July Is Vet Anniversary Month

July is the time of year at McKee-Pownall where we celebrate a lot of work anniversaries for our veterinarians. We typically hire new veterinarians after they complete a one-year internship following their graduation from veterinary college. Internships in North America usually begin sometime in June and end around the same time the following year.

We prefer hiring veterinarians from an internship for several reasons. Most vet students don’t receive sufficient practical experience in vet school, so working in a busy veterinary hospital gives offers a hands on and diverse case load. Also, we appreciate the wide-ranging knowledge new vets at MPES bring to us after their internship. We are always striving to be at the cutting edge of medical knowledge so the more experiences we can bring on board the better for our clients and their horses. Our vets have come from internships across North America, so we are the beneficiaries of some of the best veterinary minds across the continent. Finally, we have hired several veterinarians that have worked with us as students and we would like them to do an internship elsewhere, so they learn new things beyond the comforts of MPES. Inevitably, they come back home with a great background and skill level that allows them to jump right in and work with you and your horses.

We are very proud of how long many of our veterinarians have been with MPES. Drs. Maggie Turner and Michelle Courtemanche were the first associates we hired 12 years ago. Dr. Kathryn Surasky joined us 10 years ago, followed 2 years later by Dr. Tovah Caldwell. In 2012 Dr. Jim Welsh came on board, followed by Dr. Andrea Dube in 2015. Drs. Samantha Molson and Marisa Markey spent a lot of time with us as vet students and we were very happy when they came back home in 2016 and 2017, respectively. Dr. Ali Miletic, who also spent time with us as a Summer Student, joined our Newmarket practice in 2017 and we welcomed Dr. Kyle Goldie this past winter. Those of you in our Caledon practice area will soon meet Dr. Taylor Mahren in a couple of short weeks as soon as she finishes up at her internship.

Having a mix of veterans and newer vets ensures that while all vets deliver the same high level of medical care and personalized experience, the influx of new ideas makes everyone a better vet.

Happy Anniversary everyone!

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Horse Season

Happy Horse Season everyone! It is that time of year again when we Canadians can fully appreciate our horse companions without freezing our toes off. I was inspired to write this blog post during a weekend at Palgrave as the vet for the horse show. Palgrave is otherwise known as the Caledon Equestrian Park, but I have been calling it Palgrave since I was 10 years old so the name has stuck.

Horse Season – it isn’t just Horse Show Season, it is everything equine, whether you ride your horse competitively, ride for fun, work with them from the ground, spend the spring greeting new foals, or simply love watching them from afar, this time of year is just the best. On my drive to the show I drove past a group of friends hacking through some fields beside the road. The day before that I had arrived at a schooling barn just in time to see a group of kids and their ponies out to graze while they dry from their baths. Everything about this weather is screaming “Be outside with your horse!” Winter here in Canada is long and cold; most of us simply bundle up and spend some time with our horses without truly enjoying it in the way that we can in the summer. There is nothing I love more than watching a content horse graze at the end of the day, something about it is just good for the soul.

If you have never been to a large horse show or the backside at a racetrack, please go and allow yourself a moment to stand back and observe the horses and people warming up or waiting to go in the ring. This brings the most incredible collection of people who are all there because of their love for horses, their athletic ability, the freedom they give us, and their incredible hearts. You have the riders, athletes themselves, working with their horses to achieve new goals. You have the grooms, up at dawn to provide these horses with whatever they need, always ready with a towel to wipe a face or just a pat of reassurance. You have the trainers, constantly assessing what the right step is for their human and equine athletes. And you have the show parents – they may not understand their child’s love for these crazy horses but they are there, providing water and shining boots.

There is something magnetic about horses isn’t there? It is that something that makes it hard to leave the barn on a beautiful summer night, even when all of the work is done. Even though summer time brings the sweat, the flies, the impaction colics from not drinking enough, the skin hives from unknown allergies, the lameness from hard ground when it hasn’t rained, or the laminitis from fresh grass when it has – somehow all of those stresses and frustrations melt away when you make that perfect jump, perfect transition, or catch the sunset as you return from the perfect trail ride. All of the special care and extra work is worth it for those magical moments with a horse.

I am not going to use this blog as a platform to discuss deworming strategies, or making sure your horse is drinking on hot days, or protecting your horse from ticks and mosquitoes. Talk to your vet about all of those things when planning your summer.

I do want to use this blog post to encourage everyone to take as many of those magical horse season moments as they can, and to appreciate each one, because before we know it, it will be winter again!

As the saying goes, “The outside of a horse is good for the inside of a man” (or woman!)

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Vaccines, why don’t we ask?

I’ve been wondering something. Why don’t people want to ask about vaccines? Why we do them? Which ones we choose? What those diseases are? With all of the controversy surrounding vaccines in the recent past, why don’t people ask? Is it just absolute trust in their veterinarian? Is it that they worry the information is too technical? Is it that we don’t really care? I don’t think that is the answer.

