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A Visit to NEE

Published: 2/10/2011
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By Maddy Butcher Gray

When a farm call won’t suffice, who you gonna call?
For many around here, the call is to New England Equine Medical and Surgical Center in Dover, New Hampshire.
That’s where I headed last month with a client’s horse. She had several health issues requiring close examination: a chronically problematic eye as well as lameness and wellness issues we suspected were linked to the eye. And then there were some equivocal Lyme tests and poor blood test results to consider.

Through emails and phone calls to NEE, we arranged for her to make one trip to see three specialists.
First, she saw Dr. Nick Cassotis, an eye specialist. His primary practice is with small animals, but he focuses on horses at least once a week.
After examining her and discussing her history, he described his diagnosis: chronic recurrent uveitis, lens luxation, secondary glaucoma, blindness. He said  leaving the eye in and treating it daily with drops (as we had been doing for months) would not improve her condition. Indeed, he felt the diseased eye was negatively impacting her overall wellness.
We related Cassotis' findings to the horses’ owner (who was out-of-state). It was decided that she'd return for eneucleation, to have the eye removed.

[Scroll down for a detailed explanation and description of uveitis.]

Next, she saw Dr. Omar Maher who specializes in lameness. X-rays were taken of her front feet and flexion tests were performed.
These procedures confirmed the presence of arthritis, navicular disease, and showed that one of her front hooves was out of balance and would require corrective trimming.
Maher also elaborated on ways to keep her comfortable without dosing her with Legend and Adaquan, an expensive strategy we had tried for several months.

Dr. Jackie Bartol reviewed her past blood work and helped us look at the Big Picture. We agreed that the uveitis could be impacting her overall well-being. She suggested that things could improve systemically with the eye removal.

The following week, I hauled her back to Dover for the surgery. We arrived in late afternoon so she could settle in before the next morning’s appointment. The poor mare grows no winter coat and I’m sure she appreciated the 50 degree, climate-controlled stalls!

I was looking forward to observing the surgery.

Alas, another big winter storm made that a dodgy prospect. I stayed home and shoveled. But I had several comforting and informative conversations with NEE staff before and after the surgery.
All went well and the procedure was delightfully uneventful, they told me.

One of the technicians had given me a tour of the operating room and reviewed the procedure and protocol with me while I was there the previous week.
The mare was sedated in a densely padded stall. Unlike most field sedations, NEE sedates so that the patient will go down completely.
While she was lying down, the surgical team attached padded cuffs around her fetlocks and hoisted her onto the operating table.
The surgery itself lasted less than an hour. The eye was removed and sent in its entirety to be biopsied. Then the horse was lifted off the table and placed back in the padded stall to recover and wake up from the anesthesia.

I picked her up the next day. She looked uncomfortable and unhappy. We all felt this was pretty normal. Who wouldn’t feel crappy after having an eye out?

I loaded her up for the two and a half hour ride and hauled her home. She was thrilled to see her Shetland buddy and be back at her own barn. Over the next day, her spirit and appetite returned to normal.
The mare received excellent care at NEE. I’m grateful to the vets and technicians who treated her so well. The visits did not come cheap though. The final tab from Dover, including the operation, x-rays, and three vet consultations was about $4,000.

I asked Dr. Nick Cassotis about the instruments he used to examine my client’s horse, since I’d never seen them.

He writes:

I used a Slit-Lamp Biomicroscope and a Binocular Indirect Ophthalmoscope.  The first instrument allows for the identification of microscopic lesions within the eye's structures.  It has different settings to vary the amount of magnification between 10 and 16x.  It also has the ability to change the way the light enters the eye allowing for identifying the depth of a particular lesion.  
An example of this would be understanding if a lesion in the cornea is present at the surface (epithelium), the middle layer (stroma), or the deep layer (endothelium).  These differences are otherwise difficult in a tissue that is less than one millimeter in overall thickness.

The indirect ophthalmoscope is the headset that I wear for examining the posterior structures of the eye, specifically the retina and optic nerve head.  The headset allows for a three dimensional view of the structures and the hand held lens I use varies the magnification.  This is different than the Direct Ophthalmoscope that many folks are used to seeing veterinarians use that is held up to just one eye.  The benefit of the Indirect Ophthalmoscope is that it gives an overall view of the retina so that a small area of concern is not overlooked.  The retina is evaluated for structural changes that would in turn indicate or raise suspicion for a particular disease process.  This is how glaucoma, moon blindness, cancers, nutritional and neurologic diseases are discovered.

Another instrument I used during the ophthalmic examination is the tonometer.  Ours is called a Tono-Pen.  This lightly touches the anesthetized cornea and allows for the recording of the pressure within the eye.  This is useful for understanding uveitis and glaucoma.

Very cool, huh?

I found this helpful uveitis description at For the Love of the Horse:

Uveitis is a disease involving the inflammation of the uvea of the eye. The uvea is the membrane that surrounds the eye, serving as a barrier to protect the sensitive tissue, inner chambers, and surfaces of the eye from pathogens carried through the blood. Inflammation disrupts this barrier and is the instrument that progresses this disease from initial damage to blindness.

Uveitis can be caused by:

    * blunt or penetrating trauma to the eye
    * corneal ulceration
    * parasitic infiltration
    * systemic infections

If there is trauma to the eye and a cut or scratch occurs, this can be enough to set off a local infection leading to unchecked inflammation. Corneal ulcers caused by fungi or bacteria can reach deep into the cornea and induce uveitis.

View Reader Comments:

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2/11/2011 Andrea
Great article!!
2/11/2011 Missy
Yes, great article. Thanks, Maddy. healing thoughts to the mare. Uveitis, like teeth and feet problems, can affect the entire body. Great story.
2/12/2011 sonia
This is an excellent article, Maddy! Thanks for sharing. I hope the mare is fully recovered now.
2/12/2011 Vince Mahany
Thanks Maddy, Great article, very informative.
2/14/2011 Sara Bell
Excellent article! I had the pleasure of doing an advanced pharmacy rotation at NEE this fall. Your impressions are spot on, they are a fabulous group of people and the horses they treat are in the best of hands. Good luck to the mare!

"A canter is the cure for every evil" - Benjamin Disraeli, The Young Duke