Tales from a Young Vet

by Jo Hardy

  Towards the end of my month at home I was finally starting to get better and had some more energy. At that point the social secretary of our year sent around an email asking if anyone would like to be involved in organising our graduation ball. Thinking it would be my last chance to have an impact on university life I jumped at the idea and agreed to be part of the committee. We decided to have a meeting straight away, and fifteen of us got together to start planning the biggest party of our lives. It had to be huge and it had to be memorable, as it was going to be the last time many of us would see each other before leaving to start our lives as vets, spread out across the country.

  CHAPTER SIX

  For the Love of Horses

  She was beautiful. A young thoroughbred with a glossy black coat, huge dark eyes and a thick, dark mane. But with a huge bandage wrapped around her middle and a line running from a vein in her neck to four drip bags suspended above her, she looked a sorry sight.

  I stepped into the stable beside her and stroked her neck.

  ‘Hello, Ebony. You’ve had a tough time, haven’t you?’

  Her head was drooping towards the floor and she barely responded to my touch or my voice. She’d been through surgery the night before and now it would be a tense wait to see whether she would recover. Surgery on horses is complicated; a lot of owners won’t even try it, preferring to put their horses quietly to sleep. But Ebony was young and strong, and she stood a good chance of pulling through.

  It was my first day of equine medicine and I was in my element. I’m fond of all animals, but I have a connection with horses that goes back to when I was four years old and fell in love with them, so equine medicine was always going to be one of my favourite rotations. And thanks to my two, I’d already had a fair bit of experience with horse maladies and conditions. Elli and Tammy had been my world all through my teens and they were both seriously spoilt; they lived easy lives doing a bit of gentle work a few times a week but otherwise they spent their days as expensive lawnmowers in a field at the local stables. They both had thoroughbred in them, though, and despite all that pampering, over the years they’d been through just about every orthopaedic problem a horse could possibly have, and plenty of other health issues, too. Between them they’d had bone spavin (arthritis of the hocks), arthritis of the coffin joints, navicular syndrome, splints, collateral ligament injuries, tendon injuries, hoof abscesses and hoof wall defects. Thoroughbreds seem less hardy and more prone to general problems than other horse breeds, so I felt pretty well prepared for whatever equine medicine might throw at me.

  For this rotation we were back in the RVC’s state-of-the-art equine referral hospital. We’d already spent a week there for equine imaging at the start of rotations so we knew the layout of the place pretty well, but this time we would be working as members of the clinical teams, which was a lot more interesting.

  It was also Grace’s first day of filming for the Young Vets series. She wasn’t at home around horses, and with a film crew following her every move and a camera peering over her shoulder the pressure was going to be on for her. She had warned the rest of us to get ready for potential background appearances and that set off alarm bells, because ours isn’t a job that lends itself to glamour. Most days I leave the house with no make-up, my hair scraped back and dressed for encounters with mud, pet hair, drool and a variety of other noxious substances. But that morning, with my upcoming two seconds of fame in mind, I’d put on a bit of make-up, tied my hair into a French plait and put on my favourite pink and purple checked shirt. Not that anyone would see it, since we would be spending the day swathed in green overalls.

  Feeling if not exactly showstopping then at least presentable, I arrived by the whiteboard in the barn at eight. Lucy, Katy and Jade were all there, and there was a definite whiff of anxiety in the air. The combination of horses and TV cameras was worrying them, too.

  When Grace arrived, with a pile of equine textbooks under her arm, the film crew were following behind. Grace looked relieved to see us. She introduced us to Amy and Sam who we would get to know well over the next few weeks. Amy, short with blonde, curly hair, was the assistant producer. Smiling and bouncy, she was great at knocking away those camera nerves and making us laugh. Sam, the cameraman, was easygoing and friendly, and kept telling us he’d filmed for Countryfile, which I think he felt qualified him for anything to do with animals. However, we soon discovered that neither of them had much horse sense at all; they would go too close, make too much noise and hold a sound boom right over a horse without realising that horses are very easily spooked, especially by objects they’ve never encountered before. We had to give them a rapid but very brief insight into the horse world, along the lines of, ‘Don’t stand too near the horses, don’t hold cameras and booms over them, under them or anywhere near their heads, and don’t go round the back of them, especially sick horses, which are even more likely to kick out at you than well ones.’

  The whiteboard in the barn was where all the current cases were listed, and once we were all there, Imogen, the clinician in charge, dished them out between the students. Ebony had come in the night before with colic and a displaced intestine, and had gone straight to surgery. Now she needed hourly checks and I leaped at the chance to look after her.

  ‘Colic’ is a broad term for abdominal pain. It’s common in horses, and frequently we have no idea what has caused it. The animal may just have some spasms, or it might be very gassy, but it could be more serious, too, such as an impaction of food, or part of the intestine could have become displaced or entrapped. Colic can even be down to problems with the uterus or ovaries.

  Some colic is simple and can be easily sorted with time and pain relief, but in other cases, when the gut has got twisted or entrapped, fluid, gas and food matter, known as ingesta, build up behind the obstruction and it’s very serious. When Ebony arrived she had been showing clear signs of pain and distress, which indicated that this might be what was happening in her case. Horses in this state often sweat and look agitated – they kick at their abdomen with their back legs, turn to look at their flanks or lie down and roll repeatedly.