I’m not sure if it is a combination of these things or if I’m missing the mark completely. What I do know is that I’m guilty of it myself. There have been a few instances that started me wondering about this gap in communication. First, I recently presented about vaccines to our team at MPES during a staff meeting. I explained the way that I think about vaccination and the immune system. The way that I found to understand immunology in vet school was to think of the immune system as an army. Each type of immune cell has its own job or rank in the army. To me, vaccines are like Mug Shots. They show the body’s army what the bad guys look like and give them a chance to figure out how to fight them. When the body’s army sees the mug shot for the first time only a few of the soldiers see it. When we complete the primary series and give the vaccination again 3-4 weeks later those soldiers realize that this is definitely a bad guy that they need to worry about and they tell everyone! So now we have a whole army ready to fight the diseases that we are the most worried about. Once or twice a year we have to revaccinate to continue to remind the body’s army the watch out for those bad guys.  After this presentation one of our staff members told me that she had never fully understood how vaccine boosters work or why we do them! Why didn’t she ask before?

Another encounter brought this back to my mind not long after that. On a routine visit to vaccinate a horse the owner had requested that the horse receive everything except for “EWT”. The veterinarian at the appointment wondered why this might be, “EWT” is one of the core vaccines that we recommend. “EWT” stands for the three pathogens (bad guys) that are combined in this one vaccine – Eastern Equine Encephalitis Virus, Western Equine Encephalitis Virus, and Tetanus toxin. The tetanus part of the vaccine is one of the most important vaccines that we give to horses. Horses shed the bacteria Clostridium tetani in their manure and it is easily found in their environments. When this bacteria gains entry to the body through a break in the skin it begins to produce a powerful toxin that affects the nervous system and causes the disease Tetanus, a disease that is usually fatal in the horse. Due to the high environmental contamination and the high incidence of wounds, horses are at a very high risk. For that same reason horse people are also at high risk of tetanus and should stay up to date on their vaccines! Eastern and Western Encephalitis are viruses that are passed to horses through mosquito bites. Although they are rare in Ontario, these viruses are 100% fatal and we generally see at least one a year, therefore we consider it worthwhile to vaccinate for them. The vaccine is protective and safe. So why did this owner not want to vaccinate with this very important vaccine? When asked her response was, “Because I don’t know what it is”. It is our job to help teach people what diseases to vaccinate against and why, we never expect anyone to just know this information, we had to learn it at veterinary school too! So once again, why didn’t she ask?

Finally, it was my own behaviour that really brought about this question. I am lucky enough to be travelling to the Caribbean soon for my brother’s wedding. While browsing some travel sites online an advertisement for TwinRix vaccine popped up. I asked my husband if he had ever received this vaccine and if he thought we should get one before going. He asked, “What is it for?” I replied, “I don’t know but you’re supposed to get it before travelling”. As soon as the words were out of my mouth I hung my head. I am a doctor, yes for animals, but with similar training to human doctors, and I am one of the people not asking the questions – What is that for? What do those diseases do? Is the vaccine safe? Why hadn’t I asked?

In this age of Google and quick access to information do we all feel like we should have every answer? We shouldn’t have to ask the questions and we might be judged if we do ask?  I hope that isn’t the case.  I truly believe that everyone is capable of understanding the basic principles of vaccination, the diseases that we vaccinate against, and why. I also believe that your veterinarian or doctor is the best person to teach you. We all had to be taught at some point and we have all found a way to make sense of it. If my army analogy doesn’t work for you I bet I can find 5 other ways of looking at it, just in our one clinic.

So please ask! We all love to help people understand why they vaccinate their horses each year, why we deworm the way that we do, why we choose one antibiotic instead of another, and the list goes on.

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Teaching Our Feet to Walk Away

There have been a few tough cases lately. Horses that have complicated problems and day-to-day updates can be a roller coaster. They have me checking my phone at night and on my weekends off. They have me stopping in at the barn when I drive by just to quickly see for myself how the horse is doing. They have me laying awake at night wondering what else I could be doing for them.

In this occupation we are constantly learning. Every day brings a new challenge, a new disease, a new medication or therapy to learn about. In the first few years of practice it feels like there is a mountain of learning to climb. The part that most people don’t think about is the emotional education that we go through as well. At school we are in the hospital wards constantly, and then we enter our internship where most of us eat, sleep, and breathe veterinary medicine for a year. We never leave the hospital, our patients are always just a few steps away and they are constantly monitored by either us or one of our trusted team members. Even in that time though, we have to start learning to walk away. We have such a passion for what we do and we care so much for our patients that we literally need to learn how to take care of ourselves as well as them. A frequent command heard during my internship was “Marisa, go home!”  I would skip meals and skip sleep in order to stand at my patient’s stall, hoping that the power of my gaze would fix them.

