go it is enjoyable, involves hard work, provides opportunity to meet horses and individuals of all backgrounds, and every day is a different adventure. Your Three Oaks Equine Veterinary Services veterinarians strive very hard to make every visit with an equine patient a seemingly effortless and enjoyable experience for the equine patient, the owner, the veterinarian, and their staff. So many owners are fortunate enough to have not had emergency visits with the veterinarian but even during these appointments, all attempts are made to ensure that the horse receives the most appropriate and effective treatment with new therapies always considered and that the owner receives all of the necessary information, medications, and supplies needed to execute the required treatment plan. This article will highlight what goes on “behind the scenes” of some routine appointments and emergency calls. You will quickly realize the detective work required to facilitate high quality care, the tremendous amount of information involved in the veterinarian’s thought processes, and the extraordinary efforts made at the farm, consulting with other experts, and researching up to date therapies to ensure your horse is getting the absolute best of care.
A client named Jane calls the office and says “I need to make an appointment with the veterinarian. I think my horse “Bernie” has a foot abscess. He came up lame over the weekend and I’ve been soaking the foot, giving bute, and he’s no better after 5 days.” The office schedules the appointment for the following day and I arrive at the farm to examine the gelding. Jane attempts to bring Bernie out of the stall but he refuses due to obvious lameness in the right front limb. I ask Jane some questions…
• When did you notice Bernie first to be lame?
• When is the last time Bernie was seen by the farrier?
• Was Bernie this lame from the start or has it progressed? Has he improved at all?
• Has Bernie had a normal temperature?
• Is Bernie eating and drinking normally and passing normal manure?
• Has Bernie been staying in the stall or turned out? Has he been spending much time lying down?
• How have you been treating his foot?
• What medication has he been getting and how much?
The owner proceeds to tell me that Bernie has been lame for 5 days and was this lame from the onset and the lameness. Despite daily treatment, his lameness has not improved. The last time he was seen by the farrier was 3 weeks ago. The owner had not taken his temperature and Bernie has been slightly off his feed since the lameness began. He has been turned out if interested otherwise he has been confined to the stall. He has not been seen to lie down nor have shavings on him to indicate that he has been down. Bernie has been having his foot soaked daily and a foot bandage applied and on bute 1 gram twice daily. The owner reports she believes the foot abscess is draining from a sore on the back of Bernie’s pastern that has been weeping fluid.
Before I even look at Bernie, I already have a number of concerns that we most likely are not dealing with a foot abscess. First off, most foot abscess origin lamenesses start off mild and progress over one to a few days to become more severe. Since the gelding stopped eating his food normally at the first signs of lameness, it makes me concerned that he has a fever which is atypical for a foot abscess. If he had stopped eating normally after a few days, I would alternatively be concerned that the bute is irritating his stomach. Most importantly, the information about the sore on the pastern has me really concerned. This is not part of a normal foot abscess scenario.
My assistant and I introduce ourselves to Bernie. I perform an initial physical exam which to the owner observing seems like all I’m doing is listening to his heart, lungs, and GI sounds, taking his temperature, and looking at his gums. However, I have already gathered so much more information than this. I notice that he has been pawing in his stall with his lame leg as evidenced by the hoof drag marks in the shavings, I notice that he has been sitting on his water buckets to alleviate weight as indicated by the ruffled up tail hair and wet hind limbs, I notice that he is tucked up and braced in his abdomen and standing with his hindlimbs camped under, I notice that his entire right front limb is swollen up to his knee, I notice that he has left his breakfast grain and hay untouched and has no manure in his stall. While performing the initial portion of my exam Bernie reaches down and starts chewing on his right front pastern region. Although I have yet to pick up Bernie’s affected limb, I already know we are not dealing with a foot abscess. Through my initial physical exam, I’ve identified that Bernie has an elevated heart rate, is slightly dehydrated, and has a moderate fever. I proceed to examine Bernie’s right front limb with a flashlight and see the sore that the owner mentioned. Indeed, there is a small sore on the center of the back of the pastern and it is leaking yellow amber fluid suggestive of synovial fluid. I palpate Bernie’s right front lower limb and although the majority of the swelling is associated with pitting edema and is non painful, Bernie is repeatedly very painful to palpation of the soft tissue structures on the back of his pastern, has extra fluid in his digital flexor tendon sheath, and has an elevated digital pulse. I remove the owner applied foot bandage and evaluate Bernie’s foot visually, manually, and with hoof testers. Today, there is nothing wrong with Bernie’s foot and he does not have a foot abscess. I administer a mild sedative medication along with some pain management medication to Bernie. After the medication takes effect, Bernie is slowly walked out of the stall to facilitate