Category: EQUINE

CASE STUDY: TILLY’S ELECTRICAL CARDIOVERSION (TVEC)

Tilly was seen by our vet Kai during a routine yard visit for her annual vaccination. During this visit it was noted that Tilly had a very irregular heart rhythm. Tilly was consequently bought to our clinic for further investigations including blood tests and an ECG to measure the electrical activity of the heart.

The ECG showed Tilly had a condition called atrial fibrillation. This is where the upper chambers of the heart (the atrium) beat abnormally fast and erratically. You can observe from the ECG traces how Tilly’s heart compares to that of a normal horse (Figure 1).

Atrial fibrillation can cause symptoms including poor performance, exercise intolerance, weakness and collapse. Amazingly, in Tilly’s case she had none of these symptoms at the time, so it was very fortunate we picked up the abnormality early!

EQUINE SPINAL PAIN UK SPECIALISTS

• Is your horse an absolute dream in-hand or on the lunge? Then as soon as the tack comes out, you see it in their eyes and off to the back of the stable they go!!
• Do they buck when you sit to ask for canter?
• Do they periodically shoot off under saddle which is pretty damn terrifying?
• Do they plant their feet? Refuse to go forwards and vocalise their distaste when you squeeze with your leg?
• Every time your physiotherapist visits, do they say that your horse is sore through his/her spine, but you’ve had your saddle checked and that is fine??

These amongst many other signs could indicate that your horse has pain coming from the spine. This can be from the underlying bone structures, nerve pain or pain coming from the many muscles and ligaments which interact with the spinal column. This includes pain coming from the sacrum, pelvis and sacroiliac joints too!

These cases can be extremely frustrating for you as an owner to overcome. However, we deal with these cases every, single day. We have developed a thorough, systematic approach to the investigation of these cases, so that no stone is left unturned.

Spinal imaging is performed through a combination of X-ray and ultrasonography assessments. From an X-ray perspective, due to the size of the horse, a lot of powerful radiation is required which comes from a large X-ray machine in a controlled setting! These are not images that can ever (or should ever) be obtained in a yard situation, it’s simply not possible!

To visualise the soft tissue attachments of the pelvis and spine you also need powerful ultrasound machines that have a lower frequency and a specialised probe very different from a musculoskeletal ultrasound machine. The soundwaves need to penetrate much deeper tissues without losing detail and believe me these machines are very expensive and must be kept within a clinic setting.

At Oakhill Equine Vets, we can confidently boast that we have the best imaging equipment for visualising pathology of the equine spine. We also have an arena to observe the horse ridden, with or without a rider dummy on board to help us understand the kind of symptoms your horse is displaying without putting you or anyone else in a potentially dangerous situation.

Once the problem has been identified, then we can create an appropriate, specific therapeutic approach. This may consist of conservative management through a combination of physiotherapy, injectable or anti-inflammatory medication, acupuncture with Equine Director Rosie and hydrotherapy. In the unlikely event that surgery is required you can be safe in the knowledge that we have two European Specialist surgeons on hand to perform the latest surgical techniques proven to help relieve the symptoms of spinal pain in the horse. The most common techniques are interspinous ligament desmotomy (ligament snipping) and dorsal wedge ostectomies (bone shaving). Our surgeons have all of the latest knowledge to be able to discuss these options with you depending on what your horse needs.

We are proud of the fact that we can perform all investigations and start treatment in your horse within a few days of your horse’s arrival at our clinic in Goosnargh, no waiting around for test results or for the next steps to take place. We can do it all and do it all well!!

We have no preference as to whether your horse holds an insurance policy or not, we treat all horses exactly the same. There is transparency with costings throughout regardless of your insurance status. If your horse is insured, our insurance team are on hand to make the process as stress-free as possible for you.

If you simply want to start the dialogue with regards to how we may be able to help you and your horse, just give our team a call and ask to speak to one of our spinal experts.

BOO’S FETLOCK INJURY AND LIFE-SAVING SURGERY

Several months ago equine vet Jess was called out to see one of the worst fetlock injuries we as a practice have ever seen. Poor ‘Boo’ had somehow managed to do this to herself in the field, causing such a deep wound to her left fore fetlock that the joint capsule was exposed leading to a septic joint. She had also damaged some of the supporting ligaments nearby.

Her lovely owners were distraught and keen for us to do whatever we could to help Boo and give her a chance of surviving despite the odds not being in her favour. She was admitted to our clinic for further assessment of the joint and to perform life- saving surgery under general anaesthesia. Rosie, one of European Specialists in Equine Surgery, had her work cut out but as you can from the final photo below, see she did an amazing job! Over several hours she was able to flush the infected joint with many litres of fluid and somehow suture all the tissues back together.

Our next challenge was to immobilise Boo’s limb to support the wound and sutures following surgery and give her the best chance of healing. This was particularly important during the recovery phase of her general anaesthetic where she needed to be able to stand without damaging the wound. The decision was made to place a cast on her lower limb whilst she was still in the operating theatre, preventing her flexing the limb and weakening the sutures.

