This is a filly that got hurt from a fence while trying to flee from her owner who was trying to catch his 2-yo filly that has never been handled. There is a lesson to be learned here…

The pole from the fence went through all of her superficial ad deep muscles in the flank area and chipped a piece of her transverse process of two lumbar vertebrae. Through the incision palpation of the intestines, uterus and ovaries was possible. A 7- 10 inch hole was palpated. On palpation of the wound and the internal organs, no damage was noted to the viscera and other organs in the abdominal cavity.

On the first examination the wound was very contaminated, so it was decided not to close the wound. Debridement and primary closure was made, with intention of reassessing the wound in three days time. IV fluid therapy and antibiotics were administered at this time. IV and IM antibiotics were given daily for a period of 10 days.

Remarkably the filly remained alert and responsive. No other major abnormalities were noted except for the great discomfort that the wound was causing her. Her heart rate was mildly high (56 p/m) and a slight fever was taken at the time (38.8c).

A week after the initial treatment, granulation tissue and contraction of the space that was left open inside the wound led to closure of more than 65% of the space left from the trauma.

The wound was bandaged every three days (for economical reasons, hospitalizing her was not an option). The space was packed with gauze soaked in saline and antibiotics.

We are still far from the end but it looks promising. Amazing what the body can heal with just the help of fighting infection and stabilizing the animal initially. Contraction of the musculature did most of the primary closure of the dead space left after the injury. Granulation tissue will fill in the rest, from inside out.

Very interesting.

In a laminitic foot the hoof grows more toe and less heal this is obvious in the pictures below. It can get to the point where the toe starts to curl upwards, as seen in the pictures below. A Simple trim, monthly and a bi-monthly x ray can do wonders for the comfortability of the horse and the regrowth of the new hoof in the right angle (this is addressed in another post “laminitis”).

To me this horse is on the verge of “Cruelty to Animals”. I have communicated to the owners that the animal society will have to intervene if the horse will not be given the right care for this condition, starting with a Ferrier call.

Obviously the horse is unable to walk, has a typical laminitis stance (puts more weight on the hind limbs) and moves as if walking on eggshells in the front end.

In addition to all his orthopedic problems the horse has a crusty neck (sorry for not having the pictures on hand, next time, I promise).  A crusty neck means that there is a lot of access fat deposited above the mane. This is an indication for Cushing’s disease and Hypothyroidism screenings. Both of these diseases are common in certain breeds at certain ages (this will not be addressed here but in another “hormonal imbalances in the horse” post) and which puts them at great risk for LAMINITIS. These need to be addressed before an acute laminitic attack (see previous post).

If anyone has a picture of a “crusty neck” it will be very helpful for the full story about this laminitic/hormonal imbalances horse.

The best way to go about this is to ultrasound, needle it (poke it with a needle and and syringe, in a sterile manner), and surgically open it, flush it out and leave a drain in. I would keep flushing with diluted betadine.

The key is to leave the drain in (about 2-3 days) enough time for the pus to drain out and keep flushing  the pocket with the diluted betadine for a couple of days afterwards (5-7days).

Make sure that there is nothing still in there and be sure to poke in there to see how far and deep it really goes (in a sterile manner).

Antibiotics can be given 5-7 days. 5 days of Procaine Penicillin, IM, Would probably be enough.

monitor the horse for fever and malaise in next couple of day and make sure that he has enough fresh water around.

Obviously this kind of injury is very specific to country, state and area where the horse is cared for. For example, only in Israel there are 7 kinds of coral snakes.  This situation is much like toxicity from a plant source, one should learn to recognize the species in the area and know what the clinical signs and therapies available for the specific aggressor, may it be a snake or a toxic plant.

One this I would always keep in mind is to always be faithful to what the experience veterinarian has to say and trust is the key in this situation. Treatment methods for snake bites are often controversial between Veterinarians which means that there is no write or wrong, but the main goal is to treat and ensure the safety of the animal at the same time, which the both sometimes do stand side by side.

As you can see there are four pics below, the first two are hours after the bite and the two below are two days after immediate initiation of treatment.

