Aug 20, 2017 | Colic
Ernie’s Colic Surgery, part 2
When last you, my adoring fans, heard from me, Ernie was about to get on a horse trailer headed for Equine Medical Center of Ocala (EMCO). This week, you get to hear all about surgery. All I have to say is, there are a whole lot of guts inside a horse! And now, the rest of the Ernie colic story.
Tony: OK, so you have decided to take Ernie to surgery. What are you thinking as you load him on the trailer?
Dr. L: Lots of people worry about horses going down in the trailer. I wasn’t worried about that for a few reasons: 1) I didn’t tie him, so if he went down, he wasn’t stuck with his head at a weird angle, 2) I gave him a bit of sedation right before we left to help him stay as comfortable as possible, 3) We gave him plenty of room in the horse trailer so that if he went down, he had room to get up.
What I was worried about was the hour it takes to get to EMCO, and if he was going to be painful when we got there, or if he was going to have what we call a ‘therapeutic trailer ride’, and be all better. Some people feel embarrassed when their horse is all better after a trailer ride to the clinic. DON’T!!! As veterinarians, we are very happy for you! I wasn’t that lucky.
Tony: What happens when you arrive at a referral hospital like EMCO with a colic? Do they whisk them off to surgery? Are there alcoholic beverages to calm the humans? Do they have a cat to offer up a superior opinion on the matter?
Dr. L: Well, that’s a lot of questions! The first thing they do is decide if this is a surgical colic, and how sick is Ernie. Sure, I said it’s highly likely he’s surgical, but they want to make doubly and triply sure, and I agreed! I didn’t want to put Ernie through surgery if I didn’t have to!! Ernie was placed in stocks, and many of the things I did were repeated. The ultrasound showed several more loops of unhappy small intestine, rectal palpation was still normal, and his bloodwork still looked good. That meant Dr. Adams and I had to have a serious talk about surgery.
Both of us felt it was very likely that Ernie did in fact have an epiploic foramen entrapment, surgery was almost definitely needed, but there was a small chance he didn’t need it. Given that both of us felt surgery was inevitable, and small intestine doesn’t like to be unhappy for very long, I said yes to surgery. At this point, there were no alcoholic beverages, but in hindsight, I should have started myself on anti-ulcer medication. As to the cat, not every clinic is as lucky as Springhill Equine to have an amazing cat like you, so we had to go with the human opinion only, knowing it was inferior to a quality cat scan.
Tony: Eeek, surgery… That just sounds scary!
Dr. L: It is and it isn’t. I knew Ernie had a serious problem, but wasn’t systemically sick yet. I also knew the longer I waited, the more likely he was to get sicker. More importantly, I knew that if the small intestine got worse, and he was an epiploic foramen entrapment, surgery would be much, much riskier. I also had thought about all of this before it was necessary. One thing this job has taught me is to be prepared for my horse to do something very expensive, at a bad time, that requires a quick yes or no decision from me. I know without a doubt I will do colic surgery on Ernie and Vespa. I’m pretty sure I won’t do it on the rest of them, for a wide variety of reasons. The point is, I’ve thought about it, and I’ve thought about how I’m going to pay for it.
Tony: Payment, that sounds really scary. You didn’t offer me up, right?
Dr. L: First, you are priceless, so no, I didn’t offer you. Second, there are a few options when it comes to how to pay for this sort of thing. Insurance can be a great option. You have to insure for at least a certain amount for mortality, then add on major medical and surgical. Colicare from SmartPak is also a great option. You purchase a supplement from SmartPak, and they give you up to $7500 in colic insurance. That covers the cost of an average colic surgery (this one came in at about that price). Or, you can go with what I did, which is to have a savings account with the money for an expensive injury, colic surgery, or illness tucked away somewhere hard to get to.
The point is, you need to have a plan before it happens!! Making these decisions when someone is telling you your horse needs surgery or euthanasia is extremely difficult! Write these decisions down somewhere that others can find them as well, in case you are out of town when the call needs to be made.
Tony: OK, decision made. Now surgery….How does that even work?
