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Gathering information from an owner before seeing an emergency is key. It’s especially important for the equine veterinarian. With the exception of those who work at large hospitals or clinics with a haul-in facility, we are bringing the ER to you! Stocked in our truck is most all of the equipment we could possibly need for an emergency, bandages, suture, sedation, antibiotics, you name it, we’ve tried to find a spot for it. But some tools that we may need might not live in our vehicles. Ultrasound and radiograph (x-ray) machines may be too big and take up too much room to always be in the truck, or we have to share it amongst our coworkers. Certain drugs that have a short shelf life, or are not used on a regular basis may not always be at our fingertips. Therefore before we come out to see your emergency, we may need to swing by the office and pick up a few supplies. And that is why it is so important for us to gather as much information about the case before we hit the road.  It’s not that we don’t think it’s an emergency, or our secretary is just trying to make idle chit-chat, we need all the details we can get so we will be prepared. And I’ve learned that to get that info, you need to ask the right questions. Don’t ask, “Did you give your horse any medications today?” ask, “Did you give any Bute or Banamine,” as those meds are so common place in today's barns that owners may not even think to mention them, like if you went to your doctor and the nurse asked you what medications you were on, you may not even think to mention the two aspirin you took for that headache this morning. And as much as it’s our job to ask the right questions, it’s your job, as the owner/trainer/caretaker to give the right answers (to the best of your ability of course). And I want to make sure your ability is at its best! 

It happens more often than we’d like, usually when we’re talking about lacerations, that an owner describes one thing, and you find something entirely different when you reach the farm. This difference may mean that we would have prepared differently or brought different equipment with us. The confusion is usually due to terminology. There are many different names for all the parts of a horse, from the fancy Latin phrase to the layman’s term. Using the same vocabulary can help us (the vet) communicate with you (the owner) to take better care of them (our horses). Having a common language will lead to more efficient and effective communication and better care for your horse!

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Directions of the horse.

TOP TO BOTTOM

Dorsal: Near the topline or back. Think dorsal fin on a shark. 

If you run your hand down the middle of your horse’s back, you are touching the dorsal midline. The withers are dorsal to the shoulder.  

Ventral: The bottom or towards the belly. A horse that has colic surgery will have an incision made on the ventral midline. The udder is on the ventral abdomen.


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These terms apply to dogs too!

FRONT TO BACK

Cranial: Towards the head (or the cranium). The point of the hip is cranial to the tail. 

Caudal: Towards the tail. You place the saddle caudal to the horse’s neck.

Now when we’re talking about the head you’re already as cranial as you can be so you really can’t say something is more cranial than something else on the cranium. 

Rostral: Towards the tip of the nose. The nostrils are more rostral than the eyes. 

Just because we like to make it confusing, terms change when we talk about things below the knees and the hocks.

We still use dorsal to indicate the front of the limbs. But for the back of the legs we use palmar and plantar (depending on if it’s a front of back leg):

Palmar: front legs. Like our hands have palms. The flexor tendons run down the palmar surface of the front leg.

Plantar: back legs. Like we get plantar fasciitis in our hind limbs (our feet). The ergot is on the plantar surface of the hind fetlocks.

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NOT a horse, but a great diagram!

SIDE TO SIDE

Lateral: Towards the side, away from midline, the outside. The ear is lateral to the forelock.

Medial: Towards midline, the inside. The chestnut is on the medial side of the leg.

NEAR AND FAR

Proximal: Closer to the origin (the body). The knee is proximal to the foot.

Distal: Away from the origin (body). Think distal=distant. The fetlock is distal to the knee.


THIS AND THAT

With horses having so many appendages, we sometimes have to describe a location in relation to the first location and it can either be on the same side or the opposite side. These are much less commonly used terms;

Contralateral: The opposite side of the horse. A horse with a broken leg it at risk of developing contralateral limb laminitis after putting too much weight on the good leg.

Ipsilateral: The same side of the horse. When the horse fell on its side, it injured the right eye and the ipsilateral shoulder (the right shoulder).
 
