Hindlimb Proximal Suspensory Desmitis Update

Hind limb proximal suspensory desmitis (PSD) is a common condition in sports horses and usually presents in one of three ways:

  • unilateral hindlimb lameness

  • bilateral hindlimb

  • no clear lameness but horse displaying rideability problems

PSD describes inflammation and / or damage to the upper region of the suspensory ligament at the top of the cannon bone where the structure mostly originates. Accurate diagnosis is challenging and requires careful interpretation of regional nerve blocking procedures, high quality ultrasound images of both the weight-bearing and non weight-bearing limb. Radiography should be carried-out to rule out co-existing bone pathology. Interestingly, low-field MRI which is the technology used in all the standing MRI units, is not very reliable for identifying suspensory pathology but is useful for picking-up more subtle bone lesions in the upper cannon bone region. Ultrasound scans can show enlargement of the proximal suspensory ligament, loss of fibre pattern and adhesions to surrounding structures.

Conservative treatment of PSD involving rest, medication and remedial shoeing is often not very effective.Unfortunately, surgery which entails removing a section of the deep branch of the plantar nerve and releasing the fascia surrounding the suspensory ligament is the only reliable treatment option giving a 70-80% chance of resolving the lameness providing any additional problems are also addressed; for instance around 40% of PSD cases are also found to have sacro-iliac pain. This essentially denerving surgery, should ideally only be performed on cases where there is minimal fibre disruption so that the structure of the ligament does not fail when it is subsequently, fully loaded post-surgery. This is particularly true for horses with a large hock angle i.e. those with a rather straight hind leg. Studies have shown that a hock angle of 165 degrees or higher is associated with an increased incidence of PSD. So next time you are contemplating a new purchase, take a protractor with you!

This large hock angle conformation predisposes to PSD

This large hock angle conformation predisposes to PSD

Equine Flu Vaccination Update

Since the equine influenza outbreak in February this year, the vast majority of horse owners have wisely had their horses vaccinated or have had boosters to raise antibody levels. As you will be aware many organisations and societies, including the BHA who run Britain’s horse racing, have insisted that horses entering licensed premises or competition venues have had a flu booster within the previous 6 months, assuming they have already had their primary course. So where do we go from here? We thought it would be helpful provide a summary of what is required by the various equine disciplines going forward;

Thoroughbred Racing: As from 17th September 2019, the BHA has relaxed requirements for all horses entering racecourses including runners from non-licensed yards e.g. hunterchasers, nonGB runners (including Ireland and France) and other horses such as ROR competitorsand pony racers. From this date, horses must have had a booster within the previous nine calender months (ideally within 8 months but they are allowing one months grace just to make things more complicated!). This 8 month booster rule applies once the horse has had a primary course of two injections given between 21 and 92 days apart followed by a third injection given between 150 and 215 days after the second injection. Horses are considered to be vaccinated and therefore are entitled to race, after they have had their first two injections but have not yet had the third. The BHA veterinary committee will continue to monitor the prevalence of flu and could change these new requirements if they deemed necessary.

British Eventing: No Horse may take part in a BE National Event (which includes entering competition stables) unless it has a current vaccination against equine influenza which complies with the following conditions:

  • Two injections for primary vaccination, not less than 21 days and not more than 92 days apart, are required before being eligible to compete;

  • A first booster injection must be given within seven months after the second injection of primary vaccination;

  • Subsequent booster injections must be given at intervals of not more than one year, commencing after the first booster injection;

  • The most recent booster injection must have been given within the six calendar months prior to the horse arriving at the competition.

Forgotten passport. Any horse without a passport will be sent home (plus travel companions).

Unvaccinated companion horse. Passports and vaccination records in accordance with the new rules must be carried for all horses on board any vehicle. Any horses without passports and compliant vaccination records will be asked to leave the site, along with any others which they may have travelled with.