Now that I find myself working as an ambulatory equine vet, I have even more learning to do, and I’m not the only one. There are always tough cases that make it hard to go home, shower, eat a meal with loved ones, and go to bed, but we have to. These tend to be certain situations that pull at our hearts and souls more than others: laminitis, colic, colitis, pneumonia, severe lameness. The things that we can’t fix instantly and that we lose sleep over.

We have to take care of ourselves or we won’t be able to properly care for the next horse that needs us, we aren’t machines, even though we wish we were sometimes. Just recently one of my colleagues told me a story. We had a painful pony that we were helping through an episode of laminitis with multiple pain medications. This colleague stopped in late on a Saturday to administer more injectable pain medication and the pony was having a bad night. She was alone in the barn. She did an assessment, administered the medication and sat with the pony for a moment. She stood up to walk away, got half way to the door and turned around, went back and stared at him. I know exactly what she was feeling; that strong desire for the power of your stare to fix something, to take away the hurt. She stood there staring at him and then had to say to herself “turn around and walk to the truck, either to get something else to help him, or to drive away because there is nothing more that you can do while you wait for the drugs to kick in”. I’ve seen other colleagues do this as well – simply stare at the horse for a few extra seconds. I do it frequently, anyone who has ever seen me finishing up a colic exam has probably heard me say “OK, I’m just going to stare at him for a few more minutes and then I’m going to leave”. I need to see them stand there comfortably for at least a few minutes or I can’t force myself to walk away.

This is what we slowly teach ourselves. We have to learn to walk away or this career will eat us alive. We all want to curl up on the hay bale and keep an eye on the colicky horse all night, and in some situations we all have. We all want to follow the horse into the hospital to make sure that they get there okay, and that the treatment is what we wanted for them. What we learn over time is to trust our colleagues, trust our referral centres, and trust the owners that take over the horse’s care when we walk out the door. We learn that when we walk away with our feet it doesn’t mean that we are walking away with our heart or our mind. We go home, we shower, we eat, and we research every new finding about the problem in question. We fight the urge to ignore all of our other patients for that one that is having the most trouble. Sometimes what they need is time and we can’t speed up time with the power of our gaze, no matter how much we want to.

So, try to remember this the next time your vet is standing there staring at your horse – they are struggling with an internal battle, and just because their feet walk away doesn’t mean their mind does. They want those updates, those pictures, and best of all, that text that says “She is so much better!”

Dr. Marisa Markey

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Why I Love Equine Dentistry

As equine veterinarians we see a large variety of horses, and we get to be involved in all aspects of horse health and wellness. An important part of that is dentistry. All vets are trained to properly and effectively perform a dental exam and float, however we all have areas of veterinary medicine that we enjoy  more than others, so not all vets enjoy dentistry like I do.  To be clear, I’m not a specialist, I am not board certified in dentistry, this is just a part of my day that I look forward to every time.

Why do I love it?

I suppose part of it is the instant results. You can take a horse with painful sharp points in its mouth and 20 minutes later they have relief! I had braces as a kid and I can tell you that sharp points cutting into your lips and the side of your mouth are awful.

Figure 1 – www.mwveterinaryservices.com/dental-abnormalities.html

They are painful when you eat and I certainly wouldn’t have been happy with someone putting a bit in my mouth and asking me to work.  Horses form sharp enamel points due to the shape of their jaw and the grinding motion they use. The lower jaw is narrower than the upper jaw, therefore the outside of the upper jaw and the inside of the lower jaw never grind against another tooth. Over time this develops into points that can rub along the sides of the tongue and against the cheeks.  Sometimes these points are sharp enough to cut the latex gloves that we wear while we exam the mouth. Ouch! When I see those points and the ulcers associated with them I actually smile – I am about to make this horse’s life so much better!  It is also an opportunity to provide education on the need for routine dentistry.  If you are present, I have a chance to let you feel what is going on inside the horse’s mouth for yourself.  Even in mild cases, when I find ulcers, or irritation within the mouth I will ask if you have had trouble with the horse on one rein, or the other and more often than not you realize that the horse has been uncomfortable in the bit on the same side as the ulcers.

Young horses losing their baby teeth are a special joy for me too. Usually these horses are chewing in a strange way, dropping feed, throwing their head – sometimes even drooling. When I get the horse in the speculum, and open the mouth – there is a loose baby tooth just asking to be pulled out! Remember being a kid, when you would spend all day wiggling a loose tooth until it came out?  The feeling of your tooth moving every time you took a bite was so annoying. Young horses experience the same thing and we can provide instant relief by playing “big-brother” and pulling that loose baby tooth.

 Another reason that I love dentistry?

The horses are usually healthy. This is a selfish one. We see sick horses frequently and it makes us sad.  I became a vet because I love horses.  Seeing them in distress can be hard for the soul, even though I am happy to have the opportunity to help. Dentistry provides a nice break from the emotional cases. The horse is happy and healthy, we sedate him, perform a dental float, and then he wakes up even happier and healthier! Everyone wins!

