Equine

Radiography (x rays) can be undertaken at our clinic or, using the portable equipment, at home or the livery yard. Generally speaking it is more efficient and cost effective to take x-rays at the clinic, where the images can be developed and viewed immediately. If x-rays are to be taken at home then we need to have access to a reasonably dark covered area, preferably a stable, with a firm level surface and an electricity supply nearby. Generators can be used if absolutely necessary but a mains supply is preferable. The area needs to be quiet and x-raying should normally be arranged for when there are not many people around. The area around the stable will be coned off during the procedure for health and safety reasons and anyone holding the patient must not be pregnant or trying to get pregnant.

Some horses can be x-rayed without the need for any sedation. However, some views require the horse to stand very still or be placed in a slightly uncomfortable position. Also, we are sometimes working in a confined area. For these reasons your vet may decide to give a light sedative which will make the whole process smoother and safer for everyone including the patient.

If the x-rays are taken at the clinic you will normally be shown the images as soon as they have been developed. If they are taken at home then your vet would normally call you later in the day or the following day to discuss the findings. Although the hard copies remain the property of the practice, you are always welcome to view the images or to have them forwarded to another practice if you leave the area.

In the near future we plan to invest further in radiographic services by purchasing state of the art digital radiography. This technology enables us to obtain exceptional quality images allowing the earlier detection of abnormalities and injuries. Appropriate interventions and treatments can then be started at an earlier stage in the disease process, hopefully improving the response to treatment, resulting in a better long term prognosis in many cases.

Endoscopy is primarily used to examine the respiratory tract from the nostrils to the lungs including the sinuses, pharynx (back of throat), guttural pouches, larynx, trachea and lungs. It can also be used to examine the back of the mouth, the oesophagus (food pipe) and stomach, along with the reproductive tract, bladder and rectum.

We have recently purchased a new endoscope with video and still image recording capabilities, allowing us to record examinations and view the procedure on a monitor rather than having to peer down the end of the scope. The extended length of our new scope allows complete examination of the stomach to identify any evidence of gastric ulceration.

The endoscopy equipment includes a 2.7m long cable connected to a camera, which is in turn connected to a laptop computer where the image is viewed. Still photos and video footage are stored on the computer for future reference. Endoscopy can be performed either at the clinic or at home. It requires a dark stable with a power supply nearby. Depending on the area being examined your vet may need to sedate the patient lightly as some horses/ponies will not tolerate the procedure.

Gastroscopy is a procedure that we can readily perform at our clinic to examine a horse's stomach. It involves passing a fibre optic camera up a horse's nose, down the oesophagus and then into the stomach. To perform this the horse must have been starved for at least 10 hours, and not been allowed to drink for the hour prior to the procedure, commonly they are sedated for this procedure.

During this procedure we can examine the oesophagus, the lining of the stomach and where the small intestine leaves the stomach, including where bile is ejected to mix with the food.

We may recommend this procedure if we suspect the horse has gastric ulcers, is displaying signs of recurrent colic or weight loss, or has had an episode of choke and we need to check the oesophagus has not become damaged. We can also perform biopsies of the start of the small intestine this way, a part called the duodenum.

We are very fortunate to have purpose built surgical facilities where we can undertake general anaesthetics on equine patients ranging in size from the day old foal to fully grown heavy horses. The electric hoist system and operating table allow the safe positioning of patients and the specially padded recovery room provides an area for horses to recover during the dangerous recovery period with minimum risk of injury.

All operations involve at least one equine surgeon, one equine anaesthetist, and one or more equine nurses. All our equine surgical staff have many years of combined experience, undertaking the delicate task of anaesthetizing equine patients as safe as possible, using modern equipment, drugs and surgical procedures to minimize the risk of complications.

Elective Surgery

The majority of elective (non-life threatening) procedures undertaken involve the treatment of orthopaedic injuries. We also undertake a range of other procedures involving the head/neck such a dental/sinus surgery and involving the abdominal tissues such as hernia repairs.

