The International Equine Veterinarian Issue 1, 2017

Message from the Publisher

F

ive years ago Dr. Ric Redden invited me to spend a week on his farm in Versailles, KY to observe a course he calls Equine Podiatry 101. I do not have formal education in veterinary medicine nor have I ever put shoes on a horse. However, what I saw during that week made perfect sense to me. Since that time, I have heard countless debates about the subject and who should be in charge of footcare for the horse.

He taught a team approach involving an equine veterinarian and a farrier. During that week farriers were matched with veterinarians to diagnose and treat specific problems involving the hoof. The lectures and demonstrations began after breakfast around 7:30 am and went until all questions were answered . . . usually around 7:30 pm. It was like trying to get a drink from a fire hydrant.

The AAEP has a formal initiative underway for this concept and, hopefully, it will move forward. All involved recognize there are many obstacles to overcome, training to be established and some sort of certification process. I keep in touch with Dr. Redden and offer space to keep a light on how things are going. This magazine reaches an equal number of equine veterinarians and farriers. That’s why this article appears.

The remaining editorial material is self-explanatory and we hope you enjoy reading all of it.

G. Richard Booth Publisher

Table of Contents “Angel”

A very bad impaction and bloat caught just in time!

Dr. Dave Frederick describes a near-death call early one morning and how it was handled. “Angel was very close to death when she was found—not so much from the impaction and gas colic, but from her fear of being trapped on her side. How long this went on in the middle of the night.”

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Ric Redden Equine Podiatry Tips

Dr. Ric Redden offers is the first of a series of aricles on Equine Podiatry. Some material may be elementary to most veterinarians but the equine podiatry concept is a joint venture with farriers. This magazine also reaches more than 7000 farriers worldwide. We hope the first article in this series sets the stage for further discussion and development of this movement.

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Homogenization Dr. Geoff Tucker takes a cue from the current political situation and advocates for a respect for opposing views. Maybe better described as “thinking outside the box.” He relates many lectures and discussions where many are heard to dispute the presenter’s advice or findings but reluctant to offer any better solutions. When we surround ourselves with “yes” men or women, we stagnate the problem solving and everything becomes the same. Not an easy concept to describe. Just read the article for his usual sage comments.

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True & Incredible Stories of a Horse Vet Her Hoof Is Deadly Accurate . . .

When working on a horse that measures 17 hands at the withers and doesn’t take her eyes off you during the exam . . . be wary. Especially when the owners give you advance warning.

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Colorado Horse Park Announces Inaugural Dressage Symposium The Colorado Horse Park (CHP) has announced a new initiative to bring an elevated level of exposure and clinic opportunities with world-class dressage riders to the venue through Dressage Symposium In The Rockies (DSIR) to be hosted May 20-24, 2017.

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The publisher of this magazine makes no represtation and provides no warranty as to the accuracy of any advertising or articles contained herein. The views expressed by all contributors are not necessarily those of the publisher. The publisher reserves the right to decline any advertising for any reason.

Copyright 2017 by Boca Publishing, Inc., PO Box 970902, Coconut Creek, FL 33097 (954) 295-2154.

Reproduction in part or whole is not permitted without written permission from Boca Publishing, Inc. Cover photograph/artwork by G. Richard Booth.

“Angel” A very bad impaction and bloat caught just in time !

Dr. David Frederick • drdfrederick@yahoo.com

P

eople often ask me if I have to go out much in the middle of the night for emergencies. Most foals are born at night, so in the Spring I do have more night calls, but during the other seasons night calls are not that frequent.

One interesting and very serious night call came at 5:30am after I had gotten to bed at 1:45am from the previous night’s last call (vets sometimes have to sleep very fast). This particular 5:30am phone call was from a lady I had never heard from before. She apologized and explained that her regular veterinarian was out of town, and her “horse was down and really bloated, and had foam coming out of her nostrils”. I never like to make life and death decisions for people and horses I have never seen before, but this was a true emergency.

From the lady’s description over the phone, I suspected the horse might well be dead by the time I arrived after a 30 minute drive.

Sandy’s son-in-law waited for me at an intersection I was familiar with, then led me through another mile long maze of 6

winding neighborhood roads I had also never seen before.

Next Sandy met us in her driveway with a flashlight to lead me around to the backyard where her mare was down in a run-in shed. “Angel” and her pasture mate were the only two horses in the otherwise very residential riverside neighborhood. Angel, a retired 22 year old AQHA race mare, was indeed down, bloated, exhausted, and cast on her left side.

Sandy and her daughter had removed the outside plywood wall of the run-in shed, and now the large mare’s legs were through where the wall had been with a post between her legs and a horizontal 2 x 4 frame just above them. The large and heavy mare was surprisingly easy for me and her “non-horsey” son-in-law to roll onto her other side with just two short lead ropes around the downside pasterns. When free of the wall, Angel immediately got to her feet. Besides The International Equine Veterinarian • Issue 1 • 2017

being severely bloated, she was wet, filthy, and exhausted.

She was breathing so hard I suspected she was also experiencing an asthma attack, but Sandy said, “No, the other horse has allergies and coughs from time to time, but not Angel.”

We led Angel out to the front of the house where my truck was parked with a variety of drugs available to see if I could give her any medicinal relief. At this point the severely bloated mare seemed to be numb with pain. I had seen horses stand like this at the end of fatal colics after the pawing and throwing themselves on the ground had stopped, and just before dying of toxic shock. I first gave her 12cc of Dipyrone IV to start relaxing her intestine. In giving the IV injection, I noticed her esophagus next to the jugular vein was full of saliva and air. In wiping down the jugular vein with alcohol, the esophagus made a lot of very unusual sloshing noise.