Coral snakes chew there venom into the victim which largely consists of toxic proteins that can cause coagulation and hemorrhage. A snake bite may look like an allergic reaction that one would be acquainted with, but what really happens at the site is a lot of hemorrhage (bleeding, the toxins affect the clotting ability of the blood). The toxins have certain enzymes (proteolytic and phospholipase), that cause damage to the tissue at the local site of the snake bite. taking into consideration the damage to the tissue and the blood vessel (necrosis  - cell death, not in a natural way) and diminished clotting ability, the result is massive swelling. What is tricky about the local site of the snake bite is that it does not react promptly to the initiative therapy like a trauma injury (a fall or a bump) that is largely fluids trapped (edema) that are the result of inflammation, which are different from the massive necrosis and hemorrhage that a local snake bite would have. This means that the swelling will take patients and time to clear  (at least 36 to 48  hours).

The site of the snake bite is also very crucial to the treatment and the prognosis. It is clear that a snake bite on the nose (muzzle) is much more life threatening then one in the extremities (usually the the hind end)

The horse below was bitten on the muzzle. In this situation I would promptly initiate therapy to clear and air way and make sure that the swelling does not progresses to the throat (pharynx) where it would occlude the passage of air into the lungs and put the horse in life threatening asphyxia. In this situation the possibility of inserting a clean tube from the nose to the pharynx can help in allowing a small amount of air through (sometimes massive bleeding is seen, this is not serious and will stop after 5-10 minuets, it is caused from hitting mistakenly the ethmoid sinus which bleeds very easily).A tracheostomy is also a possibility if the horse is really in respiratory distress. I always check the larynx  area (throat) and the color of the tongue to be sure that there is no swelling around it and that the tongue is not blue but pink (blue would mean that the horse is not getting enough air)

Signs of the bite include pain on the site of the bite and edema, within 20 minuets. The swelling and edema progresses rapidly, especially in the hind limb area. When bitten on the muzzle the swelling progresses caudally (towards the tail).

Even when signs of improvement are seen one should remember that the Systemic effects of the venom may not peak until 4 days after the the bite. Local necrosis is also seen at this time and should be treated and addressed as well.

Treatment should include local and systemic support.

shortly after the injury cold therapy may be applied, systemic antibiotics (controversial), anti-venom (controversial), steroid therapy (controversial), non steroidal  anti inflammatory treatment, intravenous fluids (if needed). Long term treatment includes, treatment of the site itself for necrosis and infection that mite arouse, another treatment with the anti-venom ( controversial) and systemic support with IV fluids until the horse can drink and eat again.

Fresh water and high quality hay are a good way to start.

Laminitis is a very complicated and not fully understood pathology in the Equine medical community. It is not the scope of this article to go into detail of the reasons or treatment methods for a disease that has many faces. The names used to describe this pathology are not clear as well. 

Although there are two main things that are worth mentioning:

There are different forms of inflammation of the laminae and different forms of Founder. Some clinicians, would divide this disease into different categories: Acute/chronic laminitis and Acute/chronic founder.

Most clinicians would agree that most of the damage that is seen in the next couple of weeks after the initial part of the disease is done in the first hours when it occurs and the treatment is important, but can be sometimes frustrating for there is a very slow recovery and healing process. The horse will need to “grow out” it’s hoof, that is, grow another hoof wall that will attach currently to the new laminae. 

There is one very important aspect when dealing with founder cases, Farrier. The farrier will probably be the most important and valuable person that will follow the current trimming of the hoof wall, until a new wall and laminae can form. A new wall will take anything from 6 months to 1 year, or more, to grow out. The hoof grows from the coronary band downwards so you will see that changes as they develop.

In these pictures I wanted to point out the importance of good ferrier work, working aside the veterinarian with follow up x rays to ensure that the foot is trimmed correctly and most importantly that the ferrier is aggressive enough with the trimming. We want to aline the coffin bone in it’s most natural position as we can. Low heals and most importantly short toes for an easy break over. A short toe is very important and usually the reason for additional x rays after a trimming cycle (every 2-3 weeks, more often then you would usually trim the horses feet). most of the time when I take x rays the ferrier can’t believe that there is still more toe to take of, for that just looking at the foot does not show what the x rays can tell us, the distance of the coffin bone from the hoof wall. X rays are essential for reevaluating the foot with the ferrier every couple of weeks for a full recovery.