Booster given within seven days of the Event. This is fine. As long as the vaccination was given at least the day before the horse arrives at the Event, and is not more than one year after the previous booster. (see Rule 10.2.4)

Only primary course given. This is fine, as long as the horse has had the first two injections that make up the primary course, and the second injection was given within the last six months.  

Primary course given, but first booster (due within seven months) has not yet been given. Fine if second injection was less than six months ago.

Historical discrepancies (ref: rule 10.2.3). In cases where there are historical discrepancies (e.g. booster was given five days late in 2014), but the primary course is correct and the horse has had the most recent booster within the last six months, it will be at the discretion of the Vet and BE Steward as to whether the horse may compete.

British Show Jumping: Flu vaccinations are mandatory for all registered horses and ponies and they must be in possession of a valid flu vaccination certificate. It is the owner's responsibility to ensure that the horse's vaccinations are up to date and correctly recorded on the diagrammatic vaccination record. Spot checks will be regularly carried out at shows. The horse/pony must have received two injections for primary vaccination against equine influenza given no less than 21 days and no more than 92 days apart. Only these two injections need to have been given before a horse/pony can compete in competitions. In addition, a first booster injection must be given no less than 150 days and no more than 215 days after the second injection of the primary vaccination. Subsequently, booster injections should be given at intervals not more than a year apart.

British Dressage: Any horses competing under BD rules at any level must be fully vaccinated.Rule 9 (p58 of the 2019 Members’ Handbook) states: To protect the health of the other competing horses and the biosecurity of the venue, a valid passport must accompany the horse to all competitions and be produced on request. Failure to comply is a disciplinary offence and will debar the horse from competing at the event for which it has been entered. A horse will not be permitted to compete unless it has a current vaccination against equine influenza which complies with the following conditions:
- An initial course of two injections for primary vaccination, not less than 21 days and not more than 92 days apart, are required before being eligible to compete
- A first booster injection must be given between 150 and 215 days after the second injection of primary vaccination
- Subsequent booster injections must be given at intervals of not more than one calendar year, commencing after the first booster injection
- The full course or booster must have been administered at least seven days before the competition.
The vaccination record(s) in the horse’s passport, must be completed, signed and stamped line by line, by an appropriate veterinary surgeon (who is neither the owner nor the rider of the horse).

The 2020 Members’ Handbook will mandate six-monthly Equine Influenza boosters, instead of yearly vaccinations. If you’re currently outside the six month period from your last vaccination, we recommend you have a booster, but you may wait until your next annual renewal date to start your six-monthly vaccination. There’s no need to restart with an initial course, unless otherwise advised by your vet.

The requirement of 'the full course or booster must have been administered at least seven days before the competition' remains the same as in previous years.

Any horse found without adequate and up to date vaccinations will not be allowed to compete with BD and will be suspended until this is rectified.

FEI : All proprietary Equine Influenza vaccines are accepted by the FEI, provided the route of administration complies with the manufacturer’s instructions. An initial Primary Course of two vaccinations must be given; the second vaccination must be administered within 21-92 days of the first vaccination. The first booster must be administered within 7 calendar months following the date of administration of the second vaccination of the Primary Course. Booster vaccinations must be administered at a maximum of 12 month intervals however horses competing in Events must have received a booster within 6 months +21 days (and not within 7 days) before arrival at the Event. Horses may compete 7 days after receiving the second vaccination of the primary course. Horses that have received the Primary Course prior to 1 January 2005 are not required to fulfil the requirement for the first booster ( 7 month ), providing there has not been an interval of more than 12 months between each of their subsequent annual booster vaccinations.

Pony Club: A valid passport and vaccination record:

must accompany the horse/pony to all events

must be available for inspection by the event officials

must be produced on request at any other time during the event .

Subject to paragraph * below, no horse/pony may take part in an event (which includes entering competition stables) unless it has a Record of Vaccination against equine influenza which complies with the Minimum Vaccination Requirements.

