OK, well, thank you very much. So one of the things that that I wanted to to look at that would be quite useful is something that we see a lot of, in first opinion practise and in referral practise, which is the client phoning up and saying my horse has got a fever. Although I'd like you to think somewhat luxury, they might always have a fever.
They might just be hot. So we are we We're not actually really focus on this little case, but he did make me laugh. Because we saw him for, for a fever.
So and he was called hot stuff. And honestly, that's the only time in his life he was ever hot. I think when he had a fever, I don't think the rest of his life he was a a hot horse to handle.
But there we go. His own report. He had a fever of of 39 degrees C.
So we will, have a little think about that. So, how do horses control their body temperature? That's, that's my first, question to have for you guys to have a little think about.
And if you want to stick some stuff in the chat, that's that's great. You don't have to, have a little think what of course is do if they're If they're hot, how do they get cold? How do they get hot?
I'll leave you all to to think about that. And we'll, fill you in on the background. But And the obvious stuff obviously, is to start thinking you're out shivering and sweating, and we are gonna do that.
But, we're gonna have perhaps a slightly more sort of physiological. Think, your goal is to maintain a set point. How do you do that through neuronal control?
Operating through temperature sensors in the hypothalamus, you've got peripheral and central thermo receptors, and they're gonna respond to changes in ambient and core body temperature, and they activate feedback mechanisms to the hypothalamus. So actually, there's quite a lot going on, behind keeping your body temperature. And we know this, don't we?
If your temperature's too high, you need to increase heat loss, and you need to reduce heat production so you increase blood flow to the skin and horses are actually particularly good at doing that, aren't they? You sweat and then behaviour such as shade seeking. And if your temperature is too low, Cutaneous vaso constriction.
PLO erection shivering, increased cellular metabolism, increased digestion of food. We all know, don't we? If you feed a horse, they don't really get cold.
And if they are cold, if you feed them, they warm up and it's That's an extremely effective thing in a in a hi got fermenter and then behaviour such as huddling outless. They're gonna kick each other, and seeking shelter. So that's the background on how they're gonna control everything.
What are our conditions of increased body temperature? Not just infection. And I think that's really, really important.
It's the obvious one. We go to so, hot stuff over the phones and says, Oh, he's got a fever and, oh, he's got He's got an infection. Everyone thinks he's got an infection.
Well, not necessarily. And before we start talking about causes of fever, we also need to think about hypothermia. So there's a difference between hypothermia and tree fever.
So in hypothermia, the set point is unaltered. You have got too hot and all the stuff you're doing to cool yourself down is insufficient in tree fever. You're trying to warm yourself up to too high a temperature, and and and you guys actually will sit there and and have experienced this, I'm sure, because if anyone has had the flu and a fever, the first thing that happens is you feel really cold and you wanna be covered in blankets and you're shivering.
And actually, you're really you have a fever, and you really don't wanna be warming yourself up. But your set point has increased, so it's actually quite a different thing. In what your body's doing between hypothermia and tree fever.
Although, if you're just measuring it with a thermometer, you're not gonna be able to tell the difference. So hypothermia, so increased heat production or absorption of heat beyond the ability to dissipate heat. So you've got too hot and you can't get rid of it.
And it's not gonna respond treatment with anti poetic drugs. And and And I do find that interesting because I do and have and still do, treat those, you know, the the hot horses at the racetrack that finish, too hot and come over all staggering. And you throw buckets of water on them, but you as the vet, charging with an injection of flex and and and become the hero.
And actually, I think it's the people chucking the buckets because the set point hasn't changed. So conditions of hypothermia. Anyone wanna stick those down?
I've mentioned the one that we tend to see in horses, which is the exercise induced one. Anyone who's just a small animal is gonna be used to seeing dogs, cooking in cars. Well, hopefully you're not too used to seeing them.
They they they're the ones we've got. So exercise related hypothermia. And that's the biggie in horses, heat stroke, an hydras in some parts of the world.
You see that? Slightly more. More than others.
Malignant hypothermia. I've only seen that once in a horse. It was a quarter horse.
It does seem to be in quarter horses. And then some of the weird and and wonderfuls the, drugs. Macrolides can sometimes do that.
Can't they? In fs being treated for rus. So, they're the ones to be aware of.
