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The Kinder Cut – Castration of horses

This is the time of year when people start to look at their cute little foals, and suddenly realise they're starting to grow up fast... As a result, it’s also when we start to get phone calls from people to talk about gelding them. If you are considering getting a colt gelded ("cut"), my advice would be to contact your vet, who will be able to advise you on the best approach in your particlar circumstances. However, I'm going to try and go through some of the commoner questions below, so you've got some basic information on the decisions to be made, the procedure, and what you'll need to consider. The first question, of course, is whether or not to get him cut. It’s an important decision, so these are my thoughts... The majority of male horses are castrated, and for very good reason - very few people have the facilities, the time, or the inclination to manage an entire stallion. The old adage had it absolutely right - "You can tell a gelding, you can ask a mare, but you discuss the matter with a stallion". Although there are some superbly well mannered stallions out there, it takes years of expert training - and in my experience they're almost always more "bolshie" than a gelding, and much less forgiving of any mistakes. They are also much more easily distracted (e.g. by a passing mare), and prone to fighting. Does this mean you can't train them well and keep them happily and healthily? No, of course not - but it’s a lot harder. The majority of stallions can't be kept in groups because of the husbandry regimes on most yards, so have to live on their own. That's not good for their mental health, or their owners and riders! If someone has the knowledge and facilities to bring up a stallion, I don't have a problem with that, and I wish them luck, but I've seen too many bored, frustrated and borderline dangerous stallions who haven't been brought up correctly, and remain a liability. Geldings, however, can be kept in groups, can mix with other horses, and are less likely to lose the plot or throw a temper tantrum. They also don't present you with unexpected foals in your competing mares... If you decide not to have him done, you need to be sure that you're doing it for the right reasons. The majority of horses are not necessarily good breeding material - you need to take an objective look at him and decide if breeding from him is actually going to benefit the breed. If you're avoiding doing it just because you don't like the thought of the procedure, you'll need to think long and hard about whether thats in his best interest - or yours. If you are getting your colt cut, the next decision is when to do it. There are two major concerns - the time of year, and the maturity of the colt. In terms of time of year, it’s best to do it when the weather is cold enough to prevent flies from infecting surgical wounds. Ideally, then, this would be in late autumn or early spring, but gelding him in winter is perfectly acceptable if the facilities are suitable. Regarding the colt's maturity, there is an upper and a lower limit. The lower limit is the most rigid - except in an emergency (e.g. a strangulating hernia), I would never geld a colt until both testes had descended into the scrotum - because it’s really important to make sure you've got both! This usually happens between 6 and 12 months old, but it is a bit variable. In addition, the colt has to be strong and mature enough to survive the surgery, although with modern anaesthetics this isn't as much of an issue as it used to be. The upper limit is much more flexible. Stallions into their twenties are castrated fairly commonly, but once they've passed through puberty, a lot of the stallionish behaviour is learnt, and won't be reversed by castration, including some forms of aggression, and mounting behaviour. Sometimes, people like to wait until a colt is 3 or 4 years old before gelding, but I think that often even that is too late - although it does allow the colt to develop more muscle, he'll also be developing stallion traits. In addition, the younger the colt, the smaller the testicles, and the smaller the testicles, the lower the risk of bleeding during the op. During puberty, the testicles increase dramatically in size, and as a result, their blood supply increases accordingly; the bigger spermatic artery in a post-pubescent colt is much harder to control bleeding from. As a general rule (and it’s a VERY rough rule of thumb!) I'd normally look to geld between a year and eighteen months old. That said, there are a lot of exceptions - I once had to sort out the castration of a four month old colt because he'd started mounting his mother... There are also a number of opinions about weaning - before, after or at the same time? In this case, I think it depends entirely on the colt in question, and it’s an area (one of many) where I'll usually defer to the owner's judgement. Before you go any further, its a good idea to get the colt thoroughly checked out - both testicles need to be present and easily palpable; if one is "shy" and difficult to find, I usually recommend checking again in a month or so. If it’s still inaccessible, the colt may be a cryptorchid (i.e. a rig, with one undescended testis). These colts should ALWAYS be castrated, and have to be done under general anaesthetic, if possible