Lumpectomy

The previous post reminded me of a recent case at work, I'll share pictures knowing a few readers may be interested. Others won't enjoy, so Di, you may want to skip this one.

The bulbs these Lily sprouts emerged from, oddly resemble.........

The tumor sprouting from this cute guy's head! Am I right?

He is an older fellow and the owner was concerned about surgery at his age, but when the ugly mass grew large enough to droop over his eye and began to ooze, she agreed surgery was the best option.

The area was shaved and prepped for surgery.

The lump was successfully excised.

........skin opposed and sutured.

And this sweet old boy recovered rapidly and is doing quite well.

Good news, the tumor was benign, not malignant.

Warning: Laceration Repair

Yesterday I shared the humor of watching horses frolicking in play. Following my 'just keeping it real' theme, I'm showing the real life results of two 1000# hoofed creatures playing their rearing, pawing, striking and biting at one another horse games.
Not to point any fingers but my patient here is poor old Remington and from yesterday's pictures you all know who his favorite playmate is.
Actually, we didn't see the insult occur. Late one night, several days after our return from Michigan, Jerry mentions that he saw blood dripping down Rem's face, the night before.... Excuse me? Last night? Well, we all know that when a horse is walking soundly and gobbles his food down as usual, we tend to forget things like blood trickling (pouring) down a face. Right? I get that. And as a very understanding wife, I hardly made any audible rude remarks about letting him (the cowboy) bleed for 24 hours if he ever got sliced, or cut, or stabbed. So, late at night we go out to the cold dark barn, sedate the horse, use buckets of warm water to wash all of the crusty dried blood off of his face, shave away all the the dirty surrounding hair and get a good look at the source of the blood.




Ugly, yes? You can't tell from the picture but the laceration was mainly the shape and size of a horse hoof. Yes, and there is one gelding living here who likes to play like is a wild stallion, standing tall on his hind legs and pawing the air with his forelegs.

Jerry's firm grip on the ear is to keep Rem's head steady, even sedated, he would try to shake his head with any touch to his forehead. The laceration was quite deep in the center, the area was contaminated with ground in hair, and the edges of skin had already started to contract. Ideally, when suturing a wound, you want a fresh, minimally contaminated surgical site. We weren't getting that.

Lots of scrubbing, trimming damaged skin edges, and attempts to closely oppose the skin margins led to a less than ideal laceration repair. There's not much extra skin on the forehead of a horse. Not at all like a cat or dog with so much extra skin you could make a whole new pet.

The finished result was quite disturbing to me. It will heal more rapidly than leaving it open to heal, but infection is more of a worry when a contaminated deep wound is closed, and it just was an ugly repair.

Most sutures can be removed in 10-14 days. I kept him on antibiotics for a while, twice daily scrubs, and didn't remove the sutures for 4 weeks. They could have been removed in 3 weeks, but you know, when a horse is walking soundly and gobbles his food down as usual, we tend to forget things like sutures. Right? You understand that.

So here is Remington on Jan. 31st, showing just a wee bit of a scar. Once his hair grows back and he looses that goofy pony tail, no one will ever know. Except us.

See, not bad for a bald guy. If anyone asks, maybe I'll claim to have done a little brain surgery.

Naw, horse people would never believe that, as much as we love them, they don't have much in the way of...... um never mind.
Happy Healthy Trails.

Surgery Part 3, The Final Chapter

I hope that this is the final surgical post for Wrangler, don't know for sure though.
I have grouped the wounds separately to demonstrate the healing process. Some of it isn't pretty. Di, that is nice for meaning, 'some look gross'.

The first photos are the lacerations as I first saw them. Followed by the surgical views. Next I have included pictures taken five days after surgery. The final picture in each group was taken twenty five days after surgery.


This is what greeted our eyes after removing the first leg bandages.



Cleaned up and sutured as well as I could with what I had to work with.

Five days later, half the sutures have pulled out and pus is oozing. Plan: Continue bandaging, scrubbing and twice daily antibiotics.*sigh*

Twenty five days later, the leg no longer needs wrapped and I discontinued antibiotics. Healing, the skin will slowly cover the wound.

Once more, the icky left shoulder.

Sutured closed, not so yucky looking.

Five days post surgery the sutures under the greatest tension have pulled loose. They lasted a few days longer than I thought they would. Provided some protection from dirt and flies while some deep healing began. Continued daily flushing, scrubbing, and fly spray!

And twenty five days later, the deep defect has closed, no sign of infection and it is just a matter of time for the skin edges to close.

The healing right shoulder on the first day, after being cleaned.

Five days later, can you appreciate how much the defect is filling in? Looks good so far.

And again, twenty five days after we got Wrangler the right shoulder looks nice but there will be scarring.

This view of Wrangler's chest taken 25 days after surgery shows both injuries and just how much improvement has taken place.

Twenty five days is a long time to be doctoring, medicating, washing, and bandaging a horse. He and I are both weary of it. I am ready to be done with it.

For several days prior, I have been turning Wrangler out in pasture for some exercise, first by himself and then one at a time with Rock and Remington who are gentle pasture mates. They did great together.