The sun was just starting to come up, and the color of the mare’s gums was hard to assess in the predawn darkness.

Holding her lip up just aggravated the mare as she struggled to breath. Both her pulse and respiration rates were about 80 per minute. I added 2cc of Rompun and Torbugesic to next relax her mind and further soften the obvious abdominal pain. Both drugs are rapid and short acting sedatives and pain killers. I always avoid Banamine until I have diagnosed the cause of the colic and/or the owners have ruled out surgery, because Banamine makes it too difficult for me to monitor deteriorating vital signs. This makes the decision to refer to a hospital for surgery much more difficult for me after Banamine has been given.

I asked Sandy to slowly walk the mare about 100’ down the road and back, while I sent her daughter and son-in-law to get some brushes to clean the mare who had probably been down sweating and rolling in the dirt and manure in the run-in-shed for hours. I also asked for a gallon jug of warm water. When Sandy brought Angel back from her short, slow walk, her daughter started cleaning off her hips and sides, while I added Epsom Salts to the jug of warm water. Because

her rapid and loud breathing was showing no sign of easing 10 minutes after getting to her feet, I was pretty sure she was also having an asthma attack (very possibly stress induced rather than allergic), so I gave her 10mg of Dexamethazone IV. I delayed passing a stomach tube due to her still very labored breathing, so I next did a rectal exam on the mare.

There were just two small fecal balls in the rectum. The pelvic canal was full with a displaced and gas distended large colon. While I could not identify the pelvic flexure which is the most common site of impactions, the nearly empty rectum and absence of any fecal balls in the small colon confirmed for me that the mare had either an impaction or a torsion which had interrupted the passage of manure and allowed the large colon to fill with gas overnight.

I asked Sandy if, given the potential $5,000 to $10,000 cost of referring a horse to a hospital for colic surgery, she might be inclined to spend that much money on this horse. These are the questions I hate asking people, especially when I do not know their history with the horse. These are very personal family decisions. Husbands and wives often have different opinions on spending that much money on a horse with a questionable chance of survival.

My experience with having referred well over 100 such colic cases over the

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past 35 years to 7 different surgical hospitals and tracking the successes and failures often has a large influence on the owner, who usually is making such a decision for the first time in their life. I do not like encouraging people with limited resources to waste large amounts of money on hopeless cases.

Horses and people with especially close ties and more financial options are more likely to risk more money if there is any chance of success. Too often people are forced to decide when enough is enough, and more is unrealistic for them.

With surgery ruled out (at least initially, because it’s not unusual for clients to change their minds further down the road), I attempted to pass a stomach tube for a gallon of mineral oil and the gallon of warm water and Epsom salts.

Even this did not go easily as the mare was still struggling for air while I was trying to convince her to swallow a tube up her nose. It was an unseasonably warm morning, and the mare was hot from her long struggle while cast. The tube was too soft and flexible for me to find the esophagus when she did occasionally swallow. I asked for a bucket of ice water, coiled the tube up in the bottom of the bucket, and it stiffened with a slight curve at the end after a couple minutes in the ice water. This enabled me to find her esophagus on the first try with the cold and stiffer tube.

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Surprisingly the gas released from her stomach was relatively mild. It is often very sour when a colic has gone on 5 or 6 hours. I was also pleased to find very little reflux of intestinal fluids from the small intestine when we primed the tube with the Epsom salts and water. I lightly flushed her stomach with the first half gallon of the solution, then switched to the mineral oil after releasing more gas from the stomach. I pumped in the full gallon of mineral oil, then the rest of the gallon of water and Epsom salts. Before removing the tube, I again released the remaining excess gas pressure in her now rather full stomach.

My first 30 years as a veterinarian, I rarely gave two gallons at one time by stomach tube, however the last five years I have done it much more frequently and I believe it has been very helpful. The horse’s stomach is relatively small, but his intestine is nearly 100’ long with the most common sight of impactions about 80’ down the line.

Researchers determined in the 1990’s that a gallon or two of anything—feed, water, mineral oil—in the stomach causes an involuntary, sympathetic reflex dumping of water from the blood into the large colon. This physiologic response to water and oil in the stomach can be very helpful to impactions in the colon. Of course the mineral oil coats and lubricates everything while traveling to the impaction, and the oil helps prevent the water from being absorbed

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in the small intestine so a fair amount of it also reaches the impaction in the colon to soften it while the oil is lubricating it.

Most impactions can be resolved in 12 to 18 hours with this treatment if the horse can be kept comfortable and lightly walked. Allowing a horse to roll in this condition is especially dangerous. While a horse with a normal working intestine is rarely in danger of twisting it’s intestine when rolling over, a colicy horse with gas in one section of intestine and a heavy impaction in another section is at very high risk of twisting if allowed to roll. Gas distended sections of intestine tend to rise, while heavy impacted sections of intestine drop. When the horse rolls over, they frequently twist or displace themselves.

After the oil and water with Epsom salts were pumped into Angel, Sandy took her on a couple more slow walks down the road and back. She was starting to look a little better so I asked them to borrow the neighbor’s front yard where the grass was green and about 6” tall.

With a little bribery and patience Angel started to slowly accept some hand fed green grass. Within a few more minutes she was reaching down to graze tentatively on her own. I believe the slow walking and light grazing stimulates peristalsis—the involuntary contraction and relaxation of the intestine which is essential for normal gut function.

Sandy and her daughter alternated slow, short, walks down the road with 3 or 4 minute light grazing sessions for Angel, and I cleaned and put away my buckets, tubes, and drugs, while watching Angel’s slow, steady improvement. The bloating was significantly better than it had been just 30 minutes earlier, and she was starting to eat the good grass a little more like a hungry horse than a very sick horse.

