Today’s Diary Entry is sponsored by Pet Hooligans
Well after writing part 1 I’ve taken a few days R&R before the start of next semester (which is next Monday!) as its supposed to be the most intense year in the entire course with at my count around 48 hours a week of classes and practical. Now if you’ve not read part 1 you can read it here, if you have then welcome to part 2.
During my time in equine clinics I also got to see some wound healing, now this is something that I have covered in theory through a online webinar however I’d no practical experience at this point in time. Now the body is really good at healing itself (though sometimes incorrectly) if given time, however the changes are so slight that if you see it every day then its difficult to see any progress. To combat this it’s very useful to take photo’s as you go along so that you can compare the difference to a fixed point in time which can sometimes be very dramatic.
Generally with wounds it’s important to consider whether there is any damage to underlying structures which can change the prognosis considerably, and to consider and mitigate the risk of infection. The first wounds I saw were to the back of the hoofs and pastern regions (feet) and one case in particular had concern whether there was involvement of the underlying structures (cartilage etc). These wounds looked very bad initially, however over the next few weeks with regular bandage changes, debridement and treatment these healed very nicely. The bandage used here was pretty complicated yet provided great support to the injury both underneath and around – those these horses were completely confined to stables to prevent further injury!
We then had a new patient arrive in which though I did realise it at the start was going become an amazing learning experience for me. This patient was a 3 week old foal that had got a leg caught (possibly in a barbed wire fence) causing severe injuries. Though primary closure (aka suturing) was attempted this failed due to the tension in the wound and so we moved on to supportive care for healing by second intention (nature). Whilst this in itself was new to me, it got worse with the patient going septic (systemic infection with very high temperature) and so it went from general care to intensive 24 hour care with me at times actually staying overnight. This meant that I had a big learning curve on the different medications that were being used (I will never give a medication to an animal without understand its effects and potential side-effects). This worked for a while however the condition was getting worse so we started to question things, I spent a morning with textbooks working out the actually nutritional requirements including fluid (in a foal this young its a shocking 15 litres a day!) and proposed that we change our treatment quite dramatically which after discussion was accepted. During my time at BSAVA Congress I’ve met some good exhibitors (and equally some bad ones) that have been willing to talk through equipment with me even though I was not planning to spend money with them. One of the things I had been taught was about the fluid pump – no one else around knew anything about this – so I decided to bring this into play meaning that instead of just 100-200ml/hour I could get a rate of 999ml/hour of fluid into the patient instead.
So with a great improvement in the first day with this new fluid protocol (and me actually breathing a sigh of relief that I had not killed the patient with it) we could focus on the other problems. During the time in the stable the patient had developed septic arthritis (inflammation of a joint), and joint lavage had been performed twice to try to clean the infection out. One of the PhD students had done some research so we spent some time reading up on different journal articles with one of the techniques that we both noticed being that of regional limb perfusion. Now basically the theory is that drugs have side effects and the antibiotic we were using was bad for the kidney yet to get the concentration in the joint area we needed a high dose through the body which was bad (medicine really is a balancing act). Now with the regional limb perfusion technique what we did was simply create our own local area by restricting blood flow to the leg, and then delivering the drug directly to the leg meaning that instead of affecting all the body the main concentration was in the area we wanted.
Obviously this had risks as cutting of blood to any area is dangerous, and extremely painful. We used regional nerve blocks along with careful timing for this procedure with the patient sedated and after this procedure the inflammation subsided greatly. During this time we were still treating the original wounds which were healing nicely and we were supporting with a wound medication specifically to reduce the granulation tissue and so promote the contraction of the wound edges. I guess that this case will really be remembered as it’s the first time I’ve worked with a foal, and the first time that a single patient has meant looking after two animals. It really was at times quite unsettling being “watched” by mom…