Browsing tag: lameness

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!

Competition Vetting

Horse Jumping, photo by EDWARD McCABE

Horse Jumping, photo by EDWARD McCABE

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 that is non painful, and does not render it unfit (on welfare grounds) or unsafe to compete. To help them decide, they trot the horse up before the competition, and then note down any anomalies of gait or stride.
Secondly, there are some horses with minor injuries who can appear far more badly injured than they actually are. This is the reason for the Hold Box – a horse with a mild lameness due to a stone in it’s hoof (yes, it does happen, I’ve seen it!) will probably trot up sound once the offending pebble has been removed; likewise, I once saw a hopping lame (7/10 at trot, for anyone interested) horse go 100% sound after a misfitting stud was removed.
Thirdly, of course, the Ground Jury and the vets have to watch the riders or grooms who are trotting up the horse. It’s an old joke in the profession that the shorter the skirt and tighter the top of a woman competitor, the more carefully you have to check the horse, because she’s trying to distract your attention from something!

The role of the vet as a judge of fitness is of course expanded in Endurance competitions, where every horse has to be checked at various points along the track to ensure it is fit to continue, and that its heart rate drops enough to be permitted to go on. Different events have different requirements for judging, but as a general rule, the horse has to trot up sound and well hydrated, and have a heart rate below a certain value (e.g. 80 beats per minute). I was at one big competition once where there was a dispute over whether the (leading, international competitor’s) horse was sound or not. The decision was passed to a panel of 3 vets, none of us having seen the horse before that day, and its soundness or otherwise put to a secret ballot.

This used to be standard practice at two- and three day events, when there was a roads and tracks phase before the cross country. In these competitions (and there are still a few ongoing, regional Two Day Events in various corners of the country), the vet is present simply to determine whether the horse is fit and safe to continue. I once had to pull a horse because it was obviously “not right” – not an easy decision for a vet student at a CCI 3*! The rider appealed the decision – and while we were waiting, it tied up completely, and had to be recovered by the horse ambulance. I still shudder to think how badly it might have been injured if we had allowed it to run cross country.

At these events, riders, trainers etc can be very keen for the vet to pass a suspect horse as sound (although strangely, it doesn’t seem to be such a problem at Pony Club) – however, we’re really not trying to ruin your day (honest, and no, we don’t get paid to “fail” some competitors horses either), we’re just trying to make sure that an injury doesn’t ruin your horse’s week, month or season!

Of course, that brings me on to the treating vets at an event. Any equestrian competition will have a vet either on call or – especially at big events – on site. Some events (like the Pony Club Championships, Badminton or the International Show Jumping) will have the horses stabled on site. At these, there will usually be some vets assigned to the stables area, and others out on the course or at the arena.
Nowadays, we also have access to Equine Ambulances and their fantastic staff. They may look like normal horse trailers, but inside they have slings, winches, padded walls and often lowering floors – everything you need, in fact, to quickly and safely evacuate an injured horse.
The job of the course/arena vets is to be first on the scene and assess the state of the injured horse. They will give first aid, stabilise any strained tendons or suspicious fractures, and then decide where to send the horse. The big decision to make is whether it’s best to send the horse back to the stables (and if so, on foot or in the ambulance?), or refer them directly to a hospital facility. Fortunately, injuries that need immediate referral are rare; and most cases will be sent back to the stables. While assessing the horse, I like to have screens available – it doesn’t mean I’m preparing to put the horse down, but it does mean I can examine them in a calmer, more private environment. If we do need to put a horse down, we’ll usually try and move it off the track or away from the arena in the ambulance, to get some privacy.

While the course vets have to perform in the blaze of publicity, the stables vets are equally important. During the competition, the stables vets will keep in touch with their colleagues on the course, either by phone or (usually) radio. Quite often we’ll listen in on official channels as well so we can be leaning the right way if there is an incident! It’s the stables vets who will deal with most injuries and accidents during the competition, and it can get pretty hectic, stitching up rows of horses in succession…
At many competitions, there will only be a couple of us, looking after several hundred horses, 24 hours a day. I remember one memorable competition several years back where the night after the cross country phase, I got about an hour’s sleep – the rest of the night I was up treating the colicing, the sprained and strained, and the just “not quite right”. Most of my patients that week were mildly dehydrated – it’s amazing how much more horses need to drink after competing in hot weather! That’s the only time I can remember when I had to ring up a local practice to borrow more electrolyte salts, because I’d used up everything I took with me… (And the next year, when I took boxes and boxes of the stuff, they competed in gales and torrential rain, and I actually had cases of rain scald to treat… Well, that’s the English summer for you!).

If you are concerned about your horse, talk to your vet or try our Interactive Horse Symptom Guide to see how urgent it might be.

How Do You Know If A Cat Is In Pain?