in a clinic. This is because the retained testicle, being kept at an abnormally high temperature inside the body, is more likely to become cancerous. Also, the defect may be genetic - and if so, he'll risk passing it on to his offspring. Once you've decided when, there's another important decision you and your vet will have to make, and that's the details of the procedure. Basically, there are two factors to decide - firstly, do you want him done "at home or away"? Secondly (a related point), do you do him under standing sedation or down under a general anaesthetic? Regarding the location, it depends on your practice's policy and facilities. Many practices now offer castration at the clinic, but the majority of people still choose to have the op done at home. The advantage of having it done at a clinic is that the procedure can be cleaner, and all the equipment and apparatus is there; in addition, many practices charge a callout fee for coming to the yard. However, that's offset by the fact that you'll have to transport the colt to the clinic; in addition, I think it’s usually less stressful for the procedure to be done at home, assuming the appropriate facilities are available. Exactly what facilities you need depend on the technique that's going to be used. There's a lot of debate as to this decision, and some frankly ridiculous comments from some badly-informed people out there. I'm going to talk through the options and the pros and cons. The two main options that you'll need to think about for the procedure itself are whether to have the op done under standing sedation or general anaesthetic. In some cases, the decision is easy - miniature horses and small shetlands should almost never be done standing, because they're too small for the surgeon to get good access and control the site, for example. Draft breeds are at a higher risk of eventration (see below, when abdominal contents escape through the castration wound), and so need a different surgical technique, which may be easier under a general; and fully adult stallions bleed more so may need better surgical access - again, a general anaesthetic makes this easier. However, most colts can be done either way, so you and the vet need to decide which you prefer. Under standing sedation, the colt is given intravenous sedatives (see my blog on sedatives) so he becomes very dopey. He will continue standing up, but his head will drop, and he is likely to adopt a wide-based stance (which makes surgical access easier!). However, its important to remember that he is still to some extent aware of what's going on, so local anaesthetic is injected into the testicles (perhaps 20ml into each one, plus some under the skin of the scrotum) or into the spermatic cord (although I find that that's easier said than done, with most colts pulling the testicles up tight to the body wall so the cord is difficult to access from outside) to numb the area. The castration is then performed with the vet working from standing beside the horse. This approach avoids the risk of a general anaesthetic, and means the horse will recover from the sedative faster. However, the degree of sedation achieved is variable, and some colts appear to be more aware of the procedure than one would like, no matter how much sedative you pour into them. There's also a MUCH higher risk of the vet or their assistants being injured - unsurprisingly, some colts object violently if they realise what you're doing... In addition, the surgical access is poorer (the vet is having to work upside down, and largely by feel) so if there is a complication, it is harder to control it. Under a general anaesthetic approach, the colt is sedated and then given an injection of a general anaesthetic. He'll become very sleepy, and then lie down. Once he's out, an assistant lifts up the top leg, giving the surgeon access. The disadvantage is that most vets will only do a GA on a horse if there's another vet along to monitor the anaesthetic, which may affect the cost. In addition, a GA is a risk in its own right - one study suggested that the average mortality rate from GA in a horse is 1% (although this includes colics and emergency operations - the risk for a young, healthy colt is much lower). On the other hand, the risk of injury to the vet or assistants is much lower, and the risk of surgical complications is also much reduced, as the surgeon can see exactly what they're doing. Is either one definitively better than the other? No. However, it is a decision to take WITH your vet, as they may have a preference that will affect their efficiency. For what its worth, I've done geldings both ways, and personally I prefer to do them under general, because its safer for me and everyone else around - and if there was to be a complication, I've got a better chance of finding and fixing it at the time. The procedure itself is pretty much the same whichever way up the horse is. Along with sedation, I give an injection of an anti-inflammatory and painkiller, and antibiotic cover (no procedure done on a yard or in a field can ever be truly sterile, so I'd prefer to make sure there are antibiotics on board when we start). In the past, vets didn't routinely give painkillers as well as the sedation (which contains a painkilling component), but personally I don't think its fair not to. There has historically been quite a mystique about the procedure