Updated 6:33pm - ECG is now showing up!
Disclaimer - obviously it is no longer Wednesday and this is posting on Thursday....so get your answers in by Saturday!
I'm in clinics today, and I've decided to start a new when-ever-I-get-around-to-it-
Disclaimer - obviously it is no longer Wednesday and this is posting on Thursday....so get your answers in by Saturday!
I'm in clinics today, and I've decided to start a new when-ever-I-get-around-to-it-
Some
disclaimers so that school administrators don't call foul on my blog
and force me to shut it down. These are not real cases. These are made
up from my head as typical cases. The images (if provided) are not from
the VMTH. They might be my own animals. They might be random google
images. Medical images were certainly stolen from the internet.
And
yes, I did get this "medical mystery" series idea from another blog.
Check out "MD to be" - she posts a Monday Medical Mystery every week.
OK.....I present "Abby".
Abby
is a 9 year old Standardbred mare who is being used for endurance (50
mile rides). She's been competing in endurance for the last 4 years and
in the last 18 months has started top tenning in rides. At a ride last
weekend (24 hours ago) during the last half of the race, Abby took
longer than usual to recover at the vet checks (normally Abby's pulse is
within criteria less than 5 minutes) and she seemed more tired than
usual. Abby's owner told you that the ride was very hot for this early
in the season and that she felt that Abby looked a bit more tired than
usual and so elected to not continue the BC exam at that point, even
though she came in fourth.
Upon
physical exam you have a beautiful, bright, alert Standardbred mare in
front of you. Temperature is normal, HR 36, but Abby is a bit reactive
to being touched in the girth area so you didn't get a really good
listen to the heart, but you think it is irregular with no discernable
pattern to the irregularity. Respiration 20. Skin is in good condition.
Pin firing scars on her legs - upon questioning the owner she acquired
Abby off the track with the scars. Her history before acquiring her 4
years prior is unknown. Abby's neck and shoulders are clipped. Ears are
clean. Gut sounds heard in all 4 quadrants. No occular or nasal
discharge. Found 2 ticks attached to the inner thigh. Submanibular lymph
nodes are slightly enlarged. Upon questioning owner, she says that Abby
often has slightly enlarged nodes this time of year (spring) when the
trees are blooming. Abby is a 4 on a body condition scoring system of
1-9, which makes her a bit thinner than the steriotypically "ideal" of
5. Abby's owner says that she keeps her on the thinner side on purpose
because she's nervous of metabolic disease based on her experience with
her previous horse, a welsh pony.
Diagnosistics
1. CBC and chem panel - slight leukophillia, slight hypokalemia, all other parameters within normal limits.
2. ECG
The question
What
does Abby most likely have? Can she continue as an endurance horse or
must the owner retire this beautiful mare to the pasture or another
sport?
For
those vets out there - you probably know what this is and I would LOVE
to hear feedback on how realistic my scenerio is, especially once you
see my write up on the "answer" in 2 days. It was as much a learning
experience for me writing this up and trying to create a typical
clinical presentation, as I hope it will be for my readers who are
reading through this.
With no prior history of this sort of thing and judging by the extreme heat of the day, I'd say it sounds like the horse is suffering from an electrolyte imbalance, specifically potassium. I'd give her some NuSalt with dinner and breakfast and give her some time off, but she should make a full recovery. E-lyte, and specifically K, imbalance can cause cardiac arrhythmia that is temporary and harmless. I'd want to know if the horse was dehydrated (by checking skin tenting and gums).
ReplyDeleteCan't wait to hear what the answer is! This seems like a great (and interactive) idea for blog posts. I'm excited.
dom: crt and skin test are normal, she doesn't appear to be dehydrated based on observation. Hematocrit is part of the cbc blood panel and it was normal (a horse very dehydrated can have a high hematocrit because the red blood cells are "concentrated"). does this let you get more specific about your diagnosis? for everyone else if you have questions about the case I will answer them here as long as it doesn't give away the case!
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