further evaluation. At this point, my main concern is that Bernie has sustained a traumatic puncture wound to the pastern region and that the wound communicates with his digital flexor tendon sheath. Due to the duration of the injury, I suspect the tendon sheath is now infected. Once Bernie is situated in the barn aisle, the area with the wound is clipped and cleaned. An area of the tendon sheath above the wound is sterilely prepared. I insert a sterile needle into the area of the tendon sheath that has been prepared, collect a fluid sample, and infuse sterile saline. Unfortunately, the saline trickles out of the wound in the pastern region and my worst fears have been confirmed. Bernie is lame from a septic (infected) tendon sheath associated with a traumatic puncture wound that was initially treated by the owner as a foot abscess. To ensure that absolutely all of the necessary information is collected, I perform an ultrasound exam. I identify that the deep digital flexor tendon within the digital flexor tendon sheath is currently unaffected however there are signs of aggressive inflammation as indicated by the presence of thickening of the synovial lining of the sheath and the presence of fibrin tissue. During his assessment and treatment for his injury, I identified that Bernie has chronic soreness in both of his hocks and the tip off for this was the bucket sitting. With aggressive treatment to include surgery at a referral hospital and extensive follow up care and medications at home, Bernie’s septic tendon sheath injury was successfully treated. He subsequently got treatment and a maintenance program for his hock pain and he has now returned to regular riding as a beloved trail horse.
The next case involves an emergency call. Early one fall morning, my pager went off and a client named Bill had left a message indicating his horse “Samantha” is colicking. He noticed she didn’t want to eat her breakfast and now she is lying down. His neighbor recommended he administer a dose of banamine which he has done and she is no better. He asks for me to come and evaluate Samantha. As I arrive at the farm and drive to the back of the property, I notice that as usual Bill is hard at work with some farm projects. Some trees have been cleared and a new paddock area built to allow more access to pasture. As I get to the barn, I find Samantha lying quietly in the paddock. Since she is comfortable, I start with my detective work…asking Bill questions:
• When was Samantha last observed to be normal?
• When did you first notice her to be not acting right?
• Did she spend the night in the stall or turned out?
• Have you seen her pass any manure or urinate?
• What is her normal diet and has anything changed recently?
• Besides the banamine, has she been administered any other medications or supplements, ie dewormers, today or in the recent few days?
• Are any of the other horses showing signs of colic?
• Has she ever colicked before?
Bill tells me that Samantha was fine last night when he fed and nibbling on hay in the paddock in the late evening when he finished up his chores and headed inside. Samantha spent the night turned out in the dry lot paddock with hay and she is typically only stalled when the weather is very bad. Bill indicated that when he came out this morning, he immediately knew she wasn’t herself as she was slow to come up to the barn and she was not interested in eating. She did paw at the ground a few times and that is when he suspected she was colicking. Bill had not seen Samantha urinate or pass manure, she has never colicked before, she’s not been given any medications or supplements, and there have been no changes in her feed. There is only one other horse at the farm and he is fine this morning.
During the time that Bill and I are chatting, Samantha rises on her own and urinates. I immediately notice that her urine is darker in color than normal and that she is breathing fast shallow breaths. She is preferring to stand with her head down, does not have any abdominal bloating, and is overly quiet as compared to her normal personality. I perform my initial exam, and again to Bill observing it seems like all I’m doing is listening to Samantha’s heart, lungs, and GI sounds, taking her temperature, and looking at her gums. However, I have already gathered so much more information than this. I have noticed that she overall seems weak, the sclera or white portion of her eyes are yellow in color, her mucus membranes are very pale, she has an elevated heart rate, and excessively quiet GI sounds. Although I do think that Samantha may have symptoms similar to colic, I believe that the underlying cause may be unusual. Her symptoms are not consistent with routinely seen signs of abdominal discomfort i.e. gas colic, impaction colic, stomach ulcers, or displacements. I suspect that Samantha’s colic signs may be due to toxic plant ingestion. I explain to Bill my findings and my concerns. I again put my detective hat back on. I ask Bill to tell me more about the tree work that has been going on at the farm. He points to the new paddock and then says some additional trees have been trimmed on the backside of the barn adjacent to Samantha’s paddock. We walk over and find some of the trimmed limbs have fallen into the paddock and have yet to be removed. At this point, I am even more concerned that the underlying cause of Samantha’s colic be something out of the ordinary. I ask bill if any of the limbs possibly came from a red maple tree and Bill indicates “yes”. Again, my fears have been confirmed. Samantha is suffering from Red Maple leaf toxicosis. She had been nibbling around the fallen branches and consumed some of the wilted leaves of the Red Maple plant, which are unfortunately highly toxic to horses.
