Category Archives: Surgery

Wobbler Syndrome: Proof At Last!

CT Scans Allows Quantitative Wobbler Syndrome Evaluation | TheHorse.com

Current Breakthroughs in Equine Research

Over the past 30 years the Grayson-Jockey Club Research Foundation has funneled nearly $20 million into studies aimed at improving horse health. This year the effort continues with funding for a dozen new projects in fields ranging from laminitis to lameness diagnosis. A sampling:

Detecting lameness at the gallop: Kevin Keegan, DVM, of the University of Missouri, is developing an objective method (using a calibrated instrument) for detecting obscure, subtle lameness in horses at the gallop. The goal is a low-cost method that can be used in the field to increase understanding of lameness in racehorses.

Deworming and vaccines: While it’s not unusual to deworm and vaccinate horses on the same day, recent findings have raised concerns about possible interactions. Martin Nielsen, DVM, of the University of Kentucky and Gluck Equine Research Center, is investigating whether deworming causes an inflammatory reaction that affects vaccination.

Imaging injured tendons: Horses recovering from tendon injuries are often put back to work too soon and suffer re-injury. Sabrina Brounts, DVM, of the University of Wisconsin–Madison, is exploring a new method developed at the university to monitor healing in the superficial digital flexor tendon. The technique, called acoustoelastography, relates ultrasound wave patterns to tissue stiffness: Healthy tendon tissue is stiffer than damaged tissue.

Detecting laminitis early: Hannah Galantino-Homer, VMD, of the University of Pennsylvania, is investigating possible serum biomarkers (molecular changes in blood) that appear in the earliest stages of laminitis. The goal is to develop tests for these disease markers so that treatment can start when laminitis is just developing, before it’s fullblown and damages the foot.

Other new studies include evaluations of a rapid test for salmonella; investigation of how neurologic and non-neurologic equine herpesvirus 1 (EHV-1) spreads cell-to-cell in the body; an effort to map the distribution of stem cells after direct injection into veins; and more.

This article originally appeared in the June 2013 issue of Practical Horseman.

Gut Check: A New View from the Inside

Researchers are testing an endoscopic camera, contained in a small capsule and placed directly into the horse’s stomach, to gather imagery of the equine intestinal tract. The capsule sends images to an external recorder, held in place by a harness.

Researchers are testing an endoscopic camera, contained in a small capsule and placed directly into the horse’s stomach, to gather imagery of the equine intestinal tract. The capsule sends images to an external recorder, held in place by a harness.

Courtesy, Western College of Veterinary Medicine

Traditionally, veterinarians’ and researchers’ view of the equine intestinal tract has been limited. Endoscopy (inserting through the horse’s mouth a small camera attached to a flexible cable to view his insides) allows them to see only as far as the stomach. While ultrasound can sometimes provide a bigger picture, the technology can’t see through gas—and the horse’s hindgut (colon) is a highly gassy environment.

These limitations make it hard to diagnose certain internal issues and also present research challenges. But the view is now expanding, thanks to a “camera pill” being tested by a team at the University of Saskatchewan, led by Julia Montgomery, DVM, PhD, DACVIM. Dr. Montgomery worked with a multi-disciplinary group, including equine surgeon Joe Bracamonte, DVM, DVSc, DACVS, DECVS, electrical and computer engineer Khan Wahid, PhD, PEng, SMIEEE, a specialist in health informatics and imaging; veterinary undergraduate student Louisa Belgrave and engineering graduate student Shahed Khan Mohammed.

In human medicine, so-called camera pills are an accepted technology for gathering imagery of the intestinal tract. The device is basically an endoscopic camera inside a small capsule (about the size and shape of a vitamin pill). The capsule, which is clear on one end, also contains a light source and an antenna to send images to an external recording device.

The team thought: Why not try it for veterinary medicine?

They conducted a one-horse trial using off-the-shelf capsule endoscopy technology. They applied sensors to shaved patches on the horse’s abdomen, and used a harness to hold the recorder. They employed a stomach tube to send the capsule directly to the horse’s stomach, where it began a roughly eight-hour journey through the small intestine.