Impacted horses like Angel rarely pass any manure in less than 12 hours. Most require 18 to 24 hours. I remember two large horses that survived 48 hour impactions, and just one old Shetland Pony whose distal small colon was totally plugged up with a 6” hairball for 72 hours—and he was one of two Shetland Pony patients I’ve had live past 40 years old!

The point is Sandy still had hours to wait and watch while the oil, Epsom salts, water, and now green grass and light walking took time to move the impaction.

Because the drugs I had given Angel each had a rapid onset of action (within a few minutes) and a short duration of effectiveness (1 to 6 hours), I discussed adding Banamine before leaving. Banamine can be further effective at relaxing the intestine for 24 hours, however it can also mask deteriorating vital signs, making it much more difficult to recognize the need for surgical referral. Sandy again said surgery would not be an economic option, so I added 12 cc of Banamine IV for the large mare.

Sandy’s regular veterinarian was out of town, so she had the option of calling me back to recheck the mare later in the day, or the relief veterinarian at the other clinic who also had never seen the mare before. It’s very hard to assess progress when you have not seen a horse before, so Sandy preferred I follow up with Angel.

Sandy called my cell phone around noon to report that Angel seemed to be making steady progress. She was breathing normally, grazing and walking easily, but no manure had passed. She or her daughter had been with her constantly.

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I thanked her for the update, and asked her to call again if anything changed.

She called again about 5:30 pm to say that she still looked good, but she would feel better if I checked her again before it got dark. I agreed and offered that on occasion for stubborn impactions I had repeated the mineral oil, water and Epsom salts. Many times I have repeated the dipyrone before the colic was resolved.

When I rechecked Angel about 13 hours after she had been found down and bloated, she looked much better. She was still a very large mare, but not nearly as bloated as she had been earlier. Her pulse was still elevated at 60 bpm, but her respiration was much better at 20 bpm. She still had passed no manure, which was not unexpected, but before giving her more oil and water and Epsom salts, I did another rectal exam. I was thrilled to find a rectum full of soft manure.

volume of fluid in her stomach causing a reflex dumping of fluid from the circulation into the colon. In hospitalized colics, horses frequently receive 40 to 80 liters of fluids intravenously (at a cost of thousands of dollars) to create this response. The impaction was also moved by the restoration of peristalsis (the involuntary contraction and relaxation of the intestine). The drugs help this, but I also feel the light walking and grazing of good green grass are extremely helpful. I always tell people to walk a colicy horse like they are trying to walk a baby to sleep. I want them to relax, not get tired. Both walking and grazing colicing horses are done lightly to moderately. I did not give any additional oil, water, and Epsom salts.

There was no oil on the manure, so this meant her impaction had been softened by the physiologic effect of the large

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Sandy called again the next afternoon to report that Angel had been great that morning. She was passing manure fine, but she had lost interest in grazing, and seemed more lethargic in the afternoon. She wanted me to check her one more time. This was past 24 hours since the Banamine had been given, which might have been masking something else.

Angel’s temperature was 102.1, and she had mild fluid in her trachea. She was starting to come down with pneumonia from having been on her side two nights earlier. We had no idea if she had been down 1 hour or 6 hours, but a horse lying on one side that long gets very poor circulation and ventilation to the downside lung. For both lungs to work properly, a horse needs to be in an upright position. The down lung

of the night, we don’t know, but I’ve seen two other full blown panic attacks worse than hers in just the past 5 years.

My first 30 years, I very rarely gave more than one gallon of water or oil to a horse at a time, not wanting to rupture their stomach. How many times have you seen a horse drink two or three gallons at once? How much to give really demands good judgment on a case by case basis.

simply has too much weight on it. The air in the lean-to was filled with bacteria from the dirt and manure floor, which had taken advantage of the poor circulation and ventilation in the down lung and started pneumonia while we were treating the colic.

In retrospect, I should have recognized this predictable complication and given antibiotics on the first visit. I too often worry about running up someone’s bill by giving unnecessary medications. Nevertheless 25cc of penicillin followed by five days of SMZ-TMP tablets knocked out the pneumonia. Sandy said she looked great in just two days, but she continued the tablets to the fifth day. Her total bill for the 3 visits and all medications was just $314 to which she added a very generous cash tip to “buy my wife a nice dinner”.

I wrote up this case, because there was so much to learn from it. My first 30 years in practicing (and that is a very appropriate word) equine medicine, I never saw (or recognized) either a panic attack or stress induced asthma. Every horse is different. Some cast horses simply lie still and wait for help.

Others are scared to death and fight to the bitter end. Angel was very close to death when she was found—not so much from the impaction and gas colic, but from her fear of being trapped on her side. How long this went on in the middle The International Equine Veterinarian • Issue 1 • 2017

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Ric Redden Equine Podiatry Tips R.F. (Ric) Redden, DVM • International Equine Podiatry Center PO Box 507• Versailles, KY 40383 rfreddendvm@gmail.com Publisher’s Note The Veterinary Equine Podiatry Group, Inc. (VEPG) was officially announced at the 60th Annual Convention of the American Association of Equine Practitioners (AAEP) in December, 2014. The meeting was held In Salt Lake City, UT. The group, consisting of 32 veterinarians, defined their goal to set a standard for qualifications and role of a veterinary equine podiatrist. Not mentioned was the other side of the equation . . . farriers. In an effort to keep this concept in front of the equine industry, we reached out to Dr. Ric Redden, a member of the committee and president of the International Equine Podiatry Center in Versailles, KY. Dr. Redden is also a farrier.

This is the first of a series of aricles on the subject. Some material may be elementary to most veterinarians but the equine podiatry concept is a joint venture with farriers. This magazine also reaches more than 7000 farriers worldwide. We hope the first article in this series sets the stage for further discussion and development of this movement.