I’ll be honest; it isn’t all sunshine and rainbows. There are few things more disgusting than the smell of rotting tooth. When an infection takes hold of a tooth it can cause some pretty terrible nasal discharge or drainage under the jaw. It is gross and I don’t know anybody that likes that part of dentistry. When you extract those teeth in surgery you usually need to go have a shower immediately because somehow the smell just sticks to your hair and clothes.

Figure 2 slideshare.net/HorseFloss/natural-balance-or-whole-horse-dentistry

Dentistry is a fun puzzle – how does the horse chew? What is impairing normal grinding and causing any abnormalities? Could problems in the mouth relate to performance or overall health? How is it fixed without taking too much of the limited grinding surface?

Dentistry might not be everyone’s favourite part of their day, but I bet if you asked, any horse vet would admit that they do love some parts of it! All vets love how we can make such a quick and positive impact on the health of our patients.

Figure 3 – Big tongue ulcer from tooth fracture

Figure 4 – Baby teeth ready to fall out

Figure 5 – My view

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The Power of Cold

The young equestrians have just headed back to school, and the chill is starting to come in the morning air now. The schedule has lightened a little since a few weeks ago when all of the vets in the Newmarket office were booking nearly a week in advance for routine calls. Its been a hectic summer over all, and a hot one! Rumblings about where hay is going to come from have been heard out and about with all of the dry heat. I have to say that personally, I’m enjoying putting my fleece on first thing in the morning and not sweating by 9 am, but I know all too soon the snowflakes will fly. This, to me, is the perfect time of year.

The summer show season is over and we enjoyed  our clients’ successes as we watched the evolution of horse and rider teams from spring through fall, and for some, looking forward to the Royal.

Our foaling season has come and finally gone, and breeding season is over for this year. The Newmarket team has had a fairly successful breeding season, and have seen our caseload grow. We are excited with the number of mares we have “in foal”, especially the group of “retired show horse mares” who are older, and who were more difficult to catch. In many cases, it has taken a joint effort from the team, and some HARD work on the part of the clients to get these mares in foal, but we are delighted with the outcome of all of our hard work, and look forward to a big foal crop in the spring. Look out for some client education seminars over the winter on preparing for the 2017 foal crop arrival. Keep in mind your broodmares have different vaccination needs beginning with their Pneumabort vaccinations starting at either 3 or 5 months of pregnancy.

unnamedWhile I was driving from Schomberg to Uxbridge one Saturday during a busy on call weekend I began  thinking about the cases I had on deck, and  it came to me that we should discuss one of my favorite therapies in this blog.

I had seen a mild cellulits, a new and active splint, 2 pretty significant soft tissue wounds, a swollen eyelid from some trauma, a raging lymphangitis and more. The emergencies were a bit backed up, and I was having the clients start the treatment before I arrived. I said the following phrases more that weekend than I have said in a very long time – take his temperature and put some cold on it, or take his temperature and cold hose it. To one client (the raging lymphangitis who was toe touching lame and unable to walk out of his stall) I said cold hose it until I get there (and I had him give bute on account of the fever). It would seem like on that weekend (and it was 34 degrees during the day so this seemed appropriate) everything I was looking at just needed the be cooled down.

When I arrived on farms, I was amazed at what I saw, and reminded of the pure and simple genius of cold therapy and cold hydrotherapy. unnamed-4 unnamed-3 unnamed-2 unnamed-1

My lymphangitis client (who was on a well) actually cold hosed his horse for over 90 minutes consecutively and do you know what I found when I got there?  Although the leg was swollen to this horse’s hip and the upper limb still hypersensitive; with only one gram of bute and a ton a cold water – this horse could now walk out of his stall, the skin on the lower leg had actually loosened up as the swelling had already began to reduce by the time I’d arrived, and when we walked the horse out into the yard, he B-lined it for the grass. This client, nearly alone, had reminded me of something perhaps I’d forgotten, or have been taking for granted lately – cold therapy is amazing.  Pair it with a client who will give hours of their day to making sure their horse gets the best possible care – priceless – literally priceless (and as long as you don’t have to pay a water bill – this is a CHEAP thing that anyone, no matter your horse experience can do).

That client who sat and cold hosed his horse forever until I got there, his name is Don – and Don – you get the compliant client of the month award from Andrea! But as we all know, that’s not the real prize, the real prize is that Don made his horse happy and healthy fast despite a problem that can become much worse and sometimes takes weeks to resolve. What in some cases would have become a month of treatment and bandage changes, was completely resolved in about 5 days.

Now, tiny aside – those of you who know me know I’m kind of big on the cold water and ice therapies – and so maybe I’m just using a case to demonstrate my point of view???…Maybe! But, I thought perhaps I could convince a few more of the power of cold if we looked into some literature, and I could explain why we vets, and horsemen for the last 200 years have used Cold therapy as one of the staples of horse care.

