Buckeye Blog

A few weeks ago Pete and I were in a small backyard barn menagerie, looking at a horse with a healing laceration on her fetlock. Ducks were quacking, and an occasional cock-a-doodle would erupt from a rooster. There was a sudden flurry of feathers Colonel Sanders would have admired, and a big white chicken landed on Pete's shoulder. (We recently decided that the chicken must have felt at home on the down filled coat, or maybe thought she was visiting relatives there.)






This brought back a memory from years ago. At my original practice, we had an incredibly sweet and pleasant secretary named Karen. I've mentioned her before, noting her occasional naivete and the possibility that she needed to increase the volume on her phone earpiece. Karen handled most of the phone calls and scheduled the farm calls, much like our own Holly does now. This time, Karen set up an appointment for a new client, in a barn I'd never been to. Al (my assistant) and I left the Northfield office and wound up at a small stable about a half an hour away. The client was unable to be there, but Karen said we could easily find the horse because the owner said there was "a white chicken" on the stall. Hmmmm. Well, OK.

Al and I searched for a light in the gloomy barn, which seemed to contain ten or more horses in fairly close quarters. I can't tell you how many times I've gone into an unlit barn and can't find a light switch! So it was, and opening the door in the afternoon duskiness didn't help much. We quickly (unsuccessfully) scanned the stall fronts for the "white chicken", and went back to the truck for a flashlight.

A more thorough, torch assisted look didn't uncover a white chicken on a stall either. What were we looking for? A stuffed animal, like many owners leave for their horse? A white, chicken shaped paper name tag with the owners' information? A real chicken that had decided to roost in front of the stall? I went back to the truck to call Karen. (Remember, theses were the days of the "truck phone", before the communication world was attached to our hips.)

"No, she said 'a white chicken'  was on the stall door." Karen insisted. "Can you look again? I'll try to call the client."

Al and I went back in the barn and began to peer into each dark stall, hoping to find a chicken, or to identify the horse some other way. We were to examine a hind leg, but there was nothing obvious to see from over the boards.

Now we'd probably spent a half hour looking for this elusive white chicken... (They can be crafty and camouflaged you know...)

I heard the phone ringing from the Chevy truck and ran out to answer. Karen was on the line.
"I'm so sorry." she said. The owner said there was a white TICKET on the stall. NOT a chicken."
"A ticket? Like a speeding ticket?"
"No, no. Like a 3x5 index card."
"Uh huh. OK. We didn't see one of those either. We'll look again".

Did I mention that maybe Karen needed to TURN UP THE VOLUME on her phone?

I finally found the "white ticket". It had apparently fallen off the stall and had been partially covered with hay in the dirt aisle way. It would have been a lot easier if things had looked more like this...

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Our veterinary practice (for readers not familiar with the territory) is in a beautiful area. Geauga county has gently rolling hills with good farm land and large areas of forest. The region is one of the highest producers of maple syrup in the country. Nearby Middlefield has the 4th largest Amish community in the world. Amish residences are easily identified the by plain white houses with no electric wires running to them, and unadorned concrete block barns with buggies parked outside. The simple folk reject modern technology and anything flashy. Colors of fall here are astounding, with gold, scarlet, and mustard shades twirling down, piling up, and crunching under your feet. Winters are covered with thick layers of fluffy white, and cold weather sports are popular.

Last week, Pete and I were headed to see a pony at our first call of the morning, a farm out in Montville. Traveling north of Middlefield, the open fields mostly shorn of their crops, we could feel the chill of late autumn. Approaching the address, an interesting view appeared. The homeowners had built a baseball diamond, with a backstop near the road, and a 220 foot fence around the outfield in the front yard. Aggressively decorated for Christmas, a plastic Santa in his sleigh had been positioned at home plate, wielding a wiffle ball bat. Plastic penguins covered all three outfield positions, as well as first and second base. Rudolph (the red-nosed reindeer) was in ready position at short stop. Third base had no one securing it, and there was no catcher.

Now as a retired, extremely amateur baseball coach, I see a problem already. You can get by without a catcher, but all three infield base positions should be covered! Let the penguins play left and right field, shaded toward the middle, and let the second base penguin play deep to help cover shallow center. Rudolph should be quick enough to help cover second base and shallow left field! I don't think chubby old Santa can hit it too deep anyway!

The backstop was thoroughly strung with Christmas lights (obviously nothing was lit at this time of the morning), which extended all the way around the perimeter fence. Spotlights were placed to extra-illuminate the internally lighted "baseball players". The driveway had lateral stakes which were also strung with lights, all the way to the house on the right, and the barn on the left. We slowly drove up the approach, taking in the large images of Santa and Frosty (the Snowman), haloed by rings of colored lights, hung on the house and the barn. Twisted vine reindeer stood near the sidewalk, waiting for darkness to start their sparkling lamps and nodding heads. A large snowflake made of lights dangled near a tall Christmas tree created from spirals of purple LED rope lights. Undeniably, these clients took great pride in creating a substantial display for everyone to enjoy.

We rolled to a stop between the house and barn, and continued to survey the decorations.

That's when Pete spoke up:
 "Are they Amish?"

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Caution: Contains graphic images of lacerations that those who have weak stomachs may want to avoid viewing.


Late August 2011: Our intern is getting her feet wet and building confidence by covering emergencies and seeing some cases on her own. As a new veterinary school graduate, your knowledge level is very high, but limited practical experience leads many to get an extra year of mentoring and hands on work through an internship. This Friday night, she's getting quite an adventure.

RING! RING! I answer the phone to hear a concerned but calm young veterinarian. "I'm out at (insert client's name) and Grace is hurt pretty badly". Grace was a good sized, green broke, opinionated mare. She'd been born at the owner's farm.
"What happened?"
"Well, apparently she crashed into the split rail fence. Somehow she impaled herself. A rail entered her left lower neck and came out of her left shoulder."
"Holy crap!" I said, obviously concerned. "How bad is she bleeding?"
"Not that badly. I think she missed her jugular vein, but I don't know how!"
We discussed options: try to close the lacerations or refer to the specialty hospital. She decided to send Grace in.
It was a good decision.

Grace had dislodged the entire rail from the post, ramming the sharp end through the muscle mass, and dragged the 8 foot piece of wood around the pasture until it worked its' way out and fell to the dirt.

The surgeon on call explored the amazing wound and found that, incredibly, the jugular vein, carotid artery, and vagus nerve were all narrowly missed. If the vein and/or artery had been torn, Grace would have exsanguinated (bled out) within a few minutes. I've seen the results of this, and it's awful. After clipping and cleaning the wound, she could place a sterile gloved hand all the way through the tunnel as she lavaged with large amounts of saline. Due to the heavy contamination with dirt, hair and wood fragments, the only option was to leave it open and allow it to heal "from the inside out".




 After several days of hospitalization with aggressive antibiotics and cleaning of the wound, Grace went home. This left her owner with the unappetizing job of daily hosing through the tunnel (removing thick ropey aggregations of serum and pus) and long term oral antibiotics. Vaseline was spread from the edges wherever skin-irritating serum was draining (and there was a large amount of it). Insects were very active, so Scarlet Oil was used around the area as a repellant. This explains the red greasy appearance in the following pictures, taken two full months after the injury.
                                   View from the front.

                                       Left shoulder

It seemed that the gaping holes would never heal, even with the owner's tenacious diligence, cleansing the area every day.
Out of the blue (can it really be out of the blue after four months of treatment?) the tissue began to close, narrowing the tunnel. At the time of the following image, the hole had closed, leaving the skin to finish the job. 

    
As the internal flesh grew together, I had a concern: the shoulder lesion was drawing the front edge of skin inward as it healed, curling it down into the diminishing hole. If this continued, the actual edges of skin would never meet and it would not heal. I would possibly need to resect the turned in portion of the skin. In consultation with the surgeon, we decided to allow more time before cutting.

This was the right decision. The underlying tissue continued coalescing and pulled the skin along with it, edges touching and mending. Taken in mid February 2011, these pictures are almost six months after the traumatic split rail incident.






Grace is a testament to the amazing healing ability of our equine companions, as well as caring, persistent owners and dedicated veterinarians. For such strong, powerful animals, they can be incredibly fragile (ie. colics and fractures), yet remarkably resilient.

Of course, sometimes it helps to have a little bit of luck, too...

Grace has gone into training, and the injury does not seem to have left any ill effects. Here she is this summer: if you look closely, you can see the indentation in her shoulder.

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A crisp, sunny, fall weekday seemed to be going along pretty well. I was working at Northfield Park racetrack with my assistant Al when the call came in. Over the truck phone. The phone attached to the dash, with a significant number of wires running under the drivers seat, connected to the Dodge's battery and a permanent antenna mounted through the back window. Aaah. Those were groundbreaking days of cellular technology. Not quite as demanding as the digital leash that is constantly attached to my hip (with a terribly "unhip" holster. Pagers are passe as well, I understand from the fashionable set.)  The office was calling to say there was an emergency in Chesterland, a horse with a stick in its' groin.

"A what?" I asked.

" I'm just telling you what she said", Karen, our sweet and occasionally gullible secretary replied. "She sounds panicky on the phone."

"OK. Where am I going?"

