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A few Mondays ago, I was on call overnight and didn’t end up having much to do. That changed on Tuesday morning, when at 7:20 I was paged by the daughter of a very frantic owner who had a horse with a kick wound. As I was attempting to call them back, I received a second page, this time from the mom, who was on the verge of being nonsensical. Her horse had a huge gash in its side, she said, not from a kick but because he was trying to avoid being harassed and beaten up by his pasturemate by jumping the fence. Of course, he missed, and the result was “a five-inch-deep gash” and a whole lot of blood loss. Luckily, they had a trailer available and were able to load the horse up and bring him into the clinic immediately.

The owners (the mom and her two kids) arrived at the clinic with the horse at about the same time I did. They were extremely panicked and upset, but had put quite a nice “bandage” of towels and Vetrap over the wound – which was quite impressive. It extended from the upper part of the shoulder down to behind the horse’s elbow about 20 inches, and across about 8 inches – a lovely backwards “L” shape. It was pretty gruesome inside as well – a lot of the muscle and fascia had been ripped apart. The horse, Scooter, was quiet but not shocky – he had good color and the PCV we ran as soon as he walked in the door was normal. He was not actively bleeding and his pulse was strong. I gave him some flunixin and detomidine/butorphanol. As he was entering la-la land, his owners only wanted to know: “Is he going to be okay? What are you going to do?!” One of our other doctors, who was helping, answered simply: “We’re going to fix him!” I reiterated this: “Of course he’ll be okay – we’re going to put him back together,” as I put on sterile gloves and began exploring the wound. The owners looked doubtful.

The little guy was lucky: He’d missed entering his chest cavity by millimeters, but still had a nice slab of muscle that was detached with nothing much underneath I could tack it down to. I scrubbed and flushed the wound as best I could, ligated and cut a large vein that was dangling grotesquely from the huge skin flap, and debrided the inside of the wound. We used a couple of bottles of lidocaine to try to get the entire area blocked. We sent the owners off when we told him it would be a while before Scooter was ready for visitors .Then I began sewing. (Everyone needs to remember the near-far-far-near pattern – it’s awesome!)

It was almost two and half hours, 15 suture packets and one very large drain later that we finally had a decent-looking wound. Scooter stood like a champ on very small doses of detomidine/butorphanol for the entire experience. We put him on penicillin and gentamicin, gave him a tetanus booster and kept him on flunixin. The owners returned a few hours later and were blown away. The huge gap behind his leg was gone and a two-foot drain was tied neatly on the outside (I have pictures to prove it). They wanted to take him home as soon as possible, so we let him go the next morning with instructions on flushing through the drain site, antibiotics and more flunixin. (They even brought a lovely thank-you card and delicious gooey Special K bars with lots of chocolate. Apparently they knew the way to a vet’s heart!)

The one-week recheck was performed by the other doctor who’d seen the case early on. A small section of the sutures had come apart and there was some purulent drainage from the wound, but otherwise it looked pretty good. She cultured the drainage and prescribed continued flushing. The culture came back with two bugs, both sensitive to doxycycline. So far, so good – doxy is easy.

At the next recheck, I restitched some additional sutures that had come undone and we began the doxy treatment. Unfortunately, less than two hours after I left, the owner called to say Scooter had rolled and the sutures I’d just replaced had come out! Grrr… so much for that idea. The owner was disappointed but understanding – the area was a tough one to keep closed, and we figured Scooter just hadn’t been comfortable enough to lay down until recently, which caused the suture breakages. We decided to leave the wound open rather than beat our heads against the wall trying to keep it closed, and recheck in another week.