Proving the efficacy of cold therapy, or cold hydrotherapy had not been an easy task. Although it had been a staple of horsemanship for what seems like eons, we did not really understand the science behind why it seemed to help, or if there was much in the way of side effects. Since about 2000, ice and cold hydrotherapy have become hot topics in the equine veterinary scientific literature. Anyone who has ever placed a burnt finger under cold running water, or put an ice pack on an area of acute trauma freely accepts the reality of benefits cold hydrotherapy has to offer. Explaining the physiology behind these benefits seems to be more of a challenge. As a brief summary; when you apply cold hydrotherapy to an area of acute trauma a cascade of events are trigered,; we restrain the metabolic response of inflammatory cells by reducing further inflammation, and thus alleviate pain.

Not all cold is created equal!

unnamed-5 coldIn 2000 a paper was presented at the American Association of Equine Practitioners annual convention comparing deep tissue cooling and warming which I find illustrates the “Not all cold is created equal” theory quite nicely. One of the most interesting findings was that deep tissue measurements dropped by more than 15 degrees C when in ice water immersion, and the entire time the limb was in the ice water the temperature continued to go gradually down until the temperature reached approximately 10 degrees C and then stopped. Once the leg was removed from the ice water immersion, the temperature rose back to normal within 10 minutes.  Commercial ice packs were used as a comparison, and when applied to the skin only dropped deep tissue temperature by about 2.5 degrees C. The real challenge with this therapy was that the skin was at its coldest at approximately 2-3 mins into the treatment, and although the skin got quite cool, the deep tissue did not cool beyond a few degrees, and actually started to warm up again 5 minutes after the cold packs had been applied, and continued to warm up (with the ice packs still in place) so that at 30 minutes of ice pack therapy, the deep tissue was just as warm as if no ice had been applied at all. A most recent 2016 article comparing a number of “wet” and “dry” newer technologies still found the ice water slurry to be the most effective at profound deep cooling.

Take home message – commercial ice packs are not a great solution to achieve deep tissue cooling, unless you put a new frozen ice pack on the skin every 5 minutes. Though massaging, compressing or coolant circulating dry therapies are more effective than the standard commercial ice pack, ice water immersion remains a far superior method of achieving deep tissue cooling.

So how does Cold Hosing fit into what we know? Rather than asking why, if you were anything like me, sometime around the age of 10 your trainer told you to go cold hose a swelling or wound. You stood impatiently asking if you were done yet, to which you were then told “No”! Another 15 minutes went by, and then you were finally allowed to stop. When you saw the improvement in the swelling, it never crossed your mind to ask again “why?”. Cold hosing has just become the thing that horsemen so frequently do. Although not as cold as ice, cold water still offers a significant cooling effect when done over long periods of time, while adding the benefit of massage, and in the case of a wound, the added benefit of rinsing away dirt and debris. There is little scientific evidence for cold hosing, yet scholarly articles cite the many benefits over and over again. The newer research points to the potential benefit of use of hypertonic saline (aka salt water) for use is the spa systems which provide massage, cooling and compression.

Something to keep in mind when considering all of this is the horses skin and soft tissue. We humans are not able to apply ice to an area, or sit in ice water for hours. Though cryotherapy is being used increasingly in human medicine, it is not through the use of ice baths, as our skin can not sustain the cold temperatures. There is a reason your horse can stand naked for hours in a snowbank and come in absolutely no worse for wear, or perhaps even better, while we would end up in the hospital. Our skin, circulation and tissue tolerance is VERY different. We often think, well – if it works for me – it should work for my horse. Sometimes this is very true, but in other cases our varied physiology makes the outcome very, very different.

There are negative side effects to over-cooling a tissue, however we know relatively little about this in horses. More recent studies in laminitis research have attempted placing acutely laminitic hooves in ice for 72 hours with beneficial effects, yet there are no studies in horses regarding what would happen to a tendon if you iced it for that long – which I think reminds us of our horse in the snowbank analogy.

Two things I will caution in this discussion: I have seen horses skin become irritated, and even get infections with significant use of these therapies. Although I think it is most likely that the legs that got infected remained wet and soggy, instead of being well dried and managed to keep the skin happy, this is a risk and something you should watch out for if you are using a lot of cold and/or hydrotherapy. The other thing to watch are the horses’ feet – we all know if we stand a horse in soupy mud for a month it will drastically affect the quality of the hoof. Keep an eye for signs of developing thrush, hoof softening, bruising and wall cracks. Your therapy may be limited by a horse with poorer feet or sensitive skin, and which reinforces that every treatment plan should be re-evaluated often, and monitored for potential side effects.

All in all, there is less good scientific proof than I would like to have backing me up on a recommendation I commonly make at least twice weekly, but based on the evidence that is out there, along with a significant amount of positive personal (anecdotal) experience, I will likely continue to strongly encourage the use of ice for the remainder of my career.