Dr. L: First Ernie got an IV catheter so medication and fluids could be easily given during surgery. Next, he got antibiotics prior to surgery, to help prevent infections. Then he was taken into what’s called the induction stall. This is a smallish padded stall where he was sedated heavily, then given Ketamine to fully anesthetize him. You’ll hear human anesthetists say ‘put to sleep’ in this situation. Us veterinarians don’t like that terminology so much, for obvious reasons.
Once he was completely asleep, straps were placed around his feet, and he was picked up with a hoist, and placed on a surgery table. Once there, the surgery team went to work fast to clip and scrub his belly, sew his sheath shut, and get anesthesia monitoring stuff set up.
Tony: Whoa! They sewed his sheath shut?! And what’s the other stuff?
Dr. L: Yeah, you have to sew the sheath shut to prevent urination into the surgery area. No way around that, and urine in the surgical field is generally considered less than ideal.
And the other stuff. Horse bellies are pretty dirty places, even in the best of circumstances. Add in a horse who has been down and rolling from colic pain, and they are even dirtier. This means there’s a lot of scrubbing involved to get them super clean. While the scrubbing is happening, an arterial blood pressure monitor, a heart rate monitor, and the anesthesia machine are all being hooked up to make sure Ernie stays asleep, but not too asleep, during surgery. It’s really, really important to monitor anesthesia closely. It’s one of many ways surgery is a much safer option for horses than it was 20 to 30 years ago.
Tony: And now to surgery.
Dr. L: Yep, now to surgery. Ernie got one final scrub in the surgery room, then Dr. Adams and Dr. Hicks draped him. Draping basically means he was covered in big, sterile sheets so the doctors had a sterile place to put all the guts that were about to come out of his abdomen. Once they finished that, it was the moment of truth: the incision.
You have to be careful making these incisions, since there can be gas-filled GI tract pushing up from the inside. The first thing Dr. Adams looked for after making the incision was the cecum. The cecum is the landmark you use to find all the other parts of the bowel, so it’s pretty important. Dr. Adams followed the cecum to the small intestine, and announced that Ernie did indeed have an epiploic foramen entrapment.
Here’s where the ‘curse of knowledge’ kicked in for me. I was now nervous, and would get to stay that way for 45 excruciating minutes. This type of surgery requires Dr. Adams to work the 17 feet of intestine that Ernie had trapped back into the abdomen through a very tiny hole. The risk of tearing the intestine or a blood vessel is 
pretty high, and it stays that way until the moment the last of the intestine is through the hole.
I also got to watch poor Dr. Adams spend 45 minutes bent over my horse’s abdomen at a horribly awkward angle, which was killing his back. It was all worth it though. At the end of that very long time, the intestine was free, and looked pretty ok. It was bruised and a little battered, but none of it was dead or even compromised, which meant none of it had to be removed. That is what getting a horse to surgery quickly does: it keeps the intestine happy!
Tony: That sounds like a long night! I know from my experience getting neutered that waking up from anesthesia can be rough. How do horses do?
Dr. L: It’s the scariest part of surgery, if that gives you any indication. Ernie was placed in a fully padded room, on a thick padded mattress. He got a little bit of sedation as he was hoisted into the room, to let the gas anesthesia from surgery wear off some more. Then the long wait began. It’s tricky, because I wanted him to get up so I could go to bed, since by now it was 1:00 a.m. and I was exhausted. However, I know that the longer they sleep, the better they stand.
There is a very real risk that horses will break a leg as they try to stand from anesthesia. That’s why they get sedation, and the very well-padded room, but it’s still a risk. Luckily, Ernie stood like a champ. He got to hang out in the recovery stall until he got his sea legs, and then he headed back to a regular hospital stall for some fluids, and the start of the long process of returning to normalcy.
Tony: How long is that process?
Dr. L: IIt takes about three months to get them back into work after surgery. Ernie stayed in the hospital for 3 days before coming home. During that time he was on antibiotics, anti-inflammatories, and had his feet in ice for 36 hours straight to prevent laminitis. Once home, he was slowly reintroduced to hay and grain. He’ll have to stay in a stall for a month, which he already thinks is stupid. Then he can start slowly returning to normal turnout.
