Emergency Care and Preparedness

If you own horses long enough, sooner or later you are likely to confront a medical emergency. There are several behavioral traits that make horses especially accident-prone: one is their instinctive flight-or-fight response; another is their dominance hierarchy - the need to establish the pecking order within a herd; and a third is their natural curiosity. Such behaviors account for many of the cuts, bruises, and abrasions that horses suffer. In fact, lacerations are probably the most common emergency that horse owners must contend with. There are other types of emergencies as well, such as colic, foaling difficulties, acute lameness, seizures, and illness. As a horse owner, you must know how to recognize serious problems and respond promptly, taking appropriate action while awaiting the arrival of your veterinarian. 

Recognizing Signs Of Distress

When a horse is cut or bleeding, it's obvious that there is a problem. But in cases of colic, illness, or a more subtle injury, it may not be as apparent.  That's why it's important to know your horse's normal vital signs, including temperature, pulse, and respiration (TPR), as well as its normal behavior patterns. You must be a good observer so that you readily recognize signs of ill health

What's Normal? 

There will be variations in individual temperature, pulse, and respiration values. Take several baseline measurements when the horse is healthy, rested, and relaxed. Write them down and keep them within easy reach, perhaps with your first aid kit, so you have them to compare to in case of an emergency. 

Normal ranges for adult horses are:

•   Pulse rate: 28-44 beats per minute.

•   Respiratory rate: 12-20 breaths per minute.

• Rectal temperature: 99.5° F to 101.5° F. If the horse's temperature exceeds 102.5° F, contact your veterinarian immediately. Temperatures of over 103° F indicate a serious disorder. 

•  Capillary refill time (time it takes for color to return to gum tissue adjacent to teeth after pressing and releasing with your thumb): 2 seconds.

Other observations you should note:

•  Skin pliability is tested by pinching or folding a flap of neck skin and releasing. It should immediately snap back into place. Failure to do so is evidence of dehydration. 

• Color of the mucous membranes of gums, nostrils, conjunctiva (inner eye tissue), and inner lips of vulva should be pink. Bright red, pale pink to white, or bluish-purple coloring may indicate problems. 

• Color, consistency, and volume of feces and urine should be typical of that individual's usual excretions. Straining or failure to excrete should be noted. 

• Signs of distress, anxiety or discomfort.

•  Lethargy, depression or a horse that's "off-feed." 

• Presence or absence of gut sounds.

• Evidence of lameness such as head-bobbing, reluctance to move, odd stance, pain, unwillingness to rise. 

• Bleeding, swelling, evidence of pain.

• Seizures, paralysis, or "tying up" (form of muscle cramps that ranges in severity from mild stiffness to life-threatening illness).

Action Plan

No matter what emergency you may face in the future, mentally rehearse what steps you will take to avoid letting panic take control. Here are some guidelines to help you prepare: 

1.     Keep your veterinarian's number by each phone, including how the practitioner can be reached after-hours. If you have a speed dial system, key it in, but also keep the number posted. 

2. Consult with your regular veterinarian regarding back-up or referring veterinarian's number in case you cannot reach your regular veterinarian quickly enough.

3.  Know in advance the most direct route to an equine surgery center in case you need to transport the horse. 

4.  Post the names and phone numbers of nearby friends and neighbors who can assist you in an emergency while you wait for the veterinarian.

5.  Prepare a first aid kit and store it in a clean, dry, readily accessible place. Make sure that family members and other barn users know where the kit is. 

6. Also keep a first aid kit in your horse trailer or towing vehicle, and a pared-down version to carry on the trail. 

First Aid Kits

First aid kits can be simple or elaborate, but there are some essential items. Here is a short list to get yours started. (*Material that should be sterile.)

•  * Cotton roll.

•  *Non-Stick bandage/Telfa pad.

• *White Gauze/Cling Wrap.

• *Gauze pads, assorted sizes.

• Brown Gauze.

• Adhesive wrap (vet wrap) and adhesive tape.

• Leg wraps.

• Sharp scissors.

• Hemostats/Tweezer.

• Duct Tape

• Rectal thermometer with string and clip attached. 

• Surgical scrub and antiseptic solution.

• Latex gloves.

• Flashlight and spare batteries.

• Permanent marker pen.

• Pliers (to pull nails from shoe).

• 6 in. diameter PVC tubing cut in half the long way (like a gutter) into lengths of 1-1 /2 to 2 ft. (for emergency splinting).

Emergency Wound Care 

The sight of blood may unnerve you, but maintaining your presence of mind can save your horse's life. The initial steps you take to treat a wound can prevent further damage and speed healing. 

How you proceed will depend on your individual circumstances, and you must exercise good judgment. The following should be viewed as guidelines:

1.  Catch and calm the horse to prevent further injury. Move the horse to a stall or other familiar surroundings if this is possible without causing distress or further injury to the horse. Providing hay or grain can also be a good distraction. 