The Minimum Vaccination Requirements for a horse/pony are:

(a) if the current vaccination programme started BEFORE 1 January 2014 that it has received:

a Primary Vaccination followed by a Secondary Vaccination given not less than 21 days and not more than 92 days after the Primary Vaccination; and

if sufficient time has elapsed, a booster vaccination given not less than 150 days and not more than 215 days after the Secondary Vaccination and further booster vaccinations at intervals of not more than a year apart

PROVIDED THAT if all annual boosters given AFTER 31 December 2013 have been given correctly, any error with the first booster vaccination or an annual booster given BEFORE 1 January 2014 may be ignored

(b) if the current vaccination programme started AFTER 31 December 2013 that it has received:

• a Primary Vaccination followed by a Secondary Vaccination given not less than 21 days and not more than 92 days after the Primary Injection; and

• if sufficient time has elapsed, a booster vaccination given not less than 150 days and not more than 215 days after the Secondary Vaccination and further booster vaccinations at intervals of not more than a year apart.

The Record of Vaccination in the pony’s passport must be completed by a veterinary surgeon, signed and stamped line by line

No horse/pony whose latest booster vaccination is more than 14 days overdue may take part in a competition under any circumstances.

*Notwithstanding the above in cases where the Event Veterinary Officer, following consultation with the Pony Club Steward, is satisfied that the presence of the horse/pony at the event does not pose a threat to bio- security at the event, that horse/pony may nonetheless take part in the event on such conditions as the Event Veterinary Officer considers appropriate, but the circumstances must be noted on the certificate. Any horse/pony allowed to compete under this discretion must be re-vaccinated to comply with the Minimum Vaccination Requirements and the certificate duly completed before it is eligible to compete again.

No pony may compete on the same day as any relevant vaccination is given or on any of the 6 days following such a vaccination.

Clearly, many Pony Club activities take place at venues used for other equine disciplines and therefore such venues may have in place, more stringent rules regarding Equine Influenza vaccination. Many local venues are requesting that horses and ponies must have had a booster within the previous 6 months prior to competing and often that injections must not have been administered during the previous 7 days. Racecourses now require that boosters must have been given within the previous 9 months, so there is lots of scope for confusion. If in doubt and you use many different venues, it is prudent to adopt the 6 month booster strategy to avoid problems.

British Riding Clubs: This rule applies in respect of any horse or pony which competes in a BRC Area Qualifier and Championship. Section 2 20 BRC MEMBERS HANDBOOK The horse or pony must have been vaccinated against equine influenza by a veterinary surgeon who is not the owner of the animal, in accordance with the following rules: The horse or pony must have received a primary injection followed by:

• a second primary injection which is given not less than 21 days and not more than 92 days after the first

• a first booster injection which is given not less than 150 days and not more than 215 days after the second primary injection

• further annual booster injections at intervals of not more than a year apart.

If the current vaccination programme started AFTER 1 January 2014:

• the first two primary injections must be correct i.e. the second given between 21 and 92 days after the first

• the first booster must be given between 150 and 215 days after the second primary injection

• all annual boosters must be correct. However, any errors with first booster (which should be given 150 – 215 days after the second primary injection) or annual booster given BEFORE 1 January 2014 may be ignored provided that:

• the first two primary injections are correct i.e. the second given between 21 and 92 days after the first

• all annual boosters given AFTER 1 January 2014 are correct. Leap years will be ignored for an annual booster, but for the two primary injections and first booster injection, the days must be counted and therefore a leap year would interfere with the correct number of days between injections.

Horses may compete at BRC Competitions providing that they have had the first two primary injections. No injection should have been given on any of the 6 days before a competition or entry to championship stables. For example: if the horse is vaccinated on the Monday, the horse will not be eligible to enter championship stables, or compete until the following Monday.

