Drastic Measures?

No, necessary measures.

Two years ago, when we first heard of Fitz, then 25 years old, he was living in Maryland and looking for a place to go. He hadn't had any dental attention for some time and his pictures showed he was a little thin.  TREES arranged for an equine dental technician, accompanied by a veterinarian, to examine Fitz' teeth, thinking that if he had his dental issues addressed he would gain weight more easily and be easier to place in a new home.

Addressing Fitz' dental issues, however, was more easily said than done.    At first glance, it was easy to see one incisor jutting sideways from between his lips.  A few other teeth were loose, periodontal disease was out of control and Fitz whole mouth seemed unstable.  Meredith Barlow, the attending dental technician, called TREES from Fitz' side and asked "just how much dental work does TREES want to cover?"

Uh-oh.  Fitz' immediate needs were to have three teeth extracted: two incisors and one canine.  It was agreed to remove the "sideways" incisor and canine and return for the second incisor and a re-evaluation at a later date.

In the meantime, it was becoming obvious that this would be a very "special needs" horse and not one easily placed in a new home. 

Over the next few weeks, space at the Sanctuary became available and the process to bring Fitz here as a resident began.  Fitz arrived in August 2008.

By November, we were looking at this odd sight:

Fitz' gum was deteriorating, exposing the root of this incisor.  The root itself was covered by what was indentified as a "cementoblast."  Cementum is normal material covering the roots of teeth, but this was cementum gone wild.

At about the same time, we noticed that Fitz was very lethargic, and experienced some respiratory distress with very little physical exertion. 

Off to the vet clinic, where ultrasound found a significant bacterial infection in Fitz' heart.  At the same time, the incisor pictured above was removed, revealing infection in the tooth itself and in the jawbone behind it.   Not uncommon in dogs, cats, and humans, it appeared that the massive infection in Fitz' mouth led to bacteria entering the blood stream and lodging in his heart.

This tooth and one other were extracted, treatment for infection was started, and several other teeth were identifed as abnormal, requiring close monitoring.

Meredith, meanwhile, was finding bits and pieces of information about other horses with dental problems similar to Fitz'.  Then, at an AAEP convention..........PAYDIRT!  We finally had a diagnosis.  Fitz suffered Equine Odontoclastic Tooth Resorption and Hypercementosis.

As study of the syndrome advanced, most researchers agreed the only way to get ahead of the infections and other complications was to remove all of the horse's incisors.  According to all reports, the patients were immediately more comfortable after having affected teeth removed.

But, that seemed drastic!  As time went on, though, it became obvious that might be our only choice to preserve quality of life. 

Fast forward to July 7, 2010:

We could see that the angle of Fitz' incisors were changing drastically.  During our annual Summer Dentathon, xrays showed that none of the incisors were "viable."   None.

Below, the odd angles and exposed roots are easily noticeable.

Even more obvious at this angle.  Notice the small area of root becoming exposed in the area above the little wad of grass, up toward the lip attachment.

In this photo, again notice the tooth exposed the full length of the root.  Areas of decay of the teeth themselves are also easily seen.

Sedation and a little local anesthesia were administered and nine incisors were removed in less than 25 minutes.  That alone is evidence of how unstable and "unattached" these teeth were..

On this tooth, note the cavities at both ends.  Everything in between was decayed.

This tooth was also decayed from one end to the other and broked apart under very little pressure.

This one was completely hollow!

Here - on the left - is an incisor (not from a TREES horse) with a more normal, tapered, appearance.  Note that Fitz' incisor - on the right - is not tapered at all, due to extra cementum layers.  All nine of the incisors removed had the same "fat" appearance.  It is, in part, this extra cementum that pushes the teeth out of their proper positions in the gum and bone.

Fitz is on Day 6 of a 10-day course of antibiotics.  He is already more comfortable.  Naturally, we'll need to make hay available year 'round since he can no longer graze.  Is that in itself a big relief to him?   He is no longer trying to pull grass with extremely unstable teeth. so it may be.

We don't know what to expect next, but we do believe Fitz, now 27, is past the worst of his problems now. 


Big Big Big thanks to Meredith Barlow for researching this very odd issue and to both Meredith and Dr. Tracy Brown for setting our big bay Thoroughbred on the path to better health!

"When To Call The Vet"

Last weekend, we were confronted by a normally ravenous mare who had turned her nose up at two of her last three meals.  A quick check showed her temperature to be 103.1, prompting a Sunday morning emergency call to our vet clinic.  While we are still treating what seems to be a viral infection, we feel initiating immediate treatment, even on a Sunday, spared this mare further complications.

With that, we'd like to premiere the newest addition to TREES collection of educational handouts:

(Thank you, Dr. Blanton!)