The next week, Scooter came into the clinic (with a buddy for moral support) and things were looking better. Granulation tissue was starting to fill in the caudal aspects of the wound, the discharge was greatly decreased and he didn’t mind me cleaning the wound at all. Scooter is now awaiting his fourth recheck, and hopefully he will continue to heal quickly. It’s been a lesson in patience for everyone – it’s great to see progress, but from the owner’s perspective, it’s slow going. Scooter’s wound will probably take six months or better to completely heal, but we’re giving him an excellent prognosis for a full recovery and return to his function as a barrel horse. In the meantime, Scooter is enjoying stall-bound life with short walks and living on reserpine, with which we’ve had very good luck as far as keeping stalled horses a little happier and quieter. We’ve also been taking pictures of Scooter’s progress along the way – it’s a great method of documenting “cool” cases (and a great tool for first-aid seminars for owners!).

I’m an emerging leader – do I get a gold star?

I need to switch gears now and say a bit about an AAEP event I was recently invited to. The “AAEP Emerging Leaders Workshop” is an every-other-year event held in Lexington, Kentucky, and involves two days of networking with other AAEP members throughout the country who are interested in becoming leaders in the organization. Each AAEP district representative gets to nominate two “invitees” to come to the workshop. I was very fortunate that Dr. Julie Wilson, my veterinary school mentor, invited me.

We arrived in Lexington late Friday morning and spent the afternoon enjoying the opening day of live racing at Keeneland. (Incidentally, I was severely underdressed – in Minnesota, racing fans come in shorts, jeans, T-shirts and generally casual attire; in Kentucky, they look more like they are going for cocktails with their friends on Rodeo Drive. Oh well.) The racing was exciting and we got to see a lot of “big name” trainers and jockeys. In addition, Darley Stables sponsored a special prize for each groom who brought up the “best turned-out horse” in each race. The winner received a $300 check. I wish that program had been implemented at Canterbury when I was a groom! That evening we enjoyed dinner and getting to know the other attendees, which included most of the AAEP staff, the AAEP board and many student advisors.

On Saturday morning, we learned about the AAEP organization: Each staff or board member who spoke gave us some insight on each facet of the AAEP, which is quite a brilliant organization as it turns out. I was particularly excited to learn about the AAEP’s involvement in current events and legislation, and the amount of time various members spend on Capitol Hill speaking to Congress and educating our leaders about the issues plaguing equine welfare and veterinary medicine. The “On Call” program is also very important, and has been vital to the education effort the AAEP has put forth for the public when responding to catastrophic injuries at races and other equine sporting events. I learned a lot about how the organization works and how quickly it responds – in a coherent and professional manner – to events that affect all of us equine practitioners. I was, in short, impressed and inspired.

The second half of the day was devoted to leadership and management development with Tom Pierce, a private consultant for organizations. He brought us through a variety of interesting topics that concern organizations, and we split into smaller groups to discuss such issues as environmental and ethical concerns (my group), the generational differences among veterinarians today, technological changes and how they impact our profession, and the current political environment. We all got a chance to share our thoughts and opinions on the issues and maybe even spark some positive changes within the AAEP. On Saturday night we were all treated to a fabulous dinner at the AAEP headquarters in the Kentucky Horse Park. Sunday brought more information about emotional intelligence and conflict management; Mr. Pierce presented it by deftly using popular movie clips to illustrate sometimes obvious, sometimes humorous examples of his points.

While the presentations were excellent (as was the food!), the best part about the weekend was talking to the other practitioners. I was able to speak with educational partner representatives, racetrack practitioners, an FEI-certified practitioner, meet the AAEP board and also learn about the other invitees and some of the interesting ideas they’ve implemented into their practices across the country. I am very thankful to have been invited, and had the opportunity to meet so many very cool people. The weekend also inspired me to really try to get involved in the organization and work toward being one of those practitioners who others are excited to meet.

I’m not getting paid by the AAEP to say it, but I must admit I am very proud to be a part of an organization that so clearly strives to provide the best possible support for its members, and truly sticks to its goal of protecting the well-being of the horse. It was obvious in all of my discussions with the practitioners I met, seasoned or not, that this was a common thread. If any of you new practitioners or students get a chance to attend a meeting like this, don’t pass it up.

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