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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)……

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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!…………………..

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BEVA Congress 2012 – How Horse Vets Keep Up to Date

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…

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Cost of Vets – A sad story but an important message

This week I was in a situation which made me feel angry, sad, frustrated and powerless all at once. I wanted to share it because I think it highlights a really important issue about vets, pet care and cost. However, I will warn you it doesn’t have a happy ending.
There was an appointment in evening consults for a euthanasia, which in itself isn’t unusual, but this one was for a Staffie who was only six and who hadn’t been seen for a year. The history we had was brief, she had last been seen for an ear infection but not since. So, I didn’t know why her owner’s had decided to put her to sleep; I was thinking that maybe she had been under the care of another vet for a problem which had become terminal or that this was a behavioural problem like aggression.

However, when she arrived it was quite clear what the issue was. The poor dog had a terrible skin problem; she had sore and swollen feet, a nasty infection in both ears and in places has scratched herself red raw. Despite this she was lovely, happy, friendly girl, desperate for a good fuss. It transpired that she had been like this since she last came to see us, over a year ago, but her owner hadn’t brought her back or taken her to another vet because ‘the treatment hadn’t worked’ and it was ‘too expensive’, meaning that the poor creature had been itchy and painful for all this time.

I did try to speak to the man about her condition and how we might help her. Itchy skin is a common problem in dogs and although it can be difficult to find the underlying cause, most cases will respond to treatment, which is usually inexpensive. Like many illnesses we can offer different options for investigation and treatment depending on what an owner wants and the funds available but the outcome is generally an itch-free happy dog who can go on to lead a normal life. However, in this case the owner wasn’t interested in any treatment at all. He had decided he wanted her euthanased and nothing would persuade him to change his mind…………….

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Toxoplasmosis gondii, Pregnancy and Cats – Fact vs. Fiction

Well over halfway through my second pregnancy, I am currently inundated with comments from clients, mostly positive, and it has added a bit of humour and lively conversation to my otherwise increasingly tiring days. ‘Do you know if it’s a boy or a girl?’ ‘How do you think your toddler is going to react to the new baby?’ ‘Are you going to come back to work after two children?’ But one question I wasn’t expecting came from a woman with a lovely ginger tom – ‘Are you sure you’re OK to examine my cat if you’re pregnant?’ I laughed and assured her that despite my expanding waistline I could still reach the table and her cat would be fine. But after a slightly confused and very embarrassed smile, she explained that she had recently been told by a friend that she would have to give up her beloved cat once she became pregnant because it wasn’t safe for pregnant women to be around cats. It had been a while since I had heard that myth and was saddened to hear it again, but I wasn’t terribly surprised. We spent most of the rest of the consultation discussing the real facts about toxoplasmosis, the disease in question, and she left very much relieved that her feline friend was not going to have to be evicted should she ever decide to have a baby, and determined to speak to her GP if she had any further concerns.

What causes toxoplasmosis?

Toxoplasma gondii, the protozoal parasite responsible for causing the disease known as toxoplasmosis, is a tiny single-celled organism that can infect many different species from mice to sheep to humans. Cats, however, are the only hosts in which the parasite can reproduce…..

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Competition Vetting

Like everyone I know, I was glued to the Olympics – great job Team GB, especially our first Dressage and Show Jumping medals for a long time!
However, I wonder how many people think about the infrastructure and planning that go into keeping the horses fit, safe and healthy when they compete?
I’ve been a treating vet at a lot of competitions over the years, including Endurance events, local, regional and National Championship Pony Club events (where the standard is often as high as at many BE competitions!) and the International Show Jumping at Sheffield Hallam Arena. I was also on the vet team as a student at Badminton back when they still had roads and tracks before the cross country.

The vets that people most often seen are those on the Ground Jury at competitions – the notorious “Trot Up” before the competition starts, and again (in eventing) before the horses go forwards to the show jumping phase. At Badminton and most other big events, there are two vets – one on the Ground Jury, along with two or three other worthies – and one in the Hold Box. If there is a question over a horse’s fitness to compete, they get sent to the hold box, where the second vet examines them to see if there is a medical problem rendering the horse unfit. This is a very contentious area – I’ve never yet been at an event where the Ground Jury and the vets didn’t come in for a barrage of criticism over their decisions. However, it’s important to realise that they have to balance several factors:

Firstly, if a horse is unlevel on the trot up, it may be truly lame, or it may have a “mechanical lameness” – in other words, an abnormal gait………………..

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What should vets do about negative comments on their Facebook Pages?

