Teeth removal, laser surgery, an emergency colic operation and much, much more — it’s all in a day’s work at Pool House Equine Clinic, finds Aimi Clark
Behind the scenes at Pool House Equine Clinic
VET GIL RILEY IS on his first lameness investigation of the day. Pink, a 14-year-old mare used for grassroots eventing, is lame and her owners want to know why. A different horse has already been in and out of the theatre for a suspensory neurectomy while another, a veteran struggling in his later years, has been put to sleep. All that and we’re only an hour into the normal working day at Pool House Equine Clinic in Lichfield, Staffordshire. But a ‘normal’ day doesn’t really exist here. Life as a vet is unpredictable. Anything and everything can (and often does) happen — usually when it’s least expected.
Pink’s owner watches from the sidelines as Gil, a partner at the clinic for 18 years, assesses the mare being ridden in the ménage by his team member Lucy Ireland. After riding the mare in walk, trot and canter, Lucy reports the left hind isn’t stepping through properly, as well as confirming the main lameness is in the off fore. It’s showing predominantly on the right rein, but Lucy can feel it in the other direction too. “The two of us work as a team, together with the horse’s owner, who knows what’s normal for the horse better than anyone,” explains Gil. “They both bring a lot of information to the table. Without it I’m reduced to an
educated guess and I want certainty.” Gil opts for a palmar digital nerve block first — essentially numbing the mare’s heels. “Lameness is a gait change to minimise pain — that’s what a limp is,” he says. “So, if we can identify which area the pain is in by blocking it out and showing an obvious improvement in the horse’s movement, we can narrow down where the actual cause is.” At 10.30am, Gil inserts the nerve block. There’s a 10-minute wait before Pink is assessed under saddle again. “When nerve blocking, we start from the bottom and work our way up the leg. If you start at the top, it blocks out all the leg below it and doesn’t give us an accurate reading.” There’s no improvement, so nerve blocking moves to the fetlocks, blocking the suspensory ligaments of the hind legs. The latter makes a difference to the tightness behind and so Pink is booked in for a scan.
Tangled in a gate
In examination room two, a bay horse is having bandages removed by vet intern Kristen Holland, who lives on site. The mare has been at Pool House since getting stuck in a metal gate 10 days ago. The fire brigade was called and once a vet had attended to give the mare a general anaesthetic, they cut off the gate. “She’s had surgery to flush her hock joint and debride the wounds so they heal better,” says Kristen. “The gate cut right down to the tendon on her left hind.” The mare is on box rest with dressings changed every two or three days. An X-ray ruled out any bone fractures — the vulnerable splint bone was a particular concern — and so now keeping the legs clean and as still as possible is top priority for a good outcome.
Patients and patience
Gil’s second patient arrives — 11-year-old Vinnie, who is lame behind. He’s been transfered to Pool House for a second opinion, after being recommended a suspensory neurectomy at another equine clinic. Lucy feels it is worse when the painful leg is on the inside rein. Gil suspects a suspensory issue, which are increasingly common in competition horses who are being asked to engage their hind ends a lot. Vinnie is nerve blocked outside the examination room as he is claustrophobic. Gil knows from treating Vinnie previously that he’s more relaxed when handled outside. “I always say I’m here to find out why a horse is lame, not fry its brain. I give them lots of carrots and treats and do things in a way that better suits them, as far as I can. If they are more relaxed, they’re easier to work with.” Gil injects local anaesthetic into the skin to numb the area. “Then, when the bigger needle goes in, we prefer he doesn’t know anything about it.” Lucy bandages Vinnie’s tail to keep it out of the way and then cleans — and recleans — his leg using Hibiscrub. Gil puts in the lateral plantar block.
