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Blood transfusions

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Blood transfusions

Blood and plasma are vital fluid therapies for horses and foals. Unfortunately, there are no blood banks for horses (as there are for humans and some small animals) because horse red blood cells do not store well. Blood can only be drawn from a donor horse when a transfusion is needed.

In general blood transfusions are used to supply either plasma or whole blood. This article will discuss both and will also outline the ideal characteristics of a horse blood donor. Before this is discussed it is important to understand how blood is divided. Blood can be broadly divided into two parts; plasma and red blood cells. The plasma contains the white blood cells and antibodies effective in fighting infections. The plasma also contains large proteins and clotting factors that help the blood clot when bleeding occurs. The red blood cells deliver oxygen to the rest of the body.

When blood is taken from one horse and given to another there is a possibility that the white blood cells and antibodies will attack the recipients blood or the white blood cells and antibodies in the recipient can attack the red blood cells from the donor. To minimise this risk matching blood donors and recipients by blood type can be done. Humans have four major blood types and can be either negative or positive based on the rhesus factor but horses have 8 blood types and can be positive or negative on over 30 different factors! This makes getting a 100% match a one in half a million chance. However, there are only two real problem blood types to be concerned about, Qa and Aa. So, we can cross match the donor and recipient by mixing the two bloods together and looking for a reaction before administering the blood. This being said, a blood transfusion between two horses that have never received blood transfusions previously is unlikely to result in a reaction.

An ideal blood donor will be a large (>500kg) young, healthy horse. The horse cannot have or have had a blood disease (such as equine infectious anaemia) and cannot have had a blood transfusion previously, this is because if a horse has had a blood transfusion then its immune system has produced antibodies ready to fight against other blood types - these horses won’t match. Females and especially females that have had a foal, are also more likely to carry antibodies against different blood types, that may attack the recipient of the blood.

Blood donating

If your horse is donating blood, then the procedure is relatively innocuous. A catheter is placed in the horse’s jugular and 4-8L of blood is collected and mixed in a prepared sterile bag. The bag contains an anti-clotting preparation and stores the blood before its use. The donating horse may or may not need to be sedated but will make a full recovery after a couple of days’ rest. Horse can donate 20-25% of their blood volume at 2-4 weekly intervals however we do try not to take this amount on a regular basis.

Blood once it is collected, can either be given as whole blood, which is usually given to horses that have lost blood through haemorrhage, or as plasma only (blood without the red blood cells). All blood products are best used fresh but plasma can be frozen and stored for a longer period of time. Plasma also has fewer risk factors compared to whole blood so is generally safer to administer and doesn't require blood typing donor horses.  Plasma maybe administered to horses that are suffering from colic, colitis and numerous other conditions.

Because equine blood can’t be stored it is often a case of getting the blood as and when you need it. For this reason, if your horse is a blood donor you may not be required to donate for weeks or even months but when your horse does donate it will allow you to participate in a lifesaving treatment protocol.

The Move To Ashington

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Dear Client,

The Arundel Equine Hospital – New Hospital

We are pleased and excited to announce that the completion date of our brand new, purpose built, state-of-the-art equine hospital is imminent, and that we will be relocating to the new premises over the weekend of 22nd – 23rd July 2017. During this time, we will still be operating our normal weekend out of hours emergency service. On Monday 24th July, we will be running a full complement of hospital and ambulatory vets. If you need to book an appointment or speak to a vet please call the normal practice number (01903 883050) where your call will be answered and directed to the vet covering your area. Reception and Accounts will return to a normal service on Tuesday 25th July.

The Arundel Equine Hospital was founded in 1951 by Mike Ashton and since that time has undergone numerous changes, but the core aim of providing outstanding care to all horses, ponies and donkeys, has not and will not change. The new premises will enable us to expand on the range of services we are able to offer. For patients that do need to come into the new hospital, the new site provides a state-of-the-art, custom built facility to ensure the best possible treatment and care for all. We will be able to offer standing MRI from August 2017 and CT scanning from early 2018.

Our new location is more centralised within the area we cover, with good access just off the A24. The move to Ashington will not impact on the level of service that you currently experience, but will improve our coverage across the South. Vets will still attend yards as they do now, and our van will still be buzzing around with all the digital diagnostic equipment such as x-ray, ultrasound and endoscopy.