Boo recovered uneventfully from her surgery and general anaesthetic. Post-operatively, Boo had several casts placed to keep her limb as still as possible. Cast removal followed 2-weeks post-operatively and after this Boo’s distal limb was placed in a 2-layer bandage. After each bandage change, we were all quietly optimistic as her wound was holding together well and Boo remained comfortable.

We were absolutely thrilled that after 5-weeks Boo had made a complete recovery and was able to go back out in the field with her friends. This was down to the commitment of Boo’s wonderful owners supported by our veterinary team. Thank you so much to Boo’s owners for allowing us to share her story.

CHRONIC PROGRESSIVE LYMPHOEDEMA (CPL)

CPL is a condition which we are seeing with increasing frequency in our ‘hairy’ population – draft breeds, cobs and certain natives. It was only relatively recently (2003) recognised as a specific, stand-alone condition, and it is still not fully understood, but here is what we know so far.

• As the name suggests, this is a long term (‘chronic’) condition which progresses over time, resulting in build-up of lymphatic fluid within the tissues (‘lymphoedema’) of the lower limbs.
• Longstanding lymphoedema results in inflammation, tissue fibrosis and changes in the elastin fibres in the affected areas, resulting in ongoing reduced ability for the lymphatic fluids to drain from these areas – so you get a vicious cycle of fluid build-up.
• Affected horses develop ‘rolls’ or ‘nodules’ of thickened skin – in more severely affected cases these can be seen despite the feathering, but in milder/early stage cases they might not be obvious, and may only be picked up by palpation of the limbs.
• There will also be increased exudate (the ooze that comes from the skin), crusts, hyperkeratosis, and thickening of the skin layers.
• Cases range from only mildly affected (where you may need to get ‘hands on’ to diagnose by palpation) to severely affected (thickened rolls around the whole circumference of the limb, potentially extending further up the limb to the hocks or knees).

TREATMENT

Unfortunately, CPL is a lifelong condition for which there is no cure; instead, management is focused around four areas, to try and slow down the progression and reduce symptoms.

1. Lymphatic drainage – movement is really important! Studies show that horses who have less movement are more likely to be severely affected than those used for riding/working. Muscular activity acts as a pump for the lymphatic vessels. There are also massage techniques that can be used, and in some cases compressive bandaging has been used – but the latter is tricky to perform correctly, and the risk of bandage sores is high.
2. Skin hygiene – secondary bacterial skin infections are common in these cases, due to the increased skin exudate and thickening. Clipping is strongly advised to allow access to the skin, and regular cleaning/washing of the limbs in suitable shampoos/solutions, and application of topical antibacterials. Also – good stable hygiene is important!
3. Ectoparasite control – whilst feather mites are not the sole cause of CPL, they can make things worse by causing further irritation and inflammation. In severe cases where there are thick crusts, topical mite treatments applied after cleaning of the limbs may be recommended over injectable treatment, as the mites may be ‘hidden’ within the thick crusts and not accessible by an injected treatment. Maggots (‘flystrike’) are also possible in some cases.
4. Diet – higher starch/sugar diets are linked to higher insulin levels, and in turn higher levels of inflammatory cytokines within the blood stream – this can promote inflammation within the lower limbs. Therefore, a low sugar diet is recommended in these horses, and weight loss where appropriate.

Some horses with CPL may benefit from long term pain relief, to promote movement and reduce inflammation in the affected areas.

It is believed that there is likely to be a genetic link with CPL, which is why some breeds are much more likely to be affected than others, and why some individual horses will suffer from CPL and others not, despite the same management. Unfortunately, this link is not proven yet but is an ongoing area of research. We would recommend careful consideration before breeding from a horse affected with CPL however, due to this possibility.

STEM CELL BREAKTHROUGH IN EQUINE MEDICINE

Traditionally, stem cells have been used to treat tendon injuries, particularly in racehorses. These cells were usually harvested from the sternum of the injured horse and were expanded in a laboratory over 30 days for reimplantation into the site of the injury. This was used with variable success, largely as the number of stem cells harvested was inconsistent between individuals.

LASER SARCOID SURGERY

Sarcoids are a relatively common skin complaint and can affect horses of all ages. Sarcoids come in multiple forms (6 types in fact!), ranging from flat (occult) sarcoids to a rapid proliferate type (fibroblastic). All areas of skin may be affected; however, the most common locations include the inside of the back legs, sheath, armpits and face.

As sarcoids are a form of skin tumour, they should be treated promptly and with respect. Fortunately, sarcoids do not spread to internal organs and what you see externally is what you get. There are many over-the-counter products people often try before consulting their vet but such measures delay the correct treatment of these tumours giving them a chance to increase in size and for more lesions to develop. This in turn, makes them more difficult to treat.

The two most common treatment options involve surgical removal through the use of a laser or the application of a chemotherapy cream. The best therapeutic option ultimately depends on the type and location of the sarcoid and this will be determined following veterinary examination.