Tony: And how’s his human handling it?
Dr. L: It’s tough to watch your horse go through surgery, but at the end of the day, Ernie’s worth it. I know we did the best we could in surgery, and afterwards, to get him back to his normal self. There’s a risk of complications, but I just have to wait and see if those become a problem. For now, it’s patience, which is really, really hard.
Aug 15, 2017 | Colic
Many of you know that in a recent ploy to get more attention, Dr. Lacher’s horse, Ernie, decided he’d like to have colic surgery. I interviewed Dr. Lacher to get all the details about her fun evening with Ernie. Read on for this fascinating interview with one of my favorite humans!
Tony: Let’s start at the beginning. When did you find out Ernie was colicking?
Dr. L: I had just returned to the Clinic around 5pm, and was working on paperwork when Lindsey, who helps me with the horses at home, called to say Ernie was definitely colicking. He had cast himself in the stall, but managed to get himself up, but went right back down. I finished what I had to get done, then rushed home to what I figured was a gas colic.
Tony: Why did you think it was a gas colic?
Dr. L: Because, as you have noticed from your time on the front porch at the Clinic, it’s really, really hot outside. That’s why you keep making us open the door so you can come back into the air conditioning. When it’s really hot outside, horses tend to make more gas in their large colon and cecum. These areas of the intestine are huge fermentation vats. More gas means a bit of pressure, and we all know gas can be uncomfortable.
Tony: Cats don’t “get gas.” We’re too classy for that, but I digress. When did you realize it was more than that?
Dr. L: The moment our third year veterinary student, Sydney, told me his heart rate was 56. You see, heart rate is a very good indicator of severity of colic. Simple gas colic horses will often have heart rates in the mid-30’s. They might be flailing on the ground and looking incredibly painful, but they still have a low heart rate. The rest of Ernie’s exam wasn’t that exciting. He didn’t have much for gut sounds, but that can happen in these situations. He had normal gum color and hydration, his respiratory rate was a little elevated at 24 breaths per minute, and his rectal exam was pretty boring. And then he blew through my sedation in 20 minutes.
Tony: Because he got painful again so quickly, you were concerned?
Dr. L: Yes. A typical mild colic might lay down a little bit after I tube them with water and electrolytes, but they don’t thrash around and act painful. Ernie got thrash-around painful. I gave him stronger sedation while I setup my ultrasound machine, and I re-palpated him. His rectal exam was still pretty normal but I had a pretty good idea why, and it wasn’t good news.
Tony: Wait, a normal rectal exam worried you? And what does an ultrasound show you? Ernie’s a gelding, so if I understand things correctly, he can’t be pregnant.
Dr. L: HaHa! No, Ernie is not pregnant. And yes, a normal rectal exam in this situation made me think epiploic foramen entrapment. This is a very specific type of colic which cribbers are prone to. The epiploic foramen is a hole formed where some bits of the stomach, pancreas, and liver come together. Small intestine works its way through that hole and then can’t get back out. The hole is pretty far forward in the abdomen, so I can’t palpate the problem. An ultrasound lets me look inside, though. The ultrasound showed some small intestine with thick walls, and that is definitely not normal.
Tony: All of this stuff together made you decide Ernie needed surgery?
Dr. L: Yep. Any horse who gets painful quickly after repeated doses of stronger and stronger sedation is a surgical concern. Also, anything small-intestine is a big deal, and the sooner you get those to surgery, the better they do. Finally, I would definitely do surgery on Ernie if he needed it, and since it looked like we were going to need to do surgery, the sooner I got him somewhere they could do surgery, the better. Even if we ended up going down to Equine Medical Center of Ocala (EMCO), and he didn’t need surgery, all we wasted was some time and a trip, but if he did need surgery, we had him where he needed to be as soon as possible. So that’s what we did.