H

oof diseases may cause severe lameness and may be made worse by lack of proper care, inefficient treatment and management. An example of a more common and less severe foot ailment is thrush, whereas, laminitis is an example of one of the most severe. There is an old adage, “No foot, no horse” and that is definitely true!

Thrush

Thrush is a result of the invasion of anaerobic bacteria (Fusarium necrophorum) that become established along the deep fissures of the frog. The affected area is usually black and strong smelling. It is most commonly found along the central sulcus as this area can have a naturally deep cleft in some horses that can harbor moisture and debris, an ideal environment for anaerobes that thrive and reproduce in the absence of oxygen. If the thrush infection is severe enough, it may penetrate and expose the sensitive structures of the frog, often found when feet are being picked out. The horse will exhibit

pain when the hoof pick contacts the sensitive tissue often making it bleed.

Thrush seldom is the primary cause of lameness but can compromise performance. Established infections may appear to be difficult to resolve demanding further astute examination for other signs of canker that is often the culprit with nonresponsive cases. Thrush is usually caused by a constant ideal environment conducive to the growth of anaerobes. Moist debris that is trapped along the sulci for extended periods of time is a recipe for thrush. Therefore one of the most important aspects of treating an anaerobe is to expose it to the air.

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Topical treatment consists of debridement. Normally the farrier will be first to notice it or be called to take a look.

Most competent farriers will clean up the frog being careful to avoid the sensitive areas then pack it with a drying agent.

Daily treatment of thoroughly cleaning the area with a mild soap, rinse then dry the area also helps destroy the anaerobic environment. Packing the deep fissures with gauze, allows air to help eliminate the anaerobic environment. The gauze can then be saturated with a variety of topical drying agents. The author prefers 7% iodine mixed 50/50 with glycerin. Most cases are uncomplicated and heal in a matter of a few days.

If it persists with efficient treatment, canker foot may be a suspect. Prevention is the best cure. High risk feet may need to be picked more often especially during extended periods of excessive moisture, allowed to dry out, be trimmed and or picked out as often as necessary to prevent deep fissures and overgrowth from harboring this opportunistic organism.

This horse was turned out in wet muddy paddocks several hours a day but due to difficulty in picking his rear feet resulted in a good case of Thrush. (Note the cornified frog no longer protects the sensitive frog tissue.)

White Line Disease

White Line Disease is an infection in the hoof wall caused by bacteria, hoof digesting fungi (Pseudoallsheria and Scopulariopsis) or a combination of both types of organisms. The symptoms include white or gray powdery areas that involve the non-pigmented (white) area of the horn wall ,thus the name white line disease. The anatomical white line is very 14

old nomenclature that is long past due a more descriptive name,. as it is not white but dark in color and is the cornafied terminal laminae. As the white zone of the hoof is digested the defect can involve a large area of the hoof.

The hoof may sound hollow when tapped lightly with a shoeing hammer but the defect is not readily noticeable as the sole migrates over the decayed area as it forms and the horse seldom shows any signs of discomfort until the defect is large enough to cause mechanical sagging of the coffin bone in the area of the wall separation. At this stage the sole will appear fuller or dropped directly below the area of the defect and the horse may become acutely lame following a race or other stressful event. Radiographs are the gold standard for diagnosing and assessing the degree of involvement. Caution is due as most cases have several degrees of capsule rotation ,can be very sensitive over the flat or dropped sole and can become acutely lame in spite of being training sound for months as the defect slowly eats away at the inner wall.

These very same clinical and radiographic signs can be mistaken for laminitis .The characteristics of lucent zone (air space) found with the more advanced cases clearly differentiates this disease from laminitis. The history is also a key point as most all cases are quite sound until remarkable horn

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decay and subsequent displacement ( rotation ) has occurred .WLD is the result of horn wall disease and even though often very closely associated with the adjacent laminae the lucent zone does not involve the sensitive tissue ,it extends to the ground surface , has irregular borders and frequently harbors debris .These characteristics are strikingly different from the lucent zone seen in chronic laminitis. It is similar to onychomycosis in humans. Treatment is relevant to the degree of involvement and, the immediate goals of the owner. Horses with mild damage ( only an inch or so horn invasion)can usually stay in training with debridement and topical medication from the sole surface. Shod with a mechanical shoe that reduces stress on the defect and protects the opening from further debris can offer favorable results. Monitoring the defect with radiographs at each reset is very helpful. Larger areas of involvement demand great respect as training stress on the weakened wall can result in unwarranted displacement, vascular compromise due to increased compression of the sensitive sole corium and even irreversible bone damage in the advanced cases. Therefore they should be taken out of training until the wall has adequately grown out replacing the

Simplified mechanical appendage diagram

by Ric Redden, DVM

Treatment for the more advanced case should be first focused on remarkably reducing the tension on the deep flexor tendon (ddft).This tendon inserts on the caudal palmar surface of the coffin bone. The bone is attached to the laminae and laminae anchored to the wall.

Once the inner wall loses its strength due to the invading organisms the

Mild case of WLD, note the opaque area just off the apex of the coffin bone .This is debris that has entered the defect that involves the nonpigmented (white) zone of the hoof.

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the equilibrium between tendon and wall is disrupted. The wall can no longer resist the suspension effect of the ddft and rotation is the result of this pathological imbalance of natural forces. The goal is to mechanically shorten the distance between origin and insertion of the ddft/muscle unit thereby directly reducing the tearing and separation of the wall which invites even more bacterial and fungal invasion. The trim, shoe design, placement and attachment should offer sole protection from ground contact, encourage heel loading and adequately increase the angle of the palmar (plantar) surface resulting in laxity of the ddft. Palpating the tendon before and after application of the shoe can help confirm the mechanical goal has been met. Low beam lateral radiographs are also very helpful for farriers during the process of trimming and shoeing.

