A new procedure, a behind the scenes look… (Day 461)

Equine Patient Recovering from Surgery

Today’s Diary Entry is sponsored by Vet School Success

When you take a pet to the vets you expect the best treatment, and most vets strive to ensure that this is given. Sometimes however pets need special treatment or surgery that the vet has never done before. Today I wanted to talk about this as it is something that not many people actually get to see, or that is often spoken about.

A common problem in thoroughbred horses is that off splint bone fractures, basically back through evolution horses used to have more than 1 finger, and the remains of these have become really small yet stay on the side of the metacarpal and metatarsal bones. This bone in the horse is between the carpal (wrist joint) and the fetlock joint (like the knuckle in humans). Horses have the third or middle bone which is large and can support the entire weight, with the rudimentary remains of the 2nd and 4th bones as well.

Now these splint bones fracture under the pressure of normal work causing pain and inflammation along with lameness. The easiest and most common fix to this problem is to remove the fractured piece of the bone. Now this is a surgery that has not been performed at the clinic by any of the staff surgeons, yet is required to treat the horse. This is the best thing I think about being a veterinary surgeon, that you can always learn something new and so the surgeon started researching the best procedure to use for this surgery.

Now as a student I revised the basics of anatomy, functional anatomy along with the procedure. Now come Monday the surgeon did a practice surgery on a dead leg, looking at both the procedure, and the best position to operate from as well as different techniques for closing. I was asked to assist in this practice surgery which helped me understand the procedure better, as well as the surgeon to give me more experience in a place which put no patients at risk.

Now the actual surgery took place this morning with another doctor assisting, however understanding the procedure gave me the ability to also learn from it as I understood what was happening along with why. Its also given me a new appreciation of my chosen profession, and a understanding that we are all still students when it comes down to it, just some more experienced than others.

Equine Patient Recovering from Surgery

Foals, fences, legs, and equine surgery….

Preparing the equine operating theatre for emergency foal surgery

Today’s Diary Entry is sponsored by Vet School Success

Rather late finishing this diary entry as it has been a hectic week with studying and preparing for my Anatomy exam next Monday but lets hope it was worth the wait. Today I wanted to talk about foals, those baby horses that look extremely cute…

Now when I started here back in September I had very very limited experience with horses, this past semester I have done what is on our timetable as “Horse Riding” (on the other timetable it is down as Intro to horse rehab). So I’ve learnt a bit, ridden a bit, and altogether got a lot more confident with horses, however though I’ve read a little, until today my only experience with foals has been being trapped in a field with two a few years back when walking… This morning we’ve had a 3 week old foal in after getting one of her back legs stuck in a fence and tearing the skin rather badly in a few places whilst trying to get it free.

When dealing with “baby” animals a very important factor to consider is the mother, whose natural instinct will be to protect their young. This is especially so when the mother weighs 10 times as much as you, stands taller than you, and has an extremely powerful kick. Sometimes animal “moms” are so protective that you cannot even get near their young even if you are their best friend. So in this case where urgent treatment is needed, there are two options: a) Separate mom from foal or b) Keep the foal with mom and sedate her too. As the first option can cause a lot of stress for the mother and the foal we went with option b!

So in this case it was unusual as we had two horses in the operating theatre at the same time, mom who was sedated first, and our patient the foal who was placed under anaesthesia and moved onto the operating table. I somehow ended up getting the task of holding up the leg whilst it was cleaned, shaved and surgery started. Whilst this was going guarantee massive arm ache later, it did mean that I had a perfect view of the surgical field. Now I know a little of the theory behind the different suturing (stitching) techniques and when and why they are used so it was very interesting for me to see this in practice in such a large way. Also a few drains were placed, and also a catheter to allow the wound to be flushed later on to clean it. The initial part of the surgery took around 90 minutes to close 3 different wounds along the leg, and once this was complete another student took the leg from a different position for the major wound which circumvented around 60% of the leg behind the knee and involved muscles.

Us students had a debate on what technique would be used with here with the suggestion of a skin graft being used because of the amount of tension. This however is where experience beats book and the surgeon chose to close it directly suturing each layer back together. There are special suture techniques that can be used to relieve the tension across a tissue which are especially useful in cases like this with skin over joints.

Preparing the equine operating theatre for emergency foal surgeryThe surgery took a total of 2 and a half hours which is a lot for such a young animal to handle, and so I was curious as to how she would wake up. We moved both the foal and the mother to a recovery stall in the stables to come to with the foal being monitored and restrained on the ground. At this point I was giving the mare (mom) to look after as an out of control horse wouldn’t have been a good thing. It took around an hour for the foal to come partially around and though they tried she was still unable to stand alone so they set to massaging her limbs to increase the blood flow before trying again 30 minutes later where she stood and suckled a little.

We then had the pleasure of trying to get a bandage onto the leg to protect the wounds, and more importantly to stop mom trying to remove the drains. All in all, from start to finish it took around 5 and a half hours, and it was probably the most exhausting 5 hours of my week!

The end of my first week of clinics….

Endoscopy Gutteral Pouch Empyema in Horses

Today’s Diary Entry is sponsored by Supreme Pet Foods

What a week! I am actually starting to feel like a vet student now and not only have started to apply knowledge that I have learnt over the past year but also from my previous degree! In addition to this I have also managed to pass two exams this week (Veterinary Physiology on Wednesday and Animal Hygiene this morning)!!!

So this morning started with an exam, it still feels weird to me having to dress formal for exams however dressing smart also gives me a boost of confidence so I do like it. I now have a week to prepare for my Anatomy exam on the 24th June – this will be my second attempt as I failed my first one back in January as I had no clue what to expect on the question paper. Basically you are expected to just list the different parts of the bone instead of trying to write a description of how it looks 🙂 Hopefully I will do better this time!

Now this week has been pretty cool, I’ve got through a lot of Equine stuff, seen a castration, endoscopy, and wound management. Today I was slightly gutted as I arrived late after this mornings exam to find that they had done emergency surgery on a corneal ulcer (a ulcer of the eye) in a sports horse. I arrived just in time to see the movement of the horse from the operating table to the recovery box. This was interesting as when animals wake up from anaesthetic they are unsteady on their feet (same in humans but we have the ability to know what is going on and that we should lay there) and usually struggle to stand. On Tuesday for example the horse was held on the ground until he had recovered enough to stand, and then was supported with people at the head and tail vertebra. The rest of today’s surgery went to the wound management of the hoof injuries, and endoscopy lavage for the guttural pouch empyema (the bump in the image below is a large swollen abscess).

Endoscopy Gutteral Pouch Empyema in HorsesStandard treatment for corneal ulcers is applying a graft which helps healing whilst also preventing the eye from rupturing, and whilst I missed this I got to watch something else pretty cool. Now administering eye drops to a big horse is not something I had ever considered before, thinking about touching a painful area and the legs flying towards me I realise that it does require careful thought. In this case a supraorbital (above the eye) lavage system is used. Basically a small incision is made into the upper eyelid and a tube passed through this which is then fixed in place along the head. This allows a syringe to be connected and drugs to be applied directly to the eye which I think is pretty cool and makes it easier.