XL Equine vet Nancy Homewood, from Hook Norton Veterinary Group, tells us about her day dealing with cases of lameness.
It was an early start for me today as I was on duty overnight. A client had been out to check her horse before work and found it to be not weight bearing on the right fore in the field. She rang the emergency line, who then transferred the call to me. The client was understandably distressed that her horse couldn’t put any weight to the floor. Horses that are non-weight bearing lame should be seen as a matter of urgency. The three main differentials for this severity of lameness are fractures, joint sepsis, and (thankfully the most common) foot abscesses.
When I spoke to the client I asked if there was any obvious swelling or wounds on the lame leg, and if the lameness had come on acutely. When taking emergency calls, I always try to obtain as much history on the phone as possible. It can help give me a clue as to the possible cause of the lameness and will allow me to advise the client on the best course of action before we attend their horse. The client in question said her mare had been slightly lame in walk last week on the same leg, but not as severe as she had found her this morning. I loaded my dogs into my car and carried out my half eaten breakfast and got on my way to see her.
On examining the mare, there was no heat, swelling or wounds on the leg. However, the foot was warm and had a raised digital pulse. I pared the foot and released a foot abscess at the toe region. Always a satisfying find, and reassuring for the owner that there was nothing more sinister going on. I went through my usual advice about poulticing the foot to encourage drainage of the abscess and packing of the cavity once drained to allow it to dry out and prevent re-infection. Foot abscesses are generally straight forward, but they can develop complications, so I always try to make contact with owners a week or so after the initial visit to check that things are going well.
First call done and I head into the surgery to re-examine a lame horse that had a lameness work up done two weeks previously. The horse had a left fore limb lameness that was nerve blocked and localized to the coffin joint. After discussing treatment options with the owner, we elected to medicate the coffin joint with a corticosteroid injection, and correct the slight foot imbalance that the horse had in its front feet. As part of the lameness work up, radiographs were taken of the front feet, which enabled the client’s farrier to assess the foot balance of the horse and trim accordingly. The joint was aseptically prepared and medicated under standing sedation. All went well and the horse went home to begin controlled exercise. I am hopeful that remedial shoeing will help this horse a lot, along side the joint medication. I booked in a re-examination in four weeks to check progress.
We have a long-standing patient who had a severe shoulder wound who is still hospitalised. I check up on him and discuss with our nurses his plan for the day.
I then head back into the office and catch up with some admin work before heading out on routine calls for the day. Telephoning clients, interpreting and reporting results, sending away samples for analysis writing up vetting certificate for a sweet pony that I did a pre-purchase examination on yesterday, and before I know it its mid-morning! I let the dogs out for a quick run in the paddock, then I headed out to get through my routine calls. I have a vet student to take on calls today. We have students most weeks as we are a busy mixed practice, and students have to book placement over a year in advance. This particular student has seen practice with us before, so is familiar with the area and has met some of our clients, which is always good as I try to get students involved in discussion about cases, and find owners are often happy for them to be involved, especially if they see a familiar face. Vet students gain most of their practical experience when on Clinical Extra Mural Studies, provided by practices like ours. I always encourage them to make the most of inpatients at the clinic so they can practice injection techniques, bandages changes, and basic examination of patients, all under supervision. One day hopefully some of our students will end up becoming Equine Vets and they need to have the essential ‘Day One Skills’ on board when they go into practice!
After calls we head back to the surgery where we have some blood samples to send up to the laboratory and phone calls to return. One of the highlights of having a student for the day is they tend to thank you for taking them on calls by making a good round of tea!
To find out more about XL Equine visit www.xlequine.co.uk