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Tales of a Country Vet

Karla was a little girl who loved horses. She was twelve years old, had darkish blond hair, cut moderately short and had a face full of freckles. When I say she loved horses, that?s not quite accurate. She adored them and thought of nothing but horses from the moment she woke up until her final sense of consciousness flickered before falling asleep. Unfortunately, her family lived in town and had fallen on rough times. There was no chance she would ever have a horse of her own. So, she did the next best thing. She volunteered to work at a local stable. Karla was at the barn after school and on weekends, mucking out the stables, grooming who ever needed grooming and feeding and watering her charges. Lost in the sounds and smells of a horse barn on summer evening she was always dreaming of the day she would have her own horse. Her particular favourite in the barn was Rebecca, a 7 year old Arab mare. She had a mind of her own, but was a beautiful rich bay. A very impressive mare to anyone who saw her. Karla would spend extra time grooming her and would often save an extra carrot or a piece of apple for her. Rebecca responded with an inordinate degree of affection any time Karla was in the barn.
Everybody acknowledged the bond which had developed between these two. Rebecca?s owners were kind people who didn?t fail to see the love that had grown between Karla and Rebecca. However, unforeseen circumstances developed that would require them to sell Rebecca. They had anticipated the emotional devastation this would cause, both to Karla and Rebecca and dreaded having to break the news. They spoke with Karla?s mother, Sandra, to see what kind of impact this might have. When told, Sandra?s faced dropped. Eventually, she composed herself and said that they must do what ever they had to. But in a low, quivering voice she told them that Karla really had nothing else in her life. All she ever talked about at home was Rebecca. So the owners thought about it long and hard and decided to forego the sale of Rebecca, and instead, presented her to Karla as a birthday present.

The ecstasy of the moment when Karla was told Rebecca was hers was indescribable. Furthermore, once Karla owned Rebecca, her fixation on the mare grew exponentially. Karla was at the barn every waking moment. Grooming and feeding, riding and hugging. Her whole world was walking around on four feet. And she loved every minute of it.

The love affair was in full bloom, with Karla making plans for her and Rebecca for this summer, and next summer, and the summer after that, when she noticed a small area of hair loss on the horse. She wanted to call in a vet. Her uncle, a kind and well-meaning, quiet-spoken man, who also owned some horses, told her that she should consider calling in someone else. He called himself a ?Para-Vet? and he was cheaper than a real vet. Since they didn?t have any extra money to spend, they called this fellow. It turns out that he was actually a self-taught Farrier who?d always fancied himself a wizard with animals. So, with these impeccable credentials and the
chance to save a couple of dollars, how could you lose?

The Para-Vet showed up and diagnosed that the horse had an allergic reaction to some fly -wipe. He gave her an injection of an anti-histamine. ?While I?m here, I might as well give her her ?Spring Shots?? he said. They thought that since he gave the first needle so well, he could surely give another. And he was certainly cheaper than any of those over-rated and over-priced Vets.

The next day, Rebecca was a little sore on the leg that had been given the anti-histamine injection. Karla?s mother phoned the Para-vet a couple of times. He was kind of hard to get in touch with. Once she finally located him he came out and looked at the horse. He thought that she might have a problem in the stifle. ?Don?t worry. It should get better on its own.? He offered confidently. However, it didn?t. Rebecca got progressively more and more lame as the day wore on. By evening, she couldn?t move. She was left outside in the hope that the problem would pass. It didn?t. By the next morning the leg was swollen and the mare was unable to stand on it.

Karla?s mother, who admittedly knew nothing about horses was now extremely concerned. The owner of the stables was also very worried and thought that the leg might be broken. When they were able to contact the Para-Vet, he told them they should probably leave it for another day. With Karla near hysterics, her mother decided to get a second opinion.

I was called on Thursday. Because Karla?s mother was so distraught, she relayed only a small part of the story. I was told that their Farrier had diagnosed a possible stifle problem but they thought it might be a broken leg. What should they do? I told them the best thing would be to have a vet look at it because there was a big difference between what you do for a broken leg versus a strained stifle, if in fact the problem was either of these two. I also said that there was no way this could be diagnosed over the phone and that it sounded pretty serious. They then said they had no money to pay a vet.