Most vets realise the value of social media for marketing their services, but many have reservations about the possible downside of this type of direct engagement with the public. In particular, vets are often put off interactive online activity like Facebook because of their fear of negative comments by disgruntled pet owners. Is this a genuine concern, and if it does happen, how should vets deal with it?
I’ve just had my first experience of a “grumpy customer” on Facebook and I learned a few lessons during the exchange. I’d be interested to hear what other pet owners out there feel about the way I handled it. For the sake of confidentiality, I’ve changed some of the details.
It happened on a Sunday evening: an email notification arrived alerting me to a new posting on my Facebook page: “You refused to treat a sick kitten: shame on you!”. I responded immediately, by logging on to Facebook and telling the poster that I knew nothing about the situation: we are a four vet practice and it’s impossible for any one of us to know about all events happening in our clinic. The reply came back at once: “You turned a friend away because they had no money. It’s cruel to turn away a sick, dying animal”.
I responded again, explaining that our practice had a fair policy to all sick animals, prioritising their welfare, but that in order to respond properly to the comments, I would need to find out more about the specifics of the situation from the practice during office hours. I also said that it was inappropriate to discuss confidential issues in a public forum like Facebook, and I asked the person to send a private Facebook message if they wanted to discuss it further. The person responded by reposting the public allegation that it was cruel for me to turn away a sick kitten……….

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Part 3: Surgical Colic

As we saw in the previous part of this series, Medical colics are those which can be managed medically, usually on the yard. However, about 1 in 10 cases of colic require emergency referral to an equine hospital for surgery.

This is what most horse owners are terrified of. The general indicators that a horse has a surgical colic are:

1) Heart rate over 60 that isn’t relieved by injectable painkillers.

2) Dilated loops of small intestine on rectal exam

3) Positive stomach reflux from the stomach tube

4) A definite rectal diagnosis of a surgical problem.

5) “Toxic rings” – dark red or purple gums, that indicate that the horse is going into toxic shock.

Of course, it varies between horses, and the vet has to make a judgment call based on all the evidence available.

We also have to talk to the (by now usually frantic) owners about costs. Colic surgery usually costs between £4000 and £5000, but can easily be a lot more. Even if the horse is insured, it is important to check how much the insurance company will cover – there are a couple of companies out there who will only cover part of the costs of emergency surgery. If in doubt, always call your insurer’s helpline.

However, colic surgery is one of the most genuine emergency operations there is – and it can be truly life-saving….

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The death of Ben Fogle’s dog: his honest grief is helpful to us all

Ben Fogle has written a moving piece in the Sunday Telegraph about the loss of his Black Labrador, Inca. At twelve years of age, she had lost the power in both hind legs. Ben made the right decision for Inca, but it was still terribly difficult to go through the process of euthanasia. His article is unusually frank, with Ben describing how he “burst into uncontrollable tears” on the telephone when talking to his veterinary surgeon father, Bruce, about the situation. Then later, Ben describes the actual act of euthanasia:
“I carried her from the car into the house, burying my face into her fur, and laid her on the kitchen floor. Mum, Dad and my sister were all there. “I lay on the floor, hugging Inca while Dad injected her. Her breathing became heavy. I could feel her heart pounding and the warm blood beneath her skin. I breathed the familiar scent of her fur as I nuzzled into her thick coat. I have never sobbed like that in my life. It was a primal, uncontrollable, guttural sob as I felt her heart stop beating.I lay there on the kitchen floor clutching my best friend, unable to move. Wishing, hoping it was a dream, I held her lifeless body.”
Many readers have commented on the online version of Ben’s article, with some describing how tears were streaming down their face as they read his words.
Ben’s account will come as no surprise to vets and nurses: we witness people going through the emotional trauma of losing a pet every day, or even several times in one day. Perhaps the only surprising aspect is that the depth of grief isn’t discussed more commonly in public. It’s as if it’s only behind closed doors that it’s acceptable to express this level of grief for an animal……………………….

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But can’t he just die in his sleep…..?

This week my Granny died, which was sad for us all but she was very old, had had a wonderful life and her family was with her at the end. She had been in a home for some time and was cared for very well. When she became sick and bedbound, the doctors and nurses worked together to keep her comfortable and pain free, until she slipped away in her sleep. I am lucky in that she was the first person I knew well who has died and this experience has made me understand why many people hope this is how their pets will go. However, to die in their sleep is rarely a pleasant or pain free experience for our animals.

Although, just like people, our pets are living longer and healthier lives, inevitably there comes a time when their age catches up with them and illnesses develop. Advances in veterinary care mean we can do a lot for them but eventually we won’t be able to keep up with their problems. If they were people we would put them in wheelchairs or place them in a home where their needs could be catered for, for example being assisted to the toilet or spoon fed but this isn’t practical, or in most cases fair, to a pet who won’t understand what is happening….

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