  Ebony had been operated on to correct the displacement and remove the build-up of matter in her gut.

  Whenever possible, if the clinical problem allows for it, vets like to do standing surgery, sedating the horses so that they’re sleepy and then given a local anaesthetic on the operation site. Operations such as castrations, spinal surgery, head surgery, stitch ups and some orthopaedic surgeries can be done like this. But in cases like Ebony’s, where a major operation is necessary, they have to be fully anaesthetised. For this they’re taken into specially kitted-out knockdown surgical suites, in which the floor and walls are covered with thick padding. Once the anaesthetic is administered the horse will be out cold within seven heartbeats, which is around twenty seconds. After that, five or six people will snap into action; one will intubate the horse (put a tube down its windpipe to help it breathe), others will put shackles on its legs and attach it to a crane that will then lift the horse onto the operating table, which has raised sides so that the horse can’t fall off it. Once there the shackles are removed and the horse is attached to the anaesthetic machine and carefully monitored during surgery.

  Still woozy after the operation, Ebony was now in the Intensive Care Unit, a stable block that you can only enter when wearing fully sterile kit – even to step into her stable I had to go through boot dips and then put on a sterilized waterproof top, and gloves. Kitting up took a full five minutes before I went in to see her, then another five taking it all off again, and I needed to do that every hour.

  Because this kind of surgery is very risky for horses it was a big thing for Ebony’s owners to decide to try it. But the alternative would have been to lose her – she would have had to be put to sleep, and that would have been a real tragedy for a young horse with loads of potential. So despite the risk, and the cost, they had opted to give her a chance and I wanted to do everything
possible to help make sure that she made it.

  Days two to five after surgery are known as the ‘danger zone’, in which a horse has to be very carefully monitored. A high percentage of horses relapse and either get colic again or the surgical site breaks down and becomes infected. If the intestine has been damaged by having the blood supply compromised then breakdown is far more likely.

  During the first three days the horse has to be checked every hour. My checklist included looking at her gums to see that she wasn’t anaemic and to check her blood pressure was still good, taking her temperature to check it hadn’t spiked, which would indicate infection, listening to her heart-rate to make sure it wasn’t speeding up (a possible sign of pain), listening to her guts to see if they were nice and noisy, which would mean they were working again, and checking the pulses in her fetlocks to make sure they were calm and not bounding. A bounding pulse can indicate laminitis, an inflammation of the lamellae (the bits that hold the hooves onto the legs), which is possible after surgery or when toxins have been released from a compromised gut, and it can rapidly become so serious that the horse has to be put down.

  Determined to be thorough and not to miss anything, I was spending fifteen to twenty minutes working through these checks, and with the time involved in kitting up and then taking all the gear off again, it was taking half an hour out of every hour.

  To add to the complications, Grace was coming with me some of the time to learn how to do colic checks, and of course Amy and Sam were following Grace. So there were four of us, plus the camera and sound mic, crowded into the stable and, conscious that I didn’t want to get anything wrong when it was being recorded on film, I went through the colic checks even more slowly.

  Any thoughts of glamour had gone out of the window early on, as taking the sterilized top on and off had made my hair look as though I’d just got out of bed, and I was wiping the sweat off my brow with my arm as I worked so I’d long since wiped off the make-up I’d carefully applied that morning.

  Grace was worried about how to do colic checks and I was happy to show her where to place the stethoscope to listen to the guts most effectively and where to place your fingers to feel the digital pulses in the legs. I enjoyed showing her but, conscious of the cameras in front of us, I was distracted and stumbled over my words. I just hoped they wouldn’t use that footage, as I was pretty sure I came across as a babbling mess.

  Vets can’t really afford to become too attached to any particular animal. We see so many that are sick and vulnerable, but in order to help them we have to take a step back emotionally and be the scientists that we are; analysing, observing and judging what will be best for them. But every now and again, despite our best efforts, an animal gets under our skin and we just can’t help feeling a deeper connection. It was like that for me with Ebony; she was such a gallant horse and so very unwell that my heart went out to her.

  Ebony tolerated my checks patiently, and as I went about them, taking care not to startle her, I spoke to her gently, soothing her and encouraging her to get well again.

  ‘Come on, my lovely,’ I whispered into her neck. ‘You can do it.’

  On the second day we needed to encourage her to eat very small amounts. But despite being offered hay and haylage, a softer, sweeter type of hay, she remained unresponsive. In the hope that it might appeal to her, I went out and picked some grass and brought it in for her. To my delight she nibbled at it.

  I stroked her neck. ‘So that’s what you fancy, is it? Well, there’s plenty more where that came from.’

  As soon as she was allowed out I put a bridle on her and took her up to a lovely clearing close to a field where the university’s own horses were. It was quiet and open there, and much nicer for her than grazing on a grass verge by the little roads that wound their way around the campus.

  I began to gently groom her, running a big brush over her neck and shoulders, being careful to avoid the bandage around her middle. And before I finished work for the day and handed over to the night shift, I would go and pick buckets full of grass, so that they could feed them to her.