Samantha’s condition is potentially life threatening and additional information needs to be gathered immediately. I collect blood samples for lab testing, treat Samantha for her secondary colic symptoms, and temporarily leave the farm to gather more information. I drive the sample straight to the lab to get the quickest results. Her lab report indicates that Samantha is severely anemic and will need blood transfusions to survive. I return to the farm to administer the further needed treatment which involves collecting blood for transfusion from her farm mate. Samantha’s treatment is long and somewhat complicated. On multiple occasions, her condition is unstable. She eventually rallies and makes a recovery but has low grade chronic kidney damage as a result of her illness. She requires ongoing management with diet and herbal supplements. She continues to be ridden by Bill’s grandchildren.
I am contacted by a professional hunter trainer where I care for the horses. The trainer indicates that a new horse has come to the farm on lease for a talented young rider. The horse has a history of performance maintenance joint injections that he is overdue for. We schedule an appointment to evaluate the gelding named Oscar.
I arrive at the farm and the trainer produces Oscar’s medical history and suggests that he is overdue for his hock and coffin joint injections. She requests that we go ahead and perform his injections. The trainer and I discuss that I need to perform and examination prior to performing the injections. As the trainer is walking Oscar up to the grooming area, I immediately notice significant gait abnormalities. Upon presentation, I observe that Oscar is under muscled along his topline and hind end, prefers to stand in postures that are atypical for a horse, and that he has a somewhat muted personality. I ask the trainer some questions:
• Do you have a complete copy of Oscar’s medical history or did his owner tell you of any previous health problems?
• How long has Oscar been at the farm and have you noticed any performance problems?
The trainer reports that to her knowledge Oscar has had his hocks and coffin joints injected, had one mild colic episode 2 years ago, and otherwise has been healthy. He has been at the farm for 2 weeks and he seemed to be doing fine.
I perform an acupuncture and chiropractic scan of Oscar’s musculoskeletal system and observe that the gelding has interference marks on his front ankles. We watch Oscar go on the lunge line and although he does demonstrate mild hind end lameness, he also demonstrates moderate ataxia or unsteadiness on the lunge. Instead of performing a performance horse musculoskeletal exam, I inform the trainer that a neurological exam is needed. Upon performing the neurological exam, I identify that Oscar has significant neurological deficits and I suspect he is suffering from either EPM or Lyme disease. Samples are collected for laboratory testing and sent out immediately. In 3 days, we have our final laboratory results confirming that Oscar is suffering from EPM. Cutting edge medication that is on the cusp of FDA approval is recommended for his treatment. Oscar is started on treatment immediately. At his one month recheck appointment, Oscar no longer has neurological deficits, it suitable to return to riding, and is scheduled for his performance horse exam. Thankfully, this horse wasn’t simply administered hock and coffin joint injections as requested. Had I not observed him in motion and performed the required testing, his neurological issue would have gone undiagnosed and possibly progressed before being identified. Worse still, had he continued to be ridden without treatment for his EPM, he could have been a safety risk due to both himself and his young rider. Thankfully, once Oscar was back in work and evaluated, he was treated with hock and coffin joint injections, and is now back in the show ring.
These cases highlight that while your veterinarian is performing seemingly routine observation and examination, a world of information is being processed regarding your horse and its’ condition. It is the goal of the Three Oaks Equine Veterinary Services veterinarian to evaluate your whole horse, be a detective, and identify anything and everything that could be contributing to your horse’s lack of wellness. We strive to ideally prevent disease and ultimately have a completely healthy horse!