Fledgling practitioner encounters interesting and unusual cases

by Brent Kelley, D.V.M.

MY STEPDAUGHTER is now a veterinarian employed by one of the major equine veterinary firms in Central Kentucky. She has been out of school for two years and has had some pretty interesting cases. We will call her Liz for the purposes of this epistle.

I have written this before in these pages: New graduates are sharp. They are well prepared for life in the real world, and their knowledge is far greater than mine was at a comparable point in my career.

Here I will recount some of Liz's more interesting and unusual cases.

A bad injury

A client of hers--an old farmer--had a 23-year-old mare that had been a good producer; she was the dam of several very good racehorses. She had been owned by this man for 20 of her 23 years. The old girl was blind, holding her head at an angle, and dragged her feet when she walked.

Near the end of my stepdaughter's first breeding season, the owner presented the old mare. "I want to breed her," he pronounced.

On examination, she was found to be full of cysts and had an old mare's uterus (of course). Liz thought there was little chance that she would get in foal, but the owner wanted her to be bred, and bred she would be.

She conceived on one cover. Everything was normal, and the old girl was treated just as any other mare on the farm.

That September, the farm had a yearling in the fall sale. She did not bring her reserve, so she was brought home and turned out with the mares. That night, the entire herd apparently got to running, perhaps because of the new horse in their midst.

The next morning, the old mare was found with a severe lesion in the right axilla (armpit). Evidently she had run into a metal fence post. She apparently had attempted to sever her right foreleg from her body.

The lesion extended up under the leg and into the underlying soft tissue along the chest wall. Liz attempted to determine how deep it went, so she inserted her arm into the opening. Her whole arm went in and she could not find the end of the lesion.

Suturing was out of the question, so she cleaned the area as good as she could, gave a tetanus booster, and placed the mare on antibiotics and anti-inflammatory drugs. There was a tremendous amount of rapidly dripping drainage. Although obviously in pain, the mare continued to eat and drink well.

There was a large flap of loose skin, so on the fourth day Liz removed it.

That night, the mare lay down on her right side and could not get back up. Liz was called to come out in the middle of the night to tend to the mare. When she got there, they flipped the mare over so her left side was down, but the old girl still could not get up.

Liz asked if they had any nylon straps, such as those used for towing automobiles. They did. She told the owner to get his tractor, and they put the nylon straps around the mare fore and aft, attached them to the tractor, and lifted.

On the first try, although the mare was lifted off the ground, she would not attempt to stand. A second attempt was made with the same result.

By this time, the owner was in tears.

They tried again, and the only difference was that they pulled her head in the opposite direction of the first two attempts. She got her feet under and supported her weight. She was turned out the next morning.

She healed, albeit slowly, and went on to have a normal pregnancy and foaling.

Thumps

Liz was called out one evening to see what the caller said was a colic. It was not one of her regular clients, but she was on call for emergencies.

When she arrived, she was presented with a ten-month-pregnant mare that had what appeared to be constant hiccups. The mare looked scared, and her entire body was shaking. She would not move and wanted to drink, but when offered water she submerged her face up to her eyes but did not swallow. Her heart and respiratory rates were elevated.

The farm personnel had given her an injection of Banamine with no results.

Liz diagnosed the condition as thumps, a problem rarely seen. It is called thumps because of the noise made by the hiccupping. Thumps is the common term for hypocalcaemic tetany. The condition typically occurs in mares in mid-gestation, within two weeks of foaling, ten days to three months after foaling, or a day or two after weaning.

Among the causes may be heavy milk production, hepatitis, blister beetle ingestion, and stress. Diagnosis is made by the signs and decreased calcium levels in the blood.

Liz called the farm's regular veterinarian, who was skeptical of her diagnosis. She directed her to do several things, all of which were found to be normal. Finally, Liz took a blood sample to determine the calcium level. The blood sample showed the mare's calcium level to be very low, so Liz gave the mare intravenous calcium.

The intravenous calcium therapy was continued for three days, and when a normal blood level was reached, the mare was put on an oral calcium supplement through the rest of gestation and throughout lactation.

Mother and baby are well, but there are plans to give the mare the oral calcium supplement during her next pregnancy, beginning in late gestation and continuing through lactation, so she does not develop thumps again.

I have never seen thumps, and I am not sure if I would have recognized it.

The lesbian teaser

For a while, Liz and her husband kept their riding horses across the road from a horse farm. In the farm's paddock, directly across the road, was an adorable Paint pony mare. Eventually, Liz was called to do veterinary work for the farm, and she became friends with the manager. She asked if they could use the farm's round pen to break her husband's yearling. He said okay, and then later she asked if they could ride on the farm.

"Yes," the manager replied, "but be careful of our teaser pony."

"I haven't seen him," Liz said. "The only pony I've seen is that cute little mare out front."

"That's our teaser. She's a lesbian," he replied.

Liz watched her teasing one day, and the little mare teased like a stallion. Liz thought she must have a granulosa cell tumor.

And if she rode her mare near the pony, the teaser mare would approach her just as a stallion would.

One day while doing some veterinary work on the farm, Liz asked them to bring the pony in so she could examine her. She assured them there would be no charge. She found the right ovary to be about the size of a cantaloupe and the consistency of a honeycomb. It was a granulosa cell tumor. The left ovary was about the size of a lima bean.

Liz suggested that the clinic could perform the necessary surgery to correct the problem at nominal cost, and then the pony could be ridden by the owner's grandkids. They declined; the grandkids did not come around very often, and the farm needed a teaser. And this one could not accidentally get a mare pregnant.

The hollow mare

Liz was called to the stable of a regular client, a horse trader. An older Thoroughbred mare had what was described as a mild colic.

The mare was angular and slender and looked as if she was probably a poor doer. She appeared to be depressed but was described as normally cranky.

Neither the mare's heart rate nor the respiratory rate was elevated. Liz inserted a nasogastric tube, and there was no reflux. Assuming this to be an extremely mild colic, she treated her with Banamine and instructed them to keep an eye on her.

Liz was called again the next day. They said the mare's left side was sunken--hollow looking. The farm personnel were fairly inexperienced, so Liz was leery of their description. But when she returned to the farm, she found their description to be accurate. The mare's entire left side was caved in in an area roughly the size of a large watermelon. Liz palpated the area and could feel at least eight broken ribs. The injury probably was the result of a very hard, double-barreled kick.

Liz performed an ultrasound on the area and found there was a huge hemorrhage; evidently her spleen had been damaged. The mare was given fluids and a blood-clotting agent for several days.

Blood samples showed a very low hematocrit, almost to the level of needing a transfusion, but the mare kept eating and eliminating, and she eventually healed uneventfully, although her side never filled back out.

She was given away as a pasture ornament--with a dent.

Brent Kelley, D.V.M., is a retired veterinarian living in Paris, Kentucky.