So not all increased temperatures or a fever. So I think it's it's worth just a fairly brief check in your mind when you're taking the history to just rule out other other causes of, of having a high fever of having a high temperature beyond fever. So in fever, your set point increases and then is maintained by the usual mechanisms.
So and and so that's my point of your your You have a fever and you're hot, but you feel really cold. And it's actually vastly unpleasant. The next thing to then I think, is of course, everybody jumps for a fever.
For, infection has been the cause of fever, but what else can cause a fever? Does anyone wanna stick some ideas? And if, if not, think of a few in your head and we will move along.
OK? So, apart from infection, and I think this one is really important, actually, what else can cause fever? all of this stuff.
So infection, inflammation. Immun mediated disease and neoplasia. Now, all of these cause fever through the release of endogenous pyrogens.
Lots of cytokines can be pyrogenic. And they cause the hypothalamic set point to be raised. So that's how that works.
And it's all about the cytokines. So what causes a fever is endogenous pyrogens. And the origin of those can be infection inflammation and being mediated neoplastic.
So that's gonna be where your differentials go into you. And and I think it's important to broaden that up because, of course, we get these cases that you go Oh, I'll give it some antibiotics, and doesn't get better, So it's good to have had these thought processes. So what are the effects of fever now?
It is a normal physiological response, with some beneficial and some potentially significantly adverse effects to the animal. Now, I think you may have heard. I certainly did.
Growing up from, perhaps less scientific relatives that the the reason that you have a fever is to cook the pathogen, and therefore you don't you want to keep your fever so that it's it's doing that good now it doesn't tend to affect the pathogen directly. It can enhance host defences because as you get warmer, you you you sort of speed everything up. But once you're three degrees above normal, actually, you you run into a spiral metabolism anorexia, and you can go into organ failure.
So it's not ideal. So we're not wrong to be lowering these horses temperatures. But should we wait until their temperature is over 40?
When do you guys give her a non? Steroidal, I don't necessarily wait until her temperature is over 40. Why don't I?
Because you've you've got a horse with clinical signs because otherwise you wouldn't have taken its temperature. Now it's slightly different if they're in a hospital. But if they're in a hospital and you're taking their temperatures routinely, you you are monitoring them closely anyway.
And you know kind of what's going on with them. Largely. So, I would treat those because they tend, they tend to feel rubbish if they've got a fever.
So I think if you have got no problems from having a fever, and it's just doing the beneficial stuff, nobody knows you have a fever because no one has taken your temperature because no one takes your temperature till you feel rubbish, and look awful. So I tend to give it when? When?
Whenever they you take the temperature and it's and it's elevated. But is that right, I? I don't know.
Maybe we should allow them to run with a little bit of of a fever. But not too much. So it'd be Yeah.
Interesting to know whether you guys are bolder than I am, or whether you will reach for the nonsteroidals relatively early on. And and we do it in people as well, don't we? I you know, certainly if I have a a small, sad child with a fever, I'll go straight for the CP, or I'm not gonna sit there and make them be sad.
Because their fever might be beneficial for their for their bug. So, so that's where I stand on it and probably give it too soon. If you consider the physiology, but I think clinically it's probably the right decision.
So what happens? Your approach to increase in body temperature. So you've got an increased body temperature.
Your animal attempts to dissipate, Heat fails. Basically, you get a non febrile hypothermia. You're gonna work that out through history, physical exam, environmental evaluation, And then those are your differentials.
Exercise, heat, stroke and hydras, malignant hypothermia, drugs, toxins. And you should be able to to work that out from what's going on. And you're not gonna see many of these.
But you would just see the odd one that can catch you out by assuming straight away that they have a fever. What about if they have a fever, so they have an increased body temperature. But despite that, your animal is, conserving and producing heat.
So think back to sitting under your blanket with the flu, shivering when you're actually really hot. That's a true fever. So then what do you do?
History, physical exam. And I think most of us start with the blood. And I think that's sensible.
You might find localising signs in nasal discharge. They pursue targeted diagnostics. What about if there's no abnormalities?
That's quite common, isn't it, or no abnormalities that send you in any particular direction. You go and do it again. It is useful to have more than one.
History, physical exam, and blood test. My old, residency supervisor Derek, not belt always said to me that if you saw a a case, you you got, it was like getting a clip of a movie. And if you had one clip, it was very hard to work out the beginning, the middle and the end of the movie.