They have gotten to know one another in the barn also, by being in neighboring stalls for meals.

Questions have been asked about how or why this silly colt suffered so many injuries. He can see quite well, we wondered about that too. I got out the ol' eye chart and he has 20/20 vision. Well... not really a chart, just some little obstacles and watching how he sees and reacts to tiny things visually. He is a very passive colt around other horses, this puts him as low ranking horse in the herd. The dominant herd 'boss' will often pick on the wimpy horse. That is what was happening at his other home. It was a very steep, very thickly wooded pasture with dense stands of Manzanita. We believe the alpha horse there was chasing, harassing and running him into things. He is not a clumsy colt, I have watched him gallop, spin and slide to a stop in our pasture.

So we hope that here at his new, safe , loving home, he will never be injured again.

That is a Fairy Tale Ending!

I turned all four horses out in our pasture soon after I took those twenty five days after surgery pictures where you can see all of his injuries healing so beautifully.

Cheyenne our herd boss, or call him BULLY, ran and ran and chased and bullied that poor colt right into the fence.

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Daughter came out, looked, said,"I told you we should call him Johnny Gash".

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Fresh laceration right across the center of his chest. How insane is that!

More surgical repair. This time it was fresh enough and an ideal location for staples. Quick.

I promise you, no more bloody injury pictures of this horse. I can't promise he won't have any more bloody injuries, but I'm not sharing. Plus look at all of that white hair, why would anyone want a white horse? Blood red just shows up much too clearly. I like sorrel horses so much better.

Surgery Part 2 : Shoulders

This will be quick. I am working out of town, in my hotel room and about to fall asleep. I want to continue sharing Wrangler's surgical pictures while I'm in 'the big city' and am enjoying amazingly rapid image uploads on my computer! Plus, I am certain everyone is sitting on the edge of their computer chairs, anxiously awaiting the rest of the story......

Right shoulder initial appearance.

Same area as first photo, minus dirt and discharges. I love soap and water. The skin margins look good, nice healthy bed of granulation tissue with no sign of infection.

This picture gives you an idea of how large the wound was. His previous owner thought he had caught it on something. A large, deep flap was ripped away, hanging by a small section of skin. She trimmed it off and had been cleaning the wound and applying antibiotics. It was too large an area to suture and was actually doing quite well. Horse anatomy prevents successful bandaging of injuries on shoulders.

Left shoulder appearance after scrubbing. This colt doesn't always look so dopey, and he wasn't even enjoying the benefits of drugs yet.

This laceration/puncture wound was several days old. An ugly deep gash through skin and muscle layers creating a deep pocket, perfect for collecting pus and dirt, inviting colonies of bacteria to come live and reproduce.

See the plastic piece below the laceration? I had to create an exit and insert the drain to allow continual drainage of the unwanted fluids produced by the body. This was followed by liberal flushing, scrubbing and cleaning out debris. I discovered the cause of this injury.... my probing exposed the end of a branch embedded deep in the muscle. Looks like he impaled himself on a tree, at high speed I am guessing.

The next step was to trim away the dead and damaged skin and muscle. Blood is good, it lets you know you have reached tissue with adequate blood supply.

Remember blood is good.... I closed this in several layers. The deep muscle was sutured with suture material (we don't call it thread) that will be absorbed by the body over time. The skin layer was closed with suture material that doesn't dissolve.

Surgery complete. Finally.

There was more tension on the sutures than I liked, but that's the way it goes. The drain stays in for several days, the area will be hot compressed and flushed at least twice daily. There are medications to give and flies to repel. After washing twice daily, the entire chest is covered with a light film of Bag Balm or Vaseline to protect Wrangler from the draining body fluids, which will irritate the skin, cause hair to fall out and promote skin infection. I refer to this as serum scald.

Wrangler behaved wonderfully and cooperated more than I expected through the entire ordeal of twice daily treatments over the next month.

The next installment will document the healing process. Are you yawning yet? I am, good night and sweet dreams.

Surgery Part 1

I hadn't seen the knee injury yet, Wrangler's leg was wrapped when we picked him up and I wasn't sure what would be found under that bandage. I didn't have to sedate him for the unveiling, he stood quietly as I unwound that first layer. The second layer, closest to the skin was stuck to his leg with dried blood and serum, a bit uncomfortable for him until I soaked the bandage with warm water to soften the adhered gauze and was able to slip it off almost pain free.




The following picture shows the condition of Wrangler's knee and leg injuries after the bandage came off. Skin edges dried, flaps of skin hanging barely attached, and underlying tissue exposed.


These injuries needed thorough cleansing before I could further evaluate and make a plan for repair. He stood better than I expected for the water flushing of his leg, just a little dancing around and nervousness.

Another look at the leg after hosing. A large chunk of skin missing and when he flexed his leg it gaped open even wider. Both lesions look deep and I was worried about joints and tendons being involved. Infections involving those structures in horses can be very bad news.
The next step was to sedate the colt. Standing sedation; the result is a calm, quiet patient who feels little pain. I further reduced the pain factor with injections of local anesthesia right into the area I'd be working in.