  Ebony’s owner came in to see her every couple of days. She lived several hours’ away, so she couldn’t make it more often than that, and she usually arrived with her two young children in tow. The whole family clearly loved Ebony. They’d bred her and they planned to use her for show jumping when she was a bit older, but right now they were enjoying having her as part of the family. They would pet and fuss over her and ask all kinds of questions about how she was. It was lovely to see how much they cared about her.

  By day three she appeared to be doing well. She accepted some fresh haylage along with her grass and she began to look brighter. Her hourly colic checks were reduced to two-hourly. But on the fourth morning, when I arrived for work, I learned that overnight her temperature had spiked and as a result the surgeons and clinicians were very concerned. The colic checks were once again hourly, with someone doing LOBD checks – Look Over the Barn Door – every half an hour to see how she was doing.

  A few hours into the day I went to check on her and found her lying down, looking miserable and grunting. And then she started to roll.

  Afraid that she was seriously relapsing I rushed to see Imogen. She told me to go with the intern on duty, collect Ebony and bring her round to an examination room for a full work up while they rang the surgeons to have them on standby in case she needed to go back to surgery. We got Ebony gently to her feet and led her to one of the pristine examination rooms, where an ultrasound scan of her abdomen and a rectal examination revealed that her guts appeared to be healing well. Then her belly bandage was taken off, and we had our answer; Ebony’s metre-long surgical wound had become sore and infected. While any complication wasn’t ideal, it was a huge relief that she didn’t need to go back for another operation. The mortality risk of horses in surgery is scarily high, and even more so the second time around.

  She was already on the standard post-surgery horse antibiotics of penicillin and gentamicin, known as pen and gent, which were administered by injection. Now we added stronger antibiotics to fight the infection. A day later Ebony was picking up again, and once more we heaved a sigh of relief. She was a fighter.

  The following day we had a new patient arrive, a very small rescue pony called Tinker. He was a friendly little chap, only twelve hands high, dark brown with a white streak down his nose and white socks. Tinker had been rescued by the RSPCA after being found in a pretty poor condition, badly underweight and neglected. Now he had a new family, young mum Molly and her two small children, and with his new family’s love and kindness he was gradually being restored to good health.

  Tinker had come in with a lump on his face that was clearly bothering him. Poor Molly was dreadfully worried, and it worried all of us, too. You can’t see a lump on an animal without being concerned that it could be cancer. He needed a CT scan, but he was so small that he had to be propped up on wooden blocks so that he could reach his head into the scanner. To everyone’s relief, a scan confirmed that the lump was a tooth abscess. Very painful for poor Tinker, but not life-threatening.

  The operation to remove his infected tooth was one that could be done with him sedated but conscious. Tinker was Grace’s case, so she was helping with the surgery while I stroked his neck to reassure him. It’s not easy to extract a large horse tooth that is tightly wedged between two others, so loosening it with a clamp took over an hour. Thankfully, as Grace wriggled the large clamp back and forth, Tinker was so heavily sedated that he was barely aware of what was going on, and eventually his tooth was safely removed, fully intact. Tinker was brilliant throughout, and after the op he was led back to his stall to recover and given antibiotics to deal with the abscess. He made a full recovery and went home a couple of days later with a very happy and relieved Molly.

  The following week I switched to the night shift. This meant arriving at six in the evening for rounds; the hand-over from the day staff. All staff on both shifts ha
d to be present, which meant it had to be delayed until anyone still in surgery was finished. During rounds the day student in charge of each case would present it, giving us an update on the horse, its condition and any treatment or care it would need overnight.

  Nights tended to be quieter; we had regular checks to do, but, apart from one or two emergencies, the five of us spent a fair bit of time watching movies, eating popcorn and playing with Grace’s video diary. ITN Productions had given it to her to record the goings on of the night, as understandably they didn’t want to sit with us from 6pm to 7am, waiting for something that might or might not happen. The idea was for Grace to record how she was feeling, and a bit of the action, but we ended up filming through a window, with one or two of us on the other side, pretending to go up and down stairs, or up and down an elevator. It was a lot of fun, until Grace handed back the camera a few days later and we realised that it could potentially appear in a BBC show that millions of viewers could watch.

  Ebony was still with us in the stables and making steady progress. I went in to do her checks, which were now less frequent and to give her a nuzzle and have a chat. She was still being a picky eater, rejecting haylage that was more than a day old and preferring fresh grass, but that was fine, I was happy to nip out and pick a bucketful for her.

  A couple of days into my night-shift week I learned that Ebony was going home the next morning. On the day, her owner arrived bright and early with the horsebox to collect her and we all came out to see them off. I gave Ebony a hug; I was truly happy that she had recovered – I knew that she would make a fine show jumper – but I was going to miss her.

  On my next shift a little Falabella horse called Poppet arrived. Falabellas are the tiniest of all horses, perfect little creatures, sleek and compact, very like Shetland ponies but even smaller. Originally bred in Argentina, they’re now found around the world. They’re too small to be ridden, but they’re popular as show horses and as pets.