With effect from Saturday 1st July 2017, we will be changing our name to the Sussex Equine Hospital. This is designed to reflect our new location, but rest assured that all vets and staff will stay the same, and that we will retain the same friendly, helpful approach, understanding your horse’s needs.
Below is an information sheet, highlighting the new facilities, including the new logo and address of the new hospital. We are retaining our existing telephone numbers, so no need to update your phone book or speed dial, and our bank account details will remain the same too.

Finally, we thank you for your support, and if you have any questions or concerns please do not hesitate to contact us by either calling Reception on 01903 883050 or emailing info@arundelhorsevets.co.uk.

Kind regards,
Ed, Rob, Paula, Matt, Simon & Andy
Directors

Colic Surgery?

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Colic Surgery, should I put my horse through it?

The term colic simply denotes abdominal pain within the horse’s abdomen. There are over 70 different types of colic a horse can get, some of which can be managed medically but some conditions, unfortunately require surgery to correct the condition and save the horse’s life. Broadly speaking colic can be considered as either a medical or surgical colic, depending on the cause of the colic and how the horse responds to treatment. A medical colic is one that has the potential to resolve with medical management which may involve just starving and walking the horse or may require a variety of drugs and fluid therapies. A surgical colic includes any type of colic where blood supply to the gut is compromised, certain specific conditions that have not had chance of resolution with medical management, conditions that fail to respond to medical management, or are so painful, it is in the best interest of the horse to operate.

Surgical colics account for approximately 10% of colic cases seen, however, this number varies geographically around the UK. There are certain clinical examination findings that indicate a horse requires referral to an equine hospital. It should be remembered that referring your horse to an equine hospital doesn’t mean your horse necessarily requires colic surgery.

In some instances, it is unclear what it causing the colic in your horse and referring your horse to an equine hospital allows the vets to perform additional diagnostic tests such as abdominal ultrasound, rectal ultrasound and abdominocentesis (taking a sample of the fluid within your horse’s abdomen). Referral then allows the vets to monitor your horse closely and repeat those tests to determine if the horse is getting better or worse.

Some horses with confirmed medical conditions will require intense medical management including; regular veterinary monitoring, intravenous fluid therapy, regular nasogastric tubing, rectal examination and abdominocentesis. All of which can be done far easier, and sometimes cheaper than managing the horse at home.
The added benefit of referring your horse to an equine hospital is that if the colic worsens and the horse does require surgery, your horse is already in the best place and surgery can happen without delay of travel and re-assessment. Speed is of paramount importance when dealing with a colic.

Now we have established that referring your horse to an equine hospital doesn’t automatically mean colic surgery, we can discuss, what if your horse does require colic surgery.
Colic surgery is a life-saving procedure, but is also one of the most challenging surgeries and it is not without risk or complications. Horses that do require colic surgery are usually very sick individuals and that makes the anaesthesia very challenging. It has been reported that one in a hundred horses die under anaesthesia, this is an old figure and anaesthetic death rates are thought to be lower now because of better monitoring and a better understanding of anaesthesia in the horse. However, because horses with colic are systemically ill, the anaesthetic is complicated and anaesthetic death rates of horses with colic are greater. If a horse with colic is operated on sooner rather than later, the horse will be healthier and there will be fewer anaesthetic complications and a lower anaesthetic risk. This again leads to the merit of early referral of a colic so they are in a facility where an operation can be performed. There is no association with age and anaesthetic risk, this is to say older horses are not at a greater anaesthetic risk compared to young horses.

Common surgical conditions include; a displaced colon, a large colon torsion and a small intestinal obstruction. A displaced colon can be managed medically, however, some displacements fail to resolve medically or if the horse is too uncomfortable to manage medically, the aim of the surgery is to manually lift the colon out of the horse and put it back in the correct location. A large colon torsion describes that the colon is not only displaced (in the wrong place) but twisted on itself and the blood supply to the gut has been compromised. These horses will be incredibly uncomfortable, and require to lift the colon out of the abdomen, un-twist the colon and place it back in the abdomen in the correct position. If the twist in the colon has compromised the blood supply to the gut for too long a period, the colon may need to be removed. Removing a section of the horse’s colon is an incredibly complex surgery to perform, and success rates are low in these kinds of surgeries. Thankfully, this is a rare occurrence as most colons only require un-twisting. A small intestinal obstruction is almost always surgical and requires identification of the reason for the obstruction and correcting that problem. If the small intestine’s blood supply has been compromised a section may need to be removed, this unlike the colon, is a more common procedure during colic surgery and although it too carries additional risks, most horses do well following a small intestinal resection.