Reducing the tension on the deep digital flexor tendon (ddft) enhances the healing environment apparently by decompressing the vascular supply to the growth centers of the sole and horn wall .This effect can be monitored via comparative radiographs and venogram. If the defect fails to grow out at the same rate as the new wall using optimum mechanics, removing the wall exposing the defect is indicated. This allows excess to the area for thorough debridement and application of topical antibacterial and fungal medication. The proximal edge of the defect should be monitored for seed beds as the wall can quickly obscure further migration of the fungus. A variety of therapeutic shoes can be used to enhance the healing environment until the hoof is once again healthy.

Choosing the most appropriate shoe is relative to the degree of damage. Basically speaking the more damage the more mechanics is required and this is relevant to the degree of PA angle increase. This condition is most common in club feet (grades 1 to 4) when involving only one foot and can occur in the best hygiene, training establishments. Prognosis for full recovery is normally good however extensive, chronic cases can become complicated with life threatening focal laminitis.

Advanced case of WLD. Several degrees of capsular rotation has occurred, but unlike that found in laminitis the disease involves the horn wall instead of the laminae. The lucent zone (black) between the coffin bone and wall that extends to the ground surface has the same density as the air around the image. This is an air space, also much unlike that found with laminitis that is deeper within the foot but does not extend to the ground even when the bone has penetrated the sole.

High level mechanical shoe used to treat the case above.

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Case 2 WLD cas .The horn defect is not visible as the sole has migrated over it.

load of the coffin bone from the inside can also cause internal bruises and is a common cause of unsoundness. A horseshoe that falls short of the load zone of the heel or becomes loose, shifts or twist may also cause bruises especially in the heel area. When soreness or higher grade pain is the result of bruising the pain occurs sometime before discoloration reaches the surface of the sole. Sound horses frequently have evidence of mild bruising that occurred several weeks previous and never gave any indication of discomfort. The farrier is normally the one to discover the areas of hemorrhage that were once associated with the vascular corium that was transferred to the surface of the sole, frog and or terminal laminae as new growth occurred. Therefore the majority are insignificant as they are evidence of, very mild vascular disruption that occurred weeks previous, unbeknown to everyone and are easily trimmed out exposing healthy sole.

However if the horse is lame to some degree and the areas of

WLD involves a large majority of this hoof.

Once the undermined wall was removed the nails were placed outside the defect and Superfast (Vettec) secured the mechanical shoe to the foot, leaving an air space for treatment.

Sole Bruises

Sole Bruises are caused by excessive concussion to the sole. Rocks, gravel or other hard objects can cause injury especially when the sole does not have adequate depth. Therefore the majority of bruising occurs in feet with marginal sole and or heel mass. Excessive down 18

old hemorrhage cannot be trimmed out, and may feel and appear moist then it is likely the contusion extends through the sole to the sensitive structures and demands respect and efficient treatment. It is common for thin soles to become very sensitive following a routine trim when there is less than adequate sole mass. Shoes and or a protective pad can quickly produce favorable results in most cases however acute lameness can also occur after a shoe has been applied to the thin soled foot for several different reasons .Shoe bound or nail bound is a term used when the foot becomes painful a short time after being shod. When the sole is quite shallow the wall will also be quite thin relative to a strong durable wall. The increased pressure of the shoe on the sole once the farrier has clinched the nails can cause a lameness issue within hours or even a couple or three days later. If the shoe /sole contact is the cause for post shoeing pain the offending shoe can be removed, the foot put into one of the many boots on the market or protected for a few days in a cotton foot bandage. A wide-webbed shoe applied with or without a pad that has been seated out on its inner foot surface can also work well in many cases. There are several ways to glue The International Equine Veterinarian • Issue 1 • 2017

shoes on that bypass the tenderness to nail however some feet will become very soft under the adhesive in hot humid weather.

The nail bound horse can become quite lame shortly after being shod ,the result of a nail that hasn’t actually penetrated the sensitive tissue but is lying close enough to become a pressure point.

Removing the offending nail or nails solves the problem. A good preventative measure is to keep horses that are to be ridden on gravel, rocks or other hard surfaces shod or maintained with tough durable, conditioned feet. Avoid over trimming the sole. Leave nothing the

Previous sole and terminal laminae bruising frequently found in sound horses.Note the majority trimmed out as it was trapped within the cornified growth.

Corns

Corns are a specific location of sole bruises. They are deep bruises located in the angle of the hoof which is located where the wall turns toward the frog forming the bar. They are caused by excessive external and internal loading of the sole area that lies just inside the angle of the hoof wall. This is a common

problem when the heel of the shoe rest on this area instead of the stronger heel tubule. This can occur due to excessive hoof growth that displaces the shoe forward.

Corns are normally the result of cumulative damage from repeated trauma over a several day period and can cause acute lameness, especially when they become septic (abscess) .Whereas sole bruises normally result in pain the moment the sole receives more concussion than it can adequately defend. Most corns are not superficial even though the effects are visible on the surface much like an old sole bruise that occurred sometime previous. The angle of the hoof is one of the most fortified areas of the foot .The sole is thicker within the angle and due to the anatomical boundaries of the wall and bar repeated concussion is not dissipated as in other more flexible components and the damaged tissue is not only surface visible but often extends into the sensitive corium. Treatment consist of removing the shoe ,trimming the heel lower in the area of the bruise than the adjacent hoof .Applying a bar shoe to protect the painful heel from external trauma and transfer load to the frog.

This works quite well provided the frog is robust and tough.

