I don’t know if you’ve heard, but we have a pretty exciting event coming up this
Thursday, September 7th at 6:30pm! Our very own Dr. Lacher will be telling the world everything they ever wanted to know about stomach ulcers in horses! I’m more than a little ticked off that this event will be held at
Canterbury Showplace on Newberry Road, rather than the Clinic, because it means I can’t stalk the attendees for attention, and solicit treats from them that exacerbate my diabetes. It’s a free seminar, as always, so bring a friend!
Why do horses get stomach ulcers?
No one, not even the omniscient Tony, knows quite what causes ulcers to develop in one horse compared to another. But, with a quick glimpse of their brilliant anatomy *sarcasm* you can understand why horses are so prone to this painful condition, also called EGUS (Equine Gastric Ulcer Syndrome). You see, horses, like most other animals, use acid to help digest the food in their stomachs. Logically, most of their stomach is coated with an acid-resistant lining. However, the top 1/3 of their stomach lining is uncoated, and when acid splashes on it, *surprise* they get ulcers.
When should I treat my horse for ulcers?
Some signs of stomach ulcers in horses are obvious, while others are more subtle. When Dr. V’s horse bucked her off because she tightened his girth… that was a pretty obvious sign. But as the saying goes, an ounce of prevention is worth a pound of cure. If you can anticipate stress-inducing events for your horse, it is much easier and less expensive to prevent your horse from developing ulcers in the first place, than to treat them once they are already established.
For example, Dr. Lacher’s horse just underwent major surgery, and will be on stall rest for an extended period of time. Dr. Lacher has her horse on Gastrotech and Ranitidine to protect him from developing ulcers. Our amazing office assistant, Mallie, has a mare who just weaned a foal and moved to a new farm. Mallie has her on Ulcergard to prevent stress-induced ulcers.
We know that exercise, illness or injury, hauling anywhere, and change in routine are all events that have been linked to ulcers in horses. In general, it is best to treat your horse for ulcers BEFORE you think he has them.
What should I treat my horse’s ulcers with?
You have probably heard of Gastrogard and Ulcergard (which incidentally are exactly the same product, just marketed differently), but there are a myriad of other ulcer treatments out there. One of the most promising areas of recent ulcer research is in feed and supplements that prevent ulcers by raising stomach pH. Legends Gastrotech and Purina Outlast would be examples of these. Remember from high school chemistry, low pH=acid, high pH=base. In lay-cat’s terms, that means any feed, supplement, or medication that raises stomach pH is going to inhibit ulcers.
How can I learn more about ulcers in horses?
I’m so glad you asked! Simply come to my event this Thursday, Sept. 7th at 6:30 pm; don’t forget it’s at Canterbury Showplace. I can personally guarantee that every question about equine gastric ulcers will be answered in great detail. I wish I could say I will see you there, but I’ll be stuck holding down the fort at the Clinic with Teanie. Now then, if you’ll excuse me, it’s nap time.
Aug 28, 2017 | Foals, Uncategorized
Earlier this year, you all got to see picture after picture of cute baby horses. Around now, the first of those adorable foals is coming due for their first vaccines. And that’s where the fun begins! A 3-9 month foal is a whole lot like a 10 year old kid. Still pretty cute, but beginning to assert their opinions on the world.
Foals and Germs
When your foal was born, my Docs came out to do a Well Baby check in the first 24 hours. Part of that check was a blood draw to test for something called IgG. This test told them if they got enough of that very important first milk, or colostrum, to provide them with germ-fighting immunity. That IgG works for about 4-5 months, at which time those foals need vaccines to prepare them to fight the bugs of the world on their own.
Encephalitis vaccines are INCREDIBLY IMPORTANT at this age! Be a smart human, and get those foals vaccinated! We see West Nile and Eastern Encephalitis every month of the year in Florida. Un-vaccinated foals (and yearlings) are the most vulnerable to these deadly viruses. Beginning at 5 months of age if mom was well-vaccinated, or 3-4 months if she wasn’t, foals get a two to three shot series of the encephalitis vaccines. If your mom wasn’t well-vaccinated, you get an extra booster in there. Along with the encephalitis vaccines, foals also get rhinopneumonitis, influenza, and rabies. For a whole lot of very complicated reasons, the 3-9 month age is the most important time to vaccinate for rhinopneumonitis.