Reasons for a small intestinal obstruction can be, but are not limited to; a twist in the small intestine around itself, a twist around a lipoma or a lipoma cutting off the blood supply, or an epiploic entrapment (the small intestine becomes trapped in a small hole within the abdomen and requires manual removal).

An uncomplicated surgical colic operation will cost in the region of £5,000 and this is the limit to most insurance claims. However, if your horse has a prolonged recovery or there are complications, or your horse requires a second surgery, then the cost will breech that £5,000 limit. Some insurers are now offering claims up to £10,000 so it is worth shopping around and considering this when taking out an insurance policy.

In summary, colic referral doesn’t definitely mean colic surgery but it has the added benefit that if your horse does need surgery they are in the right place. An early colic referral with aggressive medical treatment may prevent colic surgery and be cheaper than managing your horse at home. Speed is essential when dealing with a colic, call the vet early and refer early to give your horse the best chance. Don’t rule colic surgery out, there are many success stories following colic surgery, even in the older horse, however prognosis will depend on diagnosis.

Poor Performance

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Investigating respiratory noise and poor performance:

From elite equine Olympic athletes to childrens’ ponies, poor performance presents a significant problem in many of our patients. Subtle changes can be very challenging to detect, sometimes requiring special diagnostic tests, equipment and expertise.

Poor performance investigations should be tailored to the individual case presented, but may include: overground upper respiratory tract endoscopy to investigate wind problems, exercising ECG to check for heart problems (cardiac arrhythmias), blood tests, gastroscopy to detect gastric ulceration, lameness investigation, investigation of lower airway disease such as inflammation, infection, heaves and allergies using video-endoscopy, tracheal washes and broncho-alveolar lavage (lung washes).

If your horse makes a noise when he/she is exercising, overground endoscopy is likely to be the most useful diagnostic test. A small endoscope is placed up the nose, fastened in position on a bridle and the horse is then ridden or exercised as normal. The exercise test must replicate the conditions under which the horse normally makes the noise, so being ridden in the school is suitable for most horses but racehorses and eventers should be exercised at speed on the gallops. A huge variety of laryngeal and pharyngeal abnormalities can be diagnosed, many of which are completely undetectable when scoping horses at rest. In 40% – 50% of cases, more than one abnormality is diagnosed. From here we can decide which (if any) wind surgeries are appropriate, or if other tests such as lung washes, should be performed. For horses with poor performance and no respiratory noise, an exercising ECG can be performed at the same time as the exercising endoscopy. It should be borne in mind that around 30% of horses with palate problems are ‘silent’, so the absence of noise does not rule out a palatal problem.

Our poor performance assessments are competitively priced, and discounts are available for groups of horses. Please contact the hospital on 01903 883050 for further information.

Bandaging

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The ability to bandage your horse effectively when they injure themselves or have undergone a veterinary procedure, is advantageous to both horse, owner and bank account. This article aims to give you the basic theory and principles behind applying safe secure bandages.

Every bandage, no matter how simple or complex, is composed of three basic layers: a primary layer which is a sterile material/pad that is applied directly to the wound or surgical site. This keeps the site clean, allows you to apply topical treatments such as Manuka honey and absorbs any discharge produced; a secondary layer which holds the primary pad in place and provides padding to the horse's leg. This padding acts as cushioning and is compressed by the outer layers to provide support to the leg; finally a tertiary layer which is composed of elastic bandage materials that bind the bandage together and compress the padding. This is also the outer layer of the bandage that holds everything together and hopefully is slightly waterproof.

