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Archive for the ‘Animal and Veterinary Stories’ Category

There are other special circumstances affecting the gastrointestinal (GI) system that can result in impaction of the small or large colon. The formation of fecaliths (a dehydrating and hardening of feces to the extent that it becomes stone-like), enteroliths (a mineral concretion) and meconium-induced impaction (early accumulation of fetal feces in newborns). Horses that have a recent and significant decrease in exercise, usually from an injury, can develop large colon impactions. Twice-daily feedings of grain can result in a measurable increase (up to 15%) in fluids secreted into the bowl from the cardiovascular system which can result in hypotension (reduction of circulating blood volume). This causes the renin-angiotensin-aldosterone regulatory to be activated resulting in the reabsorption of more fluid from the GI tract. This results in a dehydration of the feces and can also result in an impaction.

Four types of displacement colic are described in horses. Displacement occurs because most of the bowel is not anchored to the body wall but suspended from the dorsal abdominal wall in the mesentery. It is therefore relatively easy for a portion to move out of its normal position. Left dorsal displacementoccurs when the pelvic flexure moves toward the space found between the spleen, the left kidney and the nephrosplenic ligament the structure that attaches the spleen and kidneys to the body wall. Right dorsal displacement occurs when the colon lodges between the cecum and the body wall. The pelvic flexure can move to a position closer to the diaphragm resulting in a volvulus, a 180-degree twist along the longitudinal axis. Torsion (a twist along the axis of the mesentery) can also occur. The mesentery is the diaphanous tissue supporting the bowel through which veins, arteries and nerves are carried from the dorsal abdominal wall to the intestine.

Any type of displacement can result in an occlusion of the blood supply (partial or complete) to the involved portion of the GI tract.

Left dorsal displacement will often resolve itself following conservative medical treatment. In recalcitrant cases your veterinarian may elect to anesthetize the horse, put it on its left side, then quickly roll it to its right side while repeatedly pushing on the abdomen. Obviously, this is not a maneuver to be attempted by only one person.

An intussusception of the bowel occurs when a section of intestine “telescopes” into an adjacent section. This most often occurs at the ileocecal junction. When this happens, surgical correction is the only effective treatment. This condition is most common in horses about one year old and is almost always associated with tapeworms, other parasites, small masses and foreign bodies or severe diarrhea.

Epiploic foramen entrapment occurs when a portion of the small intestine (rarely the colon) becomes lodged in the epiploic foramen, also known at the foramen of Winslow. This opening is the communication between the abdominal cavity and the omental bursa. Entrapment of a loop of bowel can also occur through a rent (tear) in the mesentery.

Proximal enteritis (inflammation of the gut lining) is usually the result of infectious organisms, particularly Salmonella and/orClostridium species. Fusarium(a large genus of filamentous fungi) can also be the cause of enteritis. Fusariuminfections occur most commonly in the Southeastern U.S. Overfeeding a high concentrate diet can also result in enteritis. Horses suffering from enteritis have an increased risk of laminitis and thrombophlebitis. Colitis (inflammation of the lining of the colon) is most often associated with infectious caused by Salmonella species, Clostridium difficileand/or Neorickettsia risticii. This last organism is the cause of Potomac Horse Fever. Ingestion of toxic agents such as arsenic or cantharidin, as well as several plant toxins can result in colitis as well.

Gastric ulceration is associated with confinement (lack of adequate exercise), infrequent feeding, a high concentrate diet, over-use of non-steroidal anti-inflammatory (NSAID) drugs, and from the stress associated with shipping and/or performing.

Tumors that can affect the GI tract and result in colic include lipomas (fatty tumors) that form on the mesentery and stretch the connective tissue into a stalk as it enlarges. The stalk can wrap around a section of bowel, usually the small intestine. Neoplastic growths of the GI tract can also include lymphosarcoma, leiomyomas, adenocarcinomas and squamous cell carcinomas. The last of these usually involves the stomach.

Ileus is characterized by no, or very low, movement of the intestines. Between ten and fifty percent of horses will develop ileus following abdominal surgery, with over 80% of those animals having been operated on for correction of a strangulating obstruction. Diagnosis is made using ultrasound when more than three loops of intestine lack peristaltic waves.

Hernias can result in incorporation of a loop of bowel and signs of colic. Standardbred and Tennessee Walker stallions are prone to a large inguinal ring and inguinal hernias. Umbilical and diaphragmatic hernias are rare but can occur in any breed of horses.