The results are promising. The camera was able to capture nearly continuous footage of the intestinal tract with just a few gaps where the sensors apparently lost contact with the camera. For veterinarians, this could become a powerful diagnostic aid for troubles such as inflammatory bowel disease and cancer. It could provide insight on how well internal surgical sites are healing. It may also help researchers understand normal small-intestine function and let them see the effect of drugs on the equine bowel.

The team did identify some challenges in using a technology designed for humans. They realized that a revamp of the sensor array could help accommodate the horse’s larger size and help pinpoint the exact location of the camera at any given time. That larger size also could allow for a larger capsule, which in turn could carry more equipment—such as a double camera to ensure forward-facing footage even if the capsule flips.

With this successful trial run, the team plans additional testing on different horses. Ultimately, they hope to use the information they gather to seek funding for development of an equine-specific camera pill.

“From the engineering side, we can now look at good data,” Dr. Wahid explained. “Once we know more about the requirements, we can make it really customizable, a pill specific to the horse.”

This article was originally published in Practical Horseman’s October 2016 issue. 

Equine Podiatry

Medical History


  1. DDFT Lesion on right hind
  2. Cervical Spine Arthritis
  3. Hip discomfort due to past fall

Past Treatments Tried


  1. Stem Cell Injections: Healed the DDFT lesion in right hind until recently the lesion began to reappear
  2. Ozone Therapy: Assists in the healing of tissues
  3. Shock Wave Therapy: Assists in the healing of tissue
  4. Chriopractic adjustments
  5. Acupuncture
  6. Supplements

Initial Consultation


Chance showed decreased movement in his right hip and a audible cracking noise at the suspensory joint.  He has edema of both hind fetlocks, Pastern, and Pastern Dermatitis.  Chance was unshawed on both hinds due to his inability to stand for long periods of time and his decreased mobility.  However, his front adorned clips.

Due to the length of Chance’s front toes and the height of his heels he was unable to evenly distribute his weight (60/40) to his front and hind ends.  This would most likely cause increased tension on the DDFT tendons and corresponding ligaments resulting in an increased likelihood of tendon and ligament related injuries.  The uneven distribution of weight could also inhibit the horse’s range of motion through his hips resulting in his body compensating for this injury and causing ataxia (balance issues), pain, arthritic changes, and cervical spine misalignment.

By shortening the toe of both front feet, the heel will rise allowing a more even distribution of his weight.


Front


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Final Product: Front


Trimmed feet to corrected to the following specifications:

Foot   Beginning Angle & Toe       Corrected Angles & Toe   Total P.C.

L/F    47 Degrees at  3 7/8 inches   53 Degrees at 3 inches         6 Degrees

R/F    45 Degrees at 3 3/4 inches    54 Degrees at 3 inches         9 Degrees


Hind


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Final Product: Hind


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 Return visit to trim and shoe Chance’s hind feet with #2 OBRHB Wedge shoes.Trimmed hind feet and corrected to the following specifications:

Foot   Beginning Angle & Toe       Corrected Angles & Toe   Total P.C.

L/H   48 Degrees at 3 7/8 inches    54 Degrees at 3 1/4 inches    6 Degrees

R/H  46 Degrees at 4 1/4 inches     55 Degrees at 3 1/4 inches     9 Degrees

Note: Chance needed to be sedated by veterinarian to complete the trim and shoe his hind feet due to preexisting hip and DDFT issues.

Ozone Therapy


OZONE THERAPY – HISTORY, PHYSIOLOGY, INDICATIONS, RESULTS


 Judith M. Shoemaker, DVM 305 Nottingham Road Nottingham, PA 19362

717-529-0526 Fax 717-529-0776

http://www.judithshoemaker.com

Ozone therapy has been utilized and heavily studied for more than a century. Its effects are proven, consistent, safe and without side effects. Why is it not more universal in its use? Many of you have come with some trepidation about infusing a gas into a vessel because you are concerned about emboli, or have some dreadful fear about ozone’s toxicity since we frequently hear about the unhealthy ozone levels in the atmosphere. These fears do not apply to properly administered medical ozone, and the potential benefits of ozone therapy are profound and without associated detrimental effects.