"Well, the horse isn't in a barn. She's out in the woods, on a trail ride."

This was not sounding good.

We parked the truck across the street from the stable in a lot of a large warehouse that bordered a wooded area. As we gathered medication and equipment, a very concerned woman met us and promptly led us down a trail to two horses and their upset riders. The petite Arabian mare stood stock still, as the other horse casually nuzzled her owner, and then the ground, looking for grass amongst the colorful, crunchy leaves. Birds chattered in the trees overhead, apparently aware that something was amiss. An Arab mare. This was definitely amiss. Arabs, as you know, have a reputation for being a little, shall we say, flighty. And, mares... well, you know.

 As I checked the mare's heart rate and mucus membrane color, Marcy, the Arab's owner, introduced herself and shakily described what happened. "We were just walking along the trail, following Clyde here, when Jubilee just stopped. She refused to move, and when I got off, that's when I saw it". By this time I had gotten a look underneath her: a branch, about three inches in diameter, was jutting out of her inguinal region, having entered to the right of her udder. About four inches was protruding at a slightly downward angle, with a small amount of blood trickling from the tip. "Oh crap!" I thought. At least I think it was my inside voice. Where does this go? How deep? From the inclination of the tree limb, I was inclined to believe it might not just be in the horse's limb. The mare was surprisingly calm, although I thought she was a little shocky.

"Well, before we remove this stick, I need to do a rectal exam. I need to see if it has penetrated into her abdomen." A little tranquilization was in order (for the horse), and I put on a sleeve and lubed up my arm. Jubilee stood, quiet and cooperative. Carefully, I swept my hand across the inside of the pelvis, and advanced forward, afraid at any moment to feel the splintered wood that would mean a terrible ending. Horses do not tolerate abdominal infections well. Peritonitis means an almost certain death, and with a filthy, fragmented branch piercing into the belly, euthanasia would be the only option.

"Whew." I breathed a sigh of relief. "She feels fine inside. It must have torn up into the muscle of the thigh. How the heck did she do this?" Al hiked back to the truck for more supplies as Marcy and I pieced the event together. Apparently, there was an old, narrow tree lying across the trail, covered by leaves. The lead horse had stepped right over it, and Jubilee had the misfortune of stepping on it with a front foot. This caused the trunk to roll forward, lifting the jagged branch extending from it (under the horse) into the air and targeted at her crotch. Jubilee walked into a harpoon she had aimed at herself!

There in the woods we placed an IV catheter and began running fluids to her, not knowing how much blood she would lose when the skewer was removed. The inguinal region has blood vessels with names (meaning they are big enough to be important!), as well as nerves and lymph nodes. This is potentially a very bad place to have a piece of wood rammed into. Marcy held the horse and the bag of streaming fluids as Al and I cleaned the skin around the branch, and I contemplated my next move. We had a needle and suture material on the needle holders, ready to go. Finally I gathered my courage and pulled on the wood. It resisted for a second, and then began to move. The length that had been driven into her was astounding. At least nine inches of tree finally dislodged, leaving a deep, ragged hole gushing large volumes of thick maroon blood.  Al was unrolling brown gauze and I was packing it in the chasm as quickly as I could. Starting at the bottom of the laceration, I threw in continuous sutures, with blood pouring through the gauze, out over the top of my stitches. Finally, with the end of the gauze protruding from the top of the wound, I put in a couple single sutures to tighten the repair. I could pull these later to ease the removal of the gauze. Red rivulets continued to stream down Jubilee's leg. I was glad we were still running IV fluids to her as she was a touch unsteady.

Banamine had already been injected IV, and an IM tetanus booster, so we started two different broad spectrum antibiotics, aware that she must be heavily contaminated. Slowing the blood loss was vital, but the wound could not be scrubbed or lavaged. The hope is that the bleeding provides a flush of debris and potential infectants. It would be up to the antibiotics and Jubilee now.

When Jubilee appeared stable, we gingerly led her back towards the parking lot where a horse trailer awaited to take her to her stall in the barn across the street. She was incredibly calm, and although she was out of the woods, she was definitely not out of the woods. 

                                           Al with the perm, and the stick.

That day and over the next few weeks, I gained a lot of respect for this resilient, stoic little Arab mare. We pulled the packing the next day and began to flush the wound on a regular basis. I waited for Jubilee to get a raging infection or become toxic, but her fortitude wouldn't allow it. No wonder Arabs consistently win endurance races: they're tough! She had a large amount of swelling and had to be uncomfortable, but was amenable to whatever we needed to do to her. As her body filled in the cavity and her muscle healed, it was evident that this horse would recuperate fully.

I continued to see Jubilee in routine situations until the owners moved, taking away one of the bravest animals I've treated.

Jubilee's gone.

But I've still got the branch!

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Emergency weekends. You never know what you might get.

Two Saturday mornings ago, I was on my way to Kody's cross country meet in Glen Oak: I had made it as far as Northfield (my old stompin' ground!) when I was jarred back to reality by the ringing cell phone. The trainer sounded quite distressed. "Our old guy, Randolph, must have gotten his left hind leg stuck somewhere. He's three legged lame, won't bear any weight on it. We could barely get him out of the field and into the barn."
"I'll be there soon", I said, and turned the truck around in a deserted bank parking lot to head for Novelty. This was a different kind of cross country.

"You look different" the trainer said as I walked in. "Really?" I said. "I'm wearing khaki cargo shorts and a buttoned short sleeve shirt." The only difference from a routine workday was the length of pants... and my scary, luminously pale legs.

I found Randolph in quite a bit of pain, surrounded by several concerned women. A long, tall, skinny Thoroughbred, Randolph was around 30 years old, and like many cantankerous old men, the ladies doted on him. He had a history of a stifle problem in the left hind leg, and was old enough that a pelvic fracture would not be beyond the realm of reason. He would barely touch his toe to the ground, and would have spastic episodes of lifting the leg high and to the outside, trembling with discomfort.

Hind leg lamenesses and injuries can be extremely difficult to isolate, as the hock and stifle must move together due to the stay apparatus. As quickly as possible, I pushed around Randolph's hip and gluteals, and moved to his stifle joint and then the hock. Looking/feeling for anything abnormal: swelling, bruising, pain, grating of bone, joint capsule enlargement. Nothing exciting.  He had an abrasion running down the inside of his cannon bone and a small cut on the inside front of his coronet band. It could just be pain from the trauma and the puncture wound in the middle of the cannon scrape. (The hole was significant enough that air had been drawn up under the skin, making a small gurgle when I ran my hand down the area.) I decided to block (numb) the lower limb to be sure that the issue was not from the hock up. Randolph's owner had arrived and threw herself into the fray, alternately caressing his head and peering over my shoulder at the damaged leg.

Attempting to get the needle near the nerve below Randolph's hock proved to be more than he wanted to tolerate, so some IV tranquilizer was in order. Blocking just the inside portion of the leg made a world of difference. Randolph would rest his limb on the ground as I scrubbed the worst looking wound, inside cannon. Strapping on my handy-dandy headlamp, I put in a couple of skin sutures to pull the small hole together, still unconvinced that this was why he was so agonized.

Approaching the relatively small cut at the coronet band, I told the gathered throng that I didn't think I could pull it together. Frequently the skin can be sutured to the thin fibrous part of the upper hoof, but this cut looked as though some skin had been torn away leaving maroon tissue exposed. As I began to clean the area, something about the tissue felt wrong: instead of soft flesh that would yield to pressure, it was firm and dense. With a pair of old needle holders, I began to pluck at the top of the dark red, firm mass, and small pieces pulled off: wood.



Right. It was a piece of wood, about an inch wide, maybe a third of an inch thick, and somehow it was wedged down into the foot. "I think this is why he is so lame!" I exclaimed.  Immovable, no way to get in behind to grasp it, the only way to extract it was to remove the hoof over it. Goodbye sterile surgical instruments, hello hoof knife!

Paring away at the hoof below, the fragment was gradually being exposed. With an inch of hoof wall gone, the tenacious shard was still unbudging. At this point, Randolph's owner, feeling stressed, announced "I need a Xanax. Anyone else? They're in my car..." Although tempted, I declined. I went to my truck for something that might relieve or escalate my anxiety: the Xray machine. (Xanax and Xray. Never thought I'd use so many "X"s in one paragraph.)



As seen above, the radiograph disclosed the length of the extra large splinter: at least another inch was buried in the hoof. Nothing else looked awry, so it was back to the hoof knife.



A while later, Xanax apparently working its' magic and my hoof knife dulled after chipping away at the foot, I worked a scalpel handle (no blade) behind the offending lumber and wiggled it to gain working area. With enough space to get behind it, using a large, curved surgical clamp, I grasped the wood and pulled it out.


The wood... and a scary, luminously pale leg

Now the coronet band and hoof is very vascular. There is a dense web of vessels that encircle the top of the hoof, and the soft tissue inside the foot hemorrhages with a touch. Without the intense pressure from a slab of board smashed into the lamina to dam up the flow, the deep maroon ichor of life... er, blood... came rolling out onto the floor. This was not unexpected... by me. A surgical nurse among the observers could not overcome her training. She jumped into the melee to doggedly apply pressure with gauze. If I'm ever bleeding on a surgical table, I hope she is there!