The aims of a bandage are varied depending on what you are trying to achieve but all bandages should follow the contour of your horse’s leg and provide firm, even, pressure with no lumps, bumps or creases. Bandages have the ability to reduce swellings, encourage healthy wound healing by keeping wounds clean, removing discharge and immobilising the wound. Bandages will also provide some protection from further knocks and trauma from the environment. However, if bandages are not applied correctly, they can cause their own problems.

Bandage sores are a frustrating risk when bandaging your horse and usually occur when a bandage is either too loose and rubs the leg, or is too tight in one particular place which cuts off the blood supply to the skin causing it to die. If you have a wound, fracture or tendon injury that requires an immobilising bandage to be in place for several days or even weeks then bandage sores are to be expected but good bandaging principles will minimise these. Bandaging a horse for a long period of time will deprive the skin of oxygen and this makes bandage sores more likely. Frustratingly, once you have a bandage sore you will need to keep it bandaged until the sore is ready to be exposed to the environment.

Bandage bows are a consequence of uneven pressure throughout the bandage. If you are bandaging the lower half of your horse’s leg it is imperative that your bandage goes from the bottom of the knee/hock all the way down to the heel bulbs. This is because the flexor tendons at the front and back of the leg run from within the knee/hock all the way down to the pedal bone so to avoid any steps or changes in pressure along these tendons we need to bandage the length of the tendons also. A bandage bow can still be generated within a bandage that is the correct length if there is uneven pressure within the bandage. A common mistake is to pull the bandage tighter over the area where the injury is to “give it that little bit more help,” however, this uneven pressure can also cause a bow. Remember we want firm, even, pressure with no lumps, bumps or creases. A bow is bruising of the tissues around a tendon, however, the majority of bows are superficial and will resolve with the application of a good bandage. Generally, a bandage bow doesn't lead to damage of the underlying tendons but if you are concerned an ultrasound scan of the area is advised to check the tendons are unaffected.

A helpful indication that your horse isn't happy with a bandage, and could be getting a sore or bow, is if the horse starts to itch or rub the bandage. Some horses will do this regardless because they insist on refusing help and just don't understand we are actually trying to help! But generally if a horse is bothering at a bandage then it should be changed as it may be too tight or rubbing.
Generally, bandages can be left on for 3 to 4 days, however, this is very dependent on the type and location of the bandage. It must also be said if a bandage looks untidy and has slipped or creased after only 2 days but was expected to last 5, it is better to change the bandage now than wait.

When applying a bandage the leg should be fully weight bearing. When a horse unloads a leg the angle of the joints within the leg change, especially the fetlock. If you apply a bandage to a leg not fully loaded then when your horse does load the leg the angles of the leg within the bandage will also change, generating areas of increased focal pressure and areas of very little pressure. This is then not an even pressure and may lead to problems.

When you are next placing a bandage remember the padding layers are just padding and there is no need to pull them tight. When you do apply the pressure layers you are only trying to conform and crush the padding with firm pressure, not tight pressure. If you need lots of pressure on a bandage then keep adding secondary and tertiary layers of increasing pressure - don't go super tight on the first layers. To stop bleeding don't apply a really tight small bandage, just keep adding layers of firm pressure and the bleeding will stop. It doesn't matter if you go clockwise or anticlockwise round the leg but whatever direction you start in, keep going that way. If you have any concerns regarding a bandage or you need to apply one in an emergency call your vet and we can help talk you through it over the phone.

 

New Hospital

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Exciting Year Ahead for The Arundel Equine Hospital

Many years ago we recognized that we need to expand our hospital and the quest began to find a new site to relocate to, it took a long time to find a suitable location. We were very fortunate to be able to buy a farm and get permission to demolish the existing buildings allowing us to invest in the building of a brand new, purpose built hospital. This large investment in the practice will allow us to provide our clients and patients an even better level of care.

Why are we building a new hospital?

The Arundel Equine Hospital is one of the oldest dedicated equine practices in the country, it was founded in 1950 by Mike Ashton. The current hospital was developed on the existing site, because for years one of the biggest clients for the practice was the racehorse trainer based at Arundel Castle. Due to the number of horses and the limitations of diagnostic technology at that time, the clinic needed to be close to the racing stables for horses to be dealt with. Time has moved on, there is no longer a trainer at the Castle and with the progression of diagnostic and therapeutic technology it now means that we can do so much with horses in an ambulatory fashion, in their home stables. As such we feel that we can now move the hospital to a new location, one that is a little more central to the area covered by the practice and one with a much better road network for horse box access.
Not only do we want to move due to geographic concerns, we have reached a point where the current site is too small for the existing numbers of staff. It is also too small for us to develop the new services that we want to provide to our patients and clients.