Don’t just take my word for it:

http://www.thehorse.com/articles/10456/the-power-of-hydrotherapy

https://www.ncbi.nlm.nih.gov/pubmed/25385194

http://www.thehorse.com/articles/14217/effects-of-cold-therapies

Kaneps, A. Tissue Temperature Response to Hot and Cold Therapy in the Metacarpal Region of a Horse,  Proceedings AAEP 2000, Vol 46, 208-213.

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Spring Musings With Dr. Dubé-Collum

With the last couple of months flying by, what was meant to be the April/May blog has now become the late spring blog!

With April comes heavy herd health season for us at McKee Pownall, and one of the main times of the year that we go get to see horses who are healthy!  We generally have scheduled appointments that are unhurried, and relatively low stress time to catch up with you on how your horses are doing. It’s a great time to touch base on how you and your horses got through the winter, to check on ACTH (Cushings) or insulin resistance (Equine metabolic syndrome) markers, to pull your geriatric or yearly blood profiles, and even get your coggins test done going into show season. We really do look at these appointments as a time to make a plan as to how to keep your horse healthy, happy and sound coming into to the main riding season. For future reference, if you would like to add a performance exam, time to talk about summer performance or geriatric horses’ needs,  please make sure you let the girls in the office know when you call to make your appointment so that we make sure we have enough time to chat and look at anything that may have developed over the winter months. Fall vaccination is not too far around the corner, so keep these things in mind if you are looking forward to fall check ups and winter show season as well.

In May, things really started to pick up in terms of performance and lameness. Palgrave started, and that gave us a whole lot to do! The May long weekend seems like a very long time ago now, and the last month has been a blur of performance medicine and lameness, breeding, and emergencies. It seems impossible that now it’s the beginning of July, and we are in high “horse vetting” season! All in all, it’s been a great couple of months. Although I could have done with a few fewer difficult emergencies, its been nice to see you all, and it is so nice to see you all settling in to tackling your summer horse goals.

As promised, I am going to share one more wound case with you this month. As we head into spring, people start riding more, horses start to feel good, or have herd changes and start kicking up their heels – with all of that can come injuries, and so I think it’s a good time to review managing wounds. So we’re going to do a little case based work to emphasize a few points.

“Princeton”

I was called a few months ago to see this horse who got to fighting with his turnout buddy. One good kick and the owner was presented with this!

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As you can see, this is a pretty yucky wound, and the owner was quite concerned with the amount of bleeding and the depth of the wound – as she should have been! This is not a “wait and see” wound. From the vet perspective, the trouble with this wound is that it is deep. It is on the radius – a common site for a kick (above the horse knee). You can actually see exposed bone in the deepest part of this wound with no soft tissue over top. The ligament and musculature structures are traumatized, and the bottom of the wound approaches the carpal (knee joint), and though it isn’t an old wound, the skin over it has already retracted significantly, and the skin layer is very thin. Overall, quite a few challenges to deal with – and a “school horse budget” to keep to.

First we assessed the carpal joint and distended it with sterile fluid to see if any of the fluid we injected into the joint leaked out of the hole. We do this to assess whether the joint has been involved – because if it has, the wounds severity and how we need to deal with it changes significantly. We were lucky and had no fluid from the wound! First good news since seeing this wound.

Next we had to make some decisions so we clip, clean and explore the wound with sterile fingers and probes to assess the depth of any dissecting tracts (dissecting tracts are areas that would normally be held together by connective tissue but with the trauma, the connective tissue has separated leaving an empty space where fluid loves to accumulate, create seromas and lead to infection). Because of the nature of the flap being so thin it will be difficult to pull it over the wound, and because its blood supply is poor, it will have a good chance of dying. Perhaps you ask “So why not just cut it off????!!!” Good Question! The answer is that pesky piece of exposed bone. Bone and air do not mix. Fortunately, this horse did not suffer a fracture with his kick, but exposed, traumatized bone is always a problem. There is a very high likelihood of a deep bone bruise (which compromises circulation), the risk of disrupted periosteum (the thin membrane layer on the outer surface of our bones) and risk of dirt and bacteria  being kicked right onto it. With that combination the potential for infection of a very large, very important bone in the horse is high. Infection can lead to sequestrum formation (a piece of bone which is separated from the parent bone by either trauma or infection which can either re-attach to the parent bone or the body will start to attack it as if it were a foreign body trying to expel it!), delayed wound healing and even catastrophic bone failure. So, we know going into the wound repair that even if we stitch this wound, that it may pull apart from the tension on the flap and the flap may die and later have to be cut off, we suture it anyway – because putting live tissue over bone is the best bandage we can offer.

So, we lavage the wound heavily with sterile saline, and placed a drain in the dissecting tract.  We then close the deep tissue layers over the bone and then with the use of “pulley” sutures and stents we stretch that piece of skin over the wound and place a pressure bandage. We treat aggressively with antibiotics and …………………………make a wish.