itself - probably because people are a bit shy to discuss it. As a result, there is sometimes serious confusion - remember, gelding is NOT the same as a vasectomy, and it can't be reversed... Not even (as apparently happened to a colleague of mine) if the client stops you as you're about to drive off and, holding up a neatly severed pair of testicles, asks the vet to reattach them because she's changed her mind... So, here's a quick run through the procedure: The area of the groin is scrubbed with a skin disinfectant, and a final check is made that both testes are accessible. Whichever one is held closer to the body is the one I'll start with, just in case it is retracted later. I'll then scrub up so my hands are sterile. Some vets wear gloves, others don't - I don't think it really matters as long as they've scrubbed thoroughly. Gloves add an additional sterile barrier; but on the other hand they can reduce your feel and grip, so it depends on what the vet is happiest with. Once the scrotal area is scrubbed, the vet will use a scalpel blade to cut through the skin of the scrotum. There are a couple of different options from here on, but the principle is the same; to cut down through the tissue to the vaginal tunic (the membranes that surround the testis itself) and then gently pull the testicle down and out. In an "open" castration, the tunic will be opened, in a "closed" technique, it gets left intact and the testicle pulled down still inside. Once there's enough slack in the spermatic cord (containing the blood vessels, nerves etc that supply the testicle), the emasculators are applied across the cord, with or without the tunic, depending on the technique. These are a clever bit of kit that crush the cord, preventing it from bleeding, while at the same time cutting off the testicle itself. (Quick aside here - I was doing a gelding once and, as is customary, I showed the removed testicle to the owner to show it had been done; he was a teenage lad and he fainted dead away. Interesting ethical problem there - do I try and help the unconscious boy, or do I just keep working on the anaesthatised horse who'll soon wake up? Fortunately, he recovered on his own before I had to scrub out, but he was pretty green around the gills for the rest of the morning...) In an older stallion, most vets will put a suture through the cord to ligate the artery, but this increases the risk of infection, so we don't always put one in if doing an Open procedure. After removing the emasculators, the vet will check closely for bleeding from the stump. If there isn't any, they'll repeat the procedure on the other side. If the surgery is taking place in the field, the vet will usually leave the incision open for drainage; closing it seriously increases the risk of post op swelling and infection. As a note, there is always a bit of bleeding after the operation. The rule of thumb is, if you can count the drops, its fine! There's also invariably some swelling of the sheath, but again, it isn't usually anything to worry about. If in any doubt though, you should contact your vet. Your vet will give you instructions for post op care, but the most important thing is to keep the new gelding moving, to reduce the swelling and encourage drainage. The complications to be aware of are bleeding, eventration, and infection. bleeding is pretty obvious - some oozing from around the incision is normal, but there shouldn't be any significant haemorrhage from the stump of the spermatic cord. If there is, or if there's a lot of blood - call your vet! Uncontrolled bleeding is an emergency that may require a repeat surgery to control it. eventration, is when abdominal contents prolapse through the inguinal canal, and it’s more common in draft breeds. This is the main reason we'd do a Closed castration, as it ties off the tunic; but it does increase the risk of infection. Eventration usually involves some fatty tissue (the omentum) and although it needs urgent surgical repair, it isn't usually life threatening. Very occasionally, however, it progresses to evisceration, where loops of intestine come through. This is very serious, but (touch wood) it’s also very rare. infection is uncommon, and usually responds to antibiotics. In a few unlucky cases, though, a schirrous cord forms, where abscesses form in the canal. These take months of management, and in the end, treatment is usually surgical removal of the infected tissue. These complications are very rare, and even if they occur, they're usually fixable, so don't get scared of the possibility! I only mention them so you've got an idea of what to look out for. The last thing to bear in mind is that the gelding may still show sexual interest for some weeks after castration (at least, if he was before), and may even be fertile for a time: although he can't make more sperm without testicular tissue, there will still be some "in storage" in the spermatic ducts. I always advise that a newly gelded colt or stallion should be isolated from mares for at least 6 weeks, after which any remaining sperm will have died or been flushed out, and his testosterone levels will have declined to the point where he won't have any hormonal urges. The bottom line is this: although it doesn't seem a nice thing to do, for most colts in most situations, gelding leaves them happier and more content than they would otherwise be as entire stallions.
