If there was a veterinary god, I think he would’ve successfully gotten his message across this week…because the degree of repetition of coincidental happenings could only be forged by divine intervention. I decided by Tuesday that this week had a theme, and that the theme was a rather appropriate one for the equine world. There is no eloquent way of explaining theme, and I found it best described by the following phrase:
There is more than one way to skin a cat.
[sidenote] There are many versions to this proverb, with the earliest relevant reference in 1678 in a book of English proverbs. The less catchy, predecessor of our present-day have was “there are more ways to kill a dog than hanging.” Although both literally interpretations of the proverbs are disturbing, something about the hanging dog is abrasive and unsettling. In 1855, a variant of this proverb emerged and traded the dog and noose for a cat and cream. “There are more ways of killing a cat than choking it with cream.” Mark Twain also used this phrase in his A Connecticut Yankee in King Arthur Court in 1889, where he wrote “she was wise, subtle and knew more than one way to skin a cat.” [/sidenote]
Using different methods to achieve the same end result was the overwhelming message I got from the week. I consider myself an open minded individual, always open to learning new techniques or methods. Unfortunately, there is some mighty strong opposition out there, in some cases where if it’s not someone’s particular way then it’s wrong…regardless of whether there has been any research, investigation or try. Few things, in my opinion, are similar enough to be considered comparable. And this comparison is a thief of joy, I do my best to minimize the competition that comes with “right” or “wrong” or “better.” This week, I did some learning back on the “basic” level…Animal handling, positioning and restraint…some of which was in stark contrast to my prior training. However, with these new tools and techniques, I can’t help but feel like I have that many more tools in my belt for the future.
When horses are sedated, we usually let their head hang and watch for “tripping.” In moments of deeper sedation, horses may rock and sway then lean forward and almost fall..catching themselves with a front foot. The simple trick of keeping their head elevated and flexed, not only prevents this stumbling, but also keeps their hind hooves on the ground if someone is working back there.
Turning the horse to the side of the examiner is also a subtle trick that helps keep the right legs in place during palpation. This also helps the holder control the head, and subsequently the body. Simple tricks like raising the horses head (tipped up as if looking at the sky) helps extend out the next in a straight line…which ends up facilitating easier placement of a jugular catheter. I really enjoyed the various techniques, some of which I’ll use and some of which I wont. But there are always going to be things people vary on, like how much to flex the joints (some flex as hard as they can quickly, others hold in moderate flexion for 30 seconds). The important thing there is to just be consistent with your technique.
The speed at which you trot the horse during the lameness exam has never been the same when I’ve, worked for different practitioners. Also, handling of the head, ear twitches, neck twitches, snapping on the halter, circling tightly, walking for trotting back…these are all things that vary based on clinician preferences but, seeing as how I’m a fledging practitioner, I’ve got plenty of time to develop my own style.
The “L” word
Can you guess what word I’m talking about? And what case-loads dominated the week?
Prior to beginning our shadowing experience, students have to construct a short list of goals and desired skills we want to work on. By far, I want to improve upon my recognition of Lameness and develop a systematic approach to diagnosing a typical case. some goals. By lameness in the horse is what lives in Pandora’s box, and because of the fear it can strike into people’s hearts and the relatively little that we actually know about the condition at this time, there is a lot of theory. And theory has some sort of eleventh of opinion…
No matter what book you read or lectures and notes, lameness detection takes some knowledge…but by far much more experience. And practice. Like, watching 1000s of horses. The examination, as a subjective assessment, in inherently open to varied interpretation. Intra personal and interpersonal agreement between veterinarians or even between owners, can vary up to 60% when evaluating the same horse on a given day. The most widely used and acceptable Scale for grading Lameness is the one established by the AAEP.
A collection of members used to portray the mood (and evolving mood) of students when conducting Lameness exams early on in 4th year.
Scoring the Scoring of a Horse During the Lameness Exam
The most widely used and acceptable Scale for grading Lameness is the one established by the AAEP.
AAEP Lameness Scale Grade Degree of Lameness
0 not perceptible under any circumstances
1 difficult to observe and not consistently apparent, regardless of circumstances
2 Hard to observe at walk or trot in straight line, but consistently apparent under certain scenarios
3 Consistently observable at a trot under all circumstances
4 Obvious at a walk
5 Minimal weight bearing in motion and/or at rest or complete inability to move
Observe in Motion
While the AAEP scale ranges from 0-5, many Practitioners have split the grades into increments of 0.5. This expands the range of possible Grades of lameness, hopefully making it more specific. While the horses are casually walking (or sometimes slipping all over, snorting and getting themselves into a flared-nostril tizzy), we watch at a distance and evaluate movements and gaits of the horse. We look for things like a shortened stride, Irregular foot placement, head bobbing (down on the sound), stiffness, asymmetry, weight shifting and on hard ground, we listen for the increased concussion sound of the normal foot on the ground.
In particular, with the front limb lameness, I watch to see if the head and neck elevate or rise when the lame forelimb is bearing weight or hits the ground and nods down when the sound forelimb hits the ground. With the pelvic limb, I usually see some degree of “hip-hiking” which occurs when the lame limb hits the ground and moves downward when the sound limb hits the ground – i.e. the side with the most movement is the lame hind limb
Normal walking in a straight lining, trotting in a straight line and trotting in a circle both directions is the routine collection of exercises. Also, we do flexion to see if there is a “positive” response, indicating the horse is painful. This could be because of an access.
Flexion and Results
A horse that shows lameness, for example in the front right, will then have their front right more closely evaluated. With foot abscesses as the most common cause of lameness, hoof testers are used on almost all aspects of the hoof to see if increased sensitivity within the hoof (due to abscess) is causing the problem. She was not sensitive to hoof testers.
Most flexion tests, regardless of the location, are performed for 30-60 seconds. These act as another means of identifying location of the problem (pain due to another circumstance). Due to individuals variation, it could be that otherwise normal horses demonstrate positive responses to flexion… like arthritic changes. Most times, false positives to flexion occur. ..but a single joint can have both a positive and negative result. Different people have slightly different ways and durations for holding the limbs. I’ve been with practitioners who hold for 1 minute for each joint, light flexion. Another practitioner holds for 10-15 seconds but really cranks on the joint for flexion. Flexion tests subjectively assess the severity of damage associated with the selectid joint or affected limb. The act of flexing the joint increases the intra-articular and subchondral bone intra-osseous pressures and acts to compress/stretch the joint capsule.
Flexion of one limb cant precipitate changes in lameness in other limbs (weight-bearing limb). This is a contralateral response occuring most commonly in horses with bilateral hock or carpal problems.
Identifying lameness at or below a joint then leads us on the path to further diagnostics. In order to more accurately identify the source, anesthesic “blocks” of particular nerves are then done in a systematic and particular order… But, I’ve got an emergency to go on now…which means I’m off, and will finish with my the “L” word review in my next entry!