And if it was a comedy or a tragedy, but if you had multiple clips, you could probably work it out. So I think going back and doing that again is quite useful. But if there's no answer, eventually you say this horse has pyrexia of unknown origin.
Now it will have an origin. It's just finding it. And how hard is it to find it?
And I'll I'll come back to that. But, in in in people the definition of PU A you have you have to have had fever for three weeks, and I we do not wait that long. I'm sure of that.
So, what proportion of cases of fever do you reach a diagnosis. And I don't know if anyone's feeling up to to telling me that their gut feel, when I spoke to a group of general practitioners in in person people reckon it was it was somewhere between 20 40%. And actually, the majority of them, like they just get better.
Most of them, and we don't know, ever know why and what was going on. So I suspect that that is fairly where, where, where everyone is sitting at the moment. So the criteria for pyrexia of unknown origin, this is based on on human or based on human and guidelines.
And this was an illness of at least three weeks duration with no specific signs, a temperature of at least 38 6, on several occasions and no clear diagnosis just after taking a blood. And I mean, does anyone actually leave a horse for three weeks with a fever having done minimal investigation? But that's what they do with people.
Maybe because it just takes so long to get Doctor's appointment. May Maybe we're we're we're more on it. Maybe we're too on it.
And then when these guidelines were were produced, people weren't using serum Mao A, and I think we probably do use those quite early on. And if anyone wants to sort of share their experiences of it. My own experience of it is that it can be useful, as a as a single snapshot.
But it's far more useful looking at at at at least a couple of samples to see which direction things are are going in. And I definitely don't rely on having a normal serum amyloid a as being Oh, there's no inflammation infection going on. Because I have had the odd the odd one that just didn't make more serum amyloid A for whatever reason.
So if we go, on to look a little bit more at Pyrex of unknown origin, there isn't much work done in, in horses. But Tim Mair did this, paper, and he looked at 63 cases. And I think the numbers fit with what I've seen and I expect what you've seen.
So 43% of them did have an infection. But that's and that's sort of where we expect it to be About half, don't we? But equally when you speak to the client, the horse has a fever because it's got an infection, and actually, you're there going well, might not have a fever and then you're going well, it's just inflamed.
It's not necessarily, it's just making cytokines. It's not necessarily got an infection. So, it it just yeah, half the time.
If we go for infection, we're gonna be wrong. So I think that's something to to bear in mind, but particularly in these situations where there's a lot of pressure to put these horses on antimicrobials 22% neoplasia. And I think that's really valid.
And I've been referred to a number of cases for pex of unknown origin, which I've just walked in the door, and you kind of get this feeling of they've got cancer and I've got to find it. I don't know where it is, but they've got cancer and they've got cancer. I think because they're weird and they're really, really hot.
You know, they'll be like, 41. So I think that's just the cases I happen to have seen. But, weird and hot, I and and and really hot neoplasia actually goes higher up my, up my chart.
I think also that they're perhaps more waxing and waning, in their temperatures. But again, whether that's just the cases I've seen, 6.5% immune mediated again.
I've seen a few, sort of, you know, weird pleural effusions, that kind of thing. But not a huge number. 19% went down as miscellaneous.
So toxic opathy parasitism. And then 10%. No diagnosis.
Now, hopefully, we've got some better diagnostics now than we had in 1989 But we're still not not perhaps not great looking at abdomens and things like that yet. And these horses did not have a postmortem, so I expect we would have found the the problem. Then they are gonna have a diagnosis, aren't they?
But finding it is not always that easy. So how are we gonna approach, pyrexia of unknown origin? We need a systematic approach for sure.
With an emphasis on infectious disease, we know that's gonna catch nearly half of them. We're gonna have an infectious disease, but the other half, we're gonna have a whole bunch of other stuff and actually cancels next next on the list. So I ask the the client, or if the horse is in the hospital to track the patterns of fever.
So take, the fever and the take temperature. Morning, and afternoon. And I quite like to take it afternoon and evening.
An intermittent fever appears to be more common with infection. Although what I've found with the cancer ones is that it's perhaps more. I do see a quite a lot of intermittent fever, I think.
But they get very, very hot and then very normal. Whereas the the fever ones tend to be a bit less hot, and a bit more, I think I guess the the the normal time is perhaps not sustained. For example, as you know, with your, normal diurnal pattern, your temperature peaks in the afternoon and evening so you can have a fever in the afternoon and evening.
