#equine surgery

(written from the perspective of someone who’s already a Horse Person™ so I was already aware of the behavioral antics and Desire to Die that horses possess)

1. So many people believe they’re doing right by their horse, but they’re actually not. They may be trying so hard, but it doesn’t mean that what they’re trying is correct or best for the horse.

2. Vets need to get better at giving a poor prognosis and insisting on euthanasia. Many of the horses we had on could technically survive but not thrive, or would be fine eventually but would be miserable through extended periods of recovery. Just because we *can* get them to recover doesn’t necessarily mean we *should.* Euthanasia is a completely viable option.

3. Dentals are a lot of fun.

4. If they say they have 2 horses for you to see, that means they have 10 horses for you to see, about 50% of the time.

5. A lot of vets will not treat their own horses, even if they are boarded in equine internal medicine. They want someone else’s opinion and treatment rather than their own!

6. Isopropyl alcohol is not mineral oil. Idk why this needs to be said?? Don’t tube a horse with isopropyl alcohol.

7. More often than not, colic surgeries don’t survive. And if they do, they’re often going to feel very punky for quite a while before they get any better. And also if they do survive, they’re more likely to need colic surgery again. I can’t honestly recommend colic surgery in good faith unless the horse is very young (so would have a lot of life left if the surgery was successful) and the owner either has insurance on it or has enough money that the cost of the surgery wouldn’t be a burden. If the horse is 25 and on its third colic surgery and you’re a retired old lady, we should be looking at euthanasia instead.

8. Accomplished equine orthopedic surgeons often receive radiographs of other hooved animal, from zoos. This leads to them taking field trips on slow days just to go play with zoo animals.

9. Many times, an issue could be avoided, or treated more quickly, if the owner either a) followed directions of the vet or b) didn’t try to treat something themselves before bringing it to the vet. If your vet says bandage it, bandage it so it doesn’t become necrotic or turn into a granuloma! If your horse is colicing, for the love of God don’t try to tube it yourself, because you probably don’t have the equipment to do what we use the tube for, you don’t know how to interpret what comes out of the tube even if you did have the equipment (so the horse might not even need it) and if you get it down the wrong pipe you will literally kill your horse if you use mineral oil. Horses are expensive so don’t get one if you’re not able to pay for a professional!

10. If you’ve done something stupid (as described above) don’t hide it from your vet. We need to have all the information possible in order to treat appropriately. If your horse comes in for diarrhea with hypoproteinemia, we’re going to worry about a lot of other things before we worry about NSAID toxicity, *unless* you tell us that you gave 2g of bute to a 185-lb miniature horse (for the uninitiated, 2g is what you would give a 1500-2000lb horse once, or a maybe a 1000-lb horse split up as 1g twice daily if they were having short-term moderate pain like a hoof abscess). If you don’t tell us that, we’re going to waste your money chasing an infectious disease diagnosis in the fancy isolation suite for 3 days until you finally decide to admit your mistake.

Rood & Riddle in Saratoga FB | Aug 15th, 2017

Surgeon Ali Broyles, DVM, discusses diaphragmatic hernias.

Diaphragmatic hernia is a relatively uncommon condition in the horse. A defect in the diaphragm can be either congenital or traumatic in origin. In foals the most common traumatic cause is from a rib fracture creating a tear in the diaphragm after a difficult birth. In an adult it can be caused by parturition (especially dystocia) or a traumatic event. Small defects in the diaphragm may not cause a problem until a portion of bowel (most often small intestine) becomes entrapped within the rent (hole in the diaphragm) causing strangulation of the intestine. Horses often present with acute severe signs of abdominal pain, and it is difficult to distinguish a diaphragmatic hernia from other strangulating lesions. Diaphragmatic hernia can be suspected if dilated small intestine is seen within the thoracic cavity on ultrasound, but more often the diagnosis is made at surgery. Prognosis is generally reported as poor with the most recent reported success rates being 23% for overall survival and 46% for horses undergoing surgical correction. However, depending on the size of the defect and the amount of incarcerated small intestine, a good outcome is possible with timely surgical intervention.  

Recently two cases of diaphragmatic hernia with strangulated small intestine presented to Rood and Riddle Equine Hospital in Saratoga. Both were young Thoroughbred racehorses who presented with acute (less than 2 hours) severe signs of colic. A diagnosis of diaphragmatic hernia was made at exploratory laparotomy. Both horses had a 3-4cm defect found on the right side of the diaphragm with small intestine going through the rent and entrapped within the thoracic cavity. In both cases we were able to free the entrapped portion of small intestine from the defect, but both required a resection (3 feet in one case and 7 feet in the other) and anastomosis (reconnection). The defect in the diaphragm was accessible and repaired using a direct suturing technique. Both horses recovered from surgery and were discharged from the hospital in good condition. They are currently in lay-up and should be able to return to racing in a couple of months. 