Non-bowel related colic include the ingestion of toxins, uterine tears and torsions, disease of the liver, ovaries, spleen, urinary system, or testicular torsion. Inflammatory conditions of the pleura (lining of the lungs and thorax), uterine contractions, laminitis and rhabdomyolysis can all present with signs resembling colic.

Parasitic infestations with Parascaris equorum(roundworms), Anoplocephala perfoliate(tapeworms), cyathostomes(Strongylus-type roundworms) and Strongylus vulgariscan all result in colic. The larvae of Strongylusspecies migrate out of the GI system and find their way into the arterial system. They are sometimes found in the cranial mesenteric artery where they can cause vasospasm as well as blockage. The regular use of modern anthelminthics has reduced the incidence of this problem.

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Impaction colic is most commonly found in the pelvic flexure of the colon. It usually consists of poorly digested food lodged where the colon turns back on itself and narrows (the pelvic flexure). This condition is easily diagnoses via rectal examination, an indispensable part of the physical exam when called on a colic case. This condition is most commonly seen when the horse is confined in a small space, not receiving enough exercise and is being fed a large volume of concentrated feed, pellets and/or grain. It can also occur if the animal’s teeth need floating or if there are other dental issues preventing normal chewing (mastication). It can also occur if the animal cannot take in adequate water.

Colonic impaction will almost always respond to medical treatment. Sometimes high enemas will resolve the issue when mineral oil pumped into the stomach is not sufficient to move the blockage.

In the Southeastern U.S. coastal Bermuda hay is commonly available and used to feed horses. This type of hay can result in an impaction of the terminal ilium, the portion of the small intestine where it joins with the cecum (a large blind sac where fermentation aids digestion of roughage) and the entrance into the colon (large intestine). Obstruction of the ilium can also be the result of ascarids (intestinal parasites) after the horse has been treated for the infestation and is passing large numbers of the dead parasites. It is most commonly seen in young horses following their first deworming. When equine tapeworms are an issue treatment can result from a blockage of these dead or stunned parasites in the small intestine. When this condition occurs, the animal will usually exhibit intermittent moderate to severe abdominal pain. Distended loops of small intestine can sometimes be found on rectal exam. Ultrasound diagnosis may be necessary to identify this type of colic. Severe cases may result in gastric reflux. This usually responds to nasogastric intubation and the release of the accumulated gases from the stomach. Cases that are non-responsive to routine treatment may respond to warm soapy water or carboxymethylcellulose enemas providing the site of impaction can be located and reached rectally.

Less commonly encountered is hypertrophy of the longitudinal and/or circumferential smooth muscle layers of the small intestine (ilium or jejunum). The condition may be idiopathic (of unknown cause), or neuronal dysfunction usually associated with parasitic migration, particularly of the larval stage of ascarids. It may also be the result of increased tone of the ileocecal valve. This leads to hypertrophy of the smooth muscle of the ilium because it has to push ingesta through a smaller orifice. This diagnosis is usually made during surgery and can occur following the removal of a portion of intestine and the anastomosis (rejoining of the bowel) resulting in stricture.

Sand colic can occur when horses are pastured on sandy or heavily over-grazed pastures or fed on the ground. When I practiced in Arizona (back in the 1960’s) it was relatively common for backyard horses kept in small corrals to be fed on the ground on loose dirt. The ingested dirt or sand mostly accumulates in the pelvic flexure but may also be found in the right dorsal colon or in the cecum. The sand or dirt will irritate the mucosa (lining) and can result in diarrhea. Examination of the manure will often reveal the presence of sand and/or dirt. Accumulation and the resulting weight and abrasion on the mucosa can also result in a lack of colonic motility rather than hypermotility and diarrhea and in severe cases, rupture and peritonitis.

The diagnosis is the result of careful observation of the conditions in which the animal is kept and fed, abdominal auscultation for the sounds of hyper or hypo motility (too much or too little) and gas accumulation. Radiographs or ultrasound may be required to make the diagnosis. Medical treatment with laxatives is often effective especially with the addition of psylliumhusk. Psylliumis the common name for several members of the plant genus Plantago. Commonly marketed products of this include; Metamucil, Pinch, Fybogel, Kansyl and Luelax. Mineral oil treatment alone is less effective since it will usually float on the surface of the accumulation without penetrating. Psylliumbinds to the sand and helps to remove it. Animals with this condition may also suffer from rapid overgrowth of Salmonellaor other bacteria so antibiotic added to the treatment may be indicated. If signs of severe colic do not respond to medical treatment within a few hours surgery is indicated. Where grazing or feeding on the ground cannot be avoided prophylactic treatment feeding a pelleted psylliumproduct may be recommended by your veterinarian.