Next week, hear all about how colic surgery works. It’s amazing, even to a cat. Until next week, may your horses not colic!
— Tony
Aug 7, 2017 | Farriers, Feet, Hoof, Hoof Care
Mushy Feet
My, we have been getting a lot of rain around here lately! As you know, cats are not too fond of water. As if that isn’t enough of a reason to be concerned about the rain, daily thunderstorms plus high humidity equals muddy pastures; a recipe for disaster when it comes to your horse’s feet! Please, allow me to give you a quick rundown of “what-to-use-when” for the various moisture-induced hoof conditions we see most commonly.
Thrush
You all know the smell. That rotting, nasty, sticks-in-your-nostrils-for-hours smell that you notice while picking your horse’s feet. You may also see some dark black or gray gunk oozing from your horse’s soft frog, or deep lateral sulci (clefts). Thrush is caused by a bacteria that loves wet, oxygen-poor environments, like the deep grooves in your horse’s muddy feet! Luckily, with daily cleaning and application of Kera-Mend Thrush Paste (available through our Docs), you will have the infection well under control in no time!
Mushy Foot
This is a disorder that our Docs see regularly here in Florida in times of wet weather. The entire sole gets soft, thin, and crumbly; to the point that you can make it bounce with your thumb! [Cats don’t have thumbs, so I can’t say I’ve tried this myself.] The best treatment out there for what the Docs call “Mushy Foot” is daily application of Durasole (available here at the clinic). Durasole contains drying and strengthening agents which actually thicken and harden the sole in a remarkably short period of time.
Hoof Cracks and Crumbles
Another problem we tend to see with feet in this ugly weather is cracked, crumbling hoof walls. As always, the first line of defense in keeping your horse’s hooves intact is regular trimming by a knowledgeable farrier. However, there are a few things you can try in the interim to help your farrier out. First of all, stop washing your horses feet! Yes, you heard me right. You know what one thing is worse for feet than standing in a muddy pasture all day? Standing in a muddy pasture, having mud washed off with a hose, allowing feet to dry out, then returning to the muddy pasture. It’s actually the wet-to-dry-to-wet transition that is really bad for hooves! If your only turnout option is in a wet environment, help your horse out with some Kera-Mend Hoof Dressing (my minion Beth in the office can order it for you). Apply some to the coronary band daily (because, as we all know, hooves grow from the top down). This product not only promotes healthy hoof growth, but it also protects the hoof from that wet/dry transition. The secret ingredient is lanolin, which is the waxy substance produced by sheep to waterproof their wool! Maybe if cats had that stuff, we wouldn’t hate the water so very much.
Proper Diagnosis, Proper Treatment
If you suspect your horse may have any of the aforementioned foot problems, please have one of our amazing Docs out for an exam. There are more serious conditions (such as laminitis) that can masquerade as any one of these conditions, and an expert evaluation is highly recommended. If you would like to have any of these handy-dandy hoof products in your tack trunk, come find me here at the clinic, and I will point you in the right direction… but if it’s raining, don’t expect me to greet you outside!
Until next week,
Tony
Aug 1, 2017 | Coggins / EIA
Uh Oh, the Coggins test is positive!
You read that correct! A positive Coggins test. For most of the horse-owning world, this is a theoretical problem they will never encounter. However, for a group of horses in Canada, this is reality right now. So let’s chat about Coggins. What it tests for, what it means to have a positive test, and what happens to those horses next.
Can I study for a Coggins test?
Well, you can, but it won’t do you any good. A Coggins test is a simple blood draw (from your horse, just to be clear). That blood is then tested for the presence of the Equine Infectious Anemia Virus (EIAV). This is a particularly nasty virus. EIAV is a very close relative to the AIDS virus, and works in much the same way. EIAV can spend years wandering around a horse’s body without any signs or symptoms of its presence. During that time, however, an infected horse can spread the virus if it is bitten by one of several different species of flies. The most common fly vectors are what are known as the dirty eaters: horse flies, deer flies, and other things you humans would call huge flies.
It’s positive! Now what???
