tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS

Date:   07 May, 2010  
Focus: Small animals - dogs, cats, hamsters, guinea pig & rabbits.

Toa Payoh Vets Clinical Research
Making veterinary surgery alive
to a veterinary student studying in Australia
using real case studies and pictures

The horse kicked the vet  Part 2
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
First written: 06 May, 2010
ate:  07 May, 2010 
Be Kind To Pets
Veterinary Education
Project 2010-0129

On May 5, 2010, an expatriate couple consulted me as their Burmese cat was pawing her mouth for the second time in a month. The husband was surfing the internet and saw my pictures of mouth diseases in the Singapore cat.

"Are you an expert in cat mouth diseases?" he asked me two times as he saw pictures of my feline oral diseases cases in my website, 

"No, no," I replied. "Any vet in Singapore will be able to treat cat mouth diseases. It is just that they don't write about them in the internet. There is no money in writing about cat mouth diseases in the internet!" 

I examined the beautiful excellent conditioned Burmese cat. The case will be written up soon, if I have the time.

After the cat treatment, the husband asked me: "Do you remember one racehorse you stitched up at the Bukit Timah Saddle Club? A hanging wire cut his front leg. He is called Meltdown." the husband told me that his wife recognised me.

The wife did look familiar to me. "Yes, I can remember the racehorse I stitched," I said although I don't know whether the husband believed me. "How many years ago was it?"

"8 years ago," the husband had excellent memory because he was spot on. Later I checked out Meltdown's case using the Google search and it was really 8 years ago.

"Is Meltdown still alive?" I asked. Many racehorses are shot when they are of no use or have not won races. Some racehorses are retired to the Saddle Club for riding and dressage.    

"Yes," the husband smiled. I was very happy to know that a racehorse has lived another 8 years.    

"The racehorse was to be shot as it came in 4th in a race. '4' in the Cantonese dialect meant 'Die'. So the Hong Kong owner did not want him anymore. He was purchased from Australia for $250,000 and was to be put down. The trainer asked me I wanted him for dressage and show jumping. If I did not want it, the vet would shoot it the next day. 

"I checked Meltdown and he had excellent conformation for dressage because his back is on level with his front, unlike other racehorses. My wife trained him. He  won the top award in the regional dressage competition in the Philippines." The husband mentioned a French-sounding name of the competition but I am not able to spell it. 

He continued: "Only one in 25,000 horses can make it to win the top dressage competition. He was that horse. 24,999 horses are discarded."

I was surprised that the horse I risked my life to stitch up had performed so well and is still alive.

"However, he would not be able to win in the European dressage competition based on his ability. To win the European dressage, only one horse in 50,000 can make it."

I am very happy to know Meltdown is still alive. Racehorses all over the world have short lives when they don't perform.  "I must see Meltdown at the Bukit Timah Saddle Club one day," I said. Meltdown must be around 13 years old, assuming he was 5 years old as a retired racehorse. I had been a Turf Club veterinarian for 8 years and know that racehorses seldom live long if they don't win races. I remembered Meltdown because he put fear in my heart as he could kick and bite when I stitched him 8 years ago.              

Today, May 6, 2010, at 5 am, I went to my website, and clicked Horses. Then, in the Google custom search, I type "horse laceration". Incredible, 2 of the 3 webpages listed were articles written by me some 8 years ago when I was the racehorse vet. These are:

1. 0760horse_skin_lacerations_Singapore.htm (this webpage)
2. horse_eyelid_laceration.htm

Google custom search is very useful as I will not be able to find this article instantly without this search function. I post my article, written in 2002, on the evening I met Meltdown at the Bukit Timah Saddle Club below, for the benefit of my readers.

P.S. "Some horse vets have been killed by the back kick of the horse if they are not careful during surgery on the standing horse," I told my vet intern Theresa about my frightening experience stitching Meltdown. "Why don't you anaesthesize the racehorse to stitch him?" my vet intern who would be studying veterinary medicine soon presumed that the same procedures I used in stitching dog laceration wounds would apply to racehorses. I had told her that Meltdown was a dangerous horse to stitch as he could kick me when stitched. Theresa was assisting me in treating a Golden Retriever fully anaesthesized on the operating table and had never seen equine practice. In Singapore, new vet students rarely have the chance to see equine practice as there are no opportunities at the Turf Club.  