But you might find with those animals that their morning temperature is also pretty much high end of of normal. Remittent fever is where you have you still have this normal diurnal pattern. But your body temperature is is always high.
And then Cy click. So last days that it's normal, then days of fever. I believe, is mostly seen with infectious anaemia which, fortunately, is not something I have experience of.
Although I expect some of you attending, have and and can inform us a bit more about that. So a history, I think you've got to include previous strep equi equi because of the, risk of developing internal abscess and then travel history. But be Alicia.
I have a couple of times seen chronic shipping fee, but, I mean, he knew that was even a thing, but, horses that had been imported and then people said, Oh, they were never really what they were supposed to be. This wasn't the horse I bought. They got quite thin.
They weren't performing very well. Then they sort of took their temperature, like, a couple of months down the line. And they had a fever intermittently.
And it is only when you explored that further that you found they had some plural effusion and that things were really quite sort of fibrinous and and and chronic, so quite interesting cases, but it's obviously pretty rare. So next stage careful, clinical exam. And I think you know, certainly when you're looking at a PUO and again are you looking at one that's been like this for three weeks.
Or are you looking sooner? Which is, I think, where most of us are. But I still think it's valid to do a rectal, and to do a Nero and there There's certainly things that are tolerated.
Very well, and can give you some useful information. Clinical pathology. CBC biochem.
I think you should include bile acids, Fibrinogen, SA A, if it's very chronic, I probably wouldn't bother with with SA a, but look at fibrinogen then. And very acutely, perhaps not be so excited. About the fibrinogen yet, include a blood smear.
Although if you don't find parasite inclusion bodies, you you can't rule that out. Urinalysis midstream. Pretty easy to do, rare to find a problem, I would say, but it it it's not an expensive thing to do, So I think that's a sensible thing to include in your C clean path, part of your exam.
So what else do we tend to find? We tend to find these common but non-specific findings that we see with chronic infection or inflammation. You know, the findings where you're like Oh, yes, I have a sick horse.
Amazing. I always knew I had a sick horse. I still don't know why.
So those are anaemia, Hyper fibrinogen, anaemia? That's not easy to say. And hyperglobulinemia So we'll have a look at those so hyper gamma globulin.
You can do a serum protein electrophoresis, and and sometimes that can give you some information. So if you've got a monoclonal gummy, you might see that with the reticular endothelial system neoplasia, and and that can either, you know, directly give a fever or through increased susceptibility to bacterial infection. So you might find a clue there as to where to go next.
What about low albumin? So you know, you you can be immunodeficient. Be because of, having low albumin.
So is there something causing that? So have you got hepatic disease? So you can't make protein.
Are you losing more protein either through the G I tract or through renal loss or or loss into the third space? It tends to be a pleural effusion or or or an abdominal space. So they are the places to go and look if you've got low albumin now, hypercalcemia in the horse.
Two main causes neoplasia and renal disease. Now, in the dog, you always jump for, neoplasia if you've got hypercalcemia is my understanding the dogs, in horses, renal disease is more common. It's not common, but it's more common as a cause of hypercalcemia in the horse.
But neoplasia is next, so it is one to go looking for, but it's not that common. So obviously having normal calcemia doesn't rule. That out that blood culture now, Yeah.
We commonly use in falls, don't we? Maybe not quite the right way. So, in falls, I am used to getting one at admission, and that's it, in in people who are much, much more aggressive about it.
And, having had the joys of being hospitalised with sepsis. Because my horse broke my leg, it wasn't gonna come down to a horse, is it? They took your, blood samples for, for blood culture and I.
I had five samples taken over a couple of days, Really? And, and they did it just as my temperature started to go up. And, of course, I knew my temperature started to go up because I started to shake with cold.
Except clearly, I was really hot. And so my Yeah, I started to shake with cold, and they'd come in, stab me, and go off and and and take the blood culture that way to try and work out what was what was growing. So and And that was interesting.
So I did, afterwards, once I felt better and sort of look into that because it isn't how I am used to dealing with blood culture. And actually, it is a better way. And we all know how unrewarding blood culture unfolds is, isn't it?