My photographer apparently took a break and didn't get photos of my gloved fingers deep under his skin.

The unknown force causing this trauma not only ripped away portions of skin, it also pulled away large areas of attachments of skin to the underlining tissue, leaving large pockets. As far as I could determine, the joints of the carpus and the tendons near the lower area were not involved.

My concerns were infection, closing the defects and minimizing motion of the leg. The lower laceration would be fairly simple to close, not much skin was missing. The upper one was more of a challenge. There is a limited amount of skin on a horse leg, and with this particular injury, there was much more area to cover than there was skin left to cover it. Complicating that concern was the fact that I had to trim away, or debride, the wound edges that were already dry and black, dead tissue. I scrubbed the entire area with surgical scrub and multiple flushes.

A very vascular area, there is quite a flow of blood as skin edges and destroyed tissues are trimmed. My daughter-photographer resumed photographing and I have scores of very artistic bloody horse leg pictures.

Suturing the lower laceration first.

suturing...... attempting to 'close' the upper laceration.

suturing...... completed. As you can see, I was unable to cover the entire area with skin, which provides the best healing, but was not possible. Things are just kind of tacked together as best I could. Disappointing results but better than leaving open and loose.
For some reason my photographer was really into blood and drips and clots.

Reminds me of a story: When I moved back to Michigan and started a mobile Equine Practice, my brother enjoyed coming along on my emergency calls. He's a faint hearted kind of guy when it comes to needles, blood and guts, so I still am not sure why he liked to come along. One particular emergency involved a horse's lacerated rear leg, bled lots, big mound of clotted blood on the gravel drive behind the horse foot. Brother says the big mound of clotted blood is gross so he kicks a bunch of dirt over it. Barn dog comes nosing around, finds big mound of dirt covered blood clot and dives in slobbering and smacking as he devours the mess. Brother starts gagging and retching and almost vomiting. I'm still laughing at him at this moment....

After hosing away the blood the leg looks much better. It will still take a long time to heal. Antibiotics twice daily to control infection, antiinflammatories to reduce swelling and pain medication. So much for my Free Horse.
Every time Wrangler moves the leg, the joint flexes, which puts additional tension on the sutures. A thick heavy bandage is applied and Wrangler will spend the next 3-4 weeks confined to a stall wearing leg bandages.
That's just the beginning, next I'll share the repair of Wrangler's shoulder.
Or maybe I'll share our dusty trails, camping and riding this past weekend.
Summer has gone by entirely too fast.
Good night.

Paint Colt

I'll be introducing our new colt over the next few posts. Those of you who do not like to look at surgery posts should skip the pictures. Some of the injury and surgical views are rather graphic.

This little two year old Paint gelding has had a rough year with multiple injuries. His previous owner asked us to take him due to personal hardships and he was constantly getting hurt out in her pasture with her other horses. He was also very green and not handled much.

I like a challenge and heck a free horse! I am well aware of the old sayings, 'Nothing is ever really free'...OR 'Never look a gift horse in the mouth'.

His registered name is the worst name ever thought up, so the previous owner had been calling him 'Rebel'. After a few days with him, we knew he wasn't a 'Rebel' and needed a new name, we all brain-stormed for a bit. I wanted something western. We already have 'Remington' and 'Cheyenne' and 'Rock'. I liked Tristan's suggestion of 'Hector', Jerry didn't, said it was a mule name. I loved Amy's suggestion of 'Johnny GASH'! We decided to skip it though because we don't want him to continue to live up to that name. Jerry wanted either 'Colt' or 'Paint Horse', ugh, give me a break Jerry! I started calling him 'Wrangler' and that seems to fit and it has stuck. So Wrangler he will be known as.

We have had him here a month now. He is as sweet as can be. He has spent most of his time confined in his spacious stall/corral while he heals. We have devoted much time on his injuries and I'll be sharing that here.

Dad, let me know how I measure up to Animal Planet. Kelly Jean, you may want to leave this post at this time, Di you too!

This was Wrangler's first day at his new home, one month ago. Here he is cleaned up, his injured leg unbandaged, the next step was sedation for deep cleaning, exploration and surgical repairs.
Now for some close-ups.

1) Right shoulder before cleaning. This was the oldest injury and was in the process of closing with granulation tissue. This is called healing by second intention. The skin edges are not brought together with sutures. The tissue defect fills in and then the skin edges grow until they cover the wound. It takes the longest to heal and must be kept clean and free of flies.

2)This is the right knee, his front leg. This joint is the carpus, same as our wrist. This injury was the most recent, only two days old. Surprisingly he wasn't lame, the wound was deep but did not enter any joint or tendon sheath. His owner had bandaged it right away so it was relatively clean and free of debris.

3) The wound on the left shoulder had happened a week prior. It was very ugly and deep. It was sore but he was good about being handled and wasn't lame on this side either.

After cleaning him up, I wondered what I had gotten myself into with this guy.

Next step, surgical exploration and repair, which took almost three hours.

to be continued............