If your horse requires an elective surgical procedure this will either be undertaken using standing sedation and local anaesthesia, or it will be necessary to give the patient a full general anaesthetic. In either case you will be asked to bring the patient to the clinic either first thing in the morning on the day of the procedure or in the afternoon the day before. If they are coming in on the morning of the procedure, usually between 8-9am, you will need to remove all access to hard feed and hay/grass about 12 hours before hand. Water can be provided until you load the patient to bring them to the clinic. If they come in the day before then we will starve them overnight. You do not need to bring any food with you unless they have any specific requirement or supplements. Otherwise, you will simply bring a head collar, lead rope and any rugs that they would normally wear, including a sweat rug for use immediately after surgery when the patients are frequently quite sweaty.

A nurse will ask you to read and sign a consent form on admission and you will be contacted by either the nurse or the surgeon once the patient has stood up after a general anaesthetic or after a standing procedure is complete. The period of stay after surgery depends on the procedure being undertaken, but your vet should be able to tell you approximately how long this will be once the procedure is completed.

Arthroscopy (Keyhole Surgery)

We frequently use keyhole surgery to treat a range of injuries and conditions of equine joints and tendon sheaths, both as elective and emergency procedures. Arthroscopic surgery allows minimally invasive examination and treatment of conditions such as OCD, chip fractures and infected joints/tendon sheaths, allowing accurate assessment and treatment of injured tissues, with small wounds and resultant shortened recovery times.

Emergency Surgery

We also have the facility to undertake emergency surgery, normally including emergency colic surgery and treatment of wounds such as joint penetrations, fractures or tendon lacerations. If we are not able to undertake the procedure at our clinic we will arrange for immediate referral to a surgical centre, usually Rossdales Equine Hospital in Newmarket.

Whether the patient is undergoing elective or emergency surgery, it is important that the issue of finances is discussed with the owner, if possible before the procedure is undertaken. Please see the section on insurance claims for further details on how to initiate a claim for the cost of veterinary fees.

The vast majority of owners are aware of the high cost of surgical procedures on equine patients. If the patient is insured for the cost of veterinary fees then the decision of whether or not to operate is normally easier to make, although it is very important to check the limits and restrictions of any policy at the earliest opportunity, clarifying the level of cover with the provider if necessary. It is our experience that clients much prefer to know the sorts of costs likely to be incurred beforehand. Whilst it is often difficult to provide an accurate cost estimate due to the unpredictable factors inherent in equine surgery, we are happy to discuss costs and, if requested, provide a price range estimate. We also feel that, while discussing finances when faced with the need for emergency surgery, agreeing terms of payment at any early stage in the treatment causes considerably less distress for everyone further down the line. Please feel free to discuss this unavoidably sensitive area at any time with your veterinary surgeon or one of our administrative staff.

Information for Owners on Overnight Care

Although you may be anxious if your horse has to stay overnight at the clinic we would like to reassure you that their care, comfort and welfare is our priority. It is always best to speak to one of our nurses or vets if you have any specific queries or concerns.  Here is some general information that may be of interest:

Our purpose-built stable block is roomy and comfortable. We have six stables in the main block two of which are heated and insulated and have IV fluid line provisions.  There is CCTV monitoring in the stables which can be viewed by on- call vets and nurses remotely at any time.

To accommodate mares and foals one of the stables is extra-large and heated.  This extra-large stable can also be used for donkeys bringing their best friend with them for company. For the minis there is a small sized door on one of the stables so that they are able to view other horses and activity in the stable yard.

All the stables have weaving guards and also the ability to stop horses looking over the door should they have an IV line in place. We generally use bed down bedding or shavings, please let us know if your horse has specific bedding requests. Your horse will be rugged overnight if they are accustomed to this or if we feel they are cold.

We have haylage or haylage light and hay to feed, please let us know what you would like your horse to be fed. We have a variety of feeds available – again please let us know what your horse is normally fed or please bring your own feed in with you. Horses are fed hard feed twice daily at 8am and 5pm. They are usually fed from haynets unless medical problems prohibit this, they have plastic water buckets without metal handles in their stables.

We have two safe, post and rail, turnout paddocks which are meticulously poo-picked and kept in good order. Long term patients can be turned out for a few hours during the day but will never be left turned out when there is no-one on site.

Horses residing as inpatients will have the last day time check at 6.30pm and although there is no one living on site, inpatients will receive checks overnight and throughout the weekends.

