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ASK THE NUTRITIONIST

By Sacha Adorno

Lafite, aka Flip Flop, and his rider/owner Liza Horan were having a great round at Fair Hill International when an accident mid-course led to potentially career- or even life-threatening injuries for the 12-year-old warmblood gelding.

“The jump was pretty straightforward, and I thought I had a good shot as far as my approach and distance. It seemed that Flip Flop would jump it quite easily. But when he started to leave the ground, he grabbed his left front shoe in a way that felt like it nailed his leg to the floor,” explained Ms. Horan, who trains at Ironwood Ranch in Lompoc, Calif., and made the trip with 3 horses to Maryland for the October 2019 event.

“His front leg didn’t come off the ground, and he hit the rail of the jump really hard. He went almost vertical with his hind legs and made a heroic effort not to fall down.”

Although the horse succeeded in not falling, Ms. Horan was unseated during the accident. Medics attended to her, while Flip Flop galloped away, seemingly unphased. “He didn’t appear frantic when he took off,” Horan explained. “But I realize now he was a bit spooked by my fall—I'd never fallen from him.”

After medics cleared her, Ms. Horan went looking for her horse, who had gotten off course. When horse and rider were reconnected later in the stables, “he looked like he’d been hit by a semi-truck,” Horan said. “He had multiple wounds and lacerations inconsistent with the accident. A few people saw him on the Fair Hill grounds—we know at 1 point he was in the parking lot and hit a parked car—but we don’t have a full picture of those minutes after the accident.” Photo by Shannon Brinkman

Flip Flop needed immediate medical attention, leaving no time for Ms. Horan to retrace his steps. Bernadette K. L. Smith, DVM, MS, an associate at Equine Veterinary Care at Fair Hill Training Center examined him and found wounds on all 4 legs. Several were in areas that, if infected, could have meant a poor prognosis.

Although some of them looked gory, not all of Flip Flop’s injuries were life-threating. The dangerous lacerations were almost invisible on photos, while the bloodier ones required stitching but weren’t too risky.

“The locations of his lacerations were a big red flag,” Dr. Smith said. “Not for the size of them but for where they were on his body—any lacerations on a horse are potentially career- or life-ending, it depends on the location and which structures are involved. Some of Flip Flop’s cuts were near joints—a terrible location—and he needed immediate specialty care.”

Dr. Smith referred him to New Bolton Center, in Kenneth Square, Pa., so his case would have the full attention of multiple specialists who could make any necessary tests and treatments coordinated and swift. She said that it was almost always in the best interest of the horse with injuries like this to be referred.

At New Bolton Center, Maia R. Aitken, DVM, DACVS, DACVECC, assistant professor of clinical emergency and critical care, immediately assessed the full extent of his injuries and checked all his vitals; heart and respiratory rates and temperature were normal.

“He was walking well, but with trauma there can be a lot of adrenaline that can mask underlying damage,” said Dr. Aitken. “So, we took several radiographs to look for signs of fractures and found none. And then we systematically looked carefully at each joint, each wound, and the joints close to each wound.”

In a full accounting of his injuries, the horse had lacerations on his left axillary region, left proximal antebrachium and left front heel bulb, where he had clipped his heel during the accident. He also had a large laceration at the inside of his right stifle and gaskin as well as his left hind pastern. There were also 2 very small lacerations over his right carpus that did communicate with the radiocarpal joint. “These were the smallest lacerations but also held the most risk,” Dr. Aitken said. “I can’t stress enough that prognosis is all about location, location, location. Flip Flop had a large wound over his armpit, which involved a lot of suturing but wasn’t a great risk to the horse. Yet the 2 1-cm lacerations over his carpus looked like no big deal but were the most threatening because of the potential for infection.”

A Stitch in Good Time...

Flip Flop arrived at New Bolton Center within the window of time where—with specialized and aggressive emergency care—his wounds were treatable.

Under anesthesia, the radiocarpal joint was lavaged with a large volume of sterile fluid and injected with antimicrobials to avoid infection. In addition, each wound was thoroughly debrided and lavaged and then meticulously closed with numerous sutures. All of his repaired lacerations were bandaged, and he was moved to a padded recovery stall.

“He recovered uneventfully from the anesthesia and was an absolutely perfect patient while he was with us,” Dr. Aitken said. In the postoperative period, Flip Flop was treated aggressively with systemic and local antimicrobials as well as pain medication, wound care and bandaging.

After a week in the hospital, Flip Flop was ready for the long trip back to the West Coast. The missing minutes are still a mystery, but the horse didn’t appear too concerned and made a full recovery.

This article original appeared in Bellwether Spring 2020. https://bit.ly/314Z9oL-MeV