Hopefully, some gushing of the vital fluid was useful as a "flush" to remove leftover debris. I went to the truck to get bandage material, and wrapped the foot in layers, convinced that it was going to bleed through whatever I put on it.

Cleaning up, I overheard someone describing the incident that led me there. "He was out in the pasture and then it was all: Crash! Bang! Squeal!"
"Crash, Bang, Squeal." the trainer said. "That's never good."

Emergency weekends: a lot of Crash! Bang! Squeal!
...and not in a good way.

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It's a simple task: give the horse an intramuscular injection. A vaccine, Adequan, dose of hormones, it really doesn't matter. I approach the stall, syringe in my pocket, or maybe behind my ear. The horse casually glances my direction as I sweetly call its' name. "Hey Buttercup. How ya doin'?" Buttercup's recognition factors kick in (VET!), and as I fumble with the gate latch, she swings around to face the opposite direction. I'm left peering at her rounder extremity. The one with no halter. "Her head's on the wrong end" as my old assistant Al used to say. This has obviously added a level of difficulty.

Somehow Buttercup and I need to come to an arrangement.
What are my options?

1. The "Impending Doom"
I walk into the stall and play the "my butt is in your face and you can't catch me" game. This involves a precarious two-step dance as I try to somehow avoid being in the kicking zone while Buttercup chooses different corners to put her face into. The mental part of this game is telling myself "You have a superior intellect. You can outsmart her", while proving just the opposite. The game is almost over when you are trapped in a corner and Buttercup starts to take aim.

2. The "Command".
"Hey, Buttercup! Come here!"
It's possible that I receive a contemptuous sidelong glance. More likely I'm ignored.
"Buttercup! COME! HERE! NOW!"
This technique is equally ineffective when used on dogs and children.
Her stubborn defiance is usually followed by:

3. The "Idle Threat".
"Buttercup, if you don't drag your sorry self over here right this second, I'm gonna come in there and give you a shot!" (Reverse psychology!)
At this point, she is intently studying knot holes in the corner.
"Dagnabit Buttercup! You're making me angry. You wouldn't like me when I'm angry!" (an Incredible Hulk reference, sure to strike fear into her heart.) Buttercup is so full of dread that she glares at me and cocks her hind foot, making her own threat...
Time to move on to:

4. The "Psych Out".
I open the gate, move away, and nonchalantly ignore Buttercup while standing in the aisle. My body language says "Oh, is this door hanging open with no one watching? I hope a horse doesn't slip out undetected!" When Buttercup thinks she can sneak through the gate, I snatch the halter. This only works if she is wearing the halter. If not, I try:

5.The "Turn Out".
Opening the gate with one hand, I hold the halter in the other, being sure not to give any indication that I am entering the stall. I hold up the halter outside her door, so Buttercup can see it, and say "Are you ready to go outside? C'mon, it's time to eat grass!" If that doesn't grab her attention, I try "The flies are sleeping in this morning! Better get out there before they wake up!" As she comes to the door, visions of clover in her eyes, she may even put her head right in the halter.
This loses its effect if Buttercup has already been outside.

6. The "Bribe".
If I resort to this, I've almost exhausted my "superior intellect". It doesn't take any creativity to get a scoop of grain and appeal to Buttercup's most basic instinct. No, not hunger. Greed. It doesn't matter if she's just had her favorite meal, she'll still be interested.
Back and forth we go: as I extend the scoop, she stretches her neck towards it, I draw the grain back before she can get a bite, and she gets a little closer. Maybe I hold the halter between her and the grain so she has to put her head in it. When she is near enough, SCORE!

A dangerous variation of this is the "Between the Bars/Over the Wall Grab". With the grain poured loudly into her feed tub, she can't resist a quick bite. As she darts into the tub, the awaiting hand shoots "between the bars/over the wall" and seizes the halter. This can go terribly wrong when the startled Buttercup flies to the opposite corner, smashing the stubborn grabber against the bars, dislocating a shoulder and bloodying the forehead/nose. Fingers are raw and smoldering. For some reason, this technique is rarely used more than once.

A very satisfying modification of the "Bribe" is crinkling paper that "sounds like a mint" to attract the bribe-ee. (I am the briber.) The gratification comes after you catch her, when Buttercup realizes that your "superior intellect" has fooled her. BWAHAHA! (Evil Laugh). No treat existed. This is closely related to the "Spiteful Bribe", where grain is used to lure and capture your quarry, but is dumped back into the bin while the vanquished Buttercup watches, feeling hungry and recognizing your superior intellect.

7. The "Deceiver".
There is no way Buttercup will come to the eeeevil veterinarian, so I send in someone she likes. This trainer/owner/groom/rider/traitor then gives Buttercup up. This is the safest way for me to catch a horse, since I am not involved at all! Some level of distrust may occur if this happens repeatedly, so in its ideal form, different "deceivers" are used as often as possible.

A variant is to send in a complete stranger. This works well with veterinary students, interns, externs, or people innocently walking by the stall. Anyone gullible enough to walk in and nab Buttercup will likely be successful, as long as it isn't me.

8.The "Blowdart".
Used by wildlife conservationists, zoo veterinarians, ninjas, and the Choko Indians of South America (with poison frog juice!), this would be a viable alternative. Unfortunately, Buckeye Veterinary Service does not currently have access to a blowgun. With my luck, the horse would buck and flip the needle out, and I'd watch it tumble through the air and plunge into my thigh.

I could probably use a dose of Adequan, though.

The amusing part is, for all the rigamarole to catch Buttercup, she barely flinches when I inject her. It's all anticipation.
Or maybe, it's all a game: Buttercup testing her superior intellect...

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Sploosh. Sploosh. Oh, sorry for the noise: I think I'm waterlogged. My boots are leaking and my socks (and therefore my feet) are wet. Even with a raincoat on, the moisture rolls down the front of my pantlegs and seeps in around the hood and arm seams, leaving wetness like terribly unfortunate sweat stains. I've got permanent raisin wrinkles in my finger pads, you know, like when you've been soaking in the tub for too long. Everyday I come home with mud splattered up my pants and a storm cloud hovering over my head.

The newspaper says this is the second wettest year in the last century. During March and April, we had snow or rain for 54 of 61 days. It's made cold, gray, depressing work days, a sloppy Kentucky Derby (one jockey was wearing nine pairs of goggles), and has contributed to horse shows having bad footing, or even worse, being cancelled. Many of us are feeling flat out sapped and dispirited. Besides that, my truck, Casco, is consistently dirt and mud covered.

High school baseball hasn't fared well in this weather either, especially Solon's JV team, which my son Jesse plays for. The number of postponed and cancelled games totals 30. A few Thursdays ago was to be one of the final games of the year: it was likely that Jesse would be the starting pitcher, and I was committed to getting to the game.  Although I had made it to a few games, several previous attempts had fallen victim to emergencies or busy days. It's part of the business. Holly had tried not to over-schedule me so I could be  at Hudson High School by 4:30PM. Pete had some personal appointments, so I was on my own.

The sun was blazing overhead, steaming up the air with humidity from the saturated soil. When you've not seen the sun in weeks, even a broiling hot, sweaty day lifts the spirits and is cause for smiles and good cheer. Things were going well: no time consuming, day mangling emergencies; no complicated, improbable cases; no farm call lengthening "Hey Doc, while you're here could you look at something else?" The sky was clear as I drove toward my last call east of Middlefield. Looking good!

My GMC truck "Casco" has been pretty reliable, compared to the Ford diesel it replaced. I've had a dead battery once (I think we had a short in the Bowie unit's electrical circuit that drained it), and the tires don't have much traction on slick roads (I used 4 wheel drive more than ever this winter), but otherwise a dependable vehicle. Recently, those tires have started making a little noise: "THRUM....THRUM.... THRUM..." that wiggles the steering wheel a little. On our way back from the Andrews Osborne Academy a few weeks ago, cruising down Interstate 90, the thrumming was loud enough that Pete commented "I hope we don't blow a tire again. Especially not here. That would be too weird".

(New readers, or memories that would like to be refreshed, see the Buckeye Blog "WHY WEDNESDAY MADE ME TIRED...").
Did I mention that Pete might be psychic?

 "I'm thinking that we need to get these tires rotated and balanced." I said optimistically, glancing at the odometer. (Boy, did that sound familiar.) "They've got less than 30,000 miles on 'em."
"Which one do you think is making the noise?" Pete asked.
"I don't know... I feel it in the steering wheel. What do you think?"
"I think it's the left hind." (We wouldn't say "driver's side, rear". Think of it like a horse!)
It would be nice to make it through to the fall, and then get some tires with a little better traction for the winter. It would be nice...

 I left my call east of Middlefield at 2:20 PM, needing to drop off bloodwork quickly at the office and having plenty of time to get to Hudson. The sun was shining gloriously, and all my windows were open with the sweet smell of Middlefield in the spring blowing in. You know, road apples ripen in the heat. Cruising west on Route 87, I was feelin' it.
Feeling that vibration in the steering wheel. "THRUM... THRUM..."