Oxygen, in its several forms, cycles through the atmosphere and life processes just as water does. Ozone is produced in the upper atmosphere when UV light strikes the oxygen rising from plants, plankton, and algae in our forests and seas. It then falls back through the atmosphere, as it is heavier than air, combining with pollutants and water, cleaning the air and forming peroxides that benefit plants. Ultraviolet light breaking down pollutants and nitrous oxides also can produce ozone at the ground level, which is the eye and lung irritant in smog.

Medical ozone, used to disinfect and treat disease, has been around for over 150 years. Used to treat infections, wounds, and multiple diseases, ozone’s effectiveness has been well documented. Ozone has been used to disinfect drinking water since before the turn of the last century. A text on medical ozone therapy was published by Dr. Charles J. Kenworth in 1885! The best technology for producing ozone gas was designed and built by Nikola Tesla in the 1920’s. Heads of leading medical institutions in the U.S. contributed to a 1929 book “Ozone and Its Therapeutic Actions” describing the treatment of 114 diseases using ozone.

In 1933, the AMA began its systematic suppression of all modalities of treatment that did not complement its liaison with the emerging pharmacologic and diagnostic industries. Ozone therapy, along with many other useful therapies, were methodically eliminated from the educational process and exposure to the public in the U.S.

Less suppression has occurred in Europe and other countries, especially in Russia. Today in Germany, and other countries, ozone therapy is commonplace. Over 7000 doctors in Germany use it daily. In fact, in Germany, ozone generators are in ambulances for treatment of stroke victims. The incidence of permanent paralysis in these patients is much less than that in similar patients where ozone is not used.

Ozone generators are relatively simple and inexpensive. The equipment used to handle ozone is readily available but needs to be relatively non-reactive. Glass, Teflon, Kynar, silicon, and gold are completely non-reactive. Equipment made of other substances can contaminate the ozone or just deteriorate rapidly using up the ozone and becoming nonfunctional.

 Generators use several technologies to produce ozone

  • UV lamp – makes small amounts of ozone and is unreliable in making accurate concentrations. They burn out easily.
  • Corona discharge – dual dielectric sealed systems produce ozone but also lots of heat which is both destructive to ozone and to the machine.
  • Cold plasma generators – which produce ozone using low level current passed in 2 tubes of a noble gas between which an electrostatic plasma field forms that ionizes the oxygen.Ozone concentration is measured in u/ml or gms/L of oxygen, 5% or 70 u/ml is usually the maximum concentration used in clinical medical applications. High concentrations will damage red cells and inhibit growth of healthy cells.Dosage and frequency protocols vary widely. Initial high dose treatments may “jumpstart” the immune system followed by lower doses. Those who are fearful have been “starting slow and going low” with dosage and still have good results. Concentration must be carefully controlled with accurate flow rates, requiring pediatric regulators for the needed slow flow rates to produce high concentrations. Therefore, home made machines and lesser quality nonmedical devices are not appropriate.

    Ozone poteniates free radical scavenging substances and systems in the body, inducing the production of superoxide dismutase, catalase, and glutathione peroxidase. If ozone administration causes any respiratory irritation from out-gassing through the lungs, a bolus dose of 1 to 5 grams of vitamin C can be given and will eliminate any coughing instantly.

    Oxygen/ozone mixtures cannot cause emboli when injected at reasonable rates as they dissolve and diffuse very quickly in body fluids, unlike air (predominantly nitrogen) which is what forms emboli and causes the bends or decompression disease.

    The physiologic actions of ozone are many, the simplest of which is to provide sufficient oxygen to allow complete oxidation of sugars and other fuels to produce sufficient and efficient energy and to “burn clean” to CO2, water, and inert end products. If not enough oxygen is available, then incomplete oxidation occurs, producing carbon monoxide, lactic acid, and partially oxidized toxins that inhibit further oxygen metabolism and “clog the system”, tying up hemoglobin, water, and the mechanisms for function and elimination.