Impactions of the cecum are uncommon. They can occur when horses ingest bedding or as a result of post-operative or other pain therapy involving the use of opioids resulting in GI stasis and constipation. Because of its function as a fermentation vat gas and fluid accumulation is rapid and can lead to rupture within a day or two, if not corrected surgically. The condition can usually be diagnosed on rectal exam but rupture can occur early in the progression of the condition.

Gastric impactions are rare. It can occur following ingestion of foods that swell after eating, ingestion of bedding or poor-quality roughage, dental problems, ingestion of a foreign object or disease that interferes with normal gastric function. Ingestion of persimmons form a sticky gel in the stomach and feeding haylage can be problematic. When I practiced in Arizona ingestion or feeding of mesquite beans was a problem. Feeding sugar beet pulp can also be problematic. Diagnosis using gastroscopy or ultrasound may be necessary. Gastric impactions will often respond to treatment with water or other fluids via nasogastric intubation.

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Colic is a general term used to signify abdominal pain. It is a sign of a problem, not a diagnosis. Colic can be the result of a number of gastrointestinal or abdominal problems. Most often the problem originates in the colon, the large intestine, of the horse. However, colic can also be the result of a tumor, peritonitis, a variety of plant poisons, uterine tears, torsion of the uterus, renal problems, and others.

Some of the causes of colic respond to medical treatment, others can become fatal without surgical intervention. In domestic horses, colic is the leading cause of premature death. An estimated 4-10% of the horse population will die from complications of colic. A much larger percentage will suffer from colic at some time during their lifetime.

Many different types or causes of abdominal pain in horses are commonly described. They include; gas and spasmodic colic, impaction colic, displacement in the form of torsion and volvulus colic, intussusception colic, entrapment colic, inflammatory colic, ulcerative disease colic, foal colic, herniation colic, colic the result of uterine tears or torsions, as well as other possibilities.

Perhaps the most important signs of colic that should result in a call to your veterinarian are; anorexia (won’t eat), looking around at the abdomen, depression, sometimes grunting with pain, kicking at the abdomen with a hind hoof, sinking or falling to the ground and moderate to violent rolling on the ground. Because of the manner in which the gastrointestinal tract is suspended in the equine abdomen, and its weight, a horse rolling in pain on the ground is susceptible to a tear or twisting of the mesentery (the tissue from which the intestinal tract is suspended within the abdomen) through which the intestine can twist on itself resulting in torsion (twisting of the bowel on itself longitudinally through a tear in the mesentery) or volvulus (when a loop of intestine twists around itself vertically with the mesentery that supports it resulting in bowel obstruction). When this happens the blood supply to the affected intestine is blocked or cut off entirely leading to death of the tissue, gangrene and death without successful surgical intervention.

Because of the danger of a twisted intestine from rolling the first instruction your veterinarian will provide when contacted is to keep the horse up and walking. You need to do everything possible to not allow the horse to go down and roll.

To treat uncomplicated colic your veterinarian will generally start treatment with analgesia (pain relief), if the animal is very anxious perhaps sedation, then the insertion of a nasogastric tube. The nasogastric tube will relieve any gas accumulation in the stomach and possibly from the first portion of the small intestine and will be used to pump in intestinal lubricants, laxatives and sometimes surfactants to prevent further gas accumulation. If the colic is severe and the animal doesn’t respond to the initial treatments within a reasonable amount of time it may be necessary to support the horse with intravenous fluids and possibly with nutritional support. In severe cases treatment for endotoxemia (toxins produced in the gut) may be necessary.

We generally recognize the following major types of colic; excessive e gas accumulation in the intestine (gas colic), simple obstruction (impaction colic), strangulation (volvulus or torsion colic’s), non-strangulation or infarction colic (blockage of a blood vessel to the gut), inflammation of the gastrointestinal tract (enteritis or colitis), colic from peritonitis (inflammation of the peritonium, the lining of the abdomen), and ulceration of the gastrointestinal lining or mucosa (ulcerative colic).  I will describe each of the various types of colic in future articles.

