Vet on the Road: Part 1

“A great thing about this job,” says Stuart, “is not knowing what I’ll be doing from one day to the next! But what I do know is that it can make demands on my patience, character and stress levels, revealing qualities and traits I didn’t know I had!”

Meet the vet

Stuart Duncan MRCVS, qualified from the University of Glasgow in 1980 and after experience in East Anglia and Gloucestershire joined the Liphook Equine Hospital in 1985. His principal interests are first opinion cases and equine sports medicine. Stuart is also one of the practice’s consultant cardiologist providing second opinions both within the practice and for referring veterinary surgeons.

Case one

Mite misery

For the first call of the day, I leave the clinic early. We’re heading to see Bruno, a 12-year-old, coloured, heavyweight cob, stabled about eight miles from the practice. He has suffered from a long-term, chronic mite problem.

Mites are a perennial problem, particularly in heavy breeds and cobs, affecting the front and hind legs, and causing extreme irritation in many cases. The presence of mites in cobs is usually a permanent problem, one that we can never completely get rid of – only really manage for the best.

In Bruno’s case, the problem has been exacerbated by the fact that he is on box rest for a soft-tissue injury, caused by his exuberance in the field, whereby he has fallen over several times. So to stop him from tearing around, we put him on box rest.

However, in the stable, Bruno’s legs have become more irritable, to the point where he is biting them and rubbing them against the feed manger – and now he has open sores on his back legs.

When we arrive at the yard, we check him in-hand out of the box, then examine his legs and the lesions. He is sore and the irritation is very marked, so I decide to sedate him and clip the legs to remove as much of the coarse hair as possible. I wash the legs with warm water and a mild shampoo, then dry them well. An anti-inflammatory/antibiotic preparation is used to treat the open sores – something that should be administered twice daily, as it helps relieve the irritation – then I use an anti-mite wash on the rest of the legs.

Injections

Bruno is particularly uncomfortable at the moment so, after a discussion with his owner, Sarah, we decide to give him a couple of anti-mite injections (Dectomax), given under the skin on the neck. These have been used previously on Bruno and have been quite effective, but they don’t seem to last more than four to six months. What’s more, to help Bruno relieve the boredom and stress of box rest, Sarah is going to hand-walk and graze him two to three times a day, for 15 to 20 minutes each time. And although he can be quite lively when hand-grazed, Sarah is obviously keen to help him in any way she can.

Bruno is a typical case – he is being rested to solve one problem, but in so doing, creates another. Box rest can be a contentious issue and I have noticed over the last few years that fewer owners are willing to box-rest their horses, in preference to more turnout – and, therefore, a more natural state. I generally agree with this, especially when you consider that some of the continental, warmblood, competition horses are literally boxed from day one and rarely get any turnout or grass. And this creates a multitude of problems, including vices, orthopaedic problems and intestinal ailments, including colic.

Likewise, when continental horses are imported into this country, many find it difficult to re-adjust in mid-life to a change in management regime.

Case two:

Shoeing solutions

On to the next case, and we drive to another yard to meet the farrier. We need to discuss some remedial shoeing for a 17hh bay Irish-cross gelding, who suffers from recurrent corns in his heels.

Dermott is hunted all winter, three days a fortnight, and his owner, Pippa works in London during the week. He is kept at hunting livery and is extremely fit, so that Pippa can turn up to hunt him whenever free time allows. Dermott has suffered from corns for the past two to three seasons, and a variety of shoes has been used to try and combat the problem.

When we arrive and examine Dermott before the farrier turns up, it is a good opportunity to get him out of his box, and see him walk and trot in-hand. He doesn’t look too bad in a straight line, but when we trot him in a circle, he shows marked lameness in both front feet.

In order to ensure the lameness is coming from the feet and nowhere else, I pop in a nerve block, which has the effect of freezing his left fore foot, the worst of the two front feet.

Fifteen minutes later, when we re-trot him – having given the nerve block a chance to work – we see that Dermott is now sound on his near fore, which confirms the lameness is coming from the foot.

Once the farrier arrives, we remove the front shoes and explore the feet in more detail. Although Dermott has had a few months’ field rest during the summer and has only just started walking exercise, his feet are quite good and the presence of corns is only relatively mild. But we can still see the telltale signs of bruising in the seat of the corn in both front feet.

Carefully, we cut out the bruised and diseased horn and, after discussion with his owner and the farrier, we decide that the best way forward is to carry out some digital X-rays of his front feet, to check for any balance issues.

In balance

As vets, we are called out more and more to check the balance of horses’ feet with the farrier, which can be helped in some cases with X-rays. This can be carried out in the yard with the shoes on, using markers to tell us where the frog and coronary band (soft tissues) are. This enables us to discuss with the farrier the best way forward in terms of shoeing, to improve the horse’s comfort, increase support, improve breakover and reduce any lameness issues.

The X-rays are taken in two planes (directions)…

Lateromedial, from the side view, which shows the hoof-pastern axis and position of the pedal bone, relative to the long and short pastern bones. This gives a good indication of the situation of the heels.

Dorsopalmar view, the front to back view, which tells us more about the balance between the inside and outside of the foot and the limb.