She was so upset that I lied and told her I would be passing near the farm and would have a look at the mare if she could meet me there. With profuse gratitude she agreed and I arrived on the farm about an hour and a half later. I had earlier been called out to stitch up a torn eyelid on another horse nearby which I obviously had to attend to first.

My first glance told me the mare was in serious trouble. The mare had been pivoting on her right hind and had dug a hole in the dirt about 8 inches deep and a foot across where her right hind foot had been standing. The left hind leg was fixed in a flexed position and was non-weightbearing. The leg was at least twice its normal size. My first thought was that she had broken the right hind leg, but as I looked around the paddock I couldn?t see anywhere she could have hurt herself. The paddocks were almost spotless. There was nothing to indicate how or where she
could have possibly acquired such an injury. I checked her temperature and her attitude, neither of which were consistent with a broken leg. I then ran my hand along her back and felt the unmistakable sound of crackling. This meant gas was being trapped under the skin. The crepitance extended from the middle of the neck, along the back and down the back of the hind leg. A Clostridial infection! I checked the leg just to be certain. There was no fracture but the entire leg was exquisitely painful.

In addition to the swelling in her leg, the bottom of her abdomen along to the base of her tail, including the vulva was edematous and swollen. This mare was definitely in very serious trouble. When I told this to the mother, I thought she was going to collapse. She burst into tears and was unable to control herself for about 5 minutes. Her thoughts were only of what this would do to Karla.

I then got the full story and the time line of what had happened. Her mother kept repeating that the Farrier had told her that he was fully able to diagnose and treat horses. Sandra realized too late she had made a terrible mistake in taking his word. I didn?t have the heart to mention to her that the vaccine (?Spring Shots?) he supposedly gave were the wrong ones for horses in the Fraser Valley.

Clostridium infections are extremely lethal bacterial infections. We immediately instituted therapy to combat the infection, in a last ditch effort to try to save the mare?s life. Blood samples were collected to try to confirm the diagnosis. This was 1:30 pm. With some of the painkillers now taking effect, we were able to move her into a sheltered stall. I told her to phone me if any further problems arose, otherwise to give me a call around eight o?clock. They phoned at eight to say that the mare had just gone down. I arrived at the barn to a hoard of friends, relatives, neighbours, all trying to give assistance and offering to help in any way they could. For the next three and a half hours we worked to get the mare up, or at least make her a little more comfortable. She gamely tried to stand. With every violent struggle to get her feet under her she would thrash against the walls and the floor. Each time this happened, Karla, and her friends would cry out in empathetic agony for the horse. Once, after a monumental struggle, she did finally was able to get to her feet. This was greeted with a triumphant round of cheers, but almost immediately she collapsed again. Several people risked their safety to work on that mare. There was no shortage of sweat nor tears. One of the crew knew the owner of a rental store in Abbotsford. They were able to persuade them to open the store at around eleven PM and obtained a block and tackle. The then sizable work party cut some holes in the floor of the barn?s hay storage area directly over the stall and set the block and tackle up to lift the mare. By this time, she was so worn out that she wouldn?t even try to stand. At this point, I had pretty well given up and was packing to leave. Back at my car I slowly and methodically replaced my
equipment. I knew, and dreaded, what I was going to have to tell Karla and the rest of the crowd, the mare would have to be put down. As I replaced the last of my kit in my truck, another round of cheers exploded form the distant depths of the barn. At the eleventh hour, just like in the movies, she finally stood on her own. And this time she didn?t fall. I waited to see if she would go down again, but she didn?t. She was very unstable but she stood on her own. So I explained what they needed to do over the next hour or so. I also said that it was great that she was standing, but her prognosis was still extremely poor, maybe 20 %. However, as I drove off, I sensed much more optimism than pessimism in those I?d left behind. As for me, I still had the knot of experience deep in the pit of my stomach warning that miracles rarely come true.

The next morning at seven the phone rang. It was the owner of the stable. Her voice trembled as she told me that Rebecca had died over night.

The rest of this story unfolded in small claims court. Somewhat surprisingly, Karla was eventually awarded the costs of treatment and the value of the horse. As expected, the ?Para-Vet? had no money to make good on the judgment. It was a Lose-Lose situation from beginning to end.

What we ended up with was a distraught mother and father who blamed themselves for this tragedy, a little girl whose whole world had collapsed, a beautiful mare that died a senseless and horribly agonizing death and a quack who was only about $50 richer. It can be awfully expensive to save a couple of dollars.

