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.


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:




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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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Photo Album of the 2015 Pan Am Games: Equestrian Portion

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Three Day Eventing Prep

Although we are just days away from the arrival of Dressage horses for the first event of the Pan Am Games we find ourselves looking a week ahead as we begin planning for the most challenging week, the 3 Day Event competition. After a week of the dressage horses under our belts I am sure we will be able to handle the care and needs of an additional 50 horses that will be on site, so I am putting a plan in place to prepare the vet team for the cross country event. The 2015 Toronto Pan Am Games face a similar challenge that many countries that have hosted the Pan Am Games, or World Equestrian Games, and that is the Cross Country phase is at a different location than where the dressage and show jumping events will be contested. Our first challenge then is assembling an offsite vet treating area with all of our equipment and medical supplies. We will also need about 15 vets and the same number of technicians and students to handle veterinary care on course, in the D Box, and after cross country while we wait to go back to main stabling area at the Caledon Equestrian Park.

On the Tuesday before Cross Country we will have an emergency preparedness session where we will gather the veterinary team, the jump judges, the medical team, horse ambulances and numerous other volunteers and run through possible scenarios that we may encounter on course. We can’t cover every potential situation but we can train the teams how to think and respond collectively to whatever we may face.

To help instill a sense of the uncertainties we will face we will use a group of cyclists who will ride around the course with veterinary and medical scenarios on cards. The judges, vets and medical team will then respond to the situation written on the card in random places on course. They used this system at the Winnipeg Pan Am Games in 1999 and it worked very well.

The challenges are different for each support group. For example, the human medical team might not have any experience with horses. How will they respond if a rider has fallen and the horse is in close proximity? Its one thing to be near a calm horse in a stall, but it is another to work around an excited athlete. This reminds me of a classmate from veterinary college. He was the Canadian triathlete champion. We knew him in school to be very mild mannered, relaxed and calm; he made the Dali Lama look excited. Yet when I say him being interviewed after completing the Canadian Championship he was so intense that he would have made The Rock back off. Adrenaline changes every athlete so we will work with the medical team on how to work around an excited horse.

Meanwhile, the veterinarians have the opposing challenge in that we are used to dealing with horses in distress, but how do we work with the medical team as they treat a rider and we are examining the horse. We don’t want to get in the way of each other and we need to focus on the situation we have are facing and not be distracted by the other team.

The key to our preparation will be how well we communicate with each other. Most of our prep day will be ensuring we use the radios correctly, that we use proper terminology that everyone understands, and that we accurately describe a situation. The good news is that we will have several veterinarians that are very experienced with cross country events and they will be paired with experienced technicians.

My goal for the equestrian events remains the same: I want all of the vet team to be mind numbingly bored because if we are bored we have healthy horses. The one event that has the most potential to kick us into gear is 3 Day Eventing. With the right preparation we will be ready to deal with whatever we encounter. Hopefully, our training is for naught and we spend the day enjoying the amazing horse and rider pairs conquer a challenging course.



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Pan Am Games- Two Weeks To Go

In less than two weeks the first dressage horses will be arriving at the Caledon Equestrian Park to participate in the pan am Games and the list of things to do to prepare for them continues to grow. As the veterinarian services manager I am responsible for coordinating all of the veterinary care for the competing horses so this has required working with those responsible for bringing the horses to Canada, preparing bio security protocols, arranging for the many veterinary team volunteers and ordering the right medication, supplies and equipment to support the teams and their horses.

I have been very pleased by the generosity of 20 equine veterinarians and 18 veterinary technicians who are willing to volunteer their time to help. The Games have highlighted the close relationships veterinarians in Ontario have with each other. I hate to admit that the competitive nature of veterinary practice can lower the professionalism of some vets in other areas of North America but Ontario has a very tight group of vets that support each other. We also have 15 students from all across Canada who are using the games as part of their 3rd year externships. We had numerous clients and vet colleagues volunteering to billet the students but one student who lives in Ontario volunteered the nearby family cottage to host all of the students. Fortunately, they won’t all be there at once, but what a great experience for students to meet other students from the other vet colleges. One of this things I wanted to do when I was selected VSG was to offer as many voluntary opportunities as possible for students. When the games were in Winnipeg in 1999 Dr. McKee and I were fortunate to be student volunteers and the exposure to high level competition and the contacts we made with other vets were very useful as we developed our practice. We both wanted to make sure we gave back to students and we are fortunate that we are able to do so.

In the coming two weeks I will be arranging to have veterinary equipment set up in our portable vet treatment area before the final security sweep on July 5. There are numerous equipment suppliers that have generously loaned us equipment so we can offer full medical support to the equine athletes. We will have a full diagnostic laboratory supplied by Idexx for onsite blood and urine analysis along with expedited analysis of samples that need to be seen at their main laboratory in Markham. They are also loaning us their latest digital X-ray units so we can offer on site digital imaging along with a digital ultrasound supplied by Sonosite. This is all equipment and services we use in our vet practice so we are comfortable offering them to the competitors.

I’m also putting together a large order of medications and supplies to treat whatever situation arises. If we have a major problem or disease outbreak we will be using the Ontario Veterinary College as our referral hospital, but we hope we will be able to handle most situations on site.