Regardless deep seated corns require rest to enhance healing, especially when septic. It is important to be alert to rate of hoof growth as well as other changes that can occur between resets in order to determine the best time to pull the shoes, trim and apply another. There is not one standard time period between resets to fit all horses as the amount and quality of growth will vary due to the seasons, nutrition, exercise, shoe styles and overall strength of the wall and sole. The majority of horses are reset every 4 to 6 weeks .The larger breeds and those with strong, robust hoof capsules may go 6 to 8 or even longer as the overall added strength prevents premature loosening of the nails, shoe shift and overgrowth at the quarters.

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This horse had not been reset for several months. The hoof wall has grown over the shoe that was too small for the foot and with excessive growth the heels of the shoe were in the seat of the corn.

Hoof Abscess

A Hoof Abscess is a pus pocket or an infection that involves the sensitive tissue that can be very small or very extensive involving the sole corium, the laminae, coffin bone, navicular bone, frog or digital cushion or any combination of adjacent components. The most common is caused by a very small disruption of the horn wall /terminal laminae junction that allows moisture ,debris and bacteria to enter the sensitive structures and occur more frequently in bare feet during extended periods of wet weather. This is commonly referred as gravel among horseman in the USA .In Europe they call it a drop. In spite of a very small entry this type of abscess can cause a serious pain response but as a rule they are easily treated by opening the small fissure just enough to establish drainage and protecting the foot with a bandage or boot for a few days until it heals.

Depending on the size and location a shoe with a protective pad and adequate packing can be very helpful Caution is due when opening any area of the sole that it is opened just enough for drainage .Opening the sole enough to expose sole corium can cause unwarranted complications as the sensitive tissue can prolapse through the opening which can be quite painful and very slow to heal. Hoof testers may be useful 20

in diagnosing and locating a hoof abscess however discretion is advised ,be very gentle and seek areas of increased sensitivity with very light pressure. An abscess normally follows the path of least resistance until it breaks open and drains, sometimes at the coronary band and other times in the heel bulb. Signs include heat, exudation of purulent drainage, often a swollen pastern and fetlock and most concerning, the horse may be three-legged lame.

Puncture wounds also cause abscesses but are considered much more serious as they can become career and or life threatening when sepsis involves the coffin bone or structures in the heel region. Your veterinarian needs to be notified immediately to determine what structures were invaded. A seemingly uncomplicated sole abscess that remains sore or lame 5 to 7 days after it has been opened up most likely involves the bone and demands immedi-

The International Equine Veterinarian • Issue 1 • 2017

ate attention from your veterinarian that may need radiographs to better asses the area of concern. Applying a hot moist poultice (Animalintex) to the coronary band secured with a cotton bandage softens the hoof allows it to expand offering an easier route for the abscess to migrate, break and drain .Once they break at the coronary band the majority of the pain dissipates within hours and most heal within days. Horses should be annually immunized to protect them against tetanus, which may result from puncture wounds of the foot.

This abscess was due to a small puncture wound through the sole, radiographs revealed a small bone sequestrium that was removed with a curette. A hospital plate shoe was applied to facilitate daily care and treatment.

To be continued in the next issue . . .

The small defects in the wall and cornified terminal laminae allowed moisture and bacteria to enter the sensitive sole corium resulting in very painful abscesses.

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Homogenization

by Geoff Tucker, DVM www.theequinepractice.com

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have been going to AAEP meetings and even a BEVA meeting, off and on, hoping to become inspired and become a better equine veterinarian.

Hoping that with a mind stimulated by debate about ideas that made me question and explore possibilities, I would add springs to my steps into the next barn I visited when returning home from my adventure.

ident has done is to surround himself with people who don’t say “yes” to everything he says. In fact, many of his cabinet have actually opposed him on many issues including global warming and intelligence gathering. The article compared the idea of surrounding the leader with openly opposing views in cabinet members to what Washington, Lincoln and Roosevelt did and to some extent others. It was through spirited debate that decisions were made in the best interest of the overall purpose and they were reached with everyone

I still am waiting for the inspiration. After attending these lavish productions, I couldn’t figure out why I felt - blah.

Then an article in the Wall Street Journal appeared that made it clear. Veterinarians and veterinary medicine are being homogenized. (“The Method in Trump’s Tumult “ - A raucous cabinet can be an asset. Some of the best presidents, including Washington, wielded disagreement as a tool. By Christopher DeMuth Feb. 10, 2017) The article was analyzing the leadership style of President Trump and the author was comparing and contrasting this with styles of presidents going back to Washington. Before you all start frothing at the mouth because of your presidential opinions, hear me out. What this pres-

knowing all the ramifications and agreeing to capitulate for the good of the many.

What this means in our profession is that when I attend a meeting, I often think that the material being offered sounds all the same, especially when I listen to panelists either agreeing or questioning but never giving an opposite opin-

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ion. In essence the leaders surround themselves with “yesmen” and “yes-women.” There is no option if you are not in agreement other than to walk up to a microphone and try to put together words in a sensible sentence. This often leads to freezing of people and no dissent comes to the floor. Worse, there is an appearance in the silence following a presenter that all in the audience are in agreement which is not always true.

Honestly, I do not do well spontaneously speaking into a microphone while looking up at a speaker on stage and offer my opposing view. Not only do the words necessary for this activity come hours later to me, but I am not prepared to nor is it appropriate to start a debate in this manner. Rather, the debate should be included in the panel or some other format where it can remain constructive and not destructive.

This brings about another point of human nature. We all are passionate about what we believe and often feel threatened when an opposing belief is proposed. A belief in something often is all we have to keep our lives glued together and we will protect it with a vengeance when the belief is challenged. This makes us feel significant which is an essential need in human nature. Gathering around like-minded people all singing the same tune bolsters this significance. When an opposing belief is presented, most people usually start by defending their position and then diminish the opposing view.