    Administration can be through any route with modifications:

  • Direct IV infusion – Ozone slowly administered into a major vessel.
  • Major auto-hemotherapy – Anticoagulated blood is mixed with ozone and is infused into a vessel.
  • Rectal/vaginal insufflation – Humidified ozone is administered by catheter.
  • Minor autohemotherapy – Blood mixed with ozone is injected intramuscularly.
  • Limb or body bagging – Body or parts are bathed in humidified ozone.
  • Ozonated water – Dissolves easily in water to be used topically or consumed.
  • Ozone in Saline or LRS – Can be used topically or given IV or SQ.
  • Intra-articular administration – For joint healing and prolotherapy.
  • Prolo/Sclerotherapy – Very good, less painful than other agents.
  • Acupuncture – With ozone, more effective than B12.
  • Ozonated olive oil – Ozone is bubbled through oil until the oil is thickened. This will produce ozonides that are not irritating and thus is applied topically even to eyes.
  • Inhalation – Ozone that has been bubbled through olive oil and humidified will not irritate respiratory epithelium.
  • Subconjunctival injection – For ulcers and keratitis sicca.
  • Gingival and tooth apex injection – Can eliminate infection.
  • Urinary bladder insufflation – For chronic inflammation.
  • Disc protrusions – Prolotherapy, which can be injected at interspinous space and around facets, stabilize joints and accelerate healing.
  • Auricular – Can be direct, humidified, or bagged with a homemade device made from IV bags and tubing (á la Margo Roman).As an anticancer, antiviral, antibacterial, and ant fungal agent, ozone is unsurpassed, especially since there are no appreciable side effects.Oxygen deficit is key to the development and progression of all disease processes. Dr. Otto Warburg’s work, confirmed by others, shows that this deficit and subsequent toxin buildup is the fundamental cause of all degenerative disease, especially cancers.

    Antioxidants help the body to protect itself from excessive oxidative damage caused by multiple free radicals, many of which are inactivated by ozone. The support of free radical scavenging systems is important but only oxygen can improve the deficit that makes cells vulnerable to oxidative damage in the first place. Long-term ozone therapy can be augmented by supplementation with antioxidants, but normally they should not be administered within 4 to 12 hours of ozone therapies.

    Ozone produces the same effects as exercise, which produces significantly more free radical oxygen than can be administered in any ozone treatment. Ozone equals ”exercise in a syringe” without doing joint damage.

    Ozone potentiates more complete oxidation, helps to maintain more normal body temperature and increases the effects of most hormones, vitamins, herbs, homeopathics, and drugs. Concurrent ozone administration reduces the amount of chemotherapeutic drugs needed to achieve effect by 1⁄4 to 3⁄4. It complements chelation therapies and frequently improves the affect and sense of well being in patients.

    Continued therapy will allow Herring’s Law to manifest “Healing from inside to outside, top to bottom, front to rear, and in reverse chronological order of the insults to the body.” Healing crises, however, may occur. Ozone therapy facilitates the rapid resolution of these crises.

    2005 Judith M. Shoemaker, DVM

Chance’s Face Lift

I brought Chance in from his turn out this evening and immediately noticed this flap of skin hanging off of his forehead.  Another emergency vet visit…yay!  Unfortunately, due to the skin flap being to the side and not hanging downward from the top, Chance needed staples…I believe it was 14 staples in the end and two cuts.

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Needless to say, the vet did a phenomenal job stapling his poor forehead.

Lucky Lucky?

Well, I hate to say it but Lucky had to get castrated….after trying to keep him from relentlessly mounting the miniature pony, there was no other choice.

He he was a trooper through the entire ordeal. He was given the standard doses of antastesia medication and was walked outside to a soft and grassy area to lay down. He wobbled a bit and was guided down gently to avoid additional stress or injury.