Ultrasonography is a non-painful and non-invasive means of assessing external and internal soft tissues and the surfaces of bone/joints.

We currently have three ultrasound machines. Two are portable and are primarily used for fertility work during the breeding season. With these machines we can monitor changes in the reproductive tract when mares are cycling to help with natural breeding. We also frequently scan mares before, during and after undertaking artificial insemination (see AI section for more information). We also use these machines to investigate reproductive and urinary tract problems. To carry out an ultrasound exam at home we need a stable or reasonably dark covered area with a power supply nearby. One of our machines also works off a portable battery if no power supply is available, although we would need to know this in advance so that the vet brings the correct machine. Leg scans can also be carried out using one of the portable machines, however the image quality is inferior to the clinic based scanner.

Our clinic based digital ultrasound machine has greatly enhanced our ability to investigate leg swellings/injuries, abdominal problems, heart and eye abnormalities, creating exceptional quality images using extremely sensitive ultrasound probes. The main benefit of this machine is that it allows us to identify much milder injuries or damage to structures at an earlier stage than would be possible using the portable equipment, thereby preventing more serious damage to tissues like tendons and ligaments. The result is that treatment can be started sooner and the prognosis will be significantly better than had the injury been detected at a later stage. Although the use of this machine requires a trip to the clinic, our clients almost always feel the trip was worthwhile.

The investigation of poor performance is a particular specialty of the practice, particularly where orthopaedic limb and back problems are involved. Changes in performance, behaviour, gait or willingness to exercise can all be related to back pain and/or lameness. Even if lameness is not readily visible to the owner, many horses with back pain or a drop off in performance are actually lame, frequently in several limbs simultaneously. A thorough orthopaedic examination of these cases by an experienced equine clinician is essential to identify or eliminate the presence of lameness.

Further investigation of orthopaedic problems involves the use of a number of diagnostic tools, including nerve blocking, radiography and ultrasonography. We have many years experience investigating equine orthopaedic conditions and are fortunate to have the facilities to undertake complex nerve blocking, along with radiographic and ultrasonographic imaging of affected areas.

Nerve blocks involve the injection of short acting local anaesthetic into a joint/tendon canal or around a nerve to desensitise an area to see if the lameness or gait abnormality changes. A series of nerve blocks may need to be carried out to localise the site or sites of pain.

Further investigations with radiography and ultrasonography can then be undertaken.

We offer an extensive range of treatments for an equally extensive range of conditions, commonly including conditions such as kissing spines, sacro-iliac injuries, suspensory ligament desmitis, tendonitis, joint pain, OCD, limb fractures and annular ligament syndrome. Please feel free to contact the clinic to discuss any aspects of orthopaedic injury, investigation and treatment options.

What is it?
Whilst colic is a very common condition, the vast majority of patients do not require surgical treatment, about 5-10% of all cases of colic end up on the operating table. Colic is a clinical sign, it is not a diagnosis; there are many different causes of colic, some are physiological i.e. they affect the gut activity, while some are anatomical i.e. they result in some sort of blockage or obstruction.
Most cases of colic respond to a single injection of pain killer or anti-spasmodic injection, usually these cases involve spasms or cramping of the gut, possibly with a build-up of gas within the intestine. Lungeing of some of these cases helps dislodge any trapped gas and the increased adrenalin levels helps to normalise the gut activity.

Investigating colic
Some cases of colic may need to be hospitalised following the first examination if there is any suspicion that the cause may be more serious. Once hospitalised, a series of further tests may be undertaken to help determine the cause.

Internal examination – a rectal examination is often undertaken to attempt to identify physical blockages, enlarged or displaced intestine.

Ultrasound examination – external ultrasound exam through the body wall may help identify lengths of distended small intestine, often associated with a surgical condition

Belly tap – the collection of body fluid that surrounds the outside of the bowels within the belly. This fluid changes when certain conditions, particularly surgical conditions, are present.

Bloods – blood sampling is usually used to assess the status of the circulation in terms of hydration and cardiovascular abnormalities.