This is very evident in the forums and is why I promised my wife in 2000 never to enter another veterinary forum again.

There was too much bullying.

The oppression of constructive dissent doesn’t allow for growth. This is what I feel when I leave a meeting, like I have been swimming in thick tomato soup. Whether you like or hate President Trump, we can all agree that he has sparked debate that is open and viewed on every editorial page of every newspaper. This approach will either support or change how we govern or practice. We need this debate with tem24

perament to occur in our profession. I have to assume that if I am disagreeing with articles and lectures (and advertisements) then there are others who feel the same way. And there are, but mostly of an older age where experience can be added to the rhetoric. Those who have been there and done that can cut through the chaff of the presenter’s material. At the last AAEP meeting I sat at the lunch tables with the students and asked them thoughtful questions. They just stared back or recited what they have been told. Rarely has a student said to me, “That was an interesting point and it’s differences are causing me to think and dig deeper for answers.”

No surprise! They are learning so much and trying to pack it all into their memories that they have no room or time to think creatively.

What is happening in our government is the tossing of the status quo and this is scaring the crap out of everyone especially those affected by the decisions. But all decisions will scare half of those affected. The difference is that in our profession we all need to not only respect other ideas but to openly and honestly debate them in a setting where all can learn. Outside thought should be discovered and encouraged.

It requires leadership and courage to ask tough questions and dig deeper into untested theories and to challenge the thoughts of others

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We can all learn from Galileo when he proposed that the Earth spins on an axis and also revolves around the sun. It was an opposing view that was not taken well. He was sentenced to be burned to death (but was not though all his books were). Only after opposing views were brought together constructively was the truth revealed.

Veterinary medicine is not inherently linear in development but it is being treated this way. It reminds me of a Sudoku puzzle where all seems to go well based on solving parts of the puzzle until you get towards the end only to discover that a solution you came up with in the beginning was wrong making the puzzle unsolvable with the answers you have.

Over the years I have seen veterinary medicine work in one direction with no history being used to help us discover that the conclusions being drawn are actually ineffective or flat out wrong based on copious experience. Rather than discover the error, new facts are made to make the theories work.

This is a capital offense in science! However because there is no safe forum for debate where opposing views are welcomed and encouraged from shy but intelligent people, the given unchallenged findings are taken as gospel.

What is the solution? It lies with the president of the AAEP and the BEVA to create opportunities for members to voice their views on any subject without fear of being ridiculed. From my own questioning of members afterwards at these meetings, many are having difficulty accepting what is said from the podium. Some have offered alternatives and some have said that the speaker is flat out wrong in their experience. Of course, much new material is given thought and is probably used in practice subsequent to the meeting forever positively changing a person’s practice.

These are the jewels we all look for at a meeting. But for every tidbit learned, there is usually one that chafes an experienced vet.

We also need leadership at the veterinary schools. The mantra now is to be on the cutting edge of knowledge and technology while providing a safe experience for the student. From this, every student is taught the safe way to work with horses and the strategies to find the correct answer. On the surface this sounds good and the result is the homogenization of students graduating. They all do the same, act the same, diagnose the same, and treat the same.

Most horse owners are accepting this and the standardized care is seen all over this country.

However, many horse owners are frustrated with this as evidenced by more turning away from veterinarians as their

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true and trusted source of information. We have been replaced by Google, magazines, nutritionists, supplements, psychics, and non-veterinary therapists of all sorts. This is creating a divide where lines are being drawn and sharp words spoken between our profession and all those trying to usurp us. My point is that most veterinarians are homogenized into great technicians but we are missing the needed solution the owners are asking for. We are even dividing further the space between the other horse professionals with farriers being a great example.

My hypothesis is that we, as veterinarians, are believing and defending our own story we have created by not asking for dissent from within. If we did, we would develop a new story from which we could offer more effective care for these horses. In other words, what we are doing is obviously not working. We run around diagnosing and treating but we are not preparing horse owners to be better care givers of the animals. Maybe it is fear that if we educate them we would be out of a job. However this isn’t true. Rather we would once again be the source of true and trusted information and we would then be paid as instructors solving or preventing problems. And we all know that horses will still get into trouble so we will never be out of a job.

Developing a platform for respectful debate on everything we do as veterinarians is the first step. Developing a mindset within the profession is important too allowing us to agree to disagree but hold the more important ideal that we need to compromise and discover that several roads lead to Rome.

Learning to accept other veterinarian’s opinions is essential but leaders first need to agree where we all want to end up.

In the Sudoku example of linear thinking where there is only one correct path to the correct answer, we need to change the veterinary paradigm that there are multiple ways to get to the correct solution.

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First we need to embrace the issue that our approach to horse care may be wrong in the eyes of the horse owners who pay our bills and are spending their money elsewhere. This is what the President is doing now - challenging all we are doing and letting it all shake out. If we do the same we may find that we are doing more right than wrong, but I believe we will find the answers to improve our profession if we can all agree that the horse comes first and to get there, many approaches can be used and all can be provided by or with the help of a veterinarian.

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True & Incredible Stories of a Horse Vet Her hoof is deadly accurate . . .

by Geoff Tucker, DVM www.theequinepractice.com

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wo one inch square holes, two inches deep appeared in the earth every time her hoof lifted off the ground. These holes now littered the earth as the pair of older men positioned the black mare for me to draw the blood for the Coggins test.

The only time this mare saw a vet was for the annual blood test. The men showed no interest in my inquiries about minimum vaccinations or general health. To be fair, neither did the horse. Looking at me, she made it clear she had no interest in me or my needle.