Once he was laying down his face was covered and one leg was tied with a rope and someone held the rope to ensure the vet was not kicked. The castration procedure began and lasted about 20-30 minutes from start to clean up.


Once the procedure was completed the vet continued to try to keep Luck laying down and calm to aid in minimizing the bleeding. However, Lucky was ready to get up even before he was completely awake. He was hand walked until stable enough to walk around alone. The vet explained that it was better for him to walk around instead of standing in a stall.

I brought him in once to clean him up a bit more and add SWAT around the wound to keep the flies off.  This was only accomplished by me leading him in while begging for him to “just come inside for a minute” and promising he “could go right back outside.” While I was pathetically negotiating with Lucky, Chance came up behind him and kept nudging him lightly in his hind end! It was the cutest thing I have ever seen! After I got him inside and cleaned him up and applied more ointment I let him back out.

However, later around dinner time, when I tried to get Lucky to come inside again to eat he decided to get sneaky.  He decided to go into stealth mode and “hide” from me so that I wouldn’t try and bring him in. (Pictured below). He actually went into a random paddock that he isn’t familiar with and stood there quietly and barely moving. Just watching me out of the corner of his eye while I called for him.

Luck stayed out until about 10pm and when he came inside for the night SWAT was reapplied and a dose of Bute was given. He refused to eat his dinner but gladly inhaled carrots and drank some water.

This morning his feed was all gone and there was no apparent swelling or increased discharge thankfully. According to the vet it takes about a month for the testosterone to be depleted after castration. I’ll be interested to see the changes, if any, that occur as a result.

Luck following Chance in their new matching halters

“Ask him what he wants…you will know what to do from there.”

When I arrived at the farm I was greeted by those familiar big brown eyes and a whinny.

I brought him out of his stall and gave him a bath.  He has always loved to be groomed and bathed, even if he is apprehensive to walk into the wash stall. After his bath, we went outside for him to graze and get some sunshine.  When we walked inside the barn, I stopped him and looked into his eyes and asked him, “do you want to keep trying to get better or are you ready to give up?”  He just looked at me.  A lump immediately formed in my throat.  He nuzzled me and rubbed against me.  I said again, “Do you want to keep fighting?”  He shook his head up and down! I swear to you!  This actually happened!

The decision was made, we would keep on fighting as long as we were able to keep him comfortable.  There was nothing I wanted more than to bring him home with me, let him live out the last days of his life pain-free, and with me by his side.

This was his turn.  He had always done what I asked of him- lessons, moving stables and even cities, and he was patient while I was in school- and it was his turn for me to make it about him.  For Chance to get every ounce of my time and for me to fight for him!

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Road blocks

 

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The first round of injections provided Chance with some relief, in his ability to move around and the swelling went down a bit, but that only lasted about a week.  At about day 8, Chance was swollen again and 3 legged lame.  Thankfully, a family friend of the farms owner called me.  She explained that the farrier was out shoeing one of the horses and saw Chance’s leg, and when he arrived to shoe her horses, he expressed his concern.  I immediately contacted Vet4 an he was out the following day.

Vet4 injected the masses again as a temporary fix, until we could make some decisions.  The ultrasound showed that the masses were the exact same as they were in the first ultrasound- they hadn’t increased or decreased in size.

Later that evening, Vet4 and I had a lengthy conversation about where to go from here.

We discussed the options again, at length.  We could do an MRI to gain more insight into what is happening with that leg, go in with an Arthroscope and clean it out, or look into Stem Cell Therapy.

Well, I wasn’t comfortable putting Chance under anesthesia…he was too old and too frail.  Plus, he could break a leg or a hip going down.  So, that ruled out the MRI (unless I could find a standing one) and the surgery.  The Stem Cells would run about $3000.00, plus he would need to goto the hospital to have the procedure done.

I took the night to think it over, and stayed up until sunrise reading as much as I could on leg issues, the different options vet4 and I had discussed, and other potential causes.