The decision for surgery
The decision to operate on a patient with colic is not often very straightforward. Sometimes it is possible to identify the cause during the course of the investigation such as feeling enlarged intestine full of gas or fluid during internal examination. However, often the patient is operated on because it has failed to respond to medical treatment, or, the colic pain cannot be controlled by painkiller injections, or the patient’s condition has deteriorated despite medical treatment. For the surgeon, the exact cause of the colic and its severity may not be known until the abdomen is opened on the operating table.

Common surgical conditions
Surgical colic can be divided into several common general categories

Twisted bowel – can be the small or large intestine, often involves a fatty lump growing on the bowel wall on a long cord and wrapping itself around a length of gut, cutting off the blood supply. Any of the gut can be affected, from a few centimetres to several metres. Lengths of intestine may or may not have to be removed, depending on how long the gut has been trapped.

Displaced bowel – usually the large intestine, the bowel moves into an abnormal position, sufficient to stop the passage of food, liquid and gas, but not enough to cut off the blood supply. The bowel normally needs to be replaced into its normal position and may have to be emptied of solid, liquid or gaseous contents.

Physical obstructions (impactions) – These are normally caused by blockages of food such as straw, foreign material such as sand and foreign bodies such as plastic wrapping, or large worm burdens. They can also be caused by the growth of tumours in the gut wall. The bowel would usually need to be opened and emptied or a section of gut removed if a tumour is involved.

Torsion – similar to twisted bowel, but instead of being trapped by a fatty lump, the bowel is twisted around on itself, cutting its own blood supply off. The effect is similar and lengths of dead intestine may have to be removed.

Common medical conditions
There are many, many causes of non-surgical colic, some of which can initially be surgical problems such as a displacement, which can be treated successfully without surgery in some cases.

Spasmodic colic – Probably the most common cause of mild colic, this involves waves of cramp passing along the intestines, causing the patient to have repeated bouts of discomfort, interspersed with periods of normality. The cause is varied and non-specific patients usually respond to a single episode of painkiller injection, along with physical exercise.

Gas colic - Certain parts of the intestine can fill up with the normal gases that are produced in the equine gut. If the gas cannot escape, the patient can become extremely painful and may show signs of quite severe colic. Gas colic can lead to displaced and twisted bowel as the distended gut floats out of position. Painkiller injections combined with periods of intensive physical exercise such as lungeing, are necessary to release the trapped gas.

Parasites – Despite the widespread use of wormers, all the different species of intestinal worms are still relatively common, apart from the large red worms. Small red worms and tapeworms are both common causes of colic, which can range in severity from mild, intermittent discomfort, through to severe colic requiring surgical treatment. Unfortunately, inappropriate and incorrect usage of wormers has increased the incidence of resistance to the chemicals. We recommend regular worm egg counts (see separate display) and strategic use of wormers rather than blanket use of the drugs.

Sand enteritis – As well as causing a blockage, requiring surgical treatment, smaller quantities of sand can accumulate on the bowel floor, moving back and forth as the gut moves, causing irritation to the gut lining, resulting in inflammation and recurrent bouts of colic. Treatment involves the use of a bulking agent called psylium, that is fed daily long term, while ensuring that the patient is not grazed on sandy paddocks, especially when the grass is short.

Gastric ulceration – Inflammation and ulceration of the stomach lining is frequently recognised in the horse population. However, the relationship with the occurrence of colic is not quite so clear, as many horses have ulceration with no history of colic episodes. Diagnosis requires the use of a long endoscope, usually about 3 metres in length, passed through the nostril into the stomach, to visualise the lining. The only effective treatment for gastric ulceration is a drug named Gastroguard, which reduces stomach acid secretion, allowing the lining to regenerate. Modifying the diet to include more roughage, along with trickle feeding a constant supply of feed, should reduce the risk of recurrence.

All the equine vets in the practice are experienced in routine dentistry using our extensive range of manual and electrical/motorized dental equipment. We carry out routine examinations and floating of teeth on a regular basis.

Some patients can be treated without the need for any form of chemical restraint (sedation), however it is worthwhile considering that it is difficult to carry out a thorough examination and rasping if a patient gets distressed or excited. Many owners have concerns about sedating their horses for what is considered a routine procedure. Modern sedatives are extremely safe drugs and very rarely cause serious side effects. They also work much more effectively at lower doses if they are used before the patient gets distressed and excited. It is therefore better to give a little sedative to patients that are likely to react at the start of the treatment, rather than waiting until they are already excited. The relatively low additional cost is usually well worthwhile and makes the whole procedure much more "enjoyable" for patient and owner.