We don't find anything in half of them. And that's because I'm just not doing it properly. Now, in theory, you shouldn't be on antimicrobials, but you might have to be.
And it depends, I think on your suspicion, doesn't it of whether you've got a bacterial infection or not? It certainly my own experience with stepsister. No one was gonna leave me not on antimicrobials until they could get five, samples.
So I guess hopefully if you're on the right, antimicrobial. You don't grow anything. I did, though, actually, but I was still assisted on the right stuff.
So I don't know II. I think it's a bit bold if you've got something really sick. Like a septic fall, to not put them on on antimicrobials while you take lots of blood culture samples.
But should we be taking more blood cultures? And interpreting them really in in the face of the situation in which we've taken them, you know, whether they are on antimicrobials I. I think that's probably sensible.
What else can you do? A bit of serology might help. Equine infectious anaemia.
Bia. You've got to be careful with interpretation, haven't you? You can have bia antibodies.
Rising titti can be helpful. And the strep equi and protein again it it can increase suspicions, can't it? But on its own doesn't need it.
It's not a sort of golden bullet to giving you the answers, is it? But, it might just help point you in a particular direction, in a case that you're struggling with, but definitely care with interpretation and then a few unusual samples. So, for some suspected immune mediated disease, you might wanna do something like a Coombs test.
And some some of those and and some of the ne neoplasms I'll do a bone marrow aspirate because I think sometimes that's just the only way you can find where they're coming from. But you will have hopefully had something point you in that direction. At that point, I don't think it's really a a screening test.
I mean, you could screen from creams test, not too invasive, but, they're doing a bone marrow aspirate. It's not massively invasive, but I'd still like to have a good reason to be in there. So how do I approach, a Pyrex of unknown origin?
Well, quite basically, really. So once I've decided, Yeah, it's definitely a fever. I can split my horse into the thorax and the abdomen.
Because, as was pointed out to me by a surgeon, I clearly don't care about the legs and and rightly say so we we're just gonna split them into a thorax and abdomen. They are two compartments, and normally their fever is coming from one or the other. Always, because that kind of rules out your hematopoietic neoplasms.
But, even so, I think that's a pretty good start. Point is, split the horse into T and start investigating those, so to more fully investigate the thorax. I really like to start with Reb breathing them.
It's not that useful. You know, you can have a normal reb breathing test on a horse with problems, but actually, you can have a horse. Really, You know, quite quickly start to cough, wheeze, or have an increased respiratory rate.
And you go, I'm gonna focus on the thorax first. You know, when you've got a limited budget and you're like, Do I go thorax or abdomen first, knowing that if you pick the wrong one, you're gonna spend, too much money that's free, isn't it? And and can send you in in the right direction.
So escape them. Don't forget. Got pouches.
Grab a a sample while you're down there. As for doing a BAL, it depends if they're struggling on on reb breathing. Difficulty breathing I.
I don't, so largely on if I think it's a th I, I don't do a BAL, thoracic radiographs and thoracic ultrasound. I think they give you different information, so I think they can be quite quite valid. To do both, you can evaluate pleural fluid, geyt or a culture.
And you can do that even if there's no effusion there. Of course, it's much harder to get a sample, but if you have got an effusion definitely, definitely. Take a sample.
And then obviously, if you have got a pleural space problem, you have got the option of pleuroscopy. But I think that is you. You wanna be going down the line if I wanna try and treat this horse at the same time as to find out more information?
For those, I think rather than just do that diagnostically so it it does have a a place diagnostically, but, I think you you've hopefully got enough information. At that point, they decide whether you're gonna try and treat this horse or not, osculate the heart. It can be useful, you know, particularly if you've got a horse that is at risk of bacterial endocarditis.
Perhaps it's had a thrombophlebitis in the last couple of months or so. Even if it's not got a murmur, and it it can be helpful. I mean, definitely if you've got a murmur, but they don't always have a murmur for the first few weeks.
I don't know why, whether that's because it's more smooth, whether it's just, sort of less, you know, there's less fibri over the, over the bacteria. I don't know why, but it's caught a few people out for sure. So, it might not hurt to stick a scan out on the heart, particularly in a in a case, that nose has had a thrombophlebitis.
And then if we think about our abdomen part, rectal we've already talked about about doing, belly tap. I really like to take a belly tap. I think you've just got to be realistic on what you might find.