Equine First Aid: When to Call the Vet

Amanda L. Blanton-McAdam, DVM

As a responsible horse owner, it is imperative that you are able recognize an equine emergency, know when to call the veterinarian, and are prepared to handle the situation. The goals of this article are to help you appreciate the severity of the situation, respond promptly, and be prepared for your veterinarian and able to take control prior to his/her arrival.

General preparedness:

There are several key pieces of information that should be close at hand at all times so that during an emergency there is no time lost. The most important is your veterinarian’s office number and after hours/emergency number. It is also helpful to have directions to local referral/surgical centers on hand as well as the contact information for friends, family members, or a professional trailering service that can trailer your horse for you if you do not have access to a trailer. Educating yourself about the expense of referral procedures (e.g. colic surgery) and having a plan for each horse can also make an emergency situation less stressful.

It is critical that your horses be well trained and comfortable loading and trailering. It is likely that if the emergency is severe enough that a trailer ride to the veterinary clinic or referral center is required, both you and your horse will be stressed. Therefore, it is helpful in these instances that trailering not be an additional hurdle for you. If your horse has difficulty trailering or has never been on a trailer, there are many trainers that can offer advice and come to your farm to work with you and your horse.

Knowing your horse’s normal vital signs is an integral part of determining the severity of an emergency situation. This information is also beneficial to have when making an emergency phone call to your veterinarian.

Normal vital signs:

 Rectal temperature range: 99oF-101oF

 Pulse (heart rate): 32-48 beats per minute

 Respiratory rate: 8-24 breaths per minute

 Mucus membrane color and hydration: pink and moist

 Gut sounds: audible on both sides at close range

 Urine and manure production/consistency: know your horse’s normals

 Appetite and water consumption: know your horse’s normals

Having a well-stocked first aid kit on hand is an additional benefit during an emergency (see attached information sheet on first aid kits).

Most Common Equine Emergencies:

Below is list of common emergencies you may be confronted with as a horse owner.

 Colic:

Colic is a general term for abdominal discomfort. The signs of colic can range from subtle to severe. These signs include but are not limited to the following: depression, decreased appetite, laying down, stretching, pawing, kicking at belly, rolling, thrashing. If you notice your horse showing any of these signs, call your vet immediately. Be prepared to describe your horse’s behavior, his last bowel movement, his recent appetite, and his rectal temperature (if you can safely get a reading). Before the vet arrives, stay safe! Do not attempt to rouse a horse if he is violently or uncontrollably thrashing. Do not offer your horse any feed, hay, grass or water, and keep your horse up and walking if you are able to safely. Administer medication ONLY if advised by your veterinarian.

 Lacerations/wounds:

A laceration is a full skin thickness wound. Puncture wounds are often less obvious than large lacerations but can become severely infected if overlooked or untreated. Therefore, it is critical to evaluate your horse thoroughly from head to toe daily, paying special attention to any swelling, lameness, or evidence of wound. Before the vet arrives, catch and calm the horse, get assistance if possible, evaluate the wound, clean with water only, stop any bleeding, and call your veterinarian. Since each situation is different, these steps do not need to be followed in any strict order.

 Eye injuries:

REQUIRE IMMEDIATE ATTENTION! Call your veterinarian as soon as an eye issue is identified. Signs of ocular pain include holding the eye closed, tearing, and squinting. Be sure to note any swelling of the lids or any external injuries. Before your vet arrives, prevent your horse from rubbing the affected eye. Keep your horse quiet and place a warm compress over the affected eye (if the horse allows).

 Acute and severe lameness:

Severe lameness that comes on suddenly can be very serious. As a result, it is imperative that you call your veterinarian immediately. A non weight-bearing lameness could be as simple to diagnose and treat as a foot abscess but is important to differentiate from a fracture or nerve damage. Bilateral forelimb lameness (both front limbs) or reluctance to move forward could be a sign of founder (laminitis) and requires immediate and intense treatment. Before the vet arrives, keep your horse quiet, check the limb(s) for signs of swelling or heat, check the foot for evidence of a nail or puncture. If there is marked swelling and the horse will remain quiet, you may cold hose the limb. If you find a nail or other foreign body in the foot, keep the horse quiet but do not remove the foreign body. It is helpful for your veterinarian to see the nail, etc and perform radiographs with it in place to identify what structures may be involved.

 Choke:

Choke in horses describes an esophageal obstruction (obstruction of the food pipe). Signs of choke include food-stained saliva coming from the mouth of nostrils, an outstretched neck, and oftentimes coughing. Call your vet immediately if you notice any of these signs. Before the vet arrives, keep your horse quiet and in a stall. Do not offer feed, hay, grass, or water.

 Abortion:

An abortion in a horse is defined as a dead or dying fetus expelled < 290 days of gestation. Once an abortion is underway, it is unable to be prevented or stopped. However, due to some of the potential causes of abortions (infectious disease), it is important to isolate the mare and place the fetus and membranes in a plastic bag. Store the remains in a cool place away from dogs and wild animals. It is also good practice to discard the bedding and disinfect the stall. Call your veterinarian to examine the mare and check for any signs of retained placenta or systemic disease.