Where is the new hospital located?

The new hospital will be located on the B2133, just half a mile off the A24 outside Ashington.

What services will be provided in the new hospital?

We currently provide a huge number of specialist equine veterinary services, but with the new hospital it will mean that we will be able to have the space to put in an MRI and a CT scanner. The MRI scanner will be the first new diagnostic unit to go in, this will allow us to perform standing MRI images. The next phase of the development will be the CT scanner.

As well as the new services, we will also have more stables, a smart new surfaced arena and purpose built lameness exam areas and a pleasant client waiting area, meeting rooms where the clinicians can sit quietly and go through the cases that come in with owners. The office space will be massively expanded as will the lab and the pharmacy that we currently have. There will be a conference room where we plan to hold a series of client information evenings.

What will it mean to clients who find themselves further away from the hospital as a consequence of the move?

The ambulatory care of the equine patients in the practice will not change when we move. The vets will still attend yards as they do now and we will still have our van buzzing around from yard to yard with all the digital diagnostic equipment such as x-ray, ultrasound and endoscopy. The only difference will be a box journey of a different length in the unfortunate circumstance when a patient needs to come into the hospital, however getting to the new clinic will be so much easier due to accessibility.
What will the new hospital be called?

The name for the new hospital has not been decided upon yet and is a hot topic of discussion!

When will the project be completed?

The building work is well on track, Rob van Pelt has been driving things forward at a rapid rate and we aim to be opening the new hospital in the middle of the summer 2017!!

Chiropractic Treatments

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November 2016

Olga and Simon have both successfully passed their certification with the International Academy of Veterinary Chiropractic (IAVC) in Sittensen, Germany. Having two of our vets certified in veterinary chiropractic enables us to offer this new exciting service to our patients.

What is Chiropractic?

Veterinary Chiropractic is a manual therapy, which restores function of muscles and joints in the neck, back and pelvis to maintain optimum movement and soundness. It focuses on the biomechanical dysfunction of the spine and its effects on the entire nervous system throughout the body.
Veterinary Chiropractic treatment does not replace traditional veterinary medicine; however, it can provide additional means of diagnosis and treatment options for spinal problems as well as biomechanical related musculoskeletal disorders.

Veterinary chiropractic treatment can be used for:
• Chronic musculoskeletal problems
• Acute problems such as tension or stiffness
• Prophylactic treatment to maintain fitness
• Maintenance of soundness in older animals
• Enhance performance ability in competition horses
• Treatment of chronic and acute pain syndromes
• Complementary treatment for chronic lameness such as bone spavin, osteoarthritis, navicular syndrome or tendon problems

What does a chiropractor feel for when assessing your horse?

During a chiropractic consultation the posture and gait of your animal is assessed, followed by a thorough palpation of the horse’s spine and body. A healthy animal should move symmetrically and bend in all directions without tension. Even though horses have a very large, thick muscle mass over the spine, the vertebral joints are flexible and relatively easy to manipulate with minimal force. An animal showing tension, pain, muscle imbalance or asymmetry, will likely have restricted vertebral joints as an underlying problem. A restricted joint is also called a subluxation. Diagnosing and treating subluxations along the spine and pelvis is the essence of veterinary chiropractic care.

How does a chiropractic adjustment work?

When a chiropractor identifies a subluxation, he or she aims to correct the misalignment of the spine and restore mobility to the joint.
Realignment is made via a quick, short thrust along the plane of the joint. This is called an adjustment. The adjustment is done by placing the hands directly on the affected vertebra (previously identified in the examination). Chiropractic manipulation is not painful and no sedation is required.

When is Chiropractic useful?

Chiropractic helps any horse to move more freely and symmetrically. It prevents wear and tear and will promote their long-term health. Hence treatment can be suitable for horses of all breeds and ages.
Performance horses will need the most frequent treatment due to the stress on their body. Your veteran and leisure horse may be fine with just yearly routine check-ups.
To book an appointment or find out more about veterinary chiropractic, please ring the office on 01903 883050.