2. Get help before attempting to treat or evaluate a wound. It can be difficult and very dangerous to try to inspect or clean the wound without someone to hold the horse. You cannot help your horse if you are seriously injured yourself. 

3.  Evaluate the location, depth, and severity of the wound. Call your veterinarian for a recommendation anytime you feel your horse is in need of emergency care. Here are some examples of situations where your veterinarian should be called:

A. There appears to be excessive bleeding.

B. The entire skin thickness has been penetrated.

 C. Any structures underlying the skin are visible. 

D. The wound occurs near or over a joint.

 E. A puncture has occurred.

F. A severe wound has occurred in the lower leg at
 or below  knee or hock level.

G. The wound is severely contaminated.

4. Consult with your veterinarian regarding a recommendation before you attempt to clean the wound or remove debris or penetrating objects, as you may cause uncontrollable bleeding or do further damage to the wound. Large objects should be stabilized to avoid damaging movement if possible. Don't put anything on the wound except a compress or cold water. 

5. Stop the bleeding by covering the wound with a sterile, absorbent pad (not cotton), applying firm, steady, even pressure to the wound.

6. Do not medicate or tranquilize the horse unless specifically directed by your veterinarian. If the horse has suffered severe blood loss or shock, the administration of certain drugs can be life-threatening.

7. If the eye is injured, do not attempt to treat. Await your veterinarian. 

8. If a horse steps on a nail or other sharp object and it remains embedded in the hoof, first clean the hoof. Consult with your veterinarian regarding a recommendation before you remove the nail. If your veterinarian advises, carefully remove the nail to prevent the horse from stepping on it and driving it deeper into the hoof cavity. As you remove it, be sure to mark the exact point and depth of entry with tape and/or a marker so the veterinarian can assess the extent of damage. Apply antiseptic to the wound, and wrap to prevent additional contamination.

9. All horses being treated for lacerations or puncture wounds will require a tetanus booster.

Other Emergencies

There are far too many types of emergencies - from heat stroke to hyperkalemic periodic paralysis, bone fractures to snake bites, foaling difficulties to colic - to adequately cover them all in this talk. However, regardless of the situation, it's important to remember these points: 

1.  Keep the horse as calm as possible. Your own calm behavior will help achieve this.

2. Move the animal to a safe area where it is unlikely to be injured should it go down.

3.  Get someone to help you, and delegate responsibilities, such as calling the veterinarian, retrieving the first aid kit, holding the horse, etc. 

4. Notify your veterinarian immediately. Be prepared to provide specific information about the horse's condition, as mentioned above, and other data that will help your practitioner assess the immediacy of the danger and instruct you in how to proceed.

5. Listen closely and follow your equine practitioner's instructions.

6. Do not administer drugs, especially tranquilizers or sedatives, unless specifically instructed to do so by the veterinarian. 

Summary

Many accidents can be prevented by taking the time to evaluate your horse's environment and removing potential hazards. Also, assess your management routines to make them safer. Mentally rehearse your emergency action plan. Preparation will help you stay calm in the event of a real emergency. Keep your veterinarian's phone number and your first aid kit handy. In an emergency, time is critical. Don't be concerned with overreacting or annoying your veterinarian. By acting quickly and promptly, you can minimize the consequences of an injury or illness. Your horse's health and well-being depend on it.

 

The Importance of Equine Dentistry

This horse presented today for a routine dentistry. Young, good body condition, no noted health issues.

Perfect example of why it is so important to have routine dentistry and oral examinations performed on your horses.

He showed no outward signs of the extreme hooks on his first large premolars (106 and 206) or the matching abnormalities on his last lower molars. They were affecting how his teeth wore and would eventually lead to more serious dental conditions.

These were reduced to the level of his other premolars and molars by Dr Dewar using a speculum and a Power Float with the horse sedated.

His mouth will be examined twice a year and floated as needed to ensure these do not reoccur.

Case Study: Traumatic Coffin Bone Damage

Locking Stifles

The stifle joint in a horse’s hind leg corresponds anatomically to the knee joint in the human leg. However, instead of appearing halfway down the limb like the human knee, the horse’s stifle doesn’t even look like a joint because it is hidden within the structure of the horse’s upper hind leg. If you put your hand on the front of the horse’s hind leg where it ties into the flank, you can feel the patella, a small bone that is the anatomic equal of the human kneecap. The patella sits just above the stifle joint where the horse’s femur (upper leg bone that ties into the hip) and the tibia (long bone above the hock) meet.

 

The medial patellar ligament has the important function of hooking over a notch in the end of the femur when the horse is standing still. This stabilizes the stifle and allows the standing or snoozing horse to bear weight on the hind leg without muscular effort.

Normally, the ligament slides out of the notch when the horse swings its leg forward as it begins to walk. If the ligament gets hung up and doesn’t slip into an unlocked position, the hind leg can’t be flexed forward and the horse has to drag the stiffened limb forward for a few steps before the ligament releases. This is commonly known as a locking or sticking stifle. While veterinarians term the condition “upward fixation of the patella,” old-time horsemen have a simpler descriptive phrase: “That horse is stifled.” They might add, “Back him up a few steps to get it to release,” and this trick often works.  