Complex dental procedures can only be undertaken by a qualified veterinary surgeon. We are able to advise on all aspects of dental care including extractions, deformities/injury to teeth etc.

It is illegal to own a horse, pony or donkey without being in possession of a valid passport for that animal. Passports can be obtained very easily from a number of breed societies. We supply equine passports which can easily be completed during a routine visit by the attending veterinary surgeon. Always have your passport available for inspection/completion during all routine visits so that vaccinations can be recorded and any drugs that may need to be listed can be added to the medicines section if necessary.

Whilst foals sustain a similar range of injuries and suffer similar ailments to adult equines, there are several conditions particular to the young and growing foal that require prompt recognition and specialised treatments.

We care for a large and growing population of foals in Norfolk and north Suffolk which are susceptible to a number of conditions, some examples of which listed below:

Examples of illness commonly affecting foals:

Very young foals

Antibody deficiency – failure to drink sufficient colostrums – treated with plasma transfusions which we carry out at home premises

Joint ill – life threatening joint infections from the blood stream – these require emergency surgical treatment

Growing foals

Angular limb deformities – changes in the angulation of the joints can be corrected by both medical and surgical means if treatment is undertaken before the growth plates close.

Contracted tendons – excessive contraction of the tendons on the back of the legs can affect foals of all ages. Prompt diagnosis and treatment, possibly involving surgery to cut the affected tendon, is essential to a successful treatment outcome.

OCD – joint swelling and variable lameness can result if the joint cartilage does not develop correctly. The hock and stifle are most frequently affected with OCD and surgical treatment to remove the abnormal fragments in the vast majority of cases is very successful.

As a part of our services we offer a young foal check, which is undertaken on the first day. The mare and foal are both examined to check for any signs of ill health. The placenta is examined to make sure it has been completely passed. If necessary an enema is given to the foal to avoid a meconium impaction, a common cause of constipation. We also frequently blood test new born foals to measure antibody levels to ensure the foal has drunk a sufficient amount of colostrum. If the levels are too low then a plasma transfusion can be given to help prevent any life threatening infections.

Eye injury and disease is fairly common in equine practice, in part because of a horse’s flight response causing it to react quite violently to a sudden noise or unexpected object. Horses will pull their heads back or swing round quite suddenly and bang the facial area into fixed objects in the stable or poke the eye on branches or blackthorns in the hedgerow.

Examining an eye
When a veterinary surgeon undertakes an eye exam, it is usually necessary to have access to a stable or exam room with subdued lighting so that the pupil will dilate, allowing close inspection from front to back. Light sedation is often beneficial as patients with a sore eye will react to bright light, which can be quite painful. Horses also have very strong eyelid muscles, making examination very difficult. Local anaesthetic nerve blocks also help reduce the pain and immobilise the muscles, making it easier to examine the eye thoroughly. 
Visual examination of the eye is undertaken using an ophthalmoscope, which allows the vet to look at each layer and chamber in turn, from the cornea at the front, through to the retina at the back.

Staining the eye surface
We routinely apply a stain to the surface of the eye, to look for evidence of damage to the cornea. Normally, the stain does not stick to the cornea. Where there is damage to the surface, the stain will stick, outlining the area damage.

Ultrasound
We use the same technology as is used for pregnancy diagnosis and tendon scanning to look at the internal structures of the eye. This is particularly useful when the patient has a painful eye which it is reluctant to open, or when the injury causes the eye to become very cloudy or filled with blood.

COMMON EYE PROBLEMS

Corneal ulcers – One of the commonest eye problems involves trauma to the surface of the eye, the cornea. Superficial and deep abrasions and puncture wounds often result from blunt trauma or when sharp objects such as branches or bits of straw scrape the surface layers off the cornea, resulting in pain, inflammation and secondary infection. An orange stain is dropped onto the eye, which turns green and sticks to areas of damage. Treatment involves topical anti-inflammatory and antibiotic drops. Left untreated, ulcers can progress to cause more severe inflammation deeper in the eye.