In preparing for my vet school licensing exam, I had measured parts of my body so I couild use it as a rough meaThis blood test proved whether a horse suring stick against the horse measured in “hands” (1 hand has a communicable disease and is equals 4 inches), the tip of my nose measured 17 hands at required in every state whenever a horse the horse’s withers. Today, as I prepared my approach to this is transported, sold or exhibit giant, my eyes stared level into edd. This mare was headed to

her shoulder. My eyes then a local fair where she would

looked up to see the withers be hitched to a wooden sled

which was about level with the loaded with stones. Using the

top of my head. I was guessing traction gained by the earth

her height at 19 hands when piercing cleats, she would pull

one of the men blurted at me, the sled across a finish line. If

“Don’t get too close to her Doc. successful, the process would

She hates you already and her be repeated with more weight

hoof is deadly accurate.” until she hopefully pulled the largest load of her division and

I respect every horse’s potential the men returned home with

to hurt me and pride myself the purse money. in remaining calm around

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away from her 12 inch wide hoof. She was prancing, slowly inching her body towards me. I cautiously stepped back.

The younger of the two old men held the shining black, overweight and heavily muscled beast with one hand on the shank while he muttered threats directly to her. She listened and obeyed but her eyes never left mine You could see her think.

The older old man grabbed a truss hammer and a loop of bailing twine. He twisted one end of the twine turning the loop into a figure 8. He folded the tips of the figure 8 together creating a circle of twine made of two loops. He repeated this twice resulting in a small circle with 8 loops of twine.

Next the man slipped the head of the hammer into the middle of the circle. Grabbing two or three strands, he pulled tightly against the hammer in the other hand drawing tight the twine against the hammer head but exposing a few loops of twine.

“A twitch!” he said proudly. While I was amazed at this man’s ingenuity, I was imagining the real trick of applying this invention to the nose of the beast.

The man holding the horse brought her to the barn wall and, standing on a stool, threaded the long rope lead through a large metal eye bolted seven feet high through the wooden frame of the barn. He firmly pulled the rope and the mare walked forward until her face was against the wall. All I could see was a disaster about to unfold including the demolition of the barn in one pull.

I set my focus on the left fron t hoof and adjusted my stance keeping my feet in what I thought would be a safe zone.

My thoughts drifted to the holes in the ground and pictured the crucifixion of my foot. I can draw blood or do an IV injection using just my right hand.

Today, however, I needed my right hand to keep me away from her. I grabbed a fold of skin above the right shoulder and leaned my body into hers.

She responded by leaning her full ton back on me. The twitch man growled and twisted the twitch tighter on her nose. The lead man standing on my right shoe dug his thumb into her side. I raised my left hand with the sharp needle attached to a glass blood collection tube, distended her left jugular vein, and drove the needle through her thick hide.

Alathough fine motor skills are usually a disaster with my left hand, it was a perfect stick and the blood quickly filled the tube. But my skill did not impress the lady. Her response was to start aiming her hoof. The old man yelled, “Watch it Doc. I told ya she’s accurate with those feet.”

The mare started to show her displeasure by stomping all four hooves and shaking her head, but the other eman stepped up on the stool and quickly applied the twitch. “Go ahead Doc. She waitin’ on ya.”

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I pulled the needle out and the men released their holds. As the mare led the men back to the stall, the oldest said, “Good job Doc.” The other said “Yea, you’re the first ever to get it done on the first try and not get hurt”

The more horses you work with, the more your confidence builds. My respect for a horse’s ability to hurt you still remains,but today, my confidence notched a little higher.

Smiling, I got back in my truck and waited for my knees to stop shaking iand my heart beat to end the thumping in my ears.

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Colorado Horse Park Announces Inaugural Dressage Symposium

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he Colorado Horse Park (CHP) has announced a new initiative to bring an elevated level of exposure and clinic opportunities with world-class dressage riders to the venue through Dressage Symposium In The Rockies (DSIR) to be hosted from May 20-24, 2017.

DSIR will span five days and offer clinic and auditing opportunities with five internationally recognized dressage riders and professionals. The symposium will be hosted in benefit of the Rocky Mountain Dressage Society (RMDS) and is open to riders from around the country. The symposium will host clinic sessions focusing on mounted and un-mounted horsemanship, as well as improvements of technical dressage movements taught by masters of the sport.

CHP will welcome Scott Hassler, Michael Klimke, Steffen Peters, Lars Petersen, and Axel Steiner to the venue as headlining clinicians for the inaugural five-day educational event. Each day is open to auditors interested in attending the sessions. Packages of one, three, and five day passes are available and can be reserved by contacting ebaker@coloradohorsepark.com.

Lars Petersen is a Danish dressage competitor and trainer competing in the US. He competed in the 1996 Summer Olympics where he finished in 12th in the individual dressage competition. He has two European Championship bronze medals and is a five time Danish National Champion.

Petersen will teach sessions on Saturday, May 20, and Sunday May 21.

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DSIR will then welcome Axel Steiner, a world-renowned FEI CDI 5* judge, who has sat on panels during the Olympic Games, FEI World Cup Finals, Pan American Games and other major CDI 5* events around the globe. Steiner will begin his portion of DSIR on Sunday, May 21, and conclude Monday, May 22, focusing his sessions on a Ride-ATest format. Each session will span 45 minutes. Steiner will begin by helping participating pairs enhance their communication skills and cues.

Concluding the week of clinic and auditing opportunities, CHP will welcome Scott Hassler, one of the top trainers in the U.S. to the venue on Wednesday, May 24. Hassler has chaired the USDF Sport Horse Committee for many years and is active in the education and training of young horses and emerging professional riders around the country.

For more information on the Dressage Symposium in the Rockies visit www.coloradohorsepark.com.

The International Equine Veterinarian • Issue 1 • 2017