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Sedatives and Sedation in Horses

We routinely sedate horses in practice - after vaccination, it’s probably the most common "routine" job that we do. So, what are we doing? How do the drugs work - and why doesn't it always happen the same way? "Sedation - a state of rest or sleep... produced by a sedative drug." That's the dictionary definition, and it makes it sound lovely and simple - give a drug, and the patient goes to sleep. Of course, in reality (as usual with anything equine!) life isn't that easy... For those who haven't seen it before, a sedated horse doesn't lie down, but their head gets lower and lower, and they may require something to lean on to help them balance. It’s also important to remember that a sedated horse CAN still kick - they're just much less likely to do so! It often seems that the horse is still more or less aware of what's going on around them, but they're too sleepy to care about it. As a result, we'd almost invariably use pain relief and local anaesthetic as well if we're carrying out a surgical procedure. There are a wide range of situations in which we like to use sedation. Generally, it’s to make the horse more amenable when something nasty or scary is being done to them. Of course, this varies from horse to horse. There are quite a lot of horses out there that need a sedative before the farrier can trim their feet; and there are others that will allow you to suture up a wound without sedation or even local anaesthetic (not recommended, but occasionally necessary). Probably the most common reasons we sedate horses for are... 1) Stitching up wounds, to stop the horse wriggling! 2) Tooth rasping, especially when using power rasps and dremels 3) Some surgical operations - for example, many vets prefer to castrate colts under standing sedation, rather than a general anaesthetic. This is because sedation is much safer than a general anaesthetic... On the other hand, the surgery is easier and safer (for the vet, as well as the horse) if the patient is completely "out", so it comes down to the type of horse and the preference of the vet doing the op. It’s important to remember that all sedatives temporarily alter the way the horse's brain and body works, and have a serious impact on the heart and circulatory system. As a result, they're all prescription-only medicines, and your vet will want to satisfy themselves that the patient doesn't have any underlying heart problems etc before using them. Overdose of a sedative is rarely fatal in a healthy horse, but it can still be dangerous, especially if there is any underlying illness that makes them less good at maintaining their blood pressure. Its also vitally important to tell your vet the horse's whole medical history if you're asking them to give a sedative - there have been cases of horses who were being treated with a (very safe) antibiotic (TMPS); the owner forgot to tell a vet this, and the combination of sedative and this antibiotic has resulted in a heart attack (technically, a fatal arrhythmia). There are three routes by which we normally give sedation: 1) By syringe or in feed. This is the slowest, least powerful and least reliable way to sedate a horse, but it has two advantages - you don't need a vet to come and do it, and you don't need to get so close to the horse to give it. The drug most commonly used is ACP, sold as Sedalin or Relaquin paste. Occasionally ACP tablets are used, although there are strict restrictions on when a vet is allowed to prescribe tablets instead of paste. There is a newer drug now available as a syringe, detomidine (sold as Domosedan gel), which is absorbed across the membranes in the mouth so shouldn't usually be given with food, but does work faster and give better sedation than ACP. 2) By injection into the muscle. Many injectable sedatives can be given into the muscle - this injection is more reliable than by mouth, but requires much higher doses than if given into the vein (in my experience, you need 4-5 times as much, and it takes about twice as long to work). It’s only usually needed if the horse is too wild or dangerous to get a vein, but it’s quite useful to "take the edge off", and then I can top up with intravenous sedatives if needed. The other situation where I've occasionally used it is when a severely colicing horse has to take a long ride in a box to get to a surgical centre. In these cases, I have sometimes given the driver a preloaded syringe so that if he horse freaks out or goes crazy in transit, they can give it something to calm it down and relieve the pain until they arrive. 3) By intravenous injection. Intravenous sedation is by far the best option if possible - it works fast (usually 5-10 minutes), you need lower doses, and you get much better sedation than by any other route. This is what I'll be concentrating on below. There are three "families" of drugs used to sedate horses: Acepromazine (ACP). This is a very "dirty" drug, in that it affects a wide range of body systems. It can only produce mild to moderate sedation on its own, and the effects are very variable between horses. It’s important to remember that once sedation has been achieved; increasing the dose WON'T result in deeper sedation, just more side effects. It also has no painkilling properties. There are two side effects in particular that we as vets watch out for with ACP. Firstly, it can lead to significant drop in blood pressure, because it makes peripheral blood vessels dilate (this is why it’s sometimes used in laminitis). The second effect is much more interesting - ACP is a mild muscle relacant of some muscle types, so it can be useful in azoturia and choke. There's one exception though (male