Next week I’ll discuss the preparations that are going on for the cross country phase of three day eventing. This is when we will need the most support from our veterinary team so that we can cover all areas of the course. We will also have a temporary veterinary treating area at the Will o Wind site of the cross country event so we are having to juggle many responsibilities during eventing week. Stay tuned for more on this next week.

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The Process and Challenges of Importing Horses for the Pan- Am Games

quarantineI read with great interest last week the uproar over Johnny Depp bringing his two dogs into Australia without putting them into quarantine. It reminded of the efforts the veterinary team is doing to prevent the importation of foreign horse diseases into Canada. It seems that a large part of the preparation for the equine events  at the Pan Am Games is co-ordinating the import of foreign horses to Canada for the Pan Am Games. For those who travel to the USA with their horses it isn’t a big deal, but when we are bringing horses in from the Caribbean, Central and South America and Europe there are many more restrictions in place. The veterinary organizing team has been working closely with the Canadian Food Inspection Agency (CFIA) on the import and quarantine regulations for visiting horses. You might wonder what a food inspection agency as to do with horse importation, but the name is misleading since the CFIA is responsible for regulating the import and export of all agricultural products into Canada.

The challenge we face is that the USA and Canada share similar regulations for the importation of horses. Both countries are free of two disease in particular that some horses that will be competing might have. The first is Contagious Equine Metritis, a reproductive disease that causes fertility issues, and the second is Piroplasmosis, a tick borne disease that is prevalent in some part of Central and South America. Piroplasmosis can be life threatening to an acutely infected horse, but if they can survive the initial signs of infection they carry the disease but don’t show any signs of it. Like the border officials in Australia we don’t want to introduce foreign diseases into our country. Fortunately, both diseases only affect specific parts of horses, so there ability to exert themselves in competition is not putting the horse at risk health wise.

As a result of all of this the transport team that co-ordinates all of the arriving teams has been working with visiting teams to make sure arriving horses will be quarantined in the USA before arriving in Canada, or have a quarantine arranged in Canada to accommodate their arrival. On top of this the veterinary team has been working on a biosecurity manual that will instruct us on how to house the Piroplasmosis horses, how to inspect for ticks, and how to stable CEM horses so there is no risk of infecting other horses. Thankfully, these diseases are not easily transmissible to other horses,  nonetheless there are processes in place to keep these diseases out of Canada.

This whole process has been a great reminder of how integral veterinarians are involved in agricultural safety in Canada. It also shows how collaboration between different stakeholders is helping making these Games run as smooth as possible. Finally, it demonstrates that the global movement of horses brings manageable risks and that it is imperative that we remain vigilant to prevent the spread of foreign diseases into Canada. Johnny Depp bringing his dogs into Australia  might have seemed a trivial matter, but there is much more going on than meets the eye.


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Preparing For the Games at Rolex Three Day Event in Kentucky

Dr. Mike Pownall spent last week visiting the Rolex Three Day Event in Kentucky. Here he is sharing his experience in words, photos and videos as we prepare for the Pan Am Games.

In preparation for the Pan Am Games I spent last week in Lexington at the Rolex Three Day Event. I was particularly interested in seeing how Cross Country was run from the perspectives of general organization, and the care of the horses before, during and after the event.

I was overwhelmed by the generosities of the organizing and treating vets in allowing me to shadow them as they went about their duties. The scope of the veterinary care was incredible with 3 supervising FEI vets, 2 official treating vets, various competitor vets, and 17 vets with numerous students helping out on the Cross Country course. It takes a team for this type of event to work well and seamless communication was key to their success.

It has been awhile since I was up close to a 3 Day Cross Country course and my respect and admiration for the horses and riders grew as I walked the course Friday morning. I was exhausted after walking the 6 km course. Imagine galloping this while navigating the challenging jumps? Incredible.

Cross Country day featured torrential rain, which added another layer of complexity for horse and rider safety. Again, I was impressed by how well riders navigated the slick course. The event was overshadowed by the euthanasia of one of the horses because of an injury suffered at the end of Cross Country, but every other horse I saw in D Box following the course was sound and recovered well. As the day progresses you could see the care the riders took on course to minimize the risk to their horses. It was a display of phenomenal horsemanship.

One of our goals during the Games is to offer the best veterinary care to our equine competitors. After seeing the veterinary excellence offered at Rolex I am confident our team of vets, technicians and students will meet the challenge. Currently, we have 23 vets, 17 techs and 9 students who are volunteering their time to help!!

It is almost 2 months until the first horses arrive at the Caledon Equestrian Park. I’m looking forward to sharing more of our experiences as we prepare for the Pan Am Games. Let us know if there is anything in particular you are interested in learning about so we can share with everyone.

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Veterinary Care Well in Hand for Equine Pan-Am Games

The upcoming Pan Am Games are going to see some of the top equine athletes in the world in these parts, and they’re going to have to be cared for.

Dr. Mike Pownall, of McKee-Pownall Equine Services, has been named veterinary services manager for the equestrian events at the Games.

Excerpt from the Caledon Citizen, See full article here: Veterinary care well in hand for equine Pan Am Games

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