"SHRIIISH, SHRIIIISH, SHRIIIISH!"
It sounded like all the stacks of papers in my truck were suddenly swooshed up in the vortex of a tornado and were flying out of my right hind window. Startled, I looked back over my right shoulder, and realized my heaps of paperwork had NOT blown away. (Dang it. I guess I still have to fill out those forms.) Hmmmm. I wonder what that noise could be?

I pulled into a big, unused driveway and assessed the damage. Yep. RIGHT hind tire blown out. (Didn't Pete predict the LEFT hind? I guess maybe he's NOT psychic!) Metal fibers from the steel belt stuck out in multiple places and there was a large hole in the center of the tread. This was the fifth blown vet truck tire I've had in 20 years of practice. OK. Time to get down the spare. I found the jack under the back seat (moved the xray boxes, ultrasound case, extraneous "stuff" and a mountain of paperwork), with the wedges for the tires to keep the truck from rolling away when up on the jack. Truck rolling away: that would be bad. The black clouds crawling in from the northwest could be bad too...

The spare came down from under the truck without a hitch (HALLELUJAH!) and I proceeded to change the tire. I stuffed the flat (and everything else) into the backseat, and brushed the dirt and gravel off of me from crawling around under the truck. By now I'm sweating pretty good in the hot afternoon sun, and am a good 45 minutes behind. The storm was passing to the north, and baseball was to happen in the south. It's still good.

I started the truck and pulled forward, rolling over the wedges I'd placed in front of the tires.

Quick stop at the office, GPS the fastest way to Hudson High School from Burton, and FLY. Hmmm. The southwest sky is getting a little dark as I roll on four sound tires. Well, at least the spare should be solid.

As I pulled into the parking lot at the field, I noticed that it was fairly empty. Cars were pulling out with Hudson uniformed players. No Solon bus to be seen. There were amazingly large, angry, charcoal colored clouds covering the sky, a nasty wind whipping around, and a pretty pyrotechnics show from the lightning. Here comes the rain again. By now, I'm guessing there is not going to be a baseball game. It's not good.

Since then, we've replaced two tires, and I've threatened to replace my son who didn't call to tell me the game was cancelled. Casco ran pretty smoothly for about three days after the two new tires, and then I started to get that feeling again: "THRUMMM... THRUMMM... THRUMMM..."

I wonder what that noise could be?

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There are two "infections" commonly associated with a horse's frog. The most common is thrush, previously discussed here. Canker is much less common, and much more challenging to treat. It's interesting that both of these are also names for human mouth abnormalities: thrush is a yeast infection most often seen in babies' mouths, and canker sores are oral ulcers associated with consuming acidic citrus products.

Canker may look somewhat like thrush in its' early stages, but can start anywhere on the frog. While it was originally thought to be a problem only in draft horses, it can be seen in any breed. It can be found in any (or every) foot. The specific cause has not been determined, although some have speculated that a bacterium is responsible. It does not correlate with a wet environment, and is not contagious. It may start out as an off white to grayish area that becomes obviously different from the rest of the frog. If left unchecked, canker will continue to proliferate (grow), sometimes getting a cauliflower like appearance. It can grow out into the sole and even push its' way through the hoof wall,  destroying the normal architecture. Deformed/damaged hoof will not provide normal support, and will lead to discomfort. Lameness can result, as the abnormal tissue can be sensitive, and it will bleed very easily if aggravated.  An odor may or may not be present. Diagnosis may be aided by a biopsy, but most often canker can be identified by its' typical appearance.

When asking veterinarians and farriers about treatment, you will find dozens of answers, with none being 100% successful. Dr. Stephen O'Grady from Northern Virginia Equine is looked upon as the "expert" on canker, as he has an approach that tends to work. Therapy in the early stages has a higher chance of cure, as large, proliferative masses are difficult to control, and damage to sole and hoof wall can cause structural imbalance in the foot, causing further problems.

To treat, the foot is properly trimmed, nerve blocked (numbed), and a tourniquet applied. (This procedure will bleed profusely, making it impossible to see the structures without controlling blood flow.) The canker and surrounding frog is surgically removed (using a hoof knife at first, and a scalpel blade as you progress) until you come to healthy, normal looking tissue. I must admit, in the feet I have treated, this demarcation is not as obvious as I would like. Canker in the central sulcus that extends deeply up into the heel bulbs can be challenging to get to, and much of the support provided by the frog may be removed during the surgery. This horse will be on long-term stall rest while he recuperates.

When all the canker has been removed, cryotherapy is applied to the remaining tissue. (Freezing, using liquid Nitrogen or inverted cans of  "Dust Off").  Hopefully, this freeze will kill any remaining canker cells. A topical solution is employed daily for an extended time period. I have used a combination of DMSO, metronidazole, and Tetracycline. (This combination smells nasty, thereby making it more effective!) Dr. O'Grady uses a benzoyl peroxide/metronidazole mixture.

Sometimes hospital plates are used to protect the feet, but, depending on the case, leather or plastic boots can be effective. The frog will grow back slowly, beginning to "cornify" (become more recognizable as horny frog) in about a month. There is always the chance that it could reoccur and need further attention. Be ready to invest some time, effort and money if you are going to treat canker.

Last fall I was presented with a horse that had canker in all four feet, which was sensitive enough to make him lame. We treated the front feet as described above, and two weeks later, treated the hind feet. We lost the fall show season, as expected. Watching the frogs grow back, we monitored areas of suspicious tissue, aware that we may need to re-treat. Over the course of 7-8 weeks, normal frog appeared, sensitivity went back to normal, and we put him back into work. Recently he has competed successfully in the local hunter rings and seems to be fully recovered. Early recognition and treatment is very important.

Remember that your horse needs a dry stall to stand in, and exercise to promote healthy feet. Clean his feet everyday and watch for discoloration of the frog and sole, and for the black, foul smelling debris of thrush. Any strange appearance to your horse's feet should be evaluated by your farrier, and possibly your veterinarian.

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She's just what her name implies: a sweet, little bit of honey brown pony covered in fuzzy chestnut hair.  In her late 30's, she's been an important part of the family for many, many years. She sometimes stands with her front feet parked out, chronically footsore from founder that's been resistant to any treatment or medication. Her blacksmith has tried multiple styles of trimming/shoeing, and her veterinarian (yours truly) has tried any number of medications, all to no avail. Some days she moves around pretty well, and others are a challenge to leave the stall.

Through it all, Carmella always has a trademark nicker whenever anyone comes to visit her: it's not often that a patient is happy to see the vet! She has a love for living, and her owners love her. They are acutely aware of her "quality of life", and she seems happy even though she has painful feet. Carmella has a good appetite, is doted upon daily, and is left to wander where she wants: she frequently wants to wander outside to the sunshine.

In mid January, Dr. Agle saw her on a Saturday for an ulcer on her left eye. It's likely that some sawdust was caught in her eyelids and rubbed the cornea. It was a simple, small, round ulcer in the center of the eye. Flourescein stain proved that at least the top layer of the cornea had been removed. Typical treatment for a simple corneal scratch is oral Banamine (nothing is better for eye pain and inflammation) and topical antibiotics four times a day. Diclofenac, a topical non-steroidal anti-inflammatory (the same active ingredient as "Surpass") was also added.

I re-evaluated the eye on Monday, and it still picked up the stain, but the center of the ulcer had a gray, gooey appearance. By the next day, Dr. Kartley determined that the ulcer had perforated the cornea: the eye had ruptured.  The iris (the colored part inside the eye) had  pulled forward and plugged the hole, seen as a small brown spot in the center, keeping the eye from total collapse. The cornea was gray from the inflammation: large numbers of white cells and inflammatory agents were being sent there to help the repair.

What to do? It was not an easy decision. Carmy was in obvious discomfort and the application of ointment was almost impossible: you couldn't touch near the eye, let alone get the lids open. That's a problem when medication needs to be applied six times a day! Carmella had a catastrophic, painful injury with very little chance of vision in the eye IF it would heal. Between this, her chronic laminitis and advanced age, there was some discussion as to whether this was all too much for her to bear. Options included removing the eye (enucleation- when the eye is gone, the pain is abated), placement of a subpalpebral lavage system, or euthanasia.

After careful consideration, Carmella's family decided that she had given them so much, and they needed to give her a chance. We would place a subpalpebral lavage (SPL) system to treat the eye. Subpalpebral (under the eyelid) lavage (wash or flush): A special tube is placed through the upper eyelid and attached to the head to keep it from moving. It is woven through the braided mane and capped, allowing the owner to inject medication into the port, dripping it out onto the cornea, without touching the eye or surrounding sensitive tissue.

Three days after the rupture, we assembled a team for the SPL placement. (OK, it was anyone who could get there and wanted to see it done, but we WORKED as a team.) The skin was cleaned and we blocked (numbed) the upper lid and the cornea and pushed the large trocar (basically a needle) with the lavage tubing in it through the uppermost part of the lid. It is placed high up in the "fornix", the fold of the conjunctiva, to keep it away from the sensitive cornea. After the tubing was pulled through, it was sutured to her forehead and poll to keep it in place, and pulled though the braided mane. After capping it, we tested it with saline and found it worked perfectly: the fluid ran out over the eye, without touching the eyelids, or even her head! Her stall window was covered (light is unpleasant for an eye injury), and a fly mask put on to further protect the eye and the SPL.


