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Ring Ring: New Resources For Vet Clinics Taking After-Hours Colic Calls

Telephone triage is a critical part of modern patient care in both humans and horses. A British study explored how suspected colic cases called into a veterinarian's office were handled; from there the research team created resources to support decision making.

Drs. Katie Lightfoot, John Burford, Gary England, Mark Bowen and Sarah Freeman created an online survey targeting veterinary practices that took calls from horse owners outside of normal work hours. The team used 116 responses in their analysis: half were from veterinary surgeons, a quarter of responders were members of client care teams, 18 percent were management staff and 4 percent were veterinary nurses.

Of the group, management and client care staff felt less confident offering advice to owners and recognizing critical colic indicators, though they were the ones most likely to answer after-hours emergency colic calls. People in these roles often would not offer advice to horse owners who called the clinic, stating that it was not their role to provide suggestions. Often, information that could affect the speediness of treatment were not asked, like those dealing with equine insurance or transportation to a clinic.

The research team then created evidence-based materials that provide current information about colic and support decision-making made by those taking the calls. The materials included a form for recording information from clients and a flow chat for decision making.

Client care teams were then recruited to employ the new resources and provide feedback. The four teams used worked for East Midlands veterinary practices; they were interviewed before they used the resources and six months after their implementation. All teams reported that the information and resources were helpful, and that they had increased confidence in recognizing critical colic cases and offering owners advice.

The success of the standardization of call response led the researchers to suggest that more should be done to ensure veterinary team members were supported for after-hours emergency calls, including by implementing formal training and standardized protocols. They also acknowledged that some barriers to implementation would include the use of computerized booking systems, practice protocol and owner familiarity may be barriers to implementation.

The resources are available for free through the British Equine Veterinary Association website; they can be used in their current form or adapted to suit other requirements.

Read the full study here.

When Digging For A Diagnosis Becomes Harmful

Equine and pediatric medicine has many parallels, notes Dr. David Ramey in an article for Horse Network, including a propensity for overdiagnosis.

Ramey draws multiple similarities between the two, including that both horses and children are reliant upon adults to make medical decisions for them. Additionally, neither small children nor horses can talk, so diagnoses must be made on observation and testing.

Ramey says that a horse may have an issue where a diagnosis is warranted, but determining an exact diagnosis can be difficult—and in some cases harmful–to the horse. An ultrasound can be a helpful tool to use if a horse is colicking and a diagnosis on whether surgery is needed is imperative. However, sometimes a precise diagnosis isn't needed. If a horse is older and sore, using every diagnostic tool to determine where it is unsound may not change the treatment or the outcome—it simply adds to the owner's expense. In Ramey's words, “'Overdiagnosis' describes a situation when an abnormality is found, but detection of that abnormality doesn't actually benefit the patient.”

Though vets have multiple diagnostic tools at their disposal, their use doesn't always behoove the horse or the owner. Using every tool available to find a diagnosis might physically harm the horse: It's imperative that the owner and vet agree that the benefit outweighs the possible risk of the test or procedure.

Psychologically, naming the issue may change the perception of what a horse can do. Some owners then become focuses on “fixing” the problem, adding in supplements and other treatments that the horse may not need. Finally, the financial strain on owners who choose to offer treatments to horses that may not garner long-term improvement can be immense.

Ramey offers some thoughts on why veterinarians may seek to over diagnose the equines in their care:

Industry influence
Defensiveness
Incentives

Owners may attempt to seek out concrete diagnoses for their own peace of mind; uncertainty is not well tolerated by most people.

The benefit—to both horse and owner–of performing a test or procedure should be discussed before an owner agrees to pay for it. Many equine conditions improve on their own, so immediately throwing every test and procedure at the horse may result in the same diagnosis as waiting and not doing additional tests.

Tips For Top-Notch Hoof Care

Certified Journeyman Farrier Sean Elliott shoes horses that compete in a myriad of disciplines. He offers tips to promote hoof health and notes some things to avoid. Sean says the top three things healthy hooves need are good nutrition, a dry environment and balance.

Proper nutrition will give a horse the building blocks he needs to have quality feet. Sean recommends good hay, clean water and a ration balancer, and he discourages owners and caretakers from adding supplements just to use them if they claim they can make a difference in hoof quality. He reminds horse owners and caretakers to treat each horse like an individual and that feeding programs aren't one size fits all.

First and foremost, horses shouldn't stand for extended periods of time in mud or wet conditions, Sean says. He also recommends that horses not be bathed daily, which can strip hooves of oil essential to keeping them healthy. Sean also isn't a fan of topical hoof treatments, noting that a dry environment is more essential than anything that could be applied to the hooves.

Hooves should be seen by a qualified farrier every four to six weeks to ensure that the hoof capsule is placed correctly underneath the horse's leg. Routine trims will also deal with issues like long toes and flares in the hoof wall. Sean notes that a good farrier must have a grasp of equine anatomy and conformation, as well as understand the biomechanics of how hooves handle concussion.

Each hoof should be trimmed to be in balance and not to create hooves that look like they match one another. Shoes should be shaped to the foot and not the foot shaped to the shoe, Sean says.

Hooves can crack because the toe is too long, the heel is underrun or because the horse has been standing in a too-wet environment. Though most cracks aren't a big deal, ones that go all the way through the hoof capsule or all the way up to the hairline require an intervention by a farrier.

Contracted heels are also a common issue and are most often caused by improper hoof balance, which can affect blood flow and hoof expansion. Abscess can be startling to see as the horse tends to become suddenly, severely lame. Sean suggests that genetics may predispose a horse to abscesses and thin soles can exacerbate the problem. Abscesses are most common during spring and wet winter months, when moisture softens the hoof and the foot becomes bruised, which can lead to an abscess.

Racing NSW Implements End-Of-Life Welfare Program For Thoroughbreds

Racing NSW, the regulating body for Thoroughbred racing in New South Wales, has introduced a new program to ensure that every NSW Thoroughbred in the state has access to humane euthanasia. Created to additionally protect racehorses from being sent to slaughterhouses, the program will pay for the horse's euthanasia, should it be determined that course of action is in the horse's best interest.

Funded by a fee assessed when a Thoroughbred is registered, euthanasia under the program is only permitted when a Racing NSW licensed veterinarian has certified that euthanasia is necessary because of welfare or safety concerns. In addition to euthanasia, Racing NSW will cover the cost of cremation or burial of the horse. Euthanasia and cremation or burial of a horse can be expensive, and possibly deter owners from acting in the horse's best interest.

Specifically designed for any Thoroughbred that has lived predominantly in NSW, the program does not have an age cap for horses it assists. This means that horses that have been retired from racing and are now involved in second careers are also able to be assisted by this program.

This program was created to further strengthen Racing NSW's commitment to the welfare of racehorses throughout their lives. The regulatory body puts aside more than $26 million a year to assist with Thoroughbred welfare programs.

The organization has established a direct retraining and rehoming program for Thoroughbreds, has made it an offense to send a Thoroughbred to a slaughterhouse, has two full-time veterinarians on staff and has multiple other programs and efforts in place to assist Thoroughbreds throughout every life stage.

Read more at The Sydney Morning Herald and at Racing NSW.

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