Uveitis / Moon blindness – Inflammation of the inner structures of the eye around the pupil is called uveitis (YOU-VE-EYE-TUS) and is a relatively common serious cause of eye injury, which can lead to blindness. One form of uveitis, known as moon blindness can result from the immune system attacking the body’s own tissues, causing recurrent episodes of internal inflammation. Treatment should be prompt and aggressive to avoid cumulative damage to the eye and progressive blindness. We would normally hospitalise a patient with uveitis and insert special tubing through the eyelid to allow the frequent application of several drugs every few hours without causing discomfort and leading to a head shy patient.

Eye tumours – Cancer of the eye and surrounding structures tends to occur in older animals and is more common in those lacking pigment around the eye. Any of the structures can be involved but the third eyelid and conjunctiva are the usual sites of tumour growth. If treated early, many of these tumours can be cured without the need to remove the eye. In our practice we use a combination of surgical removal of the tumour, along with the injection or topical application of a variety of chemotherapy drugs.

Detached retina – Separation of the retina from the back of the eye will cause blindness and usually results from head or facial trauma. Diagnosis of this condition may only be possible using ultrasound examination of the eye as shown in the image.

Eyelid lacerations– Being relatively prominent tissues, the eyelids are very susceptible to trauma when horses turn their heads suddenly, pull back through a fence or have a disagreement with a field mate. Eyelid wounds should always be reconstructed promptly and carefully, ensuring that the edge of the eyelid where the lashes exit, is re-aligned to create a smooth edge. Failure to do this will result in long term problems with the tear film spreading across the eye surface.

Fractures of the orbit – The bones forming the eye socket form a frame around the eye itself, absorbing any direct impact in an effort to protect the eye from damage. Ultrasound examination of the area can help diagnose the fractures, which are often difficult to see on X-ray. Most fractures will heal well, although some may need to be surgically reconstructed with steel wire if the bones have been displaced too much.

Blindness – Partial blindness in horses is relatively common and affected patients cope extremely well with one functional eye. Loss of sight in one eye can be due to eye trauma, cancer or severe infection or inflammation, resulting in a shrunken non-functioning eye, or necessitating surgical removal of the eye, a procedure that we would normally undertake with standing sedation and local anaesthesia, avoiding the risks of a general anaesthetic.

Many causes of lameness involve the foot and treatment programs frequently include remedial farriery and the use of special shoes and shoeing techniques as part of the initial treatment and the long term management of lameness. When treating foot conditions we are happy to liaise with your normal farrier, but can also involve several highly experienced remedial farriers who work in the area and offer exceptional expertise when treating some of the more difficult foot problems encountered.

Our equine vets are happy to meet with the farrier to discuss treatment options either at our clinic or at home on the day of shoeing. Any X rays that have been taken are also available for the farrier to view prior to deciding on the most appropriate method of shoeing.

What are they?
Sarcoids are a very common type of skin tumour affecting male and female horses, ponies and donkeys. They affect all ages apart from young animals under about 2 years. Some animals appear to be genetically susceptible to developing sarcoids.

Where are they found?
Sarcoids are usually found on the skin of the head and neck, between the front legs and in the groin area, although they can appear anywhere on the body. Whilst they can spread within the skin, they do not spread to the internal body organs.

Types of sarcoid
There are about six different types of sarcoid which vary in appearance and growth patterns, from flat flaky patches to large, ulcerated pedunculated growths.

How do they spread ?
Sarcoids do not spread between animals but can be spread by flies in summer from one area of skin to another, usually when there is an open wound. For this reason it is important to protect wounds on animals that already have a sarcoid elsewhere on the body.

Diagnosis
Sarcoids vary greatly in appearance, in some cases resembling warts, areas of proud flesh or even a patch of ringworm. To confirm a diagnosis of sarcoid, a tissue sample or biopsy can be taken and examined at the laboratory. However, sampling a sarcoid can stimulate it to grow, so they are often treated without taking a biopsy first and should always be treated promptly if a biopsy result confirms the presence of a sarcoid.

Treatment
There are many treatment options available, depending on the type, location and size of the sarcoid, the temperament of the patient, the owner’s financial budget and the particular experience and preferences of the veterinary surgeon.