readers of a senstive disposition, look away now...): ACP is a very powerful relaxant for the retractor penis muscle. This is the muscle that holds the penis in the sheath, and even low doses of ACP usually lead to male horses "dropping" the penis. This can be useful, but unfortunately in some horses (especially stallions, with a larger and heavier penis than most geldings); the paralysis of the penis can be quite prolonged, which can result in penile trauma. In extreme cases, this can be permanent or lead to gangrene, requiring amputation. Bottom line - if at all possible, avoid using ACP in stallions and entire colts! ACP does, however, have a place in sedation - when mixed with other drugs, it often prolongs sedation and means that the doses of each part of the combination can be dropped, reducing the risk of side effects. A quick note on ACP tablets - under the current Veterinary Medicines Cascade laws, it is illegal to use ACP tablets instead of paste in horses unless the vet has a clinical reason (unfortunately, price isn't considered good enough) to think that they are more appropriate. As a result, if your vet refuses to give you the tablets, they're not trying to rip you off - they're just obeying the law. Opiates Although opiates on their own are only very weak sedatives in horses, when combined with other drugs they lead to much deeper and smoother sedation than any other drug on its own. The drug usually used is butorphanol, which is a synthetic opiate (it’s a mu/kappa agonist/antagonist related to buprenorphine, for anyone interested) that has a fairly good painkilling effect as well as potentiating sedation from other drugs. Fortunately, it also has very few side effects, although its worth bearing in mind that any other opiates (e.g. Pethidine or Fentanyl) that the horse is given up to about 8 hours later won't work quite like they're supposed to, as the butorphanol will partially block their activity. Alpha-2 Drugs These really are the mainstay of sedation in horses (and in dogs and cats, for that matter). Alpha-2 drugs act by tricking the body into thinking it's produced too much adrenaline, so it stops releasing it, resulting in reliable deep sedation. They're also pretty powerful painkillers. There are three drugs that are commonly used, with slightly different properties. Detomidine and Romifidine are both fairly long acting drugs (30-40 minutes after i/v use), and when mixed with butorphanol are the standard sedative preparation for intravenous use, or on their own into the muscle. Detomidine is also available in a syringe for oral use. The third drug is xylaxine; this is a bit different in that it gives milder sedation, and only lasts 20 minutes or so. It’s particularly useful for sedating horses for nerve blocks etc, where in half an hour they need to be completely recovered and able to trot up. Before I sedate a horse, I always have a good listen to the horse's heart, and check its pulse and colour to make sure its cardiovasclar system is healthy. I'll then double check it’s not on any medication, and then give i/v sedation. I like to use either detomidine or romifidine mixed with butorphanol for routine sedation - I personally prefer detomidine, but that’s probably just because it’s what I "grew up" as a vet using! For longer lasting procedures, or if I want muscle relaxation (especially for dentals where I want the tongue nice and floppy!), I add ACP into the mix. Dosage is incredibly variable between horses and experience and judgement is more important than all the book learning available. As a rule of thumb, the bigger the horse, the less sedative per kilo of body weight it needs (so Shetlands often need as much as a light hunter). In addition, it depends on temperament - the more highly strung or excited, the more sedatives are needed. The other thing to remember is that apparently identical horses, in the same circumstances, may react very differently - the dose that will have Alf so deep his head's on the floor will have Brutus untouched, while Charlie is in the "Goldilocks" zone where he's just right. Of course, it also depends how deep the sedation you want - although personally, I've found that if you aim for "light sedation" to start with, you usually end up having to top the horse up halfway through. Once the injection's been given, it is VITAL to give the horse time for it to work in a quiet, dim, calm place. If the horse gets excited while you're waiting for the sedative to kick in, it won't work well. This is doubly true for oral sedatives, but it applies to injections as well. During the procedure, its sometimes necessary to top up, which is fine - the great thing about the drugs we use is that they work fast enough i/v that you can monitor their effects more or less in real time. Recovery is usually rapid and uncomplicated, although it’s important not to let the horse eat anything until it’s completely woken up, or it may choke. Very occasionally, I've had a horse that refused to wake up, or went too deep. After my first one, I took to carrying the antidote (Atipamezole, aka Antisedan or Sedistop) with me when I sedated sick or old horses. It's very expensive, but it works within a minute or two to reverse the effect of alpha-2 drugs - and once they're reversed, the horse wakes up incredibly fast! In practice, sedating horses is as much an art as a science, and there's rarely one "right answer" - it depends on the horse, the circumstances, and what you're trying to achieve. The main purpose is to allow us to treat your horse effectively and humanely. If you are worried about any problems with your horse or pony, please talk to your vet or try our Interactive Equine Symptom Guide to help decide what to do next.