Day 1 (2)

This was a troublesome wound in the end. I did see it multiple times but we taught the owner to do full limb stack/pressure wrap and she texted pictures of the bandage change daily. The drain helped keep the flap close to the skin, and prevented pooling of fluid early on.  We radiographed the bone on the day we went back to remove the first stage of sutures (no bone infection! no sequestrum forming!) and continued on with bandaging and cleaning.

Part of the flap adhered normally to the underlying tissues and part of it died (it was pulled apart by the tension on it), but it had achieved its purpose of getting a layer of healthy tissue  grown over the bone again.

We later debrided the wound, and used manuka honey on it until the granulation bed closed. (Recent studies show that manuka is effective in fighting some infection and promoting wound healing, though the research in horses is somewhat variable, anecdotally, equine veterinarians have been having good results from its use on wounds and granulation beds).  Overall, we are thrilled with this overall outcome of this wound, despite the hiccups.

It took a lot of time, and effort on the owners’ part, but he recovered fully and is currently in prep for show season.

The take home messages from this wound are the following:

Call early: Seeing this wound early (within hours of it happening) allowed us to initiate treatment early, and gave us the best possible chance for a good closure.

Know what you are dealing with: a good assessment allowed us to know what we were up against, and allowed us to choose the best way to forge ahead. It also allowed us to prioritize our budget and make the most of our dollars. If there had been a fracture, or if the joint had been involved, we would have had to prioritize differently. Most importantly it allows us to prognosticate (give a good estimate of expected outcome), and predict and attempt to prevent possible pitfalls before they occur.

The owner’s diligence made all of the difference in the total outcome: She was careful and followed directions very well, reporting anything that seemed out of line immediately.  This horse didn’t need a vet to see him every day, he needed a good bandage, great wound care, antibiotics and to have his temperature monitored closely. Because the owner could offer all of this nursing care, she was able to keep the budget on the overall treatment low, without compromising in care.

Not every wound heals perfectly: despite out best efforts to manage them, wound repairs sometimes fail. It is as frustrating for us, the veterinarians, as it can be for the owners and the horses. However, in this case, because the client was quick to relay changes to us, we were able to adjust the plan to keep progressing in a net positive direction despite the many challenges this wound presented us. Though they sometimes take longer than we like, we are always happier with a good overall outcome.

We would like to thanks Princeton and Eagle Wing Ranch for letting us share their story with you all!

For more information on equine based research on honey for wound treatment you can see the following links:

http://www.thehorse.com/articles/28716/manuka-honey-for-healing-horse-wounds-aaep-2011

http://www.thehorse.com/articles/32515/honey-for-treating-horse-wounds

 

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March Musings with Dr. Andrea Dubé-Collum

March brought all kinds of interesting and exciting things to me, and the Nemarket practice. The March weather, save for a few fabulous days, was all Lion as far as I was concerned. So WET, and so COLD – combined! It’s odd that we got through most of the winter without any snow days and now, all of a sudden in March we are having ice storms, and thunder-snow. We all hope the clients got through all of the bad weather and power outages without too much trouble.  I’m very glad for the arrival of spring, and hopeful soon it will start feeling a little sunnier as the days go on, and continue to get longer.

Dr. Kathryn got home from showing and started back to work with us and we found out our tech Karen is pregnant (we’re so excited for Karen and Matt)! Last months wounds all continue to improve which is exciting, and perhaps, if they heal, we’ll have a couple of cool cases to share with you all next month (fingers crossed for continued smooth recoveries!).   One of our interesting wound cases was struggling so we chose to incorporate the use of sterile medical maggots to help clean up some of the necrotic (diseased or dying) tissue that we couldn’t easily access. Now, for the record, historically, I HATE MAGGOTS. If you call with a horse who has maggots somewhere, and I get called out to help, I will likely gag before I can get on with my work. That said, when it comes to garbage removal and cleanup, they are sometimes far better than any thing else we can offer.  Medical maggots need to be imported and shipped from California, so we were thrilled when they arrived alive, and delighted to see the improvement in the wound after they had done their work. See pictures and video below!

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Caution: Video Contains Graphic Content.

 

In very early March, myself, Dr. Melissa McKee, and Dr. Megan Waller attended a great weekend seminar from one of the worlds premiere lameness vets. Dr. Sue Dyson lectured for 2 days on lameness, poor performance and manifestations of discomfort in sport horses. It was frankly a very enlightening weekend, and a great warm up amongst the vets as show season gets ready to begin.

A great deal of Dr. Dyson’s presentation was based on the subtle or performance lameness (those tricky grade 1/5 or less cases) and there was emphasis on how different types of pain can be manifested behaviourally (i.e. bucking or resisting), but actually can be proven and/or fixed temporarily with regional analgesia (blocking). There were many discussions on the importance of blocking for identifying a source of pain – including the benefits and pitfalls of the procedure as well as a few Guru practice tips! For me, one of the biggest take-home messages was how different conditions exacerbate or alleviate a horses’ clinical lameness or discomfort, and how looking at horses under multiple conditions really can improve the quality of information we glean from our exams.