At CVP we treat sarcoids in a number of different ways, using a variety of topical chemical creams and drugs injected directly into the sarcoid (Chemotherapy), various surgical methods, including surgical removal and cryo-surgery. Cryo-surgery involves freezing the sarcoid tissue using liquid nitrogen spray, which has a temperature of -196°C.

Success rates
The success rate for treating sarcoids is overall normally around 70 -75%, but any sarcoid can recur at the original site or new sarcoids can develop nearby or elsewhere on the skin.

In the past, many sarcoids that were small and inactive were left untreated and monitored for growth. It is now considered better to treat a sarcoid at the earliest opportunity to increase treatment success rates and reduce the chance of further sarcoids developing.

The 6 different categories of sarcoid

1) Verrucose – Usually irregular patches of slightly raised, crusty or flaky skin

2) Fibroblastic – Consist of red/yellow ulcerated, proliferating masses, that bleed readily and may be covered in a crusty discharge, attracting flies in the summer. They may become quite large and hang down from the body

3) Nodular – Usually smooth, firm, fibrous lumps within or under the skin. They can be found individually or in groups

4) Occult – A smooth, flat area of hair loss often with well-defined margins with relatively normal looking skin

5) Malignant – Widespread infiltration of different types of sarcoid covering a considerable area, with little evidence of normal skin, usually seen in genetically susceptible individuals

6) Mixed – These contain any combination of the different types of sarcoid, occurring at the same location at the same time

Treatments

Cryo surgery – This can be carried out under sedation or under a short anaesthetic. The sarcoid and an area of visibly normal skin around the sarcoid are frozen with liquid nitrogen spray. The resultant scab is large and thick and usually separates over the next few weeks, leaving a raw wound that then heals like a normal wound.

Scalpel surgery – Cutting off a sarcoid is generally reserved for a very small number of cases, as it is very difficult to determine where the sarcoid “roots” end. Closure of the wound is difficult as a large area of tissue is often removed.

Rubber banding – A very cheap method of treating some sarcoids, rubber rings can be very effective as long as an area of normal skin is included within the area constricted by the rubber band.

BCG injections – A very effective means of treating certain sarcoids around the eye. A course of three BCG injections is usually given over a period of about a month. The sarcoid then gradually shrivels up and disappears over the following 2-3 months.

Topical chemotherapy – A number of creams are available to treat sarcoids. By far the most effective is developed and supplied by the University of Liverpool Sarcoid Department, the cream being called LUDES. Used only by a veterinary surgeon, LUDES cream is applied about five times over about a fortnight, causing considerable initial reaction. The sarcoid then dries up and the scab may take several months to fall off completely.

Shockwave therapy or extracorporeal shockwave therapy (ESWT) is a relatively recently developed treatment first applied to human sports injuries and being increasingly used in the treatment of a number of conditions in specialised equine veterinary practice and sports medicine.

Since purchasing the equipment about 3 years ago the equine vets at our practice have treated well over a hundred patients suffering from a number of orthopaedic injuries, using shockwave therapy as either the sole treatment or in combination with other therapies.

Shockwave therapy is a non-invasive treatment; the probe is applied directly to the skin over the affected area. Due to the local sensation of slight discomfort and vibrations from the compressor, most patients are lightly sedated to minimise distress and for operator/equipment safety reasons. The treatment works in two ways; desensitisation of local nerve ends provides effective and quite prompt pain relief and reduction in muscle spasms, while also stimulating tissue healing by promoting blood flow to the affected area.

The equipment is portable so treatment can be undertaken either in clinic or at home. An initial course involves three treatments, at fortnightly intervals, with each treatment taking around 10-20 minutes to complete, depending on how many or how large an area is involved. Depending on response to treatment, some patients will have further individual sessions over the following months whilst undertaking a graduated exercise regime.

The primary indications for its use in the equine population of Norfolk and Suffolk include:

Primary back injuries: These include muscle and ligament strains and sprains, kissing spines (impinging dorsal spinous processes) and sacro-iliac injuries.