This is several days after the SPL was placed. You can see the thick yellow/gray on and behind the cornea. The brown spot in the center is the iris poking through the hole.


 Here is the SPL tubing coming out of the upper eyelid. It is sutured to her head through the tape on the tubing. Note the partially closed eye and drainage onto her face: pain causes increased tear production and reluctance to open the lids.


At the end of the tubing, sticking out of the mane, a green cap is apparent. This is the port where small amounts of medications (an antibiotic, an anti fungal, and diclofenac) are injected six times a day. Although labor intensive, Carmy's owners diligently treated the eye every four hours.


24 days after the eye had "burst", you can see pink granulation tissue trying to heal the breach. The conjunctiva (inside the lids) is still very red and angry looking, and grayness covers a large portion of the corneal surface.

Luckily, we had no kinks or tears in the tubing, and Carmella tolerated it well. She seemed less painful very quickly, and happier, since we were not trying to touch her "boo boo" anymore. She was becoming her old self again.

After several weeks of treatment (and a lot of interrupted sleep for the gracious owners), we decreased her treatments to four times a day, and later to three times.


Two months after the injury, the margins of the eye have cleared and brown iris can be seen. The vessels have grown in from the margins and are providing a healing supply of blood. The conjunctiva is no longer  an irritated red, and the eyelids are wide open. Unfortunately, she has no vision in the eye, as the pupil cannot open. (The iris that makes up the pupil is adhered to the cornea: remember, it was plugging the hole and keeping in the fluid.)


About half of the cornea is clear enough to see the iris. Over time, the blood vessels should recede and leave Carmella with a dense white scar where the original ulcer was, and likely a whitish film that extends from it.  The SPL was removed just a few days after this picture was taken: over two months from the initial injury. We are trying (carefully) to get the pupil to dilate (open) using topical atropine (which she does not object to having put in her eye, now that the pain is gone). Hopefully, this will be able to break down the adhesion inside the eye

In a miserable situation, we were successful in providing comfort and saving the eye itself. Currently, Carmella is functionally blind in this eye, but if great care and love from her owners, (and a little help from the veterinarian) can find a way, she may regain some sight.  I continue to check on her, and look forward to that happy nicker when I walk to her stall.

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PRP: no, no it's not alphabet soup. It's one of the newer treatment options for equine injuries: Platelet Rich Plasma. As your veterinarian, it gives us a potent weapon against career altering injuries. As sport horse owners, it gives your horse an improved prognosis for returning to competition. At Buckeye Veterinary Service, our lab has the newest equipment to prepare this treatment for your athlete.

One benefit of Platelet Rich Plasma (PRP) is that it is an "autologous" product: that's "vet speak " that means it is made from the horse himself.  This reduces the chance of reactions, since no "foreign" material is used. After a surgical scrub, blood is drawn from the jugular vein of the injured horse into an anti-coagulant. That blood is centrifuged and processed and a specific portion is removed for use: Platelet Rich Plasma. This condensed component of the horse's own blood is full of platelets (hence the name) and at least ten different growth factors: it's been described as a "soup" of growth factors (NOT alphabet soup). These growth factors stimulate cell growth and healing, promote formation of new blood vessels, and can help make a fibrin matrix (a scaffold for repair).There are likely benefits that are still unknown...

There are several uses for PRP. It is injected into degenerative joints (arthritis) to help heal cartilage, and used topically during surgery over bone or soft tissues. Non-healing skin wounds may also respond from application of PRP. In humans it is being touted as a cure for baldness! (Injections under the skin of the scalp. OUCH!) In the horse world, we most often think of it as a treatment for supportive soft tissue (tendon or ligament) injuries.

Damaged superficial and deep digital flexor tendons, suspensory ligaments, collateral ligaments, etc. are common causes of lameness. A gradual return to exercise over many months is always the recommended "treatment". Nothing is a substitute for time, (8-12 months is the standard recovery period), but PRP can give a better final result.

After the PRP is harvested from the horse and prepared in our lab, we are ready to treat. (This is all done in a single day.) A needle is guided into the lesion(s) with ultrasound and PRP is injected. The growth factors go to work as rudimentary fibers are quickly laid down, eliminating the "holes". At 30 days post injection, core lesions (black holes) will typically be filled in. These simple strands have little tensile strength, (so you cannot put the horse into work just because it LOOKS good) but they allow healing to occur with straighter, more parallel fibers. This makes the end result stronger, more elastic, and less likely to re-injure. The beneficial effects from PRP injection may last 30-60 days. Shockwave therapy can be used in conjunction with PRP treatment to help with fiber alignment and healing. (We have a new focused shockwave generator that is ready for action.)

The ultrasound images below show a dramatic improvement in a horse with both a superficial digital flexor tendon (SDFT) and a suspensory ligament (SL) injury. Cross-sectional (transverse) images are on the left, longitudinal views are on the right. What you would like to see is a dense, white tendon or ligament, representing tightly packed, normal fibers. Here, abnormal areas can be seen in the "before" pictures. The SDFT has a large area that is less "white" and on longitudinal image, the fibers are cross-hatched and not parallel. The suspensory has a central black hole, a "core lesion". Thirteen weeks after Platelet Rich Plasma injection, damaged areas are more dense and the hole is filled in. Fiber patterns are more parallel and consistent. This is a remarkable change.

Remember, time and a gradual, controlled return to exercise is essential for tendon/ligament healing. However, PRP is a valuable tool for maximizing the quality of repair.

    INITIAL SDFT INJURY                13 WEEKS POST PRP

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Ms. Orslover is excited. After a long winter, a warm spring sun is shining, and she's going to be able to spend A LOT more time with her best equine buddy "Sparkles". Sparkles is excited too. He's been stuck in his stall due to snow and rain, and it's been difficult to keep his "house" dry. Even when he was turned out, since there was no grass, he typically waited at the gate to be brought back in, standing in the slush or mud.

As Sparkles is lead into the aisleway from his stall, Ms. Orslover notices a "bad step". Hmmm. Yes, he continues to get off that foot quickly. Ms. O clips Sparkles into the crossties and lifts his leg. She can't see much: his foot is packed full of manure and urine-soaked sawdust, clear up to the level of the shoe. Grabbing her handy-dandy hoofpick, she digs into the mass (which falls out in an oval puck of muck) and then pokes the tip of the pick into the crease alongside the frog. OUCH! As the pick goes deeper than Ms.O expected, Sparkles yanks the foot away and slams it to the ground, getting her britches dirty and barely missing her brand new paddock boots. On further examination, the creases that make the "V" shape around the frog are much deeper than normal and full of thick, black grunge. The center pocket of the frog is soft, looks "chewed up", and the black goo continues down into the heel. In addition, the area aggravated by the hoofpick is bleeding!

 These deep crevices and the depression near the heel at the center of the frog are known as "SULCI" (plural): pronounced "sulk-eye". Just one of them is called a sulcus. So Sparkles (and most other horses) has a lateral (outside), a medial (inside), and a central sulcus in each foot.

As Ms. Orslover is pondering the latin root of the word "sulcus", and wondering if she will be able to impress her friends by using it in a sentence at the next PTA meeting, something terrible happens: she smells that black, oozy substance that came from Sparkles' foot. UGH! That's nasty! Smells like rotten, infected, putridness. And now it's on her hands and pants. And guess what: that odor won't come off with even the most vigorous hand washing.

Ms. Orslover and Sparkles are the victims of an insidious, potentially lameness causing infection, commonly known as "THRUSH"!

                    


While not life threatening, this mixed infection with bacterial, yeast, and fungal components can cause chronic lameness and chronic aggravation. Afflicted horses typically have moist soles (likely from a wet environment) and frequently are narrow in the heel with a recessed frog. This conformation doesn't allow the frog to make consistent contact with the ground, so the heel doesn't expand and contract to allow debris to fall from the foot. Often these horses have been stall-bound and have not had the opportunity to run and send the "hoof packing" flying.

                         
This foot has thrush that has undermined deep into the central sulcus causing it to appear shredded, and it is working its' way up between the heel bulbs.

If there is only thrush in one foot, it may be because the horse has been bearing less weight on that hoof due to discomfort. This can cause the heel to contract and the frog to recess, thereby making it more likely to retain debris and moisture.

Treating the thrush infection is simple enough: expose it to air and remove the moisture. This can be easier said than done. The frog can have multiple undermining tracts that deeply penetrate. Any overlapping tissue needs to be removed until the depths of the blackness has been uncovered. The medial and lateral sulci need to be opened up and cleaned, as typically a lip has developed that shelters the infection in the bottom of the crevice. Your veterinarian or farrier can trim away infected and eroded tissue with a sharp hoof knife. Your job is to clean the foot well, with soap and water and a toothbrush (or other appropriate scrubbing device), and dry it before applying medication.
                   