We are fortunate to have been able to offer laser treatment of sarcoids at Oakhill for many years. Depending on the location, the sarcoids are removed by laser either under standing sedation or under general anaesthesia. We have certain cases in which laser surgery is combined with adjunctive treatments including chemotherapy creams or injectable chemotherapeutic agents.

The laser site generally heals rapidly following surgery and horses resume small paddock turn out within days of the procedure.

If you are concerned about any skin lesion on your horse, please do not hesitate to get in touch with one of our team.

TO BREED OR NOT TO BREED? (AND HOW?) IS THE QUESTION

For many of us, the thought of having our very own foal from our own mare is a recurring dream – but what does it take for that to become reality? And is it something we should be considering, for both our mare’s sake and our own?

PRE-BREEDING CONSIDERATIONS

Breeding a foal can be risky – normally, everything goes to plan, and the foal arrives safely and healthily, and mother is also well and suffers no ill effects from this. However, when it goes wrong, it can really go wrong, and in the worst-case scenario we may lose both mare and foal. Thankfully, this is rare, but it is a risk that should be seriously considered before deciding to breed.

Other considerations should include:

• • Is the mare a good candidate to be bred from? Look objectively at her conformation and temperament. Often mares are put into foal due to lameness or other ridden issues, but if these are due to physical abnormalities then these may be passed on to their offspring.
  • What am I looking to breed? This will influence your choice of stallion, and whether you breed at all.
  • Am I in a position to have a mare and foal, both in terms of finances, and practicalities (e.g. yard set up, other youngstock etc.)?

Choosing a stallion
This is one of the fun parts! Try to choose a stallion that will complement your mare’s conformation and type. Looking at a stallion’s offspring already on the ground may give an idea of temperament.

Bear in mind health testing for certain genetic conditions – this is especially important in certain breeds. If you have any specific questions regarding these please ask one of our vets.

THE FUTURE?

Embryo transfer is becoming more established within the UK and involves flushing an embryo from one mare and implanting it into a recipient mare. This is a useful technique for mares who are currently competing or cannot carry a foal themselves for health reasons. This is not something we currently offer at Oakhill (yet), but we can advise you on those who can help if this is something you are considering.

A newer emerging technique is one called ‘ovum pick-up’ where eggs are collected directly from the mare’s ovary, and ‘intra-cytoplasmic sperm injection’, where these eggs are injected with sperm. Once these develop into embryos they can be frozen, stored, and then placed into recipient mares when required. This technique is still in its infancy in this country but is likely to become more common in years to come.

CASE STUDY: EQUINE CORNEAL ULCERATION

We are often asked ‘what is considered a veterinary emergency?’ Most people will automatically think colic, difficulties in breathing, severe lameness, bleeding, a wound located near a joint or in pregnant mares, dystocia (difficulties giving birth).

Problems with a horse’s eye often don’t feature, with a lot of owners opting to try an over-the counter product in the first instance prior to involving their vet. Whilst, for very minor ocular disease cases, this may be sufficient, if your horse has a more serious complaint such as corneal ulceration, incorrect treatment will not only delay healing but in severe cases, may be detrimental and result in the loss of an affected eye. Therefore, we advise that you contact your vet immediately should you notice any ocular abnormalities in your horse.

IMPACTION COLIC

Impaction colic is a relatively common medical colic we diagnose during winter months. However, we can see cases throughout the year. Clinical signs consistent with an impaction include signs of colic, reduced gut sounds and reduced droppings. An impaction is confirmed on rectal examination by your vet.

The horses intestinal system, although very large, is not capable of coping with sudden changes to the diet. Alterations in feed type, quantity and hydration can all lead to signs of colic.

Poor weather conditions necessitating stabling are a common reason for impaction development, as horses are fed an increased amount of dry forage compared to the usual grass-based diet. In addition reduced movement will slow gut transit times. Freezing conditions also contribute to impaction development due to reduced water intake as a result of the water source being frozen or the water being cold and unappealing to drink. This leads to the ingesta within the gastrointestinal tract becoming dehydrated with resulting signs of colic and impaction development.

Prevention

• Add warm water to your horse’s water buckets when temperatures drop. This will encourage water intake and keep your horse’s colonic contents hydrated.
• Add warm water to bucket feeds.
• Supplement a second bucket of water with electrolytes or add salt to your horse’s feed – this will stimulate thirst and water intake. Ensure your horse is also offered plain water.
• Manage forage intake. Sudden changes in management are sometimes unavoidable. Feeding forage little and often is helpful in preventing impactions. Soaking forage can also be beneficial but remember not to do this if temperatures are below freezing!
• Maintain a level of exercise if possible and safe to do so. This can be difficult during freezing temperatures but movement, even turnout, will help to keep your horse’s guts moving and therefore reduce the risk of impaction colic.
• Regular dentistry is crucial year-round, but especially during winter months as an inability to properly chew hay could result in impaction colic due to an increased quantity of long fibre reaching the colon. All horses should receive at least one dental check per annum. It is often worth an additional pre-winter check in older horses and ponies.