Marco Marcatilli is bandaging the front leg of a Thoroughbred chestnut mare in examination room one. The racehorse came straight to Pool House off the track a week earlier after striking her front leg with a hind hoof and severing the superficial flexor tendon. Sadly, it’s a career-ending injury. “She’s been in a cast until today and now it’s being bandaged,” explains Marco. “She’ll be with us for a while yet and will then go home to be a broodmare.” Next door, vet intern Giulia Rapezzano is examining a mare to check where she is in her fertility cycle. Her owner hopes she will have a foal by artificial insemination (AI). A previous attempt has already failed. A camera is inserted inside the mare, so the vet can examine her reproductive system on a big screen. A debrief with the owner follows and it’s good news — the mare will be ready to undergo AI in three days’ time.
Outside, Vinnie is back in the ménage. Lucy reports a huge improvement following the lateral plantar block and it’s noticeable from the ground too. “You’ve let the handbrake off,” she tells Gil. “We’re almost getting medium trot — he’s got an extra push in his stride now, which wasn’t there before.” This is a positive finding because it narrows the pain down to the suspensory ligament, as initially suspected. “If I numb the sore structures, it enables the horse to go back to the gait he used to have,” explains Gil. “Horses don’t want to be unsound. DNA tells a horse that if he’s lame, a lion will spot the weakness and eat him for dinner. Every horse wants to be as sound as they possibly can be.” As a result of finding lameness in one hind leg (unilateral), Gil advises booking the horse in to have both legs ultrasound scanned in the morning. It can’t be done immediately, because the block needs to wear off first. “It could be that the problem is bilateral [occuring in both legs], but at the moment only one side hurts. A scan will tell us that.” Vinnie is given a paddock for the afternoon and he will spend the night in one of the clinic’s 21 stables. He won’t be alone — other horses are around, including a pony wearing a belly bandage following successful colic surgery, and Harold the blood donor, who lives in a neighbouring paddock. “This is a result,” says Gil. “If tomorrow’s scan shows the injury is towards the top of the ligament, surgery will be advised and it can be done on site straightaway. If the injury is at the bottom, in the ligament branches, a strict recovery routine will be put into place. Either way, by the end of tomorrow we’ll have a treatment plan.”
After a morning out on the road, Sam Hole, one of the UK’s few recognised European equine dentistry specialists, is spending the afternoon extracting an infected tooth. It’s tooth 209, the fourth cheek tooth on the top left jaw — a tricky and time-consuming job due to limited space and vision. The horse is sedated and standing in
stocks, and has been given a nerve block so he doesn’t feel any pain. The tooth is wobbling and Sam uses clamps to move it from side to side, encouraging it to loosen. “Slow and steady generally wins the day when it comes to getting these out,” he says. “The aim is a clean extraction, where all the roots come too, but it doesn’t always happen like that.” Success. Sam pulls the tooth free and all three roots come with it. He inserts a small camera in the horse’s mouth to examine the large hole left behind by the long tooth (it’s a good 3in in length). Sam flushes the hole to clear out any debris, then packs it with crushed antibiotic tablets and an impression material. “You shouldn’t be able to press into a tooth with a needle — it should be rock solid,” says Sam as he examines the removed molar. “It happens because the tooth has died and stopped producing minerals, so it’s weak.”
Filling a hole
Sam spots another tooth in the poor patient showing signs of dental decay. He drills into the infected part and dirty water spurts out. “That’s abnormal — it should be clean water,” he says. Drills suitably sized for horses’ teeth don’t exist. That means the longest human drill-end has to be used and it’s too short to do a complete job. A hand tool gives more depth, but the final tactic is spraying medicated bicarbonate soda into the tooth, which should get deeper. The cavity is flushed using high pressure and treated with calcium hydroxide, which is very alkaline and helps to kill bacteria. The tooth is then filled with the same composite used in human fillings. This is another time-consuming process. “Because the hole is so deep, we have to fill it in layers so it has the best chance of setting properly and lasting. This needs around six layers, with three minutes or so between each one to let the layer set.” In three days’ time, the horse will go home. Prognosis is good, providing regular six-monthly teeth checks are carried out.