There are many topical treatments, but they all are products that potentially kill bacteria/fungi and dessicate (dry) the tissue. Due to the caustic nature of many medications, great care should be taken to limit exposure to the frog and sole: the coronet band and skin would likely be chemically burned, or at least, very irritated. Your hands should be protected as well as these liquids can stain and aggravate your skin: wear gloves. In most cases, I use cotton soaked with 7% Iodine, and pack it into the sulci. Wrapping with vetrap and ductape, the owner changes the dressing every day for a week. Most likely the affliction will be cleaned up by then. If the black, foul smelling goo is not resolved, be sure that the eaten away frog is cleaned up, and try a different topical product (following label directions). White Lightning, Cleantrax, Kopertox, and Thrushbuster, just to name a few, along with any number of other home remedies. Please consult your veterinarian and/or blacksmith prior to using a non-brand name product.

After the initial problem is cleaned up, twice a week application of medication is usually sufficient to keep thrush at bay. Use a syringe or a pointed bottle tip to get it into the cracks, and again, be careful not to get it on your horse's skin. Another method is to wrap the tip of your hoofpick with a thin layer of cotton, soak it with the treatment, and squish it into deeper areas.

If the degradation is deep enough to penetrate into sensitive tissues (like Sparkle's bleeding foot) a tetanus vaccine is in order, and systemic antibiotics may be recommended. Your farrier may be able to improve narrow heels and deep frogs by trimming back the heels, applying a larger shoe, and placing frog supporting pads to help provide more normal pressure. In the perfect world, the frog should contact the ground with every step. This is also easier said than done! Remember, shoeing changes may take time to work, and any lameness issues should be addressed. If the infected fissures and clefts are not laid bare, cleaned, and decontaminated, the thrush will not be beaten.

Ms. Orselover begins to clean Sparkles' soles everyday. Her blacksmith trims out the compromised frog, and she treats the foot topically for seven days. With a concerted effort to keep the stall clean and dry, and judicious use of ductape, Sparkles' feet are soon sparkling. No more foul, repulsive, odor clinging to her hands and clothes! Sparkles is happy and Ms. Orslover is excited to be able to ride again!

 

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You need a zamboni to get out of your driveway, if you can get past the kids playing hockey on it. Your horse's coat either looks like you'll need a Bush Hog to get through it, or you haven't seen his coat because he's living under three heavy blankets and a Sleazy Jammie hood. Your truck (like mine) is covered with two inches of gray grime consisting of road salt and dried grunge, and icicles hang like frozen fringe from the fenders.

BUCK UP! SPRING IS COMING! (As evidenced by my video link of ice breaking up in the Chagrin river last week).


Soon all this snow and ice will be a memory, and you'll be riding outside in the sunshine, cursing the bugs and the heat. Now is the time to prepare your horse for the increased activity by signing up for one of our Wellness Programs.


"What is a wellness program?" you ask. What a great question! Wellness programs provide your horse the best opportunity to remain healthy throughout the year by having exams, vaccinations and de-worming in the appropriate seasons. Take the confusion out of specific products and timing of treatments when you enter a program and pay one low price. Our goal is for you and your horse to have a happy, healthy, fun year. We contact you when your horse is due, and schedule at your convenience.

 March is the big spring kick off. Anticipating more physically demanding exercise, travel to shows, and exposure to other horses, now is the time for a thorough physical exam (including ophthalmic (eyes), heart and lungs, and dental checks). You receive a "grade card" with vital information (like temperature, heart rate, and weight) and any abnormalities or concerns noted during the evaluation. Before the mosquitoes start biting and spreading disease, vaccines for Eastern and Western Encephalitis (EEE and WEE) and West Nile Virus (WNV) will boost your steed's immunity. In case of a cut or puncture wound, Tetanus antitoxin is needed to prevent that horrific, deadly, Clostridial infection. We also do a fecal exam for parasite eggs, and de-worm your horse.

While every horse is unique, most of our patients can be divided into two categories, which we have labeled "Performance" and "Pleasure". Both have the same basic exams, vaccines, and de-wormers. "Pleasure" horses (those not in intense training or shipping) are visited twice a year (spring and fall) with vaccinations divided between the calls. Splitting up the vaccines allows for a better immune response and is less stressful to your barn buddy. Rabies, Potomac Horse Fever, and an intranasal Strangles vaccine are given in the autumn.

"Performance" horses are typically on the go, taxing their immune system by traveling and showing, and being exposed to sick or "carrier" horses. Any horses who do not travel, but are stabled with those who are, are at increased risk as well. Influenza and Rhinopneumonitis (Herpes) viruses are the primary causes of illness/respiratory disease in these athletes; biannual intranasal Flu and additional intramuscular Fu/Rhino vaccines are an important part of their Wellness Program. All vaccines are separated into four visits, one each season. A Coggins test (for Equine Infectious Anemia) required for interstate travel and many shows is also included.

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It seems that we all have times when things don't seem to go our way. It seems to run in streaks. Apparently, this is true for horses as well.  This is the recent story of "Tyler" (the name is changed to protect the innocent).

On a regular weekly farm call, Pete and I had a significant list that we were working through. Typical abnormalities and concerns: lamenesses,  hairloss, skin crusts, respiratory infections, etc. It was our last stop, and we'd been working there for a couple of hours. I could feel the end of the day approaching, ready to head home for dinner, when a trainer approached. "Hey, before you leave, I need you to look at Tyler's knee. I think he was kicked earlier today." I've been Tyler's vet for a long time: he's a good old chestnut hunter, whose unfortunate owner has not been able to ride him for years. Fortunately for Tyler, other people are willing to ride him to keep him in shape and keep his mind active. This shouldn't take very long: probably just some bruising and swelling. A little Bute and cold water will probably handle it.

We pulled Tyler out of his stall and I watched him walk to the grooming area. No lameness noted, but there was a cut or abrasion on the front, upper, outside part of his left knee (or proximal dorso-lateral carpus, for those of you who enjoy "vet-speak"). While the extent of the injury was undetermined (due to hair covering it), there was a significant amount of clear(ish) fluid running down his leg from the wound. At this point I'm feeling a little paranoid.

"He came in from the pasture late this morning with this." the trainer said. "The lady who rides him came in early this  afternoon, and called me about the cut. She didn't think it was much, so she worked him. I almost forgot to have you look at him."

I carefully clipped the hair from the area, and now it was obviously a full thickness laceration (not a superficial abrasion). Now I'm getting a little concerned. Bute and cold water are not going to be enough.

With sterile gloves on and a sterile pair of hemostats ("clamp") I explored the wound. It went "up and in". What was coming out on his leg was probably joint fluid. A wound penetrating a joint is potentially a very bad thing. Infection and its' associated inflammation causes severe damage to cartilage, thickened synovium (joint capsule), excess joint fluid (poor quality), and extreme pain/lameness. They can be incredibly difficult to cure, and can lead to euthanasia of the affected horse.

To be sure the upper knee joint was compromised, we scrubbed it up, and I put a needle in the joint. Drawing back on the syringe, you should normally get joint fluid: this time I pulled out blood and blood clot. As I pushed sterile saline into the joint with a syringe, it was running out of the laceration. Now I'm really worried.

This horse had a traumatic kick (painful in itself), with the joint damaged (and open! Ouch!), and he'd been ridden, put through his paces, and he was still not lame. Wow. Now that's tough!

"Tyler needs to go to the referral hospital as soon as possible." I said. "This joint needs to be flushed and he needs to be on potent antibiotics." The owner was contacted, and luckily, Tyler had medical insurance. I gave him IV Banamine and antibiotics, wrapped up the leg, and sent him off.

The following day, arthroscopy was performed at the hospital, exploring and flushing the joint, debriding and closing the cut, and wrapping him up. The cartilage had no damage from the kick, and the surgery went very well.

I removed his sutures about ten days later, and the skin had opened up: a highly moving joint always has a hard time healing skin as it tugs and pulls. No problem: it will granulate in over time ( I know, vet-speak: it will heal with some "proud flesh" closing the wound ).

  The wound after sutures removed.

Next problem: the wound started weeping serum.  Serum looks exactly like synovial fluid, so I had to test the integrity of the knee again. First we did an ultrasound exam of the area, which looked pretty good. Then, putting a needle into the joint and forcing in sterile saline, the joint capsule distended, and Tyler grew uncomfortable. The joint was not compromised, and I withdrew the saline. Whew! Nobody wanted to return to surgery.
The bandage had already caused an ulcer over the accessory carpal bone (on the back of the knee), so we had to keep the wound covered creatively.

Scabbed ulcer from bandage pressure. A common problem with wrapping knees.

 After fourteen days of serum leakage (causing him to be stall bound to keep the knee from moving) it was apparent that it was not healing on its' own.  After consulting the surgeon, I placed a small polypropylene tube under the skin, up into the small pocket, and injected a very small amount of 7% Iodine. My idea was to chemically cauterize the oozing tissue. It took two treatments a few days apart, but the seeping stopped, and the skin closed. My concept seemed to have worked! Tyler went back to work, sound and happy.

Then, two weeks ago, Tyler came in from turn-out with another injury: a kick to the forehead. 0ver the phone, the barn manager reported that he had a head tilt and his eyes were not moving normally. A possible brain injury: I needed to get there as soon as possible! Pete and I jumped into Casco (my white GMC truck) and sped to the farm.