So, obviously a diagnosis of peritonitis and I've had a a couple of weird peritonitis that presented as, just sort of poor performance. The horse was a bit off. Someone took a temperature just to have a temperature.
And they probably had peritonitis for a few a few weeks. But really, ma, you know, not presenting like a classic peritonitis. So even if they don't present like a classic peritonitis, I think it's worth just popping a needle in there.
You might find a There's some bacterial shed from a leaking abscess, but you might not, because some of these can switch on and switch off. Depending on whether they are producing, anything at the time and some neoplasm. So the work that was done on NEOPLASIA the sort of headline of it was that if you took a belly tap you'd under the cytology, you would find one in four lymphomas and three out of four squamous cell carcinoma.
So if you find it, then you know what you have, bear in mind, however, that that paper did two belly taps not immediately consecutively, so a day or so apart. So if you're only gonna do one, you actually were gonna find one in eight lymphomas and and and so on. So, it is worth doing more than one tap again.
Sometimes you just find you've got more protein. And At least that suggests to you. You've got the You've got the right compartment of the body where the problem is, but it doesn't tell you why.
But psychology and culture then, may be your friends. So that's where I go with abdominal Andes gastroscopy looking for gastric squamous cell. I again, you You probably have some indicator that that's what's, what's going on or, discomfort when they eat or something like that.
Abdominal ultrasounds. We all know the limitations of it. But just sometimes you see either the problem or you see other pathology that is not normal.
Even if that's secondary, of course, you can really grow a false abdomen. Faecal account. It it can be useful to do, but it's rarely associated with the fever in the absence of colitis.
And and you do expect the horse to have a a diarrhoea and sometimes, you know, laparoscopy laparotomy for for biopsies, and and have a look and have a look round and and the whether which one you choose, I think very much depends on your clinical suspicions. And whether you're you know, if you really want a biopsy of large intestine, Then you're probably gonna have to go laparotomy. If you're looking at small intestine, you can go laparoscopically.
There's pros and cons, to both. But what about therapeutic trials? So I think we're not, strictly speaking, supposed to do therapeutic trials until we've exhausted all of our, diagnostic investigation, opportunities.
But, I mean, how many of us are gonna put a horse on the table? Having no idea what's going on with it without having at least put it on some antibiotics, and I'm sure we shouldn't do, but I think it's also pragmatic. And is the real clinical world that that we will, And if if you do what are what sort of thing do people do people use?
Does anyone want to really sort of think? Think to yourself. What's my what's my go to If I've got a horse with a fever and I want to try a treatment trial and how quickly do I use it?
Because I think we probably dive in pretty quickly. In first opinion practise, I would tend to go and see it. A couple of times and give it a non steroidal take some blood, blah, blah.
And if it's not improving, I probably would try an antimicrobial, which is probably not good. Antimicrobial steroid J I tend to go tr Mertens sulfonamide for most of them that are gonna stay at home largely because I kind of feel like I'm gonna abuse an antibiotic. I'm gonna abuse that one, and and and penicillin and save the rest.
If I've got something that's much sicker and and ends up in a in a hospital, then I give penicillin and gentamicin thinking, Will I sort of cover more basis? Gramme positive and gramme negative. Is that right?
I don't know. So if anyone wants to sort of comment on their own experiences and thoughts what if you think it's got a mediated disease? And to be honest, I would I would include neo neoplasia in that, do you give them steroids?
What are the challenges and what are the risks? I think sometimes they'll rally, won't they? And then you think, Well, now I still don't know if it's got cancer or immune mediated disease.
Although if it's got cancer with this will be a short term rally, and it will be a maybe a short term rally in some immune mediated disease. It may be a cure, really hard to tell. I think there are advantages to doing that particular, for for?
For doing diagnostic tests. Obviously, the huge risk is you do have, a bacterial infection, and maybe then that that gets a chance to gallop away. So it's certainly you want to try and do it with as much clinical suspicion, as you're able to achieve and and following a conversation with a client.
So that's the end of the stuff I wanted to cover. So, yeah, if anyone wants to input on, on what they do, and their thoughts, then that would be great. Veronica, thank you very much for your time tonight and for, I.
I must be honest. I've never thought of dividing the horse in two and not I and ignoring the legs. That's an interesting approach as a medic, a big thank you as well to our sponsors tonight, Bailey's horse feeds, as I said in the beginning, without their sponsorship we would not be able to bring this through to you as a free webinar tonight.