For some horses, the balance is absolutely critical and by correcting this alone, it can resolve a lot of low-grade lamenesses. Once we’re happy with the X-rays, and after discussion with the owner and farrier, we decide to shoe Dermott in a lightweight, aluminium Natural Balance shoe.

We’re starting with this for the first half of the season, but once Pippa is in the throes of hunting and Dermott’s work increases, this shoe will not be durable enough to withstand the work and will be changed to a different type. However, we think this is probably the most appropriate shoe for the early season, in order to give Dermott as much heel support as possible and hopefully reduce the trauma to the heel region.
Pads for protection

We discuss the possibility of using pads with dental impression compound, silicone or Magic Cushion (a medicated, anti-inflammatory hoof-packing material, used on horses with sore or bruised soles). However, in a hunting situation, this would probably not be feasible – the likelihood of keeping the shoes on would be hugely reduced. Pads can work well on competition horses in a controlled environment, but there’s a chance of the shoe coming off and the foot getting damaged or breaking up.

Dermott’s farrier is keen to put him into a straight-bar shoe after a couple of shoeings, which would be far more durable for a horse with a heavy workload. However, we decide to chat about Dermott in two to three months’ time and reassess the situation before making any definite plans.

Case three:

Just jabs

The next call on the list is for some routine flu and tetanus inoculations.

On the way to the yard, we discuss the recommendations and guidelines for influenza inoculations, which seem to confuse everyone!

In general terms, horses and ponies (including youngsters) should be inoculated with a primary course, which is then followed by a booster six months later and subsequent yearly injections. Horses competing at FEI competitions have regular boosters, which must be given at six-monthly intervals (plus or minus three weeks).

Manufacturers are constantly updating their vaccines to contain the latest influenza strains and these are proving extremely effective – for example, a new American strain called OHIO/03. Most people now are happy with flu injections and realise that rarely do they cause any subsequent problems or side-effects, the benefits far outweighing the odd complication.

Inoculating your horse against tetanus is also extremely important, as the disease in equines usually proves fatal. Those horses who contract it may survive with aggressive therapy – including muscle relaxants, anti-inflammatories, antibiotics and intravenous fluid therapy – in combination with intensive care and nursing.

However, in this instance, prevention is very much better than cure and horses are immunised with a vaccine containing a tetanus toxoid component, which is given at the same time as the influenza jab.

Restrictions

This owner with four horses to be vaccinated is very pleased when she is told she can carry on exercising her horses, since the manufacturers are now recommending that light to moderate exercise following vaccination has no detrimental or deleterious effect. However, I remind her of the seven-day ruling, whereby you are unable to event horses for seven days following inoculation. Therefore, timing is still quite crucial, especially for competition riders who require that the horse is vaccinated during the eventing season, to comply with British Eventing rules.

Case four:

Wound woes

Carrying out four inoculations is a relatively quick job, so we are soon at our next call, a re-examination of a wound I saw 10 days ago.

It had been self-inflicted, a 4cm/11¼2in slice on the inside pastern, which happened when the horse, Scoobie, got cast. After debriding (removing unhealthy tissue) the wound, which was contaminated, and flushing it with sterile saline solution, we sutured the edges together. We then applied a lower-limb dressing and confined the horse to box rest, as well as placing him on antibiotics.

On examining the wound today, it looks surprisingly good and shows no sign of any breakdown (coming apart and opening) – it appears to be healing well and the sutures are ready for removal. Scoobie is off all medication, but as the wound won’t have regained full strength yet, there is still a risk of it breaking down – particularly if he gets excited or rolls.

So I recommend that the wound stays bandaged for the next week to 10 days. Keeping it covered should prevent any infection or trauma, until it is fully healed. I also advise that exercise be kept at a controlled level, so Scoobie can be walked in-hand twice a day for about 10 minutes for the next five days, before starting on five days of ridden exercise.

Wounds

Nasty wounds form a significant part of our work. They range from fence/ wire wounds to bad over-reach and travel injuries. What’s more, wounds around the knee and hock are usually harder to treat, because of the minimal subcutaneous tissue in those areas. Often they become contaminated and it can be difficult to suture the wound edges together because of the tension. Also, they are more prone to breaking down and/or becoming infected.

When presented with a gaping, contaminated wound that is more than 2cm/3¼4in long, I would first debride it then flush it with large volumes of sterile fluid. And if the wound is old, I would probably ‘scrape’ it with a sharp, sterile, scalpel blade, to remove any necrotic (dead) surface tissue, prior to lavaging (flushing out) and suturing.

Certain wounds lend themselves to being stapled, but larger wounds under more tension benefit from sutures. If possible, I bandage the wound to reduce the likelihood of infection, proud flesh and wound breakdown. Unlike many human wounds, horses benefit from long-term bandaging, especially for the first week to 10 days, as it provides support and prevents contamination.

Most patients are placed on antibiotics and anti-inflammatories, to help reduce swelling and, therefore, promote healing. But in all cases, the degree of lameness must be monitored. And horses with what look like insignificant, superficial wounds, which show moderate to marked lameness, should be investigated for any synovial cavity penetration – eg, a joint compartment, or synovial or tendon sheath. What’s more, I will always check the horse’s tetanus status.