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Rain Scald, Mud Fever and Greasy Heels – Wet Weather Care for Horses

I heard on the news recently that last year was one of the wettest on record. I don't know if it’s true - but it certainly feels about right! The big danger to our horses from this, of course, is Rain Scald and Mud Fever. Most people have probably come across Rain Scald on occasions - the scabs hidden away in the coat feel like mud, until you pull them up and see the characteristic "paint brush" appearance as the hair stays stuck in the scab. Rain Scald is caused by a bacterium called Dermatophilus congolensis. This usually lives (fairly) harmlessly on the skin, but if the skin gets and stays wet, the bacteria can invade and set up an infection. Most cases are mild, with just a few scabs here and there, but (especially in older horses and those with Cushing's disease) it can be more general and leave large raw patches. Even a mild case can put a horse "off games" if the scabs or raw patches are under the saddle. Most cases resolve on their own with simple care - gently brush out the scabs, and most importantly keep the area dry to allow it to heal. That said, older horses and those with other diseases may need a helping hand, in which case a short course of antibiotics from your vet will usually clear it up. HOWEVER... Unless the underlying problem is sorted, it will rapidly return! Prevention is far more important, and that means keeping the skin as dry as possible. Remember, if your horse gets wet, that’s fine as long as he can then dry out thoroughly. It’s if the skin stays constantly wet that problems ensue - and watch out for rugs, especially in early autumn! When it’s wet, but not that cold, horses can easily sweat up under their rugs, and sweat seems to be even worse than rain for causing Rain Scald. The other thing to watch out for, of course, is Mud Fever. This is an infection of the skin behind the heels (its sometimes called Greasy Heels), and is most common in horses with long feathers. It's a far more complicated disease than rain scald, and has a large number of contributary causes. The most important is wet weather, of course - as the skin gets wet, bacteria can invade, as in rain scald - long feathers keep the water trapped in the area, slowing down the drying, so cobs and heavy horses are more prone. However, mites are also a known cause (the first signs are usually stamping of the hind legs), and its not just bacteria, because some cases include yeasts and other fungi as well. Sometimes, really aggressive bacteria like Pseudomonas can establish themselves, and they can be really difficult to manage. The symptoms vary, but generally it first presents as scabs in the angle of the heels behind the pastern. If untreated, or as the infection gets worse, cracks in the skin can open up and start oozing fluid and pus, and the legs thicken. Eventually, lymphangitis can occur and ultimately, the skin can slough or even become gangrenous. Initial treatment is very simple: wash the affected area with a skin disinfectant (like Hibiscrub or similar), and once the scabs are softened, gently wash them off. This may take several days of work! If the infection progresses, or doesn't improve, you will need veterinary attention. Most cases respond well to a course of first-line antibiotics (e.g. Penicillin/Streptomycin or Timethoprim Sulpha); however, if it doesn't respond in a week or so, I would always take a swab for bacterial culture and sensitivity testing. This give you a much better idea what bacteria you're dealing with, and how best to kill them - I had a case once which turned out to be a multi-resistant Pseudomonas infection, that needed some really powerful off-license antibiotics to resolve it. Sometimes you can use topical antibiotics (creams, ointments etc), and in severe cases, I have occasionally used a "bespoke" ointment that I made up from several different antibiotics and an anti-inflammatory. If there are mites involved, most vets will use an injectable anti-mite drug; however, this isn't licensed for use in horses so has to be put up by your vet. As usual, prevention is much better (and cheaper!) than treatment, though, so keeping the heels dry is vital. Sometimes using an aqueous cream like zinc and castor oil, or Vaseline, can be useful in encouraging the water to run off - but if you do use them, make sure you wash it off and dry it thoroughly once or twice a week before reapplying, so it doesn't get too thick. Of course, in an ideal world, keep the horses out of muddy fields and trackways... But given the recent weather, I fear we're all going to have to be a lot more careful to keep our horses and ponies warm and dry this autumn. If you are worried about any symptoms your Horse or pony may be displaying please talk to your vet or try our Interactive Equine Symptom Guide to help decide what to do next.