In the event of failure to comply with any of the requirements of this rule, the horse or pony will be disqualified and not permitted to take part in any competition to which these rules apply.

Checking of Passports and Equine Influenza Records; horses must be presented in a bridle to the flu vac checker at Championships and where applicable Area Qualifiers. For the purposes of determining whether the requirements of these rules have been met, the following documents must be available for inspection in respect of a horse or pony which is taking part in a BRC Area Qualifier or Championship.

• any passport issued for the horse and

• the full vaccination records for the horse if this is not contained in the passport

The identification of the horse or pony must be checked against that contained in the passport or on the flu vaccination record. This may be done from the diagram and description of the animal or by microchip providing that the microchip number has been recorded in the passport or flu vaccination record.

Nail penetration of the sole

Recently we have had a couple of cases of nail penetration of the foot which highlighted the potential risks of this injury and the need for immediate correct treatment. Excellent knowledge of the anatomy of the foot is crucial to understand where a penetrating object can reach and why the consequences can be so serious.

Sagittal section through the hoof, the pointer is marking the position of the navicular bursa.

Sagittal section through the hoof, the pointer is marking the position of the navicular bursa.

As you can see from the image above, a nail penetration in the direction of the pointer will pass through the digital cushion, the deep flexor tendon and into the navicular bursa. Inevitably the nail will introduce dirt and bacteria into these sensitive areas. If navicular bursal penetration is not treated immediately, the structure will become chronically infected and ultimately the horse would have to be euthanased on welfare grounds. So accurate evaluation of the injury is vital to ensure that the correct treatment options are employed. If possible, we take x-ray images of the foot with the nail in situ so that we can appreciate its trajectory. Often, however, owners have already removed the nail prior to calling the vet. In these cases, after thoroughly cleaning the sole, we attempt to introduce a metal probe into the hole left by the nail so that we can see that on our x-ray instead. We can also inject a radio-opaque dye into the hole which shows up on x-rays and helps us assess the extent of the penetration. MRI is another option, if readily available, to evaluate which structures have been compromised

Probe inserted into nail penetration tract .

Probe inserted into nail penetration tract .

The radiographic image above is from one of our recent cases; it shows the nail will have penetrated through the digital cushion and the deep flexor tendon and will therefore have introduced bacteria close to the navicular bursa.This horse was extremely lame. The foot was prepared with a rasp and hoof knife so that all loose tissue was removed. The whole foot was then dressed in iodine-soaked bandages for an hour prior to being taken to surgery. Under general anaesthesia the penetrating tract through the frog was explored and enlarged so that the digital cushion and deep flexor tendon could be flushed with sterile saline under high pressure. The arthroscope was then introduced via a portal in the pastern region, down into the navicular bursa. This structure was explored for signs of penetration, which fortunately had not occurred in this case, and was then flushed using an exit portal. Antibiotics were then deposited into the bursa. If there had been penetration of the bursa, then flush fluids would have found there way out through the frog wound, this obviously didn’t occur in this case. At the end of the surgical procedure the foot and the lower limb were dressed very carefully with sterile protective dressings. These cases are put on high doses of strong broad-spectrum antibiotics for a minimum of five days. With this case the recovery has been uneventful and following two weeks of dressings, the foot was then fitted with a shoe and hospital plate which allows us access to the frog region to regularly inspect the healing frog wound.

Shoe fitted with a hospital plate to allow access to the healing penetration wound in the frog.

Shoe fitted with a hospital plate to allow access to the healing penetration wound in the frog.

The second of the recent cases involved a nail penetration in the cleft of the frog just in front of the site of attachment of the deep flexor tendon to the pedal bone. The nail had been removed by the owner and so after thorough cleansing, a probe was introduced into the hole to establish the trajectory . Luckily although it went down to bone, it was heading forwards and so missed the tendon, but only just! With this case, the hole was opened-up to aid flushing and to provide a drainage route for any pus. The foot was poulticed for two days then dressed with iodine soaked bandages. This horse was put on the same broad-spectrum combination of antibiotics and no pain relief was allowed so that the horse’s true level of comfort was known. His recovery was straightforward. It is absolutely crucial to make sure that these patients have been vaccinated against tetanus as they would be nailed-on (excuse the pun) to get it otherwise. If in doubt, tetanus antitoxin should be given to provide immediate cover.