Back pain/muscle spasm secondary to primary lameness: Many horses with single or multiple limb lameness have pronounced muscle spasms along the back, particularly under and just behind the saddle. Any horse with back pain should be assessed by an experienced equine vet for evidence of mild lameness.

Ligament injuries: The suspensory ligament is the most frequently injured and treated ligament, particularly injuries involving the top portion of the ligament where it attaches to the cannon bone just below the knee and hock (proximal suspensory desmitis). Forelimb suspensory ligaments and to a lesser extent hindlimb injuries can respond well to treatment. We have also successfully treated damaged check ligaments, annular ligaments (fetlock), patellar ligaments (stifle) and collateral joint ligaments (mainly pastern and coffin joints).

Tendon injuries: Injuries to the lower leg, primarily involving the superficial and deep digital flexor tendons are treated with shockwave therapy in a similar manner to ligament injuries. Improved quality of healing in terms of the ultrasonographic appearance of the tendons can be seen, although a prolonged period of graduated exercise is still essential to minimise the risk of recurrence.

Angular limb deformities in foals: Recent studies have found that shockwave treatment can be helpful in treating foals with abnormal bending of the limbs, either from birth or as an acquired condition during the first year of life. Limb deviations usually involve the growth plates close to the knee, hock and fetlock joints in the fore or hind limbs and can lead to permanent deformities if left untreated, preventing any form of athletic career. Treatment of the growth plate with shockwave therapy appears to slow down the rate of growth on the affected side of the leg, thereby allowing the other side of the limb to catch up. This treatment can be used in conjunction with remedial hoof trimming and special glue on shoes. We have treated several foals successfully over the last two stud seasons which would otherwise have required surgical correction of the deformities at considerably greater expense and risk to the foals.

Cutting Edge Treatment For Tendon And Ligament Injuries

Our equine department has been treating horses with potentially career ending tendon and ligament injuries using the most advanced technique available, involving the injection of stem cells directly into injured tissues. Damaged fibres are replaced with new ones rather than weaker and less elastic scar tissue that would otherwise be produced.

Working in partnership with biotechnology company Vetcell (www.vetcell.com), the treatment involves the collection of a sample of bone marrow by one of our equine vets from the breast bone or pelvis under standing sedation. The sample of marrow is taken by courier to Vetcell's Edinburgh based laboratory, where the stem cells are separated and placed in a special culture medium. Here they multiply for 2-3 weeks until approximately 10 million viable cells are produced. The liquid suspension of stem cells are returned to our clinic where the patient is treated on a day outpatient basis.

The stem cells are injected, under sterile conditions, directly into the core of torn fibres using ultrasound guidance, allowing very accurate placement of cells. Once injected, the stem cells, under the influence of substances produced by other tendon or ligament tissue, develop into new tendon or ligament fibres. The end result is a structure which is much more resistant to re-injury compared with tissues treated using all other currently available therapies.

We are very pleased to be able to offer this service to all our clients.

If you would like to discuss stem cell therapy with any of our equine vets, please do not hesitate to contact the clinic.

Equine laser surgery 

LASER (Light Amplification by Stimulated Emission of Radiation) 

Laser has been used in the equine veterinary world for many years now, being used in treating upper respiratory diseases, wound management and more importantly tumour removal, in particular sarcoids and melanomas. 

Surgery using laser both cuts and vaporises the tissue giving us many advantages over surgical excision.  

Benefits of laser include: 

• reduction in bleeding during surgery - the laser seals small vessels while cutting 
• reduced risk of spreading tumour cells during tumour excision, this being particularly important in removing sarcoids 
• reduced pain - the laser seals nerve endings while cutting 
• promotes efficient wound healing 
• faster recovery: less inflammation and swelling, and less post-operative complications at wound site,  
• minimal aftercare, we may ask you to apply topical cream daily 
• excellent success with low rates of recurrence of sarcoids

Due to the popularity of the laser surgery we have recently purchased our own Dual Wavelength Surgical Diode Laser System. This enables us to book your appointments in promptly and at a competitive rate.  

Laser can be performed under standing sedation and local anaesthesia or under general anaesthetic. The procedure can be done as a day patient admission on many occasions.  

We have many experienced Vets that can carry out this procedure. If you have any questions or to book in please call the clinic on 01508 558228.