This is what has happened in two areas of Canada recently. Horses had Coggins tests performed in anticipation of competitions, and those tests came back positive! The next step will be to quarantine all the horses on these farms. Once a good quarantine is in place, investigators will start trying to determine if horses have traveled to or from these farms, and if they could be out spreading EIAV. In the meantime, on the farm, all the horses will have Coggins tests performed, including the positive horses, who will be retested. Then everyone who is negative gets retested every 60 days until no new cases show up on that testing, plus a few months quarantine for good measure.
What happens to the positive horses?
Horses who repeatedly test positive, unfortunately, must be isolated from other horses for the remainder of their lives, or be euthanized. To ensure that no one sells the horse as normal, a large brand is placed on the left side of the neck, ending in the letter A. This tells everyone at a glance that this horse tests positive for Coggins.
Good news on the quarantine: it’s a pretty small area. Horses only need to be about 200 yards from any other horse to prevent the spread of the disease. So, it is feasible to quarantine a horse, but it isn’t easy. If horses are quarantined, it’s likely they will live many years with very few side effects of the virus. Eventually it will begin to attack the immune system and lead to life-threatening anemia.
Fun Coggins Trivia
- Coggins testing was begun in 1972. At that time nearly 4% of horses tested were positive. For the last year I could Google about (2005), 0.01% of Coggins tests were positive.
- 95% of positive tests in the United States have come from Southeastern states. As you all know, we grow big flies really well.
- USDA thinks about 40% of the horse population of the United States gets tested in any given year
- Federal, State, and Local governments use the number of Coggins tests performed in an area to estimate horse numbers. This is important! They use that number to decide if money should be spent to create, maintain, and improve horse stuff.
Coggins is an example of testing that works for everyone! By testing the horses that travel, the number of positive horses has dropped pretty dramatically! The recent positives in Canada prove we have to keep testing though, to make sure this disease doesn’t catch us by surprise!
Until next week!!
Tony
Jul 24, 2017 | Lacerations, Uncategorized
In my many years of observing horses, I’ve noticed that they have a strong affinity for sharp objects. Is it some sort of magnetic force? Do they have little aliens inside their heads telling them to stick their leg through that rusty bush hog? Someone really needs to do some research on this topic. All I know is that horses love sharp things, and they love rubbing their bodies up against them, especially after-hours and on weekends.
Is this an emergency?
If in doubt, whenever your horse has a cut that has broken the skin, yes it is an emergency. Some things that make it more of an emergency include location (over a joint, tendon, or vital structure), bleeding (think
puddles rather than drops), and duration (did this happen 5 minutes ago, or last week). Remember, all of our docs text message, and they generally will not charge you for reviewing photos of your horse’s questionable wound to decide whether or not it needs to be seen immediately.
Does this need stitches?
The answer to this question is not always black-and-white. It depends somewhat on your goals for the horse, your budget, and the level of aftercare you are able to provide. Oftentimes it is not a question of whether or not the wound will heal without sutures, but rather how pretty it will look in the end, and how long it will take. If you want the most cosmetic outcome for your horse, and the shortest healing time, then yes it needs stitches. But if you would like the least expensive option, you only want the horse to be a pasture ornament, and you have unlimited time to spend on cleaning and bandaging the wound, then you can probably get away without suturing. I will say, though, that skin makes an excellent band-aid, and any time it can be preserved, our docs like to give it a fighting chance.
What’s next?
So, your horse’s wound is all stitched up and looking wonderful. Game over, right? Not quite. Your horse may need some antibiotics, as well as daily cleaning, to prevent the wound from becoming infected.
You also may need to implement some extra fly control around the wound, as bugs really love that seeping blood and serum. Usually our docs use sutures that will dissolve on their own over time. However, if your horse manages to rip the stitches out in less than a week, let us know right away.
The good news is that most lacerations heal amazingly well if treated quickly and properly. If you own a horse, chances are you will become familiar with their natural affinity for sharp things, if you haven’t already. Luckily you have my staff close at hand to help you when the time comes!
Until next time!
-Tony
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