So in summary, if your horse is unlucky enough to suffer from a nail penetration of the foot, call us straight away and try and resist the temptation to remove the nail!

Calcaneal Bursoscopy

On the 10th of July this year, a 10 year old brood mare was referred to us by another practice for swelling and heat in the calcaneal bursa area of the right hind (at the back of the hock). She was very lame (4/5) and painful on palpation of that area. There had been history of a tiny wound on the inside of the hock but when she came in, there was no evidence of open wounds. 

When she arrived, the mare was sedated for a thorough ultrasound scan of the hock area, which showed evidence of severe inflammation of the sub-tendineous calcaneal bursa. This bursa is located between the superficial flexor tendon, the gastrocnemius muscle and the calcaneus, it prevents the tendon from rubbing against the bone surface.

This is a pathology that should be taken very seriously, especially in the chronic stage. The prognosis is guarded and aggressive treatment is required in order to acquire healing. We decided to perform bursoscopy in order to flush the calcaneal bursa so that the inflammation could settle and the pressure would be taken off the surrounding tissues. We also performed IVRA (intravenous regional antibiosis) in the affected limb during surgery. In order to do this, a tourniquet was placed above the hock and antibiotic was injected into the metatarsal vein. By leaving the tourniquet in place for 10-15 minutes, the antibiotic can diffuse locally and obtain high concentrations at the infection site.

The surgery went very well and the mare is sound after about a month of recovery despite the poor prognosis.

On this ultrasound image distension of the bursa is visible, containing strands of fibrin

On this ultrasound image distension of the bursa is visible, containing strands of fibrin

On this image you can see the difference between the affected bursa (right hind) and the normal limb (left hind). On the image of the right hind the superficial flexor tendon is visible at the top of the image and the gastrocnemius tendon is visible at the bottom, separated by the droplet shaped inflamed bursa.

On this image you can see the difference between the affected bursa (right hind) and the normal limb (left hind). On the image of the right hind the superficial flexor tendon is visible at the top of the image and the gastrocnemius tendon is visible at the bottom, separated by the droplet shaped inflamed bursa.

Bursoscopy image from during the surgery looking inside the calcaneal bursa. The red fibrous aspect of the inside of the bursa is an indication of severe inflammation.

Bursoscopy image from during the surgery looking inside the calcaneal bursa. The red fibrous aspect of the inside of the bursa is an indication of severe inflammation.

Bursoscopy image where you can see the fibrous/flaky content of the inflamed bursa. This was debrided and flushed out.

Bursoscopy image where you can see the fibrous/flaky content of the inflamed bursa. This was debrided and flushed out.

Anatomy of the hock of the horse. “calcanean bursa” indicates the subtendineous bursa we performed surgery on (situated between the superficial flexor tendon and the gastrocnemius muscle.

Anatomy of the hock of the horse. “calcanean bursa” indicates the subtendineous bursa we performed surgery on (situated between the superficial flexor tendon and the gastrocnemius muscle.

Gastroscopy Follow-up

On July 9th, we published some images relating to a patient that had been diagnosed with both squamous and glandular stomach ulcers but had not shown any clinical signs whatsoever, highlighting the policy of routine gastric screening in horses. Untreated ulcers, as well as being extremely painful , can lead to perforation of the stomach wall , peritonitis and death, so we take them very seriously!