 
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You know how the old saying goes, “April showers bring May flowers and what do May flowers bring?”  SCRATCHES!!! Yes, its that time of year again, when the weather gets warm and the fields get muddy and your horses start to develop these crusted, irritated, painful lesions on their pasterns. It is one of the most common questions posed to online equine forums and when you plug “scratches treatment” into Google you get 13,200,000 results! While I will admit there is often “more than one way to skin a cat,” as they say, I also believe that if there a hundred different (and often conflicting) ways to treat a problem, it’s probably because we just haven’t figured out the right way yet.
Equine Pastern Dermatitis (EPD), aka “scratches,” “greasy heel,” or “mud fever” is a skin disease of the lower limbs. Most commonly seen on the hind limbs, the dermatitis affects the backs of the pasterns and occasionally moves to the front of the limb. Draft breeds and draft crosses with feathers on their distal limbs and horses with white socks  (ie: unpigmented skin) are predisposed to this condition. It is often seen in horses in muddy paddocks, rough prickly pastures and unsanitary condition, due to the high Generally the overall health of the horse is unaffected but severe cases can cause distal limb edema (swelling) and significant lameness.

The exact cause of EPD can be different in each case, but the pathogenesis (which is not entirely understood) is most likely as follows: a small break in the skin allows bacteria in (unpigmented skin is more delicate, and prickly fields more abrasive) and horses in mucky conditions or with long feathers that trap dirt, heat and moisture cannot clear the infection on their own.  There will be pain and swelling with crusted lesions. If not treated properly fissures and a foul odor may develop. In draft horses we sometimes see granulomatous growths of inflamed tissue at these sites.
The causative agents are usually bacteria including, Staph. aureus or Dermatophilus congolensis. There can occasionally be a fungal component and horses infected with mites or lice are at risk for developing infection where the parasites break the skin. While the diagnosis is often made just based on clinical signs, the only way to truly know what’s causing the infection is to have your veterinarian perform a culture and in some chronic cases a biopsy is required.
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While there may be a million and one creams, ointments and sprays out there to fix this problem, the mainstay of treatment should always be to remove all the scabs (another warm moist place where bacteria love to hide) and clean the area thoroughly and often. Clipping the hair short (with a 40# blade) will help getting down to the skin with cleaning and any topical treatments. Clipping, scrubbing and picking all the crusted areas off can be a very painful procedure and many horses have to be sedated by your vet in order to do a proper job. So be safe, especially because you will most likely be working on the hind legs!
Once the scabs are removed and the area is all suds up with an anti-septic solution such as 2% chlorhexidine, povidone iodine or benzoyl peroxide, I like to let the area sit for 5-10 minutes. This give the anti-septic plenty of “contact time” to kill the bacteria. After you rinse the cleanser off completely (dried soap can be irritating and itchy) the leg must be dried. And I mean really dried, not just wipe the excess water off with my hand like a human sweat scraper, or giving it one swipe with an already damp towl. The leg needs to be REALLY dry. For those of you with feathered horses who can’t bear the thought of clipping their lovely locks (or can’t for the summer show season) I recommend a hair dryer on a low setting to help really dry off the leg.

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The next part is where it gets confusing. Ointment or no ointment? To wrap or not to wrap? Systemic anit-biotics or no? Unfortunately we may not have the perfect answer just yet. Anti-biotic creams, or sprays can be applied twice daily to aid in fighting the infection. I like to stay away from petroleum-based ointments, in favor of creams or sprays. These Vaseline like substances water resistant and can be very difficult to completely clean off so that your scrub can reach the skin the next day. The only way to know what topical treatment will really work is to know what bacteria you are dealing with, and for that you must do a culture. Horses with lots of swelling in the lower leg or that have open fissures may benefit from a bandage but I do worry in many cases that bandages will just trap in dirt and moisture. The vast majority of cases do not require systemic antibiotics but in some cases we will treat with a course of oral or injectable medications. Obviously, you must consult with your veterinarian before beginning treatments. I think that all horses benefit from (and appreciate) the use of anti-inflammatories such as Bute or Banamine. Again, check with your vet for appropriate dosing.

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So to review, EPD is an infection in the skin (mainly bacterial, maybe fungal) secondary to breaks in the skin (due to delicate skin, rough pastures, mites/lice or normal wear and tear) that develops in wet, muddy and dirty conditions. Treatment includes clipping, cleaning and drying the affected area at least once a day, then apply the anti-microbial cream or spray du jour and keep your horse as clean and dry as possible. It’s a daunting task and may sound impossible, but the diligent committed owner should be able to get on top of a case of scratches.

 

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