"Horse vets all over the developed world usually stitch horse lacerations and neuter them at the stables using tranquilisers which are not very effective," I explained to Theresa. "A horse needs a fully padded anaesthetic room to prevent him fracturing his legs when he falls or wakes up during and from general anaesthesia. So he is just sedated and restrained with a nose twitch and stitched at the stables.

2002 --- EIGHT YEARS AGO...

The horse kicked the vet
 - Part 1
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
First written: 19 Nov, 2002
ate:  07 May, 2010

The racehorse staggered as if he was drunk. If he fell on his left, he would crush stable hand Hamid who was gripping his left ear and was boxed in at the corner of the farrier's stall. If he fell forward, stable hand Ramli would not get out in time as he was holding the nose twitch and was sandwiched between the horse and the farrier's cabinet. If the gelding fell on the right, there was some space for me to move out of the 450 kg body.

I had just finished stitching his eight-inch laceration wound on his right forelimb, below and in front of his elbow. He had bolted up a grass slope which had a loose telephone wire and had been cut. 

"We have ten minutes of tranquilisation to stitch the horse," I said to the two stable hands, after injection
Singapore thoroughbred horse - skin lacerations 7.30 p.m Day 1through the jugular vein ten ml of the drug. 

Now, it was fifteen minutes. The gelding felt the pain of the last two stitches as the tranquiliser had been metabolised. 

I pressed the swab onto the stitched area to squeeze out the small amount of bleeding beneath the stitches.  An ordinary post stitching procedure by most veterinarians. However, the gelding reacted in great pain. He lashed out his right fore leg at me, sideways and lost his balance. 

Now, a great danger confronted the stable hands and myself. And the horse too. If we got kicked in the head, we would be dead. If the horse fell on the hard concrete floor of the stable, he would be injured further. 

There was no time to think how to react in this pandemonium. I got to get Hamid out of the corner. A short and thin man of over forty years of age, he was agile. He pushed the gelding to the right. The horse wobbled more but did not fall. His head stooped low. 

There was more space for Hamid. I rushed to the left side of the gelding and pressed against his neck to prevent him falling on his left. The gelding would steady himself when there was a hand against his body. 

I had some experiences with wobbly horses during intravenous anaesthesia in the Equine Hospital.   Pressing the body usually steadies the tranquilised horse.  But here, the floor was concrete and not padded with soft foam unlike the Equine Hospital's. 

The stable hands did not feel afraid. They had worked with horses for at least one decade. Brave men who cared for horses although they would not be able to afford one.

They did not panic although they hardly encountered such a situation.  Horse laceration wounds occur once in a blue moon in this riding club. 

"The horse nearly kicked you with a side kick as you pressed the gauze on his wound," Hamid said to me afterwards.  

Stitching a horse's laceration wound is never a procedure I look forward to. In the dog or cat, the animal is blissfully under gas anaesthesia and it was so easy. Here, I had a standing horse, restrained by two stable hands and a tranquiliser which might not be effective if given less and the horse feels the pain of stitching.  If given more, the horse may not be standing at all and falls to the ground.    

It was one of those cool tropical November evenings. Fortunately the lightning and thunderstorm were not present. 

There are 14 days for the wound to heal and there are many forces preventing good healing in an open environment unlike that in a hospital. 

Stable flies want to lay eggs on any part of the exposed stitched area and irritate the horse. The high humidity and heat are conditions conducive to the growth of bacteria and fungus on the wound. The horse's propensity to bite his stitches if the wound is infected.

This was not a case of the vet's responsibility being over after stitching.  

Antibiotics were given for 3 days and a careful watch was needed. The wound had exposed the underlying muscle and the horse had been nibbling it if the separated skin was not stitched. To the owner, this was an emergency and could not wait till the next day. Therefore, stitching was done within two hours. The horse people phoned me a few times to remind me to come early and it was evening rush hour at the expressway.

To the owner, the competence of the vet would be suspect if the stitches break down and the wound opened up even though the external factors of maggots tunnelling into the muscles of the leg,  infections by micro organisms and self biting off the stitches had nothing to do with the vet. There would be no second chance at stitching once the wound is dirty.  