DenbyIt sounds like such a simple question, but the answer is actually far more complicated than we think. And it’s not just cat owners who struggle with this question, those of us who have studied these creatures for years still frequently miss signs of feline pain. Because when it comes to showing signs of pain (or any illness for that matter), cats are masters of disguise. In the feline world, complaining gets you nowhere, and showing signs of weakness can get you killed. Sure, some cats in pain will cry out, but if you see a cat crying out in pain, the problem is likely very severe indeed. Besides, cats cry out for many reasons, so even if you do see this, how can you tell if it is due to pain or some other form of stress? Next time you think your cat may be in pain, try to remember some of the following signs of feline discomfort:

• Lameness:
Ok, we’ll start with an easy one. But you’d be surprised how many people come to me with a limping cat who insist that they are not in pain. If your cat is limping, he’s doing it for a reason. And that reason is usually pain. Even if your cat doesn’t have a limp, check for other signs like difficulty jumping up or down from the bed or finding that it’s not worth their effort to climb the stairs anymore. Arthritis is hugely underdiagnosed in cats because many owners either don’t observe or don’t think to mention these changes. If you do notice something unusual with your cat’s behaviour, please speak up as sometimes vets don’t think to ask these kinds of questions.

• Vocalisation
Yes, as previously mentioned, some cats in pain (particularly severe, sudden pain) will cry out or howl. If you see this, take them to the vet immediately to have them checked out, even if you can’t see anything else wrong with them. But it’s not always a howl that they make; sometimes it’s just a more insistent meow, or even a lack of sounds such as normal greetings or cries for food.

• Decreased appetite
Speaking of food, it’s true that some cats in pain will either stop eating, or not eat as much as normal. But not every cat will respond this way because in the wild, a cat that doesn’t eat will die so if they are able to eat despite even very significant pain, they often will.

• Hiding
A cat in pain will often hide from you. You may notice them spending more and more time under the bed or in the back of the cupboard. Or, you may notice that they are quite restless and have a hard time settling in any one place. To you, it may just seem like odd behaviour but to them, it can be a cry for help. Hiding isn’t the only behaviour that can indicate pain, any change in their normal routine may be a clue no matter how subtle, so try to take notice and figure out why the change occurred.

• Eye position and expression
This one is much more subtle, and unless you are very observant you may not pick up on it at all. A painful cat may sometimes have slanted eyes that are squinting or partially closed. They may also have dilated pupils (the blacks of their eyes look very large or ‘wide eyed’), and a generally strange expression on their face. Or they may seem to ‘zone out’ and just stare blankly ahead. Now there are lots of reasons why a cat will show one or more of these things, so don’t be too quick to diagnose your cat as painful if you don’t notice any other signs. But if you do notice a strange look in their eyes, it’s probably best to have them checked out by a vet.

Amber-on-grass• Posture
If you picture a happy cat in your mind, you may think of one who is relaxed and playfully rolling around in response to a good petting session. Now consider the opposite – a painful cat will often sit in a hunched, guarded position. Their muscles may be quite tense, and they will flinch or pull away when touched. Some cats just don’t like being touched, but if yours normally does and then suddenly doesn’t, consider pain as a possible cause.

• Aggression
As previously mentioned, a painful cat won’t want to be touched and this often leads to aggression. If you stroke your cat and he turns around to bite or scratch you, or if he hisses at you when touched, or even if he just starts to twitch his tail in an agitated manner when there doesn’t seem to be any reason for it, get him checked out by the vet.

• Licking, chewing, or fur loss
Cats will sometimes make a fuss over the particular part of their body that is in pain, but this is not always the case. Some cats with cystitis (bladder disease) will lick their tummies and cause fur loss in that area. Likewise, some cats with arthritis in a particular joint may lick or chew at that area more frequently than normal. Rarely, this licking is enough to cause damage to the overlying skin.

• Other medical changes
There are some signs of pain that only your vet is likely to pick up on (although you may notice that something just doesn’t seem right), including increased heart rate, breathing rate, temperature or blood pressure. Because these things require the help of a professional to properly measure, it is very important that you take your cat in to the vet whenever you suspect something out of the ordinary.

As you can see, pain in cats is no simple subject. There are some obvious signs of course, but many more that may go unnoticed for some time. Therefore, if you do happen to notice any of the above signs, it’s always best to take your cat to the vet to have them checked out as soon as possible. Even then, it can be very difficult to tell if they are in pain, so sometimes the best test is to treat for any possible pain and then re-evaluate to see if it made any difference. Whatever you do, try not to ignore it because unlike humans, who are very good at expressing discomfort, cats will most often suffer in silence and it’s our job to make sure they don’t have to.

If you are worried that your cat may be showing signs of pain described above, talk to your vet or try our Interactive Cat Symptom Guide to check any other symptoms you notice.

More Useful Information

Examining your pet

Simple ways to check the health of your pet. Vets use these techniques as part of their clinical examiniation.

Medicating your pet

Arming you with the same simple techniques for stress free pill giving.

Worming & Flea Treatment

Information and advice in treating your pet for worms and fleas.