Thankfully the horse mentioned in the previous blog responded well to treatment with omeprazole (Peptizole) to reduce gastric acid production, coupled with sulcralfate which coats the stomach wall to protect the damaged tissue. He was re-scoped yesterday and the images are seen below:

This image shows the junction of the squamous and glandular regions, now with no ulceration.

This image shows the junction of the squamous and glandular regions, now with no ulceration.

IMG0002.jpg

As can be seen, this horse has responded well to our normal treatment regime but not all patients do so well. A recent review article in Equine Veterinary Education by B W Sykes, highlighted the fact that around 15 to 30% of squamous cases and up to 75% of glandular ulceration patients fail to respond to normal treatment. It is postulated that there may be marked variation in individual’s uptake of omeprazole and this can be affected by the timing of drug administration and feeding strategies. For instance, we advise generally that ulcer patients have ad lib fibre but Sykes suggests that omeprazole uptake will be more optimal if given after a period of fasting i.e. first thing in the morning when hopefully the horse finished his late in the evening and also around 60-90 minutes before giving sulcralfate which in coating the stomach wall, will affect omeprazole uptake. The slow-release intramuscular omeprazole injection should definitely be considered if oral dosing is proving ineffective. Work is also being done to evaluate an alternative proton pump inhibitor to omeprazole, called esomeprazole. Studies have shown that this new drug produces more pronounced suppression of gastric acid at lower dose rates than omeprazole.

The importance of Gastroscopy

Two weeks ago we discovered stomach ulcers in one of our patients by performing a gastroscopy. Interestingly the horse did not show specific signs of gastric ulceration. We decided to perform a routine gastroscopy since the horse recently moved yards and underwent a stressful journey. To our surprise we discovered quite severe glandular  (grade 3/4) and non-glandular (grade 2/4) ulceration (shown in the videos beneath).

==> in this video you can see the clear separation between the glandular part of the stomach (pink) and the non-glandular part (white/beige). The separation between the two parts is called the “margo plicatus” and this particular region is very prone to ulceration. In this horse you can see bleeding ulcers along the margo plicatus.

==> in this video you can see the “Pylorus”, this is the exit of the stomach towards the small intestine and is part of the glandular part of the stomach. Glandular ulceration is visible all around this exit (orange coloured).

 

Gastric ulcers can either cause obvious clinical signs such as: reduced or selective appetite,lethargy,  being sensitive to girth up, losing weight, colic (scraping, flank watching/biting) or yawning. Unfortunately the signs can also be very subtile such as: being of colour, losing condition, dullness of the coat, behavioural problems and more.

This condition is quite easily treatable with Omeprazole (for squamous ulcers) and Sucralfate (for glandular ulcers) for usually at least a month. Another important factor is the management of the horse. Reducing stress, giving multiple meals a day, ad libitum hay/haylage and a feed high in protein (13-14 %) are the main changes you can apply.

The horse will be re-scoped in a month's time to check whether the treatment has been success. An update will follow with the results.

Foal Wound and skin graft

A Progress update from the foal who tried to jump a fence.

The wounds remained closed for a few weeks, this was vitally important to keep to exposed bone covered and prevent sequester formation. Sequestration is where an area of bone dies and becomes like a foreign body in need of surgical removal.

The skin around the wound began to die back and the wound contracted - this is a normal phase of wound healing. Over the next month the foal underwent regular bandage changes. The wound took time to fill in and when it did there was exuberant granulation tissue - proud flesh.

Proud flesh is common in equine wounds, especially on the distal limb. It is treated by excising the tissue that is above (proud) to the skin - thus allowing the skin to epithelialise over the top.

In this case as the wound was so large, the decision was taken to take skin grafts from the neck and place them in the wound. These islands of skin promote skin growth over the top of the wound.

As you can see from the photos the wound is closing up well and in a few weeks we should have a completely healed leg.

As you can see from this last photo, there is a different texture to the tissue between the islands of graft - this is skin beginning to heal over the top

IMG_0048.JPG

Blackthorn Injury

Six weeks ago a hunter had a small cut on his leg after a days hunting. It all healed well with good hygiene and rest.