Foals and Worms
Worms love foals more than encephalitis. The good news is this is a relatively easy problem to solve. Foals get all the same worms as adults, along with a special young horse bonus one called an ascarid. Ascarids are the grossest, nastiest worms you’ve ever seen. I included a picture just because I can, and they’re pretty gross. Ascarids also think Ivermectin is candy. So here’s our recommended foal deworming schedule for your convenience:
- 90 days old- use pyrantel pamoate
- 5 months old- use ivermectin
- 7 months old- use fenbendazole or oxibendazole
- 9 months old-use ivermectin
- 11 months old-use pyrantel pamoate
- 13 months old- use ivermectin
- 15 months old- use fenbendazole
- 17 months old- get a fecal egg count, they’re old enough to start fighting those worms themselves
Mamas don’t let your babies grow up to be not halter broke!
This baby knows how it’s done!
All that discussion about vaccines and deworming was a lengthy preamble for this section. Teach your foal how to be a good citizen starting the day after they’re born! Put a halter on, take it off, repeat about a bajillion times. Teach them how to lead. Teach them about boundaries. Just like pre-teen humans, pre-teen foals test the boundaries of what’s allowed (and your patience). Teaching them that the crazy humans are going to ask you to do some weird stuff, but are never going to hurt you, makes adulting easier.
Foals at 4-5 months of age are usually too big for my techs and Docs to hold up off the ground like they can the newborns. However, if they are halter broke, they can start to train them that while shots are a moment of needle prick, they come with scratches, a treat, and a whole lot of rewards. You see, my whole team of Springhill Equine minions, I mean staff, work hard to teach horses that visits from the veterinarian are fun. They start that process from the very beginning. Having a halter broke baby makes it easy-peazy. Having to start by introducing the 500 pound foal to a halter does not make it easy!
With a little help, we can all make those tough pre-teen months a little easier. Now the teenage years….That’s an exercise in patience, just like it is with the humans. Until next week, may your litter box be clean and your food bowl full!
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
We started off the evening by meeting these guys: Rascal and McGee. I have been around the Anheuser Busch Clydesdales before but I find their size awe-inspiring every time. I also find their tolerance for the crazy stuff they are asked to do pretty impressive. Rascal and McGee spent two hours standing in a hotel lobby (on a red carpet with padding underneath) being incredibly bored while 250-300 veterinarians and technicians oohh’d and aaahh’d over them, took selfies, marveled at their feathers, their extreme level of clean, and how they did their hair, and never once lost their cool. I can’t get Vespa to calmly stand on crossties in the barn at home reliably! 
You humans have a thing you do with your middle finger. Horses one-up you: they walk on theirs! That’s right. The coffin bone is the tip of your middle finger. Feel the bones moving down your finger, back toward your hand, and you have the equivalent of the short pastern, long pastern, and cannon bone. You’ve got a navicular bone too, but only in your thumb. This whole ‘walking on one finger’ thing is why horses have so many lower leg problems.
Now why did I say in a freshly trimmed foot? Take a look at where the heel is located on this hoof. It’s nearly ¾” farther forward on the untrimmed side, when compared to the trimmed side. That’s not because the farrier did it wrong 5 weeks ago, that’s because the foot grew forward. It’s what they do.
After assessing the bottom of the hoof, pick up the leg. Put your hand underneath the end of the cannon bone, and let the hoof hang. Notice there are no human hands in this picture. That’s they way it’s supposed to be! When you hang the hoof like this, a line drawn down the center of the pastern and heels should be perpendicular to the bottom of the hoof. 
Due to the aforementioned lack of actual Winter in Florida, you may need to cut that newly grown winter coat off. Horse hair is an amazing insulator, so when it’s 85 degrees on Christmas Day and you want to go ride, you may find your furry horse is a less than willing partner. Never fear, this doesn’t mean you have to go spend $1000 in horse blankets. You can do what I refer to as the “crazy horse people haircuts.” I have heard other people call them bib or trace clips. I still think they look funny. However, they do let your horse sweat and release heat in all the important places, while giving them protection from our “cold” weather. And if you get inspired to add some zest and style to your clip job, take a picture and put it on our Facebook page!
I hope you’re not eating, because this is pretty gnarly. Summer sores happen when larvae from the stomach worm Habronema are deposited in a wound or mucous membrane. Yuck! The larvae cause a severe inflammatory reaction in the skin, which creates the red, thickened, oozing granulation tissue we so fondly recognize as a summer sore. They commonly occur on the legs, in the inner corners of the eyes, on the sheath, or in the corners of the mouth. I’ve never had one myself, but they don’t look like much fun.
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