If this were just a single occurrence, it would be a rare tragedy. Sadly, stories like this are all too common. Unfortunately, owners are often too embarrassed to talk about them, and the guilty just keep plying their trade of misery, giving the Farrier community a black eye. As a consequence, it is important that every horse owner take responsibility to protect their animals and their investment in those animals. Ensure anyone working on your horse is covered by insurance

Skilled, reputable Farriers are so busy, they have neither the time nor the inclination to break the law, for that is what they are doing when they go beyond working with feet. Farriers are critical and highly-valued members of the horse-care team. Every equine veterinarian respects their abilities and relies on them to do their job. Unfortunately, where there is a dollar to be made, unscrupulous individuals are only too eager take advantage, regardless of the carnage they leave in their wake.

Dr. Bruce Burton DVM

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Farrier X-Rays – An Exercise in Teamwork

By Robert Moats DVM & Marian Moats DVM

For a number of years (since 1982), when Rick Redden introduced me to the concept, I have encouraged owners and farriers to rely on radiographs when abnormalities of the foot are involved. This is especially true when laminitis is thought to be or known to be a problem.

This can be a challenge because veterinarians and farriers often don?t cooperate very well. In my experience with these situations I usually find the procedure to be a positive knowledge building and bonding experience where all three parties ? the horse, farrier and veterinarian benefit.

With the advent of modern radiology and crucial knowledge of laminitis and the foot from the likes of Redden, O?Grady, Chapman, and Pollitt, the only x-ray you?re sorry for is the one you didn?t take. To quote Mark Twain ?It isn?t what you don?t know that hurts you, it?s what you know for sure that?s wrong that really hurts you.?

This article is a brief outline of a number of reasons why ?farrier x-rays? are important.

In my practice ?farrier x-rays? historically refer to views of the foot to detect front wall thickness and rotation and accurately measure both. It also detects other details of laminitis and look-alike disorders.

Positioning and aiming the x-ray beam is critical to accuracy. The system I use is to stand both forefeet on lazy susan round blocks. This is amazingly well tolerated. The block is custom built so the top is exactly plumb with the horizontal ?cross hairs? of the collimator of my x-ray machine. The collimator is a lighted site like the crosshairs of a rifle scope. My blocks are round (never out of line to position the cassette). They have lazy susan bearings so that the horse can adjust to small misalignments and have a wire ring embedded in the top. (Figure 1 & 2).

Figure 1 & 2

The reason for the wire is to confirm that the aiming is exact. If the positioning is correct the ring appears as a straight line under the foot. (Figure 3). If the floor is off level or the operator (me) makes a mistake the ring appears as an oval and has to be repeated. (Figure 4)

All laminitis is not created equal and is not always obvious. Sometimes an increase in front wall thickness is th only sign. One of the gems of knowledge from Dr. Pollitt?s lecture is the geometry that allows calculation of the normal front wall thickness. Everything above this thickness is abnormal and laminitic and as stated above can be the only sign.

By measuring from the tip of the coffin bone to the navicular joint and dividing by 4, the maximum normal front wall thickness for that foot is calculated.

Prior to Dr. Pollitt?s work, all we had were breed approximations which were inexact in marginal cases. These measurements are now very precise.

The side bonus of farrier x-rays is detecting related abnormalities that may otherwise be hidden.

Seedy toe which often masquerades as laminitis or is combined with it. The separation in these cases occurs from the ground up and often intrudes close to the coffin bone. (Figure a)

Laminitis with separation between sensitive and insensitive laminae which is a much more serious situation when present. (Figure b)

Club feet with contracted deep digital flexor tendon (Figure 6)

X-rays of these cases look dramatic and terrible but often have a much better outcome than laminitis. The case here responded very well to check ligament desmotomy to decrease the tendon pull and allow lowering of the heel and reshaping of the toe. (Figure 7)

With fairly routine follow-up farrier care this horse went from three legged lame to a mid-level riding horse and brood mare.

Additional changes seen on farrier x-rays:
i. Club feet often have remodeling of the ?point? of the coffin bone
ii. Marginal (on the edge) fractures of the coffin bone
iii. Osteomyelitis ? which are changes caused by infection

The above information shows the truth of the adage ?Knowledge is power?. Knowing what you?re dealing with gives much better opportunity for a good treatment outcome.