Rood & Riddle in Wellington - FB || 15 April, 2017

WARNING ⚠️ GRAPHIC CONTENT : The following images and/or content may be disturbing to some viewers. Viewer discretion is strongly advised!

Case of the week:

Again, Dr. Beccar-Valera brought another great case to RREH in Wellington for surgery. Thoroughbred mare with no airflow in the right nostril and facial deformity. Skull radiographs showed a large soft tissue mass in the sinuses resulting in destruction of the normal internal structures and deviation of the nasal septum. Examination of the right nasal passages with the endoscope was limited due to the obstruction of the common nasal meatus. Surgery was performed standing by Dr. Beccar-Valera and Dr. Bras and access to the sinuses was accomplished with a large frontonasal bone flap. Paranasal sinus cysts are usually seen in horses ranging in age from nursing foals to young adults, but it is also seen in adult horses. The exact cause and pathogenesis are unknown. The most common clinical signs in this horse are difficulty breathing, facial swelling, and nasal discharge. The cysts are typically filled with yellow, viscous fluid unless they become infected for other reasons. Surgical management consists of removing the cyst lining.

GRAPHIC CONTENT WITHIN

A horse waits in his box for surgery at the veterinary clinic of the equestrian training center of Grosbois in Marolles-en-Brie, on November 17, 2016.

A horse falls asleep after being anesthetized before surgery at the veterinary clinic of the equestrian training center of Grosbois in Marolles-en-Brie, on November 15, 2016.

An anesthetized horse is brought to surgery at the veterinary clinic of the equestrian training center of Grosbois in Marolles-en-Brie, on November 15, 2016. 

An anesthetized horse is brought to surgery at the veterinary clinic of the equestrian training center of Grosbois in Marolles-en-Brie, on November 15, 2016. 

A horse is brought to a recovery room after surgery at the veterinary clinic of the equestrian training center of Grosbois in Marolles-en-Brie, on November 15, 2016.

Veterinaries help a horse as he awakes in a recovery room after surgery at the veterinary clinic of the equestrian training center of Grosbois in Marolles-en-Brie, on November 15, 2016.

A horse is brougth away after surgery at the veterinary clinic of the equestrian training center of Grosbois in Marolles-en-Brie, on November 15, 2016. 

Photos: Martin Bureau / AFP

Images and info via : afp-photo

Dorsal Displacement of the Soft Palate (DDSP) 

(Can be more commonly referred to as “choking down” or “flipping the palate.”)

[ Anatomy ref can be found HERE ]

Horses with intermittent DDSP are exercise intolerant and most (70-80%) affected horses will make an abnormal noise during exhalation at fast work. The displaced soft palate billows dorsally during exhalation as air flows beneath the soft palate. Horses often produce a “snorting” noise when the soft palate is displaced, and this is caused by a low frequency fluttering of the caudal margin of the soft palate during expiration. However, in approximately 30% of horses with DDSP, noise is not reported. The caudal edge of the soft palate in each horse has a different stiffness, and this may be why 20-30% of horses are “silent displacers.” Dorsal displacement of the soft palate could still be considered as a possible diagnosis in horses with a sudden decrease in performance and no history of respiratory noise. This disease is more common in racehorses, especially 2 to 4-year-olds, but in Europe, it is also common in older National Hunt racehorses. It is an uncommon disease of hunters and western pleasure horses, but does affect horses that carry their head and neck in a flexed position, such as upper level dressage horses and saddlebreds.

Dorsal displacement of the soft palate is an expiratory upper airway obstructive syndrome that can cause increased respiratory impedence, decreased minute ventilation, hypoxia, and hypercarbria. […] During inhalation the soft palate rests dorsal to the epiglottis and does not cause obstruction because inspiratory pressures maintain it in a relatively stable position on the floor of the nasopharyinx. [Laying flat along the bottom of the airway.] However, during exhalation the soft palate billows dorsally into the nasopharyngeal lumen, thus diverting some of the flow of air through the oropharynx and the mouth. [ The palate billows to partially block the airway. ] […] Some horses suffering from DDSP exhibit the characteristic sign of mouth breathing during exhalation, recognized by fluttering of the cheeks as air is diverted underneath the soft palate and through the mouth.

The cause of intermittent DDSP is unknown, but many theories exist to explain the etiology of this condition which is likely multifactorial. Some theories focus on dysfunction of the nerves and muscles that control the soft palate, and others concern the stability and the proximity of the epiglottis and larynx to the soft palate.*

Surgical options include:**

Staphylectomy

Sternothyroid myectomy

Combined staphylectomy and sternothyroideus tenectomy

Epiglottic augmentation

Partial sternothyroidectomy and laser cautery of the caudal aspect of the soft palate

Laryngeal tie-forward

[ SOURCE - Equine Respiratory Medicine and Surgery ]

* There is more. I can add the infomation upon request