Veronica one question when you do, an abdominal or an abdominal centesis Do you ever do a lavage with it as well To increase your yield, or do you just do a straight synthesis? I never have. Well, I've lavage them therapeutically, although I'm still not convinced that that's hugely effective.
I did it quite a lot as an intern. I think that's a pretty good intern job, isn't it? And would stick in, like, five litres of fluid.
And I don't know. You can't shake the horse, Penny. So you take it for a walk.
But I'm not sure we weren't just washing the bottom of its abdomen. For for increasing yel I haven't done. Now, I guess normally I tend to find I either get enough fluid or I get nothing.
And if I get nothing, I'm probably stuck in spleen or momentum or something like that. And I just try again, a little bit later. I often you know the same day, or half an hour later Or an hour later.
Take the horse walk and try again and try to get a different spot. Guided. This is a lot of fluid.
I actually haven't found it that helpful. Apart from to see how much fat there is, how long a needle I need to use or or cannula. And I guess that's the other option.
If you're not getting enough through the needles to go with a cannula, I prefer a needle. Some people prefer a cannula. I can I can bore you for ages on the, having having done some work on this on the risks and benefits of of either the technique, but it works out about the same.
You know, a a cannula is, safer. But if you do cause a problem with a cannula, you cause a bigger problem. Whereas a needle you will cause you know, a problem more more often.
But it's going to be less of it. So So those two. But I haven't tended to put anything in I.
I don't know if anyone, has and does that routinely I Yeah, I haven't done that. And what is your sequence of sites that you pick as your sort of first sight second site, if you're gonna do repeat, repeat belly taps again, people are different. So a lot of people I work with like to go to the right of midline to avoid the spleen.
Maybe because I need to work with a lot of fat horses. I go midline II. I tend to find I'm I'm more likely, to hit the spot midline.
But I think that is personal preference, and I just get the most dependent part midline. If I didn't get anything, I just try a little bit, like, probably at the same time. Stick the needle in while it's still in my scrubbed area.
So a few centimetres away and try again. If I don't succeed, then go away and try again a bit later. And again, I might just I might go in the same place again.
Guts move around. I might sit the scanner on, if I'm getting really desperate, but, unless they're really fat, I usually find I get a sample. That day.
Ok, that's interesting. Yeah. So the fat ones obviously just block up your catheters and your needles or hide the fluid higher up, but yeah, or you're just not I don't have anything.
An instrument that is long enough. So I have done the odd one, after ultrasounds, scanning them with a spinal needle to get one long enough to get through the fat, and some of the different breeds, because I and I worked in Sweden. We saw quite of Icelandic, and they'll have a lot of subcut fat, even if they're not actually fat.
Because it just keeps them warmer, but it it catches you out because they're quite small horses. And and if you've got one, that's not very, you know, doesn't look over fat. You know, you just stick a normal needle.
You don't get anything. And then you put the scanner on and go. Oh, hello.
What's going on there? I get a bit braver and go with a spinal needle, but I do go carefully with those. Yeah, Yeah, a good a good.
Especially when a needle into a horse's abdomen. It's a technique that isn't very much in it's not. There's a lot of things that I had to, to smile just now when you were talking about the difference between human and veterinary medicine.
My eldest son is a medical doctor. So there's a lot of in-house banter about who's better vets or doctors. And I have to tell you, hands down vets are better than human doctors.
So that's why we don't have to, you know, Wait, take five. Take five, samples and wait three weeks before we tell somebody they've got a fever. Yes.
I mean, it is I. I do think it's quite remarkable, isn't it? But, but then in the end, sort of certainly in the UK human system as you go, And, I mean, my mother in law has just done There's nothing bad, fortunately, but, you know, she went in for some biopsies, and then three weeks later, she she gets an answer.
Yeah, whereas I know our clients are, like, a bit disappointed. They have to wait three days, and you're like, really the tissue does need to fit. No, it is.
It is its expectations, I think. Yeah. Excellent.
Veronica, Thank you so much for your time tonight. And thank you for sharing your knowledge with us. Once again, a big thank you to Bailey's horse feeds for their generous sponsorship and thank you to everybody who attended tonight.
So from myself, folks, it's good night.
