Initiation Week
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Oct 13, 2011
As She Sees It
Bethany Couture, DVM
It was a busy week for everybody. One doctor was working at a horse show. Another was on vacation for the week. And to top it all off, one of the technicians was sick. It had the makings of an excellent week, and I had only been working at the clinic for two months.
Monday was quiet, not many calls and nothing of great significance in the hospital. Then Monday night's on call shift came. What sounded like a simple call turned into hospitalization of a horse that appeared to be "tying up." The medical term for this is rhabdomyolysis, and it results in muscle stiffness and extreme pain. Usually from extreme exertion, such as racing or even a hard workout in an unfit horse, tying up can often be treated with tranquilization, muscle relaxers, and anti-inflammatories. If a horse becomes severely affected, substances are released into the bloodstream that can cause kidney disease. For that reason, in a severe case we prefer to administer IV fluids to keep an adequate blood supply to the kidneys and prevent any adverse affects. The horse I saw that night was extremely painful and her muscles were very firm. However, she did not respond to tranquilization and pain medication like most horses with rhabdomyolysis do.
She was brought into the hospital where we began IV fluid therapy and pain management. In the morning, she was slightly more comfortable but still significantly painful, which ruled out the diagnosis of tying up. A rectal exam revealed that she had a pelvic fracture with a large hematoma present. A hematoma is a pocket of blood and in this case, it was large enough to decrease the horse's platelets and cause her to become anemic. She required IV fluid therapy and continuous infusion of heavy duty pain medications, as well as steroids and antibiotics, in case the cause of decreased platelets was infectious or immune mediated.
While we were continuing supportive care on the mare with the pelvic fracture, a foal came in presenting with a puncture wound in a hoof from stepping on a nail. Her diagnostic work up revealed an infected coffin joint. She required daily treatments which included IV antibiotics, local antibiotic perfusions to the infected area, and flushing the infected joint with sterile saline.
The same day, another doctor in the practice sent a horse with severe corneal ulcers into the hospital for treatment. Both eyes were severely affected, but one eye was much worse than the other. We placed a subpalpebral lavage system in the worst eye and began round the clock treatment with antibiotics and antifungals every two hours. Because I live in an apartment at the hospital, I am often responsible for overnight treatments if they 
are needed. Getting up every two hours to treat a horse's eye is not on my list of favorite things, but it was necessary for the successful treatment of this horse. To these three cases add our regular appointment schedule with after- hours emergencies and you've got one busy week for two doctors to handle.
On the plus side, all three cases ended well. The foal went home sound and continues to do well on the farm. The horse with the pelvic fracture was sent home on long term stall rest but she is very happy and comfortable in her convalescence. And the horse with the corneal ulcers went home to continue treatment and on follow up appointment she was back in training.
It was a challenging but excellent week for me because I learned a lot and was managing hospital cases nearly on my own (with only a mild amount of input from one of the other doctors). This is what I worked toward all those years in school and I'm so grateful that I'm finally putting all my hard work to good use.