That next morning, I received a call that Chance was worse.  Vet4 was out of town due to an emergency, so I called Vet3.  She got out to the farm immediately.

Vet3 gave Chance Surpass topical to put on the leg, Banamine, Ulcer Guard, and continued with the Prevacox to keep him comfortable.

I asked her what she thought about the options- she felt, as I did, the surgery wasn’t a good idea and that an MRI should only be done without sedation.

I called Vet4 and we spoke about the current situation.  What else is going on? He suggested changing the course and trying different diagnostics.  He explained that TSMs (Tendon Sheath Masses) can cause swelling and pain, but they are usually relieved by the injections.  The ultrasounds showed that his suspensory tendon and ligaments looked good.  Could this be an infection? Soft tissue damage? A bone issue?

I asked him if he felt moving forward with more tests was a bad thing…was I being cruel keeping Chance alive like this?  Something that had been weighing on me from the start.  And what Vet4 said, empowered me to continue down the path I initially felt in my gut to be the right decision.  He said, “I am not the kind of person to ever give up on someone or something.” I asked if we were able to manage his pain adequately and make sure he was comfortable and he said, yes.  He advised me to “make a decision based on the horse” and “not to listen to the opinions of everyone else”.

The next day, I cleared my schedule, and headed to the farm.

 

Answers

Vet4 came out immediately.  I was beyond grateful!

He did an ultrasound of the back right leg and called me.  He found that Chance has Chronic Cellulitis and that there was Vascular constriction, and masses on the tendon sheath between the superficial and deep tendon sheaths.  The Doppler showed good blood flow and a thickening of the synovial lining. Hoof testers- Negative

We spoke about my opinions- MRI, Arthroscopic surgery, Regional Diffusion, Cold Compression Therapy, Nerve Block Injections, Steroid Injections

We decided  to try the Steroid Injections into the 3 Synovial masses to hopefully reduce the size and thickening.  Thus allowing us to see behind the masses to see what is actually happening.

Injections were into the Proximal Digital Flexor Tendon Sheath with 6mg Betamethasone and d100mg of Amikacon. Leg was covered with SSD and DMSO and bandaged.

Once injected, cold compression therapy for about 5 days twice a day and stall rest. Banamine daily.

The Call

One day I received a call that I needed to come out and see Chance because he wasn’t doing well and, according to Vet1, he needed to be put down.  I quickly canceled my appointments and got on the road.  The 4 hour drive was excruciating…once we finally arrived, my heart broke.

My old guy was skin and bones.  His back right leg was swollen and he wasn’t able to bare weight on it.  His eyes were dull.  He could barely walk, and when he did, he wouldn’t put any weight on the right hind.  There were even times when he would do this “neurologic dance” (coined by the farm’s owner and C’s other mom) where he would lift up his back right leg and hop!

But when he saw me pull up, he whinnied.  He was excited to see me.  He ate the pureed carrots but refused the apple puree (only my mom would make this for him).  He wasn’t ready to die.



I called the vet who said that Chance should be put down to see what his thoughts were.

Me:   What do you think is going on with C?

Vet1: I think he is ready to be put down. 

Me: Because of what?

Vet1: Lymphangitis

Me: Okay, well, what is the cause of the Lymphangitis? Did you run any diagnostics?

Vet1: No

Me:  I would like to manage his pain and run a few tests before making that decision.  (I reviewed the research that I had done and asked where to go from there.) Could it be EPM?

Vet1: “It’s not EPM”

Me: How about Cushings? Or Laminitis? Lymes?

Vet1: Nope. Just old age.

Me: The journals I read said that some of the symptoms…(I was cut off)

Vet1: “I don’t care what journals you read!  It’s a bunch of…”

Me: One was from VA Tech actually…



Well, that was that! Vet1 did not completely lack compassion but he was more “old school” I guess one could say.  He was well respected in the horse world and up until this point, he did the job I needed. But I will say I was disheartened by our conversation.  

I decided to contact the other vets that I had worked with in the past, who also knew Chance, and get second, third, fourth opinions.  

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