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Equine Education (Part 2 – Vet Students)

Have you ever wondered who the young person trailing behind your vet is? They appear, at best they're introduced as "so-and-so, who's seeing practice with us", and then they disappear, never to be seen again... Well, the odds are they're vet students who are "seeing practice" with your vet. Training as a vet is a long process - vet students spend 5 or 6 years at university doing lectures, practicals and clinical work. However, in that space of time, they also have to do the equivalent of an extra year of "EMS" (Extra-Mural Studies, generally known as "seeing practice"). This is their chance to get out of the lecture theatre, away from the ivory towers and out into the real world of practice! As vets in practice, our job is to take these students and teach them the nuts and bolts of veterinary practice. They'll learn the science, and all the theory, at vet school; however, there is also an art to veterinary practice, and that's our responsibility. For example, if the client can't afford the best treatment, how do you proceed? Or if a client refuses consent for a surgical procedure, what other options can be explored? At the vet schools, students tend to learn a lot about the more esoteric and uncommon diseases, operations and procedures - this is because they operate referral hospitals (although Nottingham uses an expanded version of the EMS system for virtually all their clinical tuition). Although they do have first opinion practices, in all seven schools the teaching tends to be biased towards the rare and exotic. Out in general practice, however, the axiom "Common things are common" applies - for every septic pedal joint, there are dozens of simple hoof abscesses! It can also be useful to us having students along (opening gates, for example - sounds silly, but when you have yards with five or six sets of gates, it gets very time consuming stopping to open and close each set!). In addition, though, they will often have learnt new approaches, new solutions to problems, that we can use. For example, I once had a student along with me when I was dealing with a stallion with an injury in a VERY sensitive area. To examine it properly, I would need to nerve block the whole area - time consuming and potentially dangerous. However, my student at the time had learnt in her pharmacology lectures that it had recently been discovered that one of the local anaesthetic agents I was carrying was effective through the thickness of the skin. We therefore applied it with gloves - and managed to numb the area enough to examine him properly. In one practice where I worked, I did an awful lot of equine dental work. In some situations, we used a powered dremel; however, we didn't routinely carry it, so if there was an intermediate case, we'd usually try and complete the work by hand, rather than come back later. Now, I can assure you that rasping down large hooks and ridges is physically very hard work! Having a student to alternate with makes it go much faster and more efficiently - which often means less time and sedation. The big problem vet students have, however, is getting enough clinical experience in practice. Some clients are, sadly, unwilling to allow a student to carry out even simple procedures (like giving injections, or drawing blood samples). If you think you might be in that situation, I'd like you to consider three things...
  1. The vet will be closely supervising, and will be in a position to step in at any point if they aren't happy.
  2. We wouldn't ask the student to do it if we thought they'd make a hash of it.
  3. Most importantly of all, if they don't get a chance to practice as students, they won't develop the skills they need as graduates. That means they won't get the experience they need if they're going to grow into good horse vets - because they didn't get the practice they needed as a student under controlled conditions.
So, for the sake of your horses in the future: please allow the student to carry out any procedures that your vet thinks they're ready for!
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BEVA Congress 2012 – How Horse Vets Keep Up to Date

Equine Education (Part 1 - CPD) As vets, we're always trying to do the very best for our patients. However, veterinary medicine is constantly changing - every year, hundreds, even thousands of new papers are published, new drugs become available, and new machines and tools come on the market. What was the "gold standard" of treatment for a disease ten years ago might now be proven to be more harmful than helpful! At a recent conference (BEVA Congress - see below for more on that...), John Walmsey, one of the foremost and best respected members of the profession, gave the plenary lecture talking about the massive changes that have taken place in equine veterinary care in the four and a half decades since he graduated. The drugs we have now are far more effective, the machines and tools more robust and more useful. Even ten years ago, MRI in the horse was really rare and (to be honest) unreliable; now it's a standard tool in working up a complex lameness. As a result, with the field of knowledge constantly changing, it's more important than ever for vets in practice to keep up! The process of keeping up to date is known as CPD (Continuing Professional Development), and we are expected to do at least 5 days a year. It can be made up in a number of ways, including lectures, seminars, webinars, practical courses and reading journals and papers. Like most equine vets, I receive the big journals Equine Veterinary Journal and Equine Veterinary Education, which (respectively) publish papers on equine science and equine surgery and medicine. I also try to attend relevant courses and lectures as often as I can. In September, I was at the BEVA (British Equine Veterinary Association) Congress in Birmingham. This is one of the biggest gatherings of horse vets in the world, and I try to go most years. Congress lasts for three days of lectures and seminars, as well as a large commercial exhibition. It's a great place to go to pick up the latest ideas, new treatments and medicines, and catch up with colleagues from across the country. I sometimes think we learn almost as much from talking over cases with colleagues as we do in the lecture theatres! This year was notable for...