Pink’s assessment continues. After several nerve blocks the mare, who underwent kissing spines surgery in December 2017, is moving better in front and behind, but she’s
still not completely sound. Gil is faced with several sources of pain. “Horses react to the biggest area of pain at that time. So first it was her front feet, then she got uncomfortable in her hindlegs and now that we’ve blocked those two out, she’s feeling it in her back.” An X-ray of Pink’s back shows that nothing is amiss there. It’s crunch time. “We’re at the point where we have to consider that she’s bilaterally lame in front and behind [so lame in all four legs] and now she’s sore in her back too. She’s in pain all over. Is it time to retire her? It’s my job to manage the client’s expectations around that.” Pink returns to her stable while her owner heads home. There is a lot to consider, and difficult decisions to be made.
The clinic has two theatres — a ‘clean’ theatre for procedures such as neurectomy and a ‘dirty’ theatre for operations like colic surgery. Shortly before 4pm, a horse appears outside the knock-down room to be prepared for laser surgery on a number of sarcoids. A catheter is already in place in his neck, ready to receive anaesthetic and pain relief. Vet staff clean out his hooves — theatre must be dirt-free to avoid contamination — and his mouth is flushed out with water several times to remove any loose food. This is so nothing can get pushed down the windpipe when the ventilation tube is inserted — a potentially fatal scenario. All four hooves are bandaged so the horse doesn’t slip on the mats as he comes round from the anaesthetic and starts to get up. Inside the knock-down room — a box that is fully padded, just like the coming-round room, so it poses as low a risk as possible to horses going under or coming round from anaesthesia — the horse is wedged between a padded partition and wall as the anaesthetic takes effect and he slowly slips to the floor. Vet intern Kristen inserts a ventilation tube into the horse’s mouth. Senior partner Richard Stephenson and vet Federica Cantatore attach the winch to all four legs and the horse is slowly hoisted into the air by an overhead machine. The vets support his head as he moves to the operating table, where he is placed lying on his back so that the sarcoids are easy to access. Any operation is a big job and this one requires five theatre staff. Once unconscious, time is of the essence. Before moving into ‘clean’ theatre, all the sarcoids have the hair around them removed with clippers, a Henry hoover sucks away loose hair and the areas are Hibiscrubed multiple times. A clean operating environment is vital, so everyone wears scrubs from head to toe. The horse is wheeled into theatre, out of Your Horse magazine’s view. Now only those in the theatre wearing protective eyewear against the bright laser are able to watch.
At 4.45pm an urgent call comes in. A colicking horse has been referred to Pool House and is en route for an emergency operation. It’s all hands on deck to prepare ‘dirty’ theatre for his arrival and those involved will work into the night. The sooner the horse gets onto the operating table, the better his chances. Outside the hospital ward, calls for vets to visit horses at home have come in thick and fast too. There’s a suspected sheath infection, a possible case of choke, a foal needing to be microchipped and health checks for the Blue Cross charity. Two unplanned pregnancies have been reported too — and Giulia whizzes off to scan two miniature donkeys. It’s fast paced, but the vets thrive on it. Tomorrow, it all starts again.
“Any operation is a big job and, once a horse is unconscious, time is of the essence”
The area is scrubbed several t imes before a n erve block is put in Nerve blocking the heels
ABOVE: A gate injury — the left hindleg was slashed right down to the tendon
LEFT: After a thorough clean, the injured legs are rebandaged
This patient is easier to handle when not in a confined space
After examining the mare for possible artificial insemination, Giulia discusses options with the owner
Tooth removal can be a tricky process
Teeth are impenetrable — unless infected Horses teeth are very long!
Fully prepped, the anaesthetised horse is wheeled into theatre for laser surgery Once asleep in the padded knock-down room, vets work quickly to get the horse onto the operating table
Pink’s assessment includes having her back X-rayed
The horse is linked to a ventilation machine during surgery