In the case, ideally, the horse should be stitched under general anaesthesia in a soft padded room at the Equine Hospital and thereafter hospitalised in a clean dust-free fly-free air conditioned stable. 

However, the veterinary fees would be ten times more. Therefore standing operations at the stable in a dusty environment are done at great risks to the vet and helpers sometimes. 

This is the type of surgery I hope will not occur, for the sake of the horse and for the good stable hands. And for me.
Singapore thoroughbred horse - bandaged tightly  9 pm Day 1
Dusk had fallen and it was dark by this time. "It is best to keep the horse in the air conditioned stable," I said. There was one available but Mrs Thiele who could not bear to see the horse being stitched up earlier, said that the horse would not step over a raised concrete bar at the entry of the stable and preferred the breezy stable. The bandage around his elbow fell off as he walked exposing the stitches. 

Bandages around the elbow area tend to slip down. "You should use the sticky bandage first," Ramli said to me. Around thirty years old, he had the David Beckham hair shaved off. His broad shoulders gave assurance that he was strong to handle horses. He was helping Hamid and me without being asked. 

I applied the sticky bandage as the first layer followed by the blue elastic one which had lost much of its adhesiveness. I cut the end of the blue tape and tied a knot tightly, just behind the point of the elbow.  Hamid taped a white tape round the wound. 

Before anti-fly powder applied. Few flies disturbing the horse. Day 2 4.40pmThe bandage looked secure. The horse just would not move his right front leg as his elbow joint was locked. What should I do? The stable hands were watching me. Should the bandage be loosened?

No. It would fall down as the leg tapers. 

"Push the horse backwards two steps," I said. The horse could back. Then we pushed it four steps into the stable. This was day 1 and everybody was satisfied. The battle of bandaging was won but the war of good healing had just begun.

Singapore thoroughbred horse - stable flies - 4 pm Day 2"The horse likes to lie down in his stable, unlike most horses," Hamid said. "He is a bit of the devil and likes to bite when groomed."  I could not believe that this horse bites people. Neither did Mrs Thiele who told me that her horse was well behaved.  A laid-back horse much loved by his owner. 

Nearly twenty hours after stitching, I checked on the horse. His white tapes were gone. Three flies were interested in the blood of his bandages.   

Singapore thoroughbred horse - anti-fly powder 4.30 pm Day 2The bandage was holding well. The knotted end was preventing it slipping off. Hamid had a bottle of wound healing powder. I gave him two bottles of antibiotic cum anti-fly  powder as this situation required this type of powder. The flies disappeared.

Would the bandage hold for the next 12 days?  Thirty hours after stitching, the bandage had rolled down the elbow exposing the stitches. The wound was still clean and the horse did not bite the stitches. 

"Shall I bandage the wound at night?" Hamid asked me. "It is best to bandage now," I said. "The horse may bite at the stitches." I gave the horse the antibiotic injection. He really hated being injected, brought his head low, turned and chomped at me with his jaws open.

This horse did bite in protest. He was not the vicious type and therefore Hamid could turn his head away. Hamid gripped the skin of his neck to restrain him and I completed the injection. 

If the wound was checked daily and bandaged, chances were that this horse would make a good recovery. 

"Should I exercise the horse?" Mrs Thiele asked on the second day. There was a big swelling of the muscle tissue at the wound area now. I gave the horse the pain killer injection so that he would feel better. 

"Just a few minutes of walking, as the stitches may break down if you exercise the horse too much," I said. A horse cannot be confined to a stable for the whole day, unlike the dog or cat. 

Singapore horse lacerated right fore limb - sutured. Day 3. Bandage fell off Re-bandaged again.
On day 3 after stitching, the bandage rolled down. Anti-fly powder applied. Nylon stitches holding well.  11 days to go before stitch removal. Re-bandaged so as to prevent the horse nibbling its stitches. A good stable hand cared for this horse. I advised bandaging 24 hours/day rather than just at night.

Excellent photos of Meltdown
presented by the owner to Dr Sing in 2010. The pictures will help the Vet Student in the study of conformation and equine anatomy


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Be Kind To Pets
Veterinary Education
Project 2010-0129
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