After a quick physical exam and neurological evaluation, I determined that Tyler was "normal", (other than two lacerations high on his right forehead). To be proactive, in case of latent brain swelling, I gave him IV DMSO and Banamine. Nothing is quite like the smell of Di-Methyl SulfOxide. Within minutes of intravenous dosing, the potent anti-inflammatory is penetrating most tissues (including the nervous system) and the patient is tasting it, and exhaling that familiar odor throughout the barn. Some think it smells/tastes like garlic, and some lucky folks are genetically unable to "appreciate" it. (The following day a horse owner came in the barn door, said "UGH, DMSO! I can't stand it!", turned, and left!)

We tranquilized Tyler (since for some reason he was reluctant to have his head touched! Hmmm. Kicked in the noggin, cuts, throbbing headache maybe?), clipped, scrubbed, and blocked the edges of the cuts. Since the lacerations were shallow, I used skin staples to appose the edges. As you can see, Tyler looked great.

Staples. Notice my swell non-braiding of his forelock. Stylish!

With little train tracks across his brow, Tyler probably could still hear the locomotive whistle from the "train" that hit him. (Or maybe little birdies flying and tweeting around him like a halo. It happens in cartoons!)

Tyler did very well: no exacerbation of the neurologic signs, acting bright and normal, and eating well. Four days later we saw Tyler again. Mount Vesuvius was about to erupt on his forehead! A large pocket full of purulent exudate (that's PUS, if you do not enjoy vet-speak) had accumulated under the "V" shaped laceration and had created a mound, as if poor Tyler was trying to grow a unicorn horn.

Clip and scrub as you may, fairly often equine injuries get infected. Debris and bacteria is deposited deep in some wounds, and undermined areas trap seepage and provide a wonderful environment for microbiological growth. Imagine the bacteria: they had just been in some fecal material, or maybe in the crevice of a hoof, and now they're lounging in a small hot tub of serum, (around 100 degrees F), protected by the skin (repaired by the vet) with plenty to eat, and not a care in the world. Kind of like being at a full service resort. No wonder they have the inclination to multiply!

 As I applied the staple removers to the bottom-most staple, Tyler tossed his head, loosening the staple and the tip of the flap, and the thick, yellow (slightly stinky) discharge splooshed down the right side of his face. Taking out two staples opened the flap enough to flush the pocket with sterile saline and insert some antibiotic. After systemic antibiotics and a few flushes and daily antibiotics in the wound, Tyler looks pretty darn good. He's well on his way to being "normal" again.

A run of bad luck, right? Let's consider.

 In the traumatic carpal(knee) injury, Tyler could have fractured a bone, had extensive cartilage damage, or had a severe, resistant joint infection that could have led to his demise. Imagine if he'd stumbled and fallen on the knee while he was being ridden: arena "footing" ground into an open joint! Instead, he had a longer layup than normal, but is sound and back to work.

With the kick to the head, he could have fractured his facial bone, with shards penetrating his frontal sinus. His grey matter might have been concussed to the point of severe neurological problems, including seizures and ataxia (Sorry: vet-speak again. Ataxia means not knowing where your feet are going causing you to weave/wobble around) not to mention eardrum and eye injuries. The subcutaneous infection was easily cleared, not "flesh eating" bacteria!  (Imagine flesh eating bacteria at an all inclusive resort. THAT is frightening!) Also, Tyler had insurance to help cover the medical bills. He's in a stable that provides high quality care and astute observation.  Maybe most importantly, Tyler has an owner (and trainer) who loves him.

I think he's a very lucky horse.







 

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So, faithful readers (and confused first time readers), this is the last post about my vacation. My next post will definitely be about veterinary medicine. Probably. Most likely. Indulge me for the moment, and let me bring some sunshine from my vacation into these COLD winter days...
 
So far, my family's Caribbean cruise had started out chilly, but we had an excellent, warm, educational outing to Tulum on Wednesday. Thursday morning was beautiful: temperature in the 80's, sun shining, blue skies. The four of us were the only ones to ride on the outside of the tender to Belize City, and we enjoyed the sun and sea spray.

                                                        Kody on the tender
We boarded a bus and settled in as the guide told us about Belize. Backpacks held a change of clothes, as we were headed to "cave tubing". I know. It sounds exciting: underground river, rapids, stalactites, bats!

Houses in the city were mostly run-down and once we were in the country, it didn't look much better. Tin roofs, partially completed shacks, and junk in the yards were the norm. I was surprised and saddened by the poverty. This part of Belize was not quite what we expected.

                                                          Belize home
Our guide was Garifuna, our bus driver was Creole, and some of the other guides were Mestizo and Mayan. A fascinating blend of cultures make Belize a "melting pot" (sound familiar?). We also learned that there are "Geman" communities in Belize: Mennonite, Amish, and "mechanized" Amish. (I wondered if the mechanized Amish used machinery, or if they were actually robots. Or bionic!)  The surprise mention of the Amish made me think of home and our practice.

Many buses were parked at the site for cave tubing. A lot of people. We piled out of our bus and onto an old school bus for a bouncy trip up and down a steep hill, the wheels hitting huge ruts and throwing us around. Quite entertaining. After being fitted with our life vests and helmets with headlamps, we trekked through the jungle with our new guide, carrying our green inner tubes, learning about the plants, trees, people, and wildlife of Belize. It was then we learned about the woman on our bus who after we arrived at the cave tubing site, claimed she was sick, and wanted to go back to the ship. (We were a 45 minute ride from the dock.) Members of her family in our group were critical of her performance. She had suddenly become "ill" when told there could be bats in the caves! Apparently she's deathly afraid of them! Afraid enough to feign sickness and waste an entire day of her cruise.  But really, who would have thought that there would be bats in caves?? And wouldn't you expect to be in a  cave if you are going cave tubing?

Sitting our backsides in the tubes, we linked feet under armpits, and the eight of us formed a 2x4 train, pulled along by our guide. The water was quiet and not too cold, and we were in a cave right quick. The "party" behind us really was having a party: whooping, hollering, splashing made it hard to hear our paddling guide, and distracted from the surroundings. As we came out of the first cave, more groups from a different service poured themselves into the river. It reminded me of Cedar Point. In the middle of the jungle. Without electricity. And no roller coasters.

Interesting Mayan history was shared as we took in the caves. Occasional rock formations passed slowly by. "Butts up!" We were going over the shallow rapids. Ummm. Maybe "rapids" isn't the right word. Ripples, or murmurs, or tinkles, maybe. Low water, slow water.

So, it wasn't the exciting, thrilling, dangerous expedition I had hoped for, but it was educational and fun. NO BATS! Darn it!


                                               Jesse and me in the tube train

Somewhere underground, feet and backside soaking in the river, my throat started to get sore. Now remember, I auditioned to be Elvis in the "Carnival LEGENDS" Show on Saturday night, in the Ivanhoe Theater. It's fairly typical for me to get stressed prior to a performance and psych myself into a sore throat, so this was no surprise.

Thursday night's show was called "Far From Over", a tribute to the '80s, an era I remember very well. The highlight of the show was the two break dancers, who spun and flipped and whirled all over the stage. The songs, costumes, and dancing were perfect copies of popular videos: Madonna, Michael, Janet, Cyndi Lauper, Dirty Dancing ("I     had     the time of my life...."), it was all there, for better or worse. Very well done! ( No Sir Mix a Lot, though. How disappointing. No tribute to the "80's should be without the classic: "I    like   big    butts and I cannot lie...")

Friday was supposed to be the best day, weather-wise: mid 80's and sunshine on Isla Roatan in the Honduras. I'd been trying to plan our last excursion for days, agonizing over zip-lining for an hour and a half, or going to a beach where we could snorkel, swim, rent wave-runners, play on the beach, etc. We had missed our only beach opportunity on Monday since it was canceled due to cold, windy, weather. With no helpful input from the family (despite frequent pointed and  frustrating questioning) I finally decided we would just go spend the day at the beach. Tabyana Beach was a beautiful place, highly recommended by several people we spoke to: crystal clear water, white sand, snorkeling at a nearby reef, water sports, etc. Since I'd had all of about an hour on the ship's deck with my shirt off in the sun, I was looking forward to the gallon of sunscreen I'd require to prevent my pasty white skin from sizzling into something resembling pork rinds. Maybe Stephanie could apply it to me with a paint roller...

I slept badly, edema taking over my throat, making me snore with my mouth closed, and every swallow felt like razorblades. This was NOT psychosomatic.

Friday morning, New Year's Eve, we were up and at 'em, bathing suits on, SPF 10,000 in hand, when the captain announced that, due to windy conditions, we would not be able to dock. We would be heading back to Miami instead of visiting Isla Roatan. An additional "Fun Day At Sea"! Yippee. The boys ran off with friends, and Stephanie and I made the best of it, going to "Name That Tune" and Music Trivia Contests.
Seven days at sea on a caribbean cruise, and NO BEACH!

I'd been given an MP3 player with the "Jailhouse Rock and Hound Dog" medley to practice with for the Saturday night Carnival LEGENDS Show. My throat was pathetic: raw, painful, no high range, and cracking. Pretty. I practiced, mostly in my head, and thought about what I would do on stage. Worry and concern was setting in. That always adds to the enjoyment of vacation.

The New Year's Eve party was fun; free champagne for everyone, a very good Motown singer with the ship's band, and a switch to live TV from New York to watch the ball drop on the huge screen on the Lido deck. Everyone was dancing and having a good time, and it was pretty warm for midnight. Welcome 2011!