Schirrous cord is the second most common complication seen when castrating horses, the first being excessive hemorrhage.

Although castration is the most common Equine Field surgery it is also the number one reason for malpractice suits in the Equine industry. 

There are several ways to preform castrations:

1) standing castration 

2) castration in general anesthesia

They can be preformed in the field, in a small paddock in a clean stall or in a surgery room, on an operating table with a sterile technique. They can be preformed in a “closed” manner, “open” or a “semi closed” castration method. Suture placement on the cord is optional and depends largely on the preferences of the surgeon performing the castration

Most castrations are done in the field and it is the Veterinarians responsibility to decide if the surroundings are fit. For example, a muddy field would not be suited for the post operative stage, where we are cautious about infection.

Castrations are usually successful when done correctly, complications are rare but do occur. 

A Schirrous cord is an infection of the cord and is usually seen when there are many horses castrated in a non sterile environment or in a poorly fashion. Although some clinicians would agree that castration is not a sterile procedure most clinicians would agree that it is best to keep it as clean as possible using antiseptic scrub solutions and sterile emasculators. 

The pictures below are of a surgery in a sterile environment, an Equine Hospital, to resolve the infection that has occurred in the cord. It is important to understand that Schirrous cord will not resolve with antibiotics. Usually the signs are a mild fever, the horse is uncomfortable and most importantly there is drainage of purulent (pus) material from the incision that does  to close after the 14 day post op period. On palpation there is a hard, open and draining tissue felt. the infection is trapped inside and the infected part of the cord needs to be removed. Once the part of the healthy cord is found it is severed and crushed with a pair of sterile emasculators. Usually there is hemorrhage and a  laparotomy sponge can be left in for a period of 48 hours.

The importance of the test from IDEXX Labs:

“Low levels of IgG can lead to bacterial infections, arthritis, pneumonia and enteritis. 

Up to 25% of foals may have low levels of IgG. 

^{Foals have only 24 hours after birth to absorb immunoglobulins from the colostrum.}

^{Delayed test results necessitate costly intravenous delivery of immunoglobulins.}

^{If left untreated, defenseless foals may die.”}

Now, onto the video:

Laser surgery is also incorporated with endoscopy and allows to reach inaccessible areas as the nasal cavities and the nasopharynx.

The use of laser allows better healing, faster recovery and a less painful procedure inra-operatively and in the post-operative period.

Laser surgery ablates (vaporize) tissue into smoke and steam. There is less bleeding inra-operatively and post-operatively due to the heat produced by the laser beam.

Laser technology was especially warranted for this 30 yo mare that has been suffering form  bilateral tumor growths in the frontal nasal cavities which have been obstructing air flow and causing abnormal turbulence in the nasal cavity, not allowing her to ventilate her lungs adequately.

This procedure has earned her more precious time with her owner.

One good example is this case of overbite (Parrot teeth), where the horse is still racing good and has not lost any weight due to it’s dental abnormalities.

It is warranted to take radiographs before and after, to assure that no fragments are left behind, as one would do for a routine tooth extraction. Repulsion of the tooth involves trephening a hole to gain access to the base of the tooth and driving the tooth from it’s socket into the mouth. Two surgeons are required for that one would place a hand into the horses mouth and another would preform the repulsion. A mallet and a chisel are needed to access the base of the tooth. When the root of the tooth is identified the surgeon with the hand inside the horses mouth will ensure that the current tooth is being repelled and hold the punch in place when there is more then one cheek tooth to be removed.

The more caudal the tooth is the harder it will be to repel it. Signs of pathologies that involve the base of the cheek teeth are secondary sinusitis with purulent nasal discharge that does not resolve with antibiotic treatment or lavage of the sinus cavity. When the disease involves the mandibular teeth, swelling and chronic drainage can be seen from the ventral border of the mandible.

When the cheek teeth are removed a period of at least 3 weeks is necessary for granulation tissue to start filling in the gap where drainage  should be put into place at this time to insure that food does not prevent the healing process. The drainage should be changed every tow days and the material that is used for the drainage should be soaked with a solution the promotes granulation tissue to fill in.