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After our visit to the veterinary school at UNAM, I called Dra. Aline. She didn’t exactly remember me but I suggested I should pay her a visit and she immediately demonstrated the gracious hospitality I remember her for, and invited me to come for a visit and stay for la comida (the major late afternoon meal). She said she would be out of town for a few days so we arranged for me to come to her home on Wednesday. Wednesday came, but Alexis was under the weather, so I went to visit the Doctora on my own. Her house, built by her father just after World War II, was as I remembered it, a beautiful, Spanish hacienda, quiet solitude in the middle of a very busy, and noisy city. Here’s a photo of her living room:

When I arrived, she was still resting from her trip to Puebla, and another place that I didn’t catch the name of, where she went to attend the livestock markets. She is on a mission to convince the Mexican people that if they treat their livestock in a more humane manner, the health of the animals, and indeed, the quality of the meat, will improve. She explained that it was difficult to change the attitudes of the farmers and ranchers towards livestock, but she is so well respected by the veterinary profession, and so persistent with her message and with government authorities, some progress has been made. In Puebla, she told me, ramps have been installed for unloading and loading the animals, instead of forcing them to jump into and out of the trucks. “But,” she told me, “except for people who own pets in the big cities, the general attitude is to physically force animals to do what you want them to. You also see many stray dogs and cats in the streets of the cities, as well as in the countryside.” We certainly saw more homeless dogs than homeless people as we moved about.

We had a great visit and despite my beard she recognized and remembered me, especially after we spoke of a study we did, before the Olympic Games, to evaluate the effects of the Mexico City altitude on horses brought here for the equestrian events. She was pleased when I told her the article we published with the results of that study are still referenced, now and then. We reminisced about my FAO colleagues and the effect that project had on veterinary education at UNAM. The results were not immediate, but she feels our efforts may have hastened many changes that have taken place over the past 50 years.

At age 97, she told me she was born in 1920, she is remarkably lucid and mentally agile. If I live that long I hope I can match her.  She lives alone, except for a very dedicated and solicitous housekeeper/ cook, who also has day help to keep up the house. Doctora also employs a man who takes care of any necessary home repairs, the garden, and drives her where she needs to go. Her dedication to animal welfare is what keeps her active and focused.

Tomorrow morning, we return to Seattle. The trip has been extremely worthwhile for me. I hope Alexis has enjoyed my pleasure in revisiting all the places I remember. Our Airbnb hosts, Thomas Friedman and Juan Carlos Luna Vaszquez, have made everything easy for us. They are always helpful and concerned that we do everything we want to do as easily as possible. The apartment in this historic house has served us extremely well. The house is located on Avenida Yucatan #16, in the heart of Roma Norte and we were able to explore widely on foot. Alexis feels she has to walk at least 3 hours a day for exercise, and although she had to reduce her pace for me to keep up, I managed to stay with her, mostly because she keeps stopping to inspect anything that catches her interest.

Part of the wonder of Mexico is the public art. The photo below shows blow-up stills from famous movies. The display lines the walk next to Paseo Reforma as that famous street winds its way through Chapultepec Park.

The next photo shows blow-ups of artifacts recovered from the Templo Mayor excavations in the Zocalo of the historic district. Art and culture are everywhere.

 

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When I was here in Mexico in 1967-68, working with the Food and Agricultural Organization, the most helpful, friendly and professional Mexican faculty member colleague, was Dra. Aline Schunemann de Aluja. After we arrived here on this trip I made some inquiries and learned that she is not only alive, at age 98, she is a Professor Emeritus at UNAM, and still maintains a laboratory at the veterinary school. More than that she comes to the laboratory, every now and again, to do some work.

We visited the vet school and, of course, after fifty years, everything has changed. None of the buildings I remember are to be found, at least by me. The small animal clinic looks quite new, and was busy, with a lot of students, faculty, clients and patients, going in and out.



The next stop was to find the house we lived in, at Avenida San Francisco #12. Here is the house as it was in 1967:

The house was behind a stone wall, down a curving cobble stone drive. The property behind the huge oak gate, consisted of a small house next to the gate, five stone houses, and the owner/architect’s office, that was the building to the right of the white pickup. There was a lot of open land around us, and only a few houses and stores on the roads leading up the hill to our house. The commute from the University to the house usually took me 10-15 minutes. Not today. The trip was well over 30 minutes, through significant congestion, a busy freeway on a Friday afternoon, narrow streets, crowded with businesses on both sides. We found the place but the beautiful oak gate was replaced by this:

 

 

 

 

A private security guard was on duty and even with a long explanation, and showing him my identification, he could not allow me in, even though I assured him it was just to take a photo of the house from the drive. He had to check with his boss. He made a phone call but then told me his boss was not available until after 5 pm. The best I could do was to stick my phone through the gate, with his permission, and snap this photo:

 

 

Close, but no cigar, our old house cannot be seen. I understand that the guard could have lost his job if he opened the gate for us. We regained our good spirits by lunching at the San Angel Inn. It’s in an old monastery, the building over 350 years old. The restaurant was a very elegant and special place to eat fifty years ago, and it still is. You can Google it and find photos and even a menu. Our special meal cost less than $100, with wine, desert, and the tip.