Saturday. The day of the Carnival LEGENDS Show. My throat was terrible. We had rehearsal at 10:00 AM. A dancer was assigned to each of the nine of us suckers, uh, audition winners, and they would get us the microphone, take us by the arm, and guide us to where we were to stand (on a white tape X, center stage. Don't move around TOO much, because there will be dancers behind you!). The woman doing Aretha Franklin was very good, although caucasian. Actually, the guy doing James Brown was white, too. And the woman doing Gloria Estefan was African-American. No typecasting here! We accept anyone who has no sense, er, guts enough to do this!

The costume was typical '70s Elvis: sparkly white "jumpsuit" (actually pants and a high collared shirt, pinned up to fit anyone), big sparkly belt (with velcro closure in the back), ridiculous wig with sideburns, and to top it off, the big gold sunglasses he made famous (only plastic).  All of the costumes were kitschy, but pretty accurate. We laughed at one another and had fun with it. After rehearsal, I purchased Dristan Cold and Sinus, and began taking them as frequently as the directions allowed.

College football on New Year's Day! Not so much. Very limited. I watched Michigan State play a little, and went out on deck to see the Rose Bowl in all it's glory on the big screen. The sun was going down, and even with a sweatshirt on, the wind was too cold. Steph and I went to watch it in the sports bar. The Big Ten crashed and burned in the bowl games. Ugh.

The Carnival Legends Show! Somehow I made it through. My voice wasn't up to par, but not horrific, and I remembered enough Elvis type moves to get by on stage. After the show, still in costume in the lobby, a nordic sounding gentleman eagerly approached me. "Are you professional"? he asked. "Uh... no. No I'm not." I replied. "You were great! Can I get a picture with you?"
"Uh, sure." I said uncomfortably. His wife (who had the most unnaturally red hair I've ever seen) took a couple of photographs (I did a little smile with the curled lip), and I said "Thank you. Thank you very much" in my most Elvisy of voices. As I turned, his wife said "I want a picture too!". As I posed with her, I thought, Elvis was so amazing, even someone doing a bad impersonation can be popular!

They gave all of us a (surprisingly poor quality) DVD of the show, which I am not willing to release to the general public, but is good for a laugh. Even sick and stressed, it was fun and worth while. Talking with the dancers, seeing backstage, and meeting the other "Legends" was a hoot!

                 The King and Stephanie

Sunday, we left the ship (carrying our backpacks full of coats and Saturday's clothes) and ventured into Miami. I had left all of  my tattered voice on stage the previous night. Every word was a searing pain with a hoarse whisper. I was reduced to communication by sign language, and since I don't know sign language, my pathetic flurry of moving fingers usually were met with laughter or bewilderment. We took an airboat tour of the Everglades (I'd love to drive one of those things!) that was fun, even though the airboat pilot threatened to leave us in the middle of the 'glades if we all didn't tip her. I flashed some sign language at her.

                                               Airboat in the Everglades

After that, I took my talents to South Beach, where we had a late lunch and did some people watching. Wow, what some people wear!  Or don't wear! One very bronzed, late middle aged, guy, came flying through the crowd on a bicycle, wearing nothing but a very small, very high cut bikini brief exactly the same shade of suntan as he was. At first glance, he appeared to be naked. Even the other "unique" folks gawked at him as he hopped off and back on his bicycle, narrowly avoiding plowing over people. Quite entertaining.

Our plane left Miami at 8:00PM, and we opened the door to our house at midnight. Back to work bright and early Monday morning, voiceless, tanless, and I still haven't finished reading my book.


                               South Beach. Is that LeBron in the background?

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OK, let me recap. My family is on vacation. On a Carnival Cruise Ship ("Valor"), and we've just cruised out to open water. The first night was a flurry of unpacking, exploring the ship, having a nice dinner, and meeting the "crew" in the Ivanhoe Theater. (Pretty awesome theater, with suits of armor in strategic places, coats of arms, and a lot of red velvet.) Our cruise director was called "Goose", short for Gustav. He seemed entertaining, but who can live up to Julie McCoy? (A "Love Boat" reference. Come on... you remember Captain Steubing, Gopher, Doc, and Isaac the bartender, right? No, really?)  It was also our first introduction to "Fun Ship Freddy", the oddly disconcerting mascot for Carnival Cruise Lines. His head is modeled after the "wing shaped funnel" on the back of all the Carnival ships. Freddy didn't look just FUN, he looked like something from a disturbing hallucination. See for yourself...

Fun Ship Freddy... who could be this happy?

Monday we slept in. When we actually made it outside, it was COLD. Come on, we left Cleveland to get WARM! Hard winds plus 60 degrees equals too cold to do much on deck. I know: 60 degrees SOUNDS warm, but the whipping wind chills and chaps. The upper decks were closed: no ping pong or miniature golf. No sun-worshiping (maybe my pale skin would have had tan goose pimples). Taking a dip in the pool would have resulted in frostbite. Despite the cold, I rounded a corner and discovered my new favorite thing: ice cream machines (open 24 hours)! Strawberry frozen yogurt I squirsheled into a cone just like the Dairy Queen! Wonderfully addictive!

Jesse and Kody went to Club O2, for 15-17 year olds, and started making friends immediately. Kids from multiple states and nationalities found that they had things in common: mostly, avoiding their parents and staying out as late as possible. The boys could track down a group of youths to hang out with at any time, and count their new relationships as the best part of the trip.

Prior to dinner, we all saw the "family" comedy special, and Steph and I went to the late night "adult" show as well. I'd not heard of either one, but both comedians were very funny, although they struggled a little with the "clean" show.
The production in the Ivanhoe Theater was very good: two singers and about twelve dancers covered a broad range of musical styles. Unfortunately, the show was "hosted" by a bizarre, animated  couch with giant eyes that blinked mechanically, who spoke from between his cushions. This thing was on the video screen, and "magically" appeared, bigger than life, on stage, to give awkward segues. Fun Ship Freddy and this inexplicable piece of furniture must be closely related, or from the same sick, twisted genetic experiment gone wrong.

Tuesday morning we were up early for our excursions. Swimming with stingrays and snorkeling off Grand Cayman island! Fifteen minutes before we were to get on the "tenders" (small boats that ferry you to the island- NOT a tasty, breaded chicken treat) Goose made an announcement over the PA. "Due to the weather, some of our excursions have been canceled."
I told you it was cold and windy. No snorkeling, as breaking waves tend to submerge your breathing tube. No stingrays. (After what happened to Steve Irwin, maybe that was a blessing.) Wearing sweatshirts, we took a taxi to the touristy shops downtown and spent several hours looking at the same trinkets in every store, and not buying anything but lunch. Whoo. The excitement was palpable. In line for the return tender, the comedians, who had been on the island using the internet, ended up next to us. Scotty K and Jason Blanchard were amusing and personable in real life, and gave us some insight as to the life of an entertainer, traveling often, and working cruise ships for months at a time.

Both boys had encouraged me to audition for the "Carnival Legends", a show on the last night featuring passengers as famous singers. Tuesday evening they were looking for Elvis. During karaoke, despite second thoughts, I sang "Hound Dog". Since I was soooo amazing, I was given the part. Or maybe it was because I was the only one to audition as Elvis. What was I thinking? A medley of "Jailhouse Rock" and "Hound Dog" to prepare before Saturday? I'm supposed to be on vacation.

Wednesday was a nice day, mostly sunny and in the seventies. We docked in Cozumel and took a ferry to a bus to Tulum, an ancient Mayan walled city on the cliffs overlooking the Caribbean Sea with watchtowers on the corners. The ruins were fascinating, and the knowledge the Mayans had (well before the birth of Christ) of the movement of the planets and stars and the calendar was amazing. Our guide was Mayan, and he loved to tell of all their accomplishments, and downplayed the more repugnant history of human sacrifices. The temple, however, had a prominent stone altar at the top of the stairs. Hmmmm.

The temple at Tulum

Our guide explained that the Mayans did NOT predict the end of the world in 12/2012. This is simply the end of the fifth epoch, and the beginning of their new calendar, the SIXTH epoch. More time would have been appreciated at Tulum, but we were rushed out because the bus had to leave. A seven hour excursion gave us one and a half hours inside Tulum. Hurriedly I purchased fish tacos and fajitas from a vendor and we made a mess eating them on the way back to the ferry. I was surprised that fish tacos were actually very tasty! Who knew?

Tulum. Jesse and me.

At dinner, our waiter told us to be careful the next day in Belize. "Do not wear any bling. We've had problems with people having things stolen in Belize City." I was expecting Belize to be clean and beautiful, a tourist's paradise, and now I wasn't sure what we were getting into.

The show in the Ivanhoe theater was a magician who acted like he really did not want to be there. I guess he didn't, because he disappeared from the stage. (He showed back up again in the audience).

The movement of the ship had been more than I expected from day one, (walking the halls, at times you needed your "sea legs" as you drifted from wall to wall) but it was pleasant to go to sleep with. Our little cabin seemed to transfer the noises from the ship's hull: groans, shudders and the occasional slap. Drifting off to dream, we were all excited about the next morning: cave tubing in Belize.

TO BE CONTINUED...

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