Locking stifles aren’t limited to one breed or type of horse or pony, but they are somewhat more common in horses that have very upright hindlimb conformation, with overly straight angles of the hock and stifle joints. There isn’t much an owner can do to correct this faulty conformation, but putting the horse in a gradual conditioning program will strengthen the muscles around the stifle and decrease the incidence of locking. The problem of sticking stifles has been relieved in some young horses that gained 55 to 100 lb (25 to 45 kg), possibly because they developed a larger fat pad behind the patella. Any desired weight gain in horses should be the result of a gradual increase in caloric intake, not through drastically increasing the amount of grain given to the horse.

Corrective shoeing helps to eliminate sticking stifles in some horses. The farrier encourages hoof rotation by trimming the inside wall or applying a lateral heel wedge. Better medial breakover can be enhanced by rounding the medial aspect of the toe of the hoof or shoe.

In one study¹ that looked at treatments for locking stifles, 40% of horses with locking stifles showed complete recovery, and 20% had marked improvement following corrective shoeing.  Another 10% of affected horses showed improvement when corrective trimming was combined with weight gain and exercise.

If these noninvasive techniques don’t help, veterinarians can use one of several procedures to cause mild scarring of the ligament, decreasing its elasticity. When the ligament is somewhat less flexible, it can be pulled into position more easily rather than stretching and staying locked in place. These procedures eliminate the problem in some horses but are less successful in others.

Sticking stifles are not always a serious problem, and mildly affected horses may be usable as long as the rider takes into account that the horse should not be asked to make smooth, athletic movements as it begins to walk after standing still. These horses may not always show classic locking, but might display more subtle signs such as a shortened stride, difficulty picking up or maintaining a canter lead, or a bit of scrambling while going up or down hills. Horses that regularly display classic locking stifles and don’t achieve a normal gait after a few strides may not be safe to ride.

 If you suspect a problem with legs or joints, ask the veterinarian about your concerns.    

(From the researchers at Kentucky Equine Research)

Potomac Horse Fever

Potomac Horse Fever (Equine Monocytic Ehrlichiosis)

What is Ehrlichiosis?

     A category of diseases caused by a type of gram negative bacteria that infect white blood cells.  They are called "intracellular" bacteria because they live and are only able to reproduce inside the cells of a host animal.  Once inside the host animal's white blood cells they can form circular chains that can often be seen on blood smears and used to diagnose some forms of ehrlichiosis. The two commonly seen forms of ehrlichiosis in horses are Anaplasmosis (transmitted by ticks) and Potomac Horse Fever.

How is Potomac Horse Fever Transmitted?

     Potomac Horse Fever (Neorickettsia risticii) is believed be transmitted by horses accidentally ingesting infected small aquatic flies (May flies, Caddis flies) that are infected with Neorickettsia risticii by consuming the larvae of infected snails. Transmission is typically increased in the hot months of July and August, especially in times with lots of standing water for the snail – aquatic fly life cycle to occur. Horses infected with Potomac Horse Fever are not believed to be able to spread the disease to other horses, however other diseases that present with very similar signs can be extremely contagious so biosecurity measures should be put into place as soon as signs are seen or suspected.

What is the "Incubation Period"?

     An incubation period is the time during which a disease establishes itself in the body.  During this time the animal is infected with the organism (bacteria in this case), but does not show clinical signs of the disease.  The incubation period for Potomac Horse Fever is typically 3-9 days. Horses may start to show a fever and depression about on day 5 and diarrhea about day 14 post infection.  

What are the Clinical Signs of Potomac Horse Fever?

     Horses with typically present with fever, depression, anorexia, and diarrhea. The first sign that a veterinarian is called for may be colic or abdominal discomfort prior to the development of diarrhea. This is typically seen in adult horses, and presents very similarly to Salmenelosis. Laminitis is a very common sequelae to Potomac Horse Fever.

How is it Diagnosed?

     Most forms of ehrlichiosis can be diagnosed by viewing the characteristic circular chains of bacteria inside white blood cells.  Potomac Horse Fever, however is not able to always be diagnosed this way.  A polymerase chain reaction (PCR) test on blood samples can be used to identify the presence of the Neorickettsia risticii bacteria in the blood.

How is Potomac Horse Fever Treated?

      If diagnosed early a tetracycline antibiotic such as Oxytetracycline or Doxycycline is commonly used, along with supportive care to treat clinical signs such as colic, fever, laminitis, edema, or diarrhea.  Treatment can be successful in most cases if diagnosed early.  It can be life threatening when associated with colic and/or laminitis, and should be treated quickly and aggressively.

What can be done to Prevent Potomac Horse Fever?

     There is a vaccine for Potomac Horse Fever, however it is not protective against ALL of the disease causing strains of the bacteria. Horses that are affected by Potomac Horse Fever and recover have been found to be protected for up to 20 months from reinfection.