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The day before yesterday we visited a Warhol exhibit at the Jumex Museum. It was an experience. Neither of us knew about his fascination with violent death. Many images of suicides landing on cars, terrible auto accidents, and criminals condemned to the electric chair. The renderings of famous people, soup cans, and boxes were what we expected, but there was also an interactive display called “Silver Clouds”. Here is Alexis inside that display.

The Jumex Museum was across the street from a huge Costco store, so we went in to see if anything was different. Not much.

Yesterday was time for the Anthropology Museum, overwhelming. I did learn that when I was here last the famous artifact known then as the “Aztec Calendar”, in fact isn’t a calendar. It is now known as “The Stone of the Sun”. It was discovered in December, 1790, and has been moved five times before finding a permanent home in the Anthropology Museum. It is, actually, a large gladiatorial sacrificial altar, known as a temalacatl. It was never finished because on the back side is a large crack that runs from an edge to the center. It is believed that it was used to stage ceremonial fights between warriors, despite the crack. Here’s Alexis in front of the Stone of the sun.

In the large plaza in the middle of the museum is an amazing carved-stone water feature that cools the place by at least five degrees centigrade.

Today we spent about three hours at the “Templo Mayor Museum”, and associated archeological digs. The excavations for this dig didn’t start until 1978, although the Stone of the Sun was found near this site over two-hundred years earlier. It is an amazing place, in the historic center of Mexico City. The site and museum, which must have well over a thousand artifacts, most taken from the site, are both very well done. Almost all the explanatory writings have English translations and are very informative. The displays are artfully done and allow close examination (but no touching). The site includes the original location of the main pyramid (temple) but is only a small portion of the sacred precinct of Tenorchitlan. That covered an area not comprising seven city blocks in what is now the Zocalo and surrounding buildings.

Here is a photo of a small part of the excavation that shows a statue of Tlaloc (the Rain God). He is identified as such by the goggle shapes around the eyes, long fangs, and complex decoration on top of the head that represents a headdress with folded paper fans on the sides and a band of green stones, topped by white feathers.

I was not aware, before this trip, that the buildings and temples of all the various city/states in Mexico, were, in many places, covered with plaster that was painted in brilliant colors and depicted important celebrations and events. It seems Mexico has been a colorful, civilized place, for a very long time.

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We spent the day wandering the Zocalo (the main plaza) in the historic district of Mexico City. Unfortunately, it was Monday and the National Palace, with all of the famous murals, and the archeological digs very near to the Cathedral, were all closed. No matter, we’ll go back. The whole area was crowded, so the people watching was good, although we didn’t spot very many tourists. I suppose most of them got the word that the museums and public buildings are all closed on Mondays.

We had an early dinner (2 pm) with a view from the Mayor (a huge bookstore) rooftop restaurant, just off the Zocalo. We are now into the swing of Mexico; a late breakfast (9:30 – 11 am) depending on when we get ourselves out of bed. We have coffee and yogurt with fruit and granola in the apartment. Our main meal in the afternoon (3 – 5 pm), in a nice restaurant, and a light cena (snack), usually some cheese and crackers or a salad in the apartment (9 – 11 pm). It’s a very civilized way to live and we rarely require any sort of snack.

Here is a view of the archeological digs with the Cathedral in the background, the perspective is somewhat distorted, but the façade on the far left of the Cathedral really is leaning, as are many buildings in the area. The Zocalo is built in the center of what was the original ceremonial district of the Aztecs (now preferably called Mexica here). Cortes had all the pyramids razed and the Cathedral and National Palace contain stones from those pyramids. The whole Mexico City basin was full of shallow lakes and canals, much of the land created by dredging. Pumping of domestic water from the aquafer results in sinking land, ergo the leaning buildings.

 

We entered the Cathedral where mass was being said in two different, and separated, naves in the huge building. Each nave had small chapels on either side with, of course, significant amounts of gold-plated decoration of the main areas as well as the chapels. Pretty impressive.

We were strolling through a small mall, near the cathedral, and found several stores selling medicinal herbs. Here is a photo from one front window. Each package is a different dried herb touted to be effective for various diagnoses.

 

One of the stores had a bin with fresh herbs. Aviz is translated as root. The only one I recognized is jengibre (ginger)

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