 Dystocia (foaling difficulties):

Normal foaling occurs within minutes, so any problem (dystocia) is an urgent emergency. Call your veterinarian if it is greater than 15 minutes since the water breaks and there is no foal on the ground, if there is only one leg protruding after 15 minutes, or if there is a “red bag” (whole placenta coming with foal. This will require you break open to placenta so the foal can breathe. Your veterinarian will guide you through this over the phone because there is no time to spare!).

 Recumbent (down) horse:

Several causes of a horse that is down and unable to stand on its own are as follows: complications of old age (arthritis, muscle wasting), malnutrition (weakness), fracture, neurologic problems, drug reactions, illness. Because horses are such heavy animals, prolonged recumbency can result in irreparable damage to the lungs and muscles. Horses often struggle when they go down and can rapidly become exhausted if they are not roused quickly. As a result, it is imperative to call your vet immediately. Before your vet arrives, keep the horse as quiet as possible, clear the area of any debris that may obstruct rousing the horse, and most importantly, stay safe! Be sure to approach horse from its back or head and stay away from its thrashing feet.

 Seizures:

If you find your horse having seizures, call your veterinarian immediately and STAY SAFE. Stay out of the stall with the horse to prevent from being hurt.

 Illness:

There are a variety of different signs of illness that include lethargy, decreased or no appetite, fever, and diarrhea. If you notice any of these signs, call your veterinarian immediately.

It is important to keep in mind that this is just a list of the most common types of equine emergencies. Do not hesitate to call your veterinarian at any time if you have a question about your horse. It is also a good idea to develop a good working relationship with your veterinarian during routine examinations, vaccinations, etc. prior to an emergency situation. He or she will be happy to work with you to prepare for an emergency.

=====================================
 
Be Prepared for an Equine Health Emergency/Emergency First Aid Kit

If you own horses long enough, sooner or later you are likely to confront a medical emergency. From lacerations to colic to foaling difficulties, there are many emergencies that a horse owner may encounter. You must know how to recognize serious problems and respond promptly, taking appropriate action while awaiting the arrival of your veterinarian.

Preparation is vital when confronted with a medical emergency. No matter the situation you may face, mentally rehearse the steps you will take to avoid letting panic take control. Follow these guidelines from the American Association of Equine Practitioners (AAEP) to help you prepare for an equine emergency:

1. Keep your veterinarian’s number by each phone, including how the practitioner can be reached after hours.

Clinic name and phone number ___________________

After hours: __________________________________

2. Consult with your regular veterinarian regarding a back-up or referring veterinarian’s number in case you cannot reach your regular veterinarian quickly enough.

3. Know in advance the most direct route to an equine surgery center in case you need to transport the horse.

4. Post the names and phone numbers of nearby friends and neighbors who can assist you in an emergency while you wait for the veterinarian.

5. Prepare a first aid kit and store it in a clean, dry, readily accessible place. Make sure that family members and other barn users know where the kit is. Also keep a first aid kit in your horse trailer or towing vehicle, and a pared-down version to carry on the trail.

First aid kits can be simple or elaborate. Here is a short list of essential items:

• Cotton roll

• Cling wrap

• Gauze pads, in assorted sizes

• Sharp scissors

• Cup or container

• Rectal thermometer with string and clip attached

• Surgical scrub and antiseptic solution

• Latex gloves

• Saline solution

• Stethoscope

• Clippers

Many accidents can be prevented by taking the time to evaluate your horse’s environment and removing potential hazards. Mentally rehearse your emergency action plan. In an emergency, time is critical. Don’t be concerned with overreacting or annoying your veterinarian. By acting quickly and promptly, you can minimize the consequences of an injury or illness. For more information about emergency care, ask your equine veterinarian for the “Emergency Care” brochure, provided by the AAEP in partnership with Educational Partner Bayer Animal Health. More information can also be obtained by visiting the AAEP’s horse health web site, www.myHorseMatters.com.

Reprinted with permission from the American Association of Equine Practitioners.

TREES to Receive Free Vaccine

Earlier this year, Traveller's Rest Equine Elders Sanctuary applied for free vaccines through the Unwanted Horse Veterinary Relief Campaign, coordinated by the American Association of Equine Practitioners and Intervet/Schering-Plough Animal Health.

Today, TREES received a letter informing us that we will be the recipient of 20 doses of PreveNile, 20 doses of Pres V and 20 doses of Rabies vaccine......enough to innoculate all horses currently in residence.

The vaccines should arrive the first week of April and will save TREES a significant amount in the Spring 2009 budget.

Kudos to Intervet/Schering-Plough and the AAEP for developing this program to help those who dedicate their time to helping horses in need.