  • The debate over firing of tendons. (Quick recap on that one - the Royal College, our regulatory body, does not permit firing of tendons etc; some equine vets think firing should be permitted again in certain circumstances; however, others disagree. The argument goes on!).
  • Andy Bathe from Rossdales in Newmarket had some hilarious stories about working at the Olympics, as well as a number of thought provoking points. For example, some of the showjumpers were receiving a wide range of different (legal) medications to keep them performing at their peak throughout the competition; and every single dose of every single medication had to be certified by an official vet on a separate form. That led to a HUGE pile of forms for the FEI vets to certify each day!
  • There was also a long session on current approaches to laminitis - unfortunately, none of the existing theoretical studies are an exact match for the real disease, and researchers are still plodding along, gathering information. Sooner or later, we will have a good understanding of the condition; however, at the moment we have to be content with identifying horses and ponies who are at high risk, and managing them to minimise the risk. There aren't any easy tests available to measure how high the risk is, however, so it still comes down to the clinical judgement of the vet on the ground.
  • New work being done on RAO (Recurrent Airway Obstruction, what used to be called COPD). Almost all the vets in the audience, as well as the panel of experts, agreed that this year has been especially bad for summer pasture associated RAO, and that cases seem much more resistant to normal treatment than usual. No-one knows why, but it seems likely that the unusual weather has resulted in more pollen than usual (or at least, more of the particularly reactive pollens). One lecturer from Switzerland had a fascinating paper to present on the genetic basis of RAO - he and his team have identified at least 2 different genes that can cause it, one of which is also associated with extra resistance to worms and other parasites. Unfortunately, though, it looks like it will be a long time before there is a simple genetic test, because there are another 11 genes that are also involved... as usual with any horse disease, nothing is as simple as it at first appears! However, he did have one useful tip... In Switzerland, a horse with summer-RAO is routinely moved into the mountains, which seems to reduce the severity. Obviously, this isn't always practical here, but one UK-based expert on the panel suggested moving to the coast for the same reason - to remove the horse from the source of the allergens that are causing the problem.
  • As well as the main lectures, there is always one lecture theatre devoted exclusively to Clinical Research - vets and scientists (and mostly people who are both) present their papers on all sorts of subjects, ranging from Soft Tissue Surgery to Reproduction to Imaging to General Medicine. If I tell you that papers presented include "Carbon Dioxide laser surgery with adjunctive photodynamic therapy as a treatment for equine peri-ocular sarcoid: Outcome and complications in 21 patients" and "Validation and reliability of orthoganal ultrasonographic projection dimensions of the kidney in the horse", you should get some idea of the level of science being presented!
Of course, after Congress, every delegate takes home a copy of the Proceedings - a (big fat) book containing a summary of all the lectures and papers presented. In addition, all the lectures are recorded and vets can access them online, if there was a lecture in particular that they missed. For a lot of us, Congress is only the beginning - on the train home, or over the next few weeks, vets across the country will be reading up on papers and lectures in their particular areas of interest. At most practices - including mine - whenever anyone has been on a course or conference, they then have to boil it down into practical, "hands-on" information. We then present it to the other vets (and nurses etc, if it involves new techniques or machines), so that everyone's patients can benefit from the new knowledge. Sometimes it's hard - it can be very difficult for all of us to accept that a long-cherished treatment has been proven not to work! - but for the sake of all our patients, we work hard to use the most up to date information, and not to be trapped in old, comfortable ideas that aren't as effective. The other side of veterinary education, of course, is the education and teaching of students that happens in practice. I'll be talking about that in my next blog!
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