Pre-Purchase Examinations

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The pre-purchase examination of a horse is broken down into stages. There are two main types of vetting: a two stage or a five stage vetting. Some people choose to go for the shorter and thus cheaper two stage examination (includes stages one and two), risking that some things may not be picked up on. The stages are as follows:

Stage one – This occurs in the stable. The vendor is questioned about previous medical history and vices, then a full clinical examination is performed, assessing conformation, palpation of limbs and back, examination of the mouth and eyes, and listening to the heart. Surgical scars and conditions like sarcoids are looked for.

Stage two – The horse is examined outside the stable in-hand, again assessing conformation. The horse will be walked and trotted in a straight line looking for lameness. Flexion tests are then performed on the limbs. The horse may then be lunged at trot.

Stage three – This is the exercise test where the horse is ridden, usually in a sand school. It is evaluated at walk, trot, canter and gallop. Primarily we are looking for lameness but we are also evaluating the horse’s breathing for abnormalities. The heart is assessed after exercise. The horse may also be lunged on a soft surface.

Stage four – The horse is rested for approximately 20 minutes before being trotted again in stage five, to check for stiffness following exercise. We also listen to the heart as it slows down after exercise. The horse’s markings will be taken, microchip scanned and a blood sample taken. The optional (recommended) blood sample is taken to prove that the vendor had not administered any medication beforehand. The sample is stored for six months and tested if there is a problem after purchase. During this stage vets might examine the horse’s feet.

Stage five – This is a final trot up. Sometimes the flexion test may be repeated.

A pre-purchase examination is very much a legal contract between the vet and the purchaser. The vetting is done on behalf of a specific purchaser, for a specific purpose. The findings about a horse may be acceptable for the intended use by one person and so the horse passes the examination, but not acceptable for another person so the horse would fail.

Choosing between a two or five stage vetting often depends on the horse’s age, value and intended use. The same is true of whether radiographs should be performed. Sometimes a standard set of images is obtained and sometimes images are obtained of issues that have been identified on the clinical examination, such as a swollen joint. A standard set of radiographs would include the front feet, all four fetlocks, both hocks and stifles. Extra images such as of the back and knees can be taken if appropriate.

Many competition horses would undergo an endoscopic examination of the upper airway to assess laryngeal function. This would also be carried out if an abnormal inspiratory noise was heard during stage three. If on palpation, swelling in the limbs was identified then an ultrasound examination could be performed. This too can be done as a matter of routine, especially if the horses has already competed at a very high level.

Sometimes a blood sample is collected (there is an additional fee for this) and assessed. It is advisable to request that the horse has a blood sample collected and stored at a forensic laboratory, this allows the horse to be screened for some painkillers and sedatives administered by the vendor prior to the pre-purchase examination, if the horse turns out be lame or have behavioural issues when you get it home. Every horse I vet has this sample taken as it protects the vendor and purchaser if something goes wrong after the vetting. 

If the horse is to be insured, then the insurance company may dictate what they require to be done in terms of vettings and tests so it may be a good idea to speak to your insurance company prior to the vetting.

As to which vet should do the vetting, most people try to use their usual vet as they trust their judgement, however if a large distance must be covered, this can be cost prohibitive. It may be best to get the vendors vet to examine the horse as they should, with the vendor’s permission, provide you with the horse’s medical history – learning more about the horse than just what is gleaned from the examination. If you employ their vet to examine the horse on your behalf, they will be working for you with your interests in mind not the vendor’s.

Written by Dr Ed Lyall, BVetMed, CertEM (StudMed), MRCVS

New Theatre Table!

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New Theatre Table @ AEH

It was an exciting day at the hospital today as we were pleased to install a new surgical bed! As part of our move towards replacing our equipment prior to relocating to the new hospital we have purchased a new theatre bed. This is a "top-of-the-range" table which will make operations more comfortable both for the staff and horses. The new bed also has the ability to tilt into different positions allowing us better access to previously inoperable areas. The surgery team at Arundel are very excited about the new prospects this will bring enhancing our services to our clients and patients!