The Horse:Your Guide To Equine Health Care provides monthly equine health care information to horse owners, breeders, veterinarians, barn/farm managers, trainer/riding instructors, and others involved in the hands-on care of the horse.
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25 February 2016 THE HORSE TheHorse.com sutured—one of my favorite parts of equine medicine. I block the nerves in the area with local anesthesia and then rinse to remove any contaminants. The clini- cian explains the suture pattern he wants me to use for a stifle laceration that's in an awkward location—all my practice has been on cadavers placed in the perfect position for me to work on. I sit on a stool on the opposite side of the horse and work almost underneath him to reach the medial (inner) stifle. Luckily, this horse is very well-mannered and stands quietly as I work. After placing a few vertical sutures called mattress sutures to bring the edges of the skin together, I place a cruciate liga- ture pattern (consisting of single crossed sutures) between and leave the lowest portion of the wound open for drainage. I use a few cruciate ligatures to close a lac- eration on his cannon bone, as well. We flush all other abrasions and place lower limb bandages on both hind legs. 4:30 a.m. — We're finally done treating our patient, and he can go to his stall for IV fluids and rest. I now have to make his treatment sheet and set up his fluids and medications. Like any normal young growing Thoroughbred, he's hungry, and as soon as we put him in his stall, he tries to eat the shavings. So I put a muzzle on him. He's now resting comfortably, attempting to play with his water bucket and searching for food. We can't start refeeding him, however slowly, until we know he is doing better (e.g., bright and alert, good gastrointestinal sounds, pass- ing manure, normal abdominal ultra- sound, and rectal palpation). For now he remains on colic watch. For most veterinary students, the least exciting aspect of veterinary care is paperwork. I have to write a "SOAP" (subjective, objective, assessment, plan) twice a day for my patients. The subjec- tive and objective portions include my evaluation of the patient through physical exam as well as all diagnostics performed. The assessment portion includes possible diagnosis and reason for all abnormal di- agnostic results. This is the portion where I flex my knowledge and work hard to understand why we chose each diagnostic method and what the results mean for my patient. The plan outlines our steps going forward. For the Thoroughbred, this includes IV fluids at 2 L/hour, IV pain medication, omeprazole ulcer medication (which he was on before he arrived), and close monitoring for any signs of discomfort, pain, bleeding at laceration sites, bandages getting out of place, bowel movements, and urination. 5:00 a.m. — I can now go back to help- ing my rotation-mates with treatments for the other in-hospital patients. I'm not as tired as I expected to be; however, this is only the first day of overnight rotations. 7:00 a.m. — I need to do a complete physical and work-up on my patient so I can be sure he's stable and ready to present to the equine medicine daytime student. His TPR (temperature, pulse, and respiration) is within normal limits. He occasionally kicks at his belly, but the GI sounds are much more normal than when he got here. His blood work is within nor- mal limits. Overall, I believe my patient is stable and won't need further treatment this morning. We will slowly allow an in- crease in feed intake throughout the next couple of days, with careful monitoring for return of abdominal pain. 8:00 a.m. — I present the case to the student taking over and answer all of his questions. 8:30 a.m. — Off to the barn to see my own horse, get a ride in, clean him up, and then figure out how I'll sleep during the day. Being a veterinary student has been the most stressful yet exciting three years of my life. I'm one of those students who knew at a very young age that all I wanted from life was to fix animals— more specifically, horses. I can't imagine doing anything else as a career. I'm lucky enough to spend my "vacations" work- ing with my mentor, who has more faith in me than I usually have in myself. She runs my dream practice in Reno, Nevada—ambulatory, strongly rooted in medicine, compassionate, and deeply bonded to clients and their horses. This year is all clinical rotations. I get to immerse myself in clinical equine medicine and apply everything I learned in the last three years. These rotations will prepare me to excel in a one-year equine internship at Alamo Pintado Equine Medical Center, in Solvang, Cali- fornia (my dream since 2009) where I can grow as a veterinarian under excellent in- struction before eventually going out "on my own" and starting a practice as my mentor has. The rest of the academic year will be exhausting, exciting, educational, and testing of my life outside vet school. I wouldn't trade this life for anything. h Hayley's colic patient was not very happy with the muzzle he had to wear to prevent him from eating the shavings. An example of the beginning of Hayley's ICU sheet for her colic patient's hourly care. One of Hayley's patients suffered a stife lacera- tion requiring sutures.