A few thoughts to ponder:

In hand, horses are seen un-obstructed by a rider, tack or harness (and/or weight), and thus lameness issues are noted as the horse moves freely.  Changing conditions (lunging, travel on hard or soft ground, placing a surcingle, and even placing a bit or side reins) can affect the horse in negative or positive way, and thus observing the horse in a variety of conditions can sometimes give us additional information. For example:  A horse who is perfectly comfortable to travel in a straight line and on a lunge line that then becomes uncomfortable and starts bucking or crow hopping with the placement of a surcingle. What might this be telling us? Lameness is sometimes easier to see in hand because a great rider, or certain riding conditions have the ability to make the horse look better than it truly is, while a poor rider, poor fitting tack, or even difficult conditions can make a horse less sound instead.

Under tack exams are sometimes preferred, as subtle performance issues or lameness cannot be detected with the horse in hand alone (regardless of the surface; straight line or circle) – That’s to say that the horse looks sound in hand. Sometimes there are performance issues present that the rider feels, which are not seen, or are only noted under specific working conditions (the horse that is consistently missing or is late in his left-to-right lead change or the horse who tosses its head travelling right, but only under tack). Sometimes the issue only presents itself when there is weight on the horse, when there is weight in the saddle or when contact is collected. Similarly, harness horses may not display problems in hand, but at high speed or with weight behind them, small issues become exacerbated and become more visible to the veterinarian.

The reality is that there are benefits and drawbacks to every condition we may choose to examine a horse under, and different conditions can help or hinder our exam. Sometimes, we may only see something clinically if the conditions are optimized to bring out the issue, and sometime, it takes work, and time to get to the bottom of these “less than grade 1” or “just not right” cases. As spring gets going, and we all start working towards our summer riding goals, it’s good to keep in mind how different conditions affect your horse and what that might mean for your horses comfort and health!

Happy Spring!

 

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All-Time Favourite

20120907-_MWP8577Let me start by saying that in most equine practices February is a slow month. This, however, was absolutely not the case this at McKee-Pownall in Newmarket. First of all, it was dentistry month, which means that the practice has a large list of horses who need their teeth done for our dental promotion. It’s a long list which at the beginning of the month seems to be never ending, but come the end of the month, it is a big relief to have that number of dentistries taken care of before we move into Spring.   All of us, as a result, have much stronger looking shoulders than we did at the beginning of the month, and there are many horses in the Newmarket practice area whose mouths are much more comfortable.

February was also busy with Dr. Surasky and Dr. Turner both away. Maggie had a baby boy, and Kathryn had a successful trip to Ocala while showing her mare CeCe. With only three of us here, and a steady flow of what we all consider routine work (dentistry and vaccines, etc.), all of the extras added up to make things faster paced – which is great, especially in a winter month.

For me, most of the add-ons were wounds. Many, many wound emergencies. Large and small wounds, over joints, in bursas, or with chips of bone inside. Fortunately, all of these patients are holding their own, and healing with the diligence of their caretakers (touching wood while I type this). Bandage material and Flamazine sales are at a high because of this.

This makes a great opportunity for me to discuss the wonder and “magic” of the less commonly known (and my personal all-time favourite) ointment – Flamazine. Where many of the ointments and salves we use routinely in horse care can be contraindicated under certain wound circumstances, there are few things you can keep in your tack trunk that are safe to put anywhere on a horse – Flamazine is your super safe, all round choice; from in the eye, to any mucous membrane surface, and on any skin surface, wound or granulation bed – you can’t go wrong.  Flamazine (otherwise known as Silver Sulfadiazine or SSD), is commonly used in human burn patients, and has good antibacterial properties. In horses, it is helpful in abrasions, cuts, and healing granulation beds. Unlike many petroleum based products, it tends to let the skin breathe while having good antimicrobial activity on staph, strep and pseudomonas (common equine bugs). After having to use it on a number of cases this month, I am reminded why I love Flamazine.

With the hours spent in barns with all of the dentals, and running around for emergencies, I was grateful for all of the warm weather we got. I have to say, I didn’t miss the snow at all, and am glad for the spring to be settling in.

Andrea Dubé-Collum, DVM

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Veterinarians keeping horses hydrated at Pan Am Games

Excerpt from the article in the Caledon Enterprise written by Matthew Strader talking to  veterinary Service Manager for the Games, Dr. Mike Pownall.

Talk baseball, and it’s Tommy John.

Hockey? Groins.

On the track, it’s always the hammy.

Every sport has a nagging concern. The notorious injury that plagues athletes, haunts managers and owners, and frustrates the health workers tasked with keeping the athlete on the field.

Funny, that in the horse world, the concern is the content of the one saying everyone knows. “You can lead a horse to water, but you can’t make it drink.”

Read Full Article Here

 

 

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