Nashville

Dr. Kimberly Brokaw, DVM

(1/2014) Every year the American Association of Equine Practitioners (AAEP) has a large conference. About 3,000 equine veterinarians, vet techs, and others from the horse industry attend the conference. The conference provides over 90 hours of continuing education lectures; enough to meet the continuing education requirements required for veterinarians to renew their licenses. In addition to numerous learning opportunities, it is also a time to catch up with friends and share ideas and treatments with other equine veterinarians. As it also a social event, the location rotates every year to allow for veterinarians from different parts of the country to attend. Previous destinations for the AAEP conference have included Anaheim, Las Vegas, San Antonio. This year, Nashville was the site for the conference.

I'd decided that Nashville was close enough that rather than fly to the conference, I would drive down. While flying could have been faster, it worked out for the best that I drove. While at the conference, I talked with a vet who had her flight delayed because of the weather, and ended up missing the first day of the conference. Driving was the definitely the right choice. I would have been very frustrated if I had spent a large sum of money on a flight and hotel room, and then missed the first day of lectures.

Nashville is a very fun town with live music in every bar and restaurant. Nashville is also the home of the Grand Ole Opry. There was a lot to look forward to after the long days of learning. I attended numerous lectures on varying topics from neurology to anesthesia to lameness. A huge number of topics are covered at the AAEP conference, and most of the topics relate to general equine practice. After hours of lectures, I still found the energy to go out and enjoy music downtown. Every day I sent my boss text messages about new things I'd learned that he should know, as well as a poorly lit bar photo of some band, so he would feel jealous that I was having fun.

My first day back at work provided an opportunity to use some of my newly acquired knowledge. The horse, who I'll call Tennessee (yes I lack creativity) had injured his eye earlier in the week. The owners been diligently treating the eye every day, and while it had looked like it was getting better, suddenly it was swollen again. Frequently I will try to figure out the most likely diagnoses of a horse before I even get to the farm, based on what the owner has told me. This helps to ensure that I bring the correct medications with me and also is a good skill to develop for those times when an owner declines to have me come out to examine their animal but wants some advice over the phone. I arrived at the farm ready to do a thorough eye exam.

Tennessee is a 15 year old appaloosa gelding who, when one of my colleagues saw him earlier in the week, had a scratch on the cornea of his left eye. As the eye was more swollen, after days of seeming to improve, Tennessee's attentive and observant owners called me out to examine him again. In my mind I had decided it was likely one of two things. Either the scratch was getting worse despite the treatment or as Tennessee is an appaloosa, co-existing uveitis was likely.

Upon examination I noticed that the left eye was a bit swollen and was sensitive to light. Luckily the owners had kept a fly mask on which helped to protect the eye from the light. I applied some stain to the eye and noted that while the scratch was healing, it still wasn't fully healed. I also saw some inflammation in the eye. Using a technique I learned at the AAEP conference, I dilated the pupil by injecting a colic medication into the vein. This allowed for a more rapid and more thorough exam of Tennessee's eye, than I would have been able to do with just using the traditional eye ointment to dilate the eye. Not only was there a scratch on the cornea but also uveitis in the left eye. The right eye had a cataract and while the owners didn't recall any previous episodes of uveitis, the cataract was a likely sequela from that previous, unrecognized, episodes of uveitis.

I advised the owners that Tennessee would likely be more susceptible to uveitis flares for the rest of his life. However, they needed to make sure that they didn't just assume that any time his eye was swollen it was uveitis. The common treatment for uveitis involves putting an eye ointment with steroid in the eye. Using steroid in an eye that does not have uveitis can cause serious problems. Had the owners put steroid in the eye while the corneal scratch/ ulcer had been there, they could have potentially created a situation where the horse lost his eye. To further complicate matters, the tubes containing the two different ointments (one with steroid and one without) are practically identical. Owners must be extremely careful to use the correct ointment for the condition that they are treating. I took extra time with the owners to point out that while the two tubes look almost the same and in fact have two of the medications that are the same in them, it was extremely important that the ointment with dexamethasone (steroid) was not used when the cornea was damaged. Steroid containing eye meds should only be used if they have been recommended after an exam by the veterinarian.

Luckily, Tennessee's eye scratch healed well, and he is being treated successfully for uveitis. He is a good patient and allowed the owners to put the medication in his eye multiple times per day without putting up too much of a fight. This was good because, while one of the lecturers at AAEP was a huge advocate of the subpalpebral lavage device to assist with treatment of eyes, I was not looking forward to putting one in. These devices are great for making sure that the medication gets in the eye, but are very annoying to manage in a non hospital environment. This is an example of one of the many times when in hospital care varies from field treatments. While I didn't use the lavage device, I was happy with the results of using the injectable medication, as advised at the AAEP meeting, to get a good eye exam.

When your veterinarian heads off to the AAEP annual meeting, and is gone for almost a week, it is tempting for clients to have disparaging thoughts that the veterinarian is off having a good time instead of working hard at the practice. While I admit that veterinarians do have fun at the annual meeting, the continuing education really is important. We really do strive to keep up to date so that the animals we see, can get the best care possible.

Read other articles by Dr. Kim Brokaw