However, over the last few weeks it has been becoming swollen, discharging a small amount of pus and then going down again. Tim examined him this morning and saw an acoustic shadow on ultrasound scan indicating the presence of a foreign body. This afternoon the horse came into the Clinic and had a HUGE blackthorn removed.

All well in the end, and so lucky that the blackthorn didn’t penetrate any joint or tendon sheath.

Farewell to Ray

Tonight we are all raising a glass to celebrate the life of Ray Imberger MRCVS. Tim Galer attended a memorial service today at Our Lady and St Alphonsus Church, Hanley Swan, Worcs. to pay his repects to Ray along with many parishioners, friends and grateful clients. The Church was full to capacity and many people having to listen to the service outside. Ray graduated from Sydney Veterinary School in 1965 and came to England to develop his skills. He gravitated to Upton on Severn in 1968 and never left the area. Ray was an enormously popular man and a great vet with a close affinity for all the animals he treated. He will be greatly missed but never forgotten. Our thoughts are with his wife Trish at this sad time.

A severe wound

This horse was found in a neighboring field after having jumped across the fence. There was a deep wound to the left axilla (armpit) which went through several layers of muscle. After assessing the depth and severity, the wound was cleaned thoroughly, partially stitched closed and the horse started on antibiotics and pain relief.

Due to the area of injury there was no possibility of placing a bandage but with box rest to keep it clean and limit the amount of movement these injuries usually do very well. Over the next few weeks the outer tissue layers gradually died back (as expected) allowing the wound to heal by second intention.The deeper muscular layers healed very well. These injuries tend to look worse before they look better - but this is the body removing any dead and necrotic material to then be able to heal properly.

He is now back in work and doing well.

BEVA congress 2018

All three of our vets spent time at the British Equine Veterinary Conference at the ICC in Birmingham last week. This is an annual event over three days where lectures and workshops in all different aspects of equine veterinary medicine and surgery are presented by the world leaders in their respective disciplines. So rest assured our vets are all up to speed with the latest developments and ideas to keep your horses performing at their very best!

Liver Biopsies

Today we have had Professor Andy Durham in the Clinic, to scan and biopsy the liver of one of Emilie’s cases. The patient was one of a group of horses that have recently shown signs of liver disease or hepatopathy. The condition was diagnosed via a metabolic blood profile that we run in our lab here at Peasebrook. All the horses showed markedly raised liver enzymes. Hepatopathy is a reasonably common but very worrying condition, partly because it is very difficult to pinpoint the cause. The usual suspects are mycotoxins from feedstuffs other plant toxins or viral infection.

Fortunately, the liver has great powers of recovery following a toxic event so if the cause is removed, most animals will recover. Removing the cause, because it is difficult to ascertain, usually means changing grazing and feed. The biopsy is taken to assess the degree of inflammation and any more chronic pathology. This information allows us to instigate appropriate treatment as soon as possible. The ultrasound scan can identify problems with the liver and it shows the size of the organ but its main usage with these cases is to ensure the correct path of the biopsy needle so that we obtain a diagnostic sample. This is a skilled technique and so we get Andy to perform the procedure as there is nobody more experienced.

We will get the histology results in 48 hours and hopefully the prognosis will be favourable.

New website for Peasebrook

We are delighted to publish our new clinic website @ www.peasebrookequineclinic.co.uk Our previous website @.com was hacked last Autumn and still remains in the clutches of Russian robots it seems. We have learned a lot about cyber crime in the interim and the bottom line is that it's pretty difficult to do much about it, so be warned and make sure you are secure! What anybody wants with a second hand equine clinic website beats me, but it's a strange old world!

So our new site is totally run by us and is extraordinarily easy to play about with, Tim has largely created it, so it must be! We will be updating things regularly and posting stuff as often as possible.