One of the things we have been incredibly thankful for during this strange year is the contact we have been able to maintain, albeit virtually, with the TSB authors with whom we are so lucky to work. But in the midst of editorial, production, or the initial marketing push for a new book, we don’t often have time to trade details about our daily lives. So when Dr. Stacie Boswell, author of THE ULTIMATE GUIDE FOR HORSES IN NEED, shared 24 hours of her life as a vet in 2020, we loved getting this chance to peek into her typical day on the job as a rural vet. And OH MY GOSH we learned so much!
5:00 am I’m trying hard to be awake.
Even my dogs are not awake yet. Peso El Guapo is still cuddled under his blanket on the bed. He doesn’t move when I get up, but Tia gets up off her dog bed and follows me. We found Peso while out trail riding, and I kept him because he has a severe heart problem that will shorten his lifespan considerably. Tia is pathologically attached to me. I acquired her as a job hazard from working in mixed animal practice. She was morbidly obese, weighing in at 30.8 lbs. Her previous owner brought her in to be euthanized because she couldn’t walk. For a year we worked on diet and exercise, and she now stays a much healthier 11 lbs. She has lots of extra skin, but also significantly more pep in her step.
It’s early dawn gray right now, and while I make some coffee, I watch my two yearling mules chase a mule deer doe and fawn across our pasture. This morning, I have three recommendations to write for capable young women applying for admission to veterinary school. Like many people who write, this early time of day is my best time. My brain isn’t crowded yet, and the quiet in the house is advantageous for my focus. I want my recommendees to succeed, so I definitely want to write the best possible letters that I can.
6:30 am The other dogs are finally up. It’s exciting — breakfast!! I also wake my husband, Sid, and get ready for work.
7:30 am And we’re off!!!! My appointments begin. During COVID-19, veterinary practices have been extremely busy. We aren’t sure why this is the case, but it may be that people are home observing their pets (or stressing them out), or that veterinarians are more welcoming and feel safer than human hospitals. The New York Times wrote about this topic in August.
Most of my morning appointments are vaccines or minor problems, but I feel like I’m early in the marathon of the day and I’m already trying to catch my breath. We are doing curbside service to reduce client and staff possible exposure to COVID-19, and that also adds a layer of challenge to communication, and an additional time commitment to each appointment.
10:30 am Yep, now we begin to rearrange the day to accommodate true emergencies. A very nice but worried mom drops off her seven-year-old daughter’s cat, Princess Jingles. Princess Jingles has been vomiting for about a week, and although she is still eating, she has lost a significant amount of weight. About a year ago, she vomited some hair ties, but recently it’s been mostly food and bile. Princess Jingles is a cute, long-haired calico cat. I palpate her, and in the cranial (forward) portion of her abdomen, I can feel a lump that shouldn’t be there. The cat mews—she’s uncomfortable. Apparently, I make a face that’s obvious even with my mask on; my assistant asks, “What are you feeling?” I’m worried that it’s hair ties (again) in Princess Jingles’s stomach. I call her owner and discuss doing X-rays.
11:30 am X-rays are done. For sure there is something in the cat’s stomach that shouldn’t be there. There is also a small area in the colon that is suspicious. These are outlined in the yellow arrows on the X-ray below.
I’m a large-animal surgeon but really love all surgery. An abdominal exploratory will be necessary for Princess Jingles. I always think of this procedure like it is a box of chocolates: “You never know what you’re gonna get.” That makes it fun for me. This time, I’m pretty sure it will be hair ties. I call my afternoon appointments and rearrange my day to accommodate the procedure. One of my colleagues is gracious enough to take over an overlapping early afternoon appointment.
12:30 pm I finish my morning appointments, and our wonderful technicians get everything set up and ready for surgery.
1:00 pm Princess Jingles is anesthetized and “on the table.” My practice has a visiting fourth-year veterinary student, Alyssa, getting some hands-on real-world experience. She scrubs in with me, and it is so nice having an extra set of capable hands who can retract the stomach as I cut it open and extract ten hair ties and two pieces of yarn. After removing the foreign objects, I close the cat’s stomach. All the other bowel and internal organs are evaluated. There is another hair tie in the colon, but I avoid opening the dirty, bacteria-filled colon during surgery and instead massage the hair tie as far toward the “exit” as I can.
1:40 pm I close the deepest layer of the incision, and then pass the finish off to capable Alyssa. I call Princess Jingles’s people with an update. They are relieved and happy to hear that surgery went smoothly.
Post-operatively, we take two more X-rays to make sure we removed everything. I know from surgery that I did, but I also want to show Alyssa and our other future veterinarians what a “pneumoabdomen” (air in the abdominal cavity) looks like, so the X-rays are a learning opportunity.
We give Princess Jingles an enema to remove that final hair tie. It’s the pink one!
2:30 pm I work on finishing a little paperwork while scarfing cheese and crackers for lunch.
3:00 pm I start my afternoon with horses. Today, I am seeing Bronwynn, a Warmblood mare I’ve seen since she was a foal. She is now six years old. I see her about twice a year, and every time she has grown larger. I think she is about 17 hands at this point. I really love getting to know my clients and their animals over time.
Bronwynn’s person, Joella, really wanted a lovely Warmblood for dressage, and so she bred the mare she had (Bronwynn’s dam). A caretaker was looking after her pregnant mare, but something went wrong, and when Bronwynn was born, the filly was found stuck and frozen in the mud shortly after birth, and was severely hypothermic with a core body temperature of 87oF (normal foal body temperature should be 100oF to 102oF).
The areas of skin injury from the frostbite Bronwynn suffered are now scars. Because of her injury, her right hind leg is somewhat weaker and not as conformationally correct as her left hind, so keeping her foot balanced is challenging. Today I am taking X-rays of her feet to help optimize her hoof trims and keep her foot as straight and balanced as possible.
4:30 pm My next appointment is Jennifer, who is bringing in her new off-the-track Thoroughbred, Mike. She was able to come in now instead of her originally scheduled time of 2:00 pm. Jennifer runs a boarding facility and has quite a few horses of her own. She ended up with Mike after his racing-career-ending injury. He’s a sweet horse, and she hopes to make a trail horse out of him.
Mike’s left front foot is more upright, with a small scar and marks from freeze-firing. This information tells me that the left forelimb has some chronic pain and lameness problems.
Freeze-firing has replaced pin-firing (which used heat) as a treatment for bowed tendons, bucked shins, or splint problems. The use of pins makes scars, which can be seen on the skin overlying the injury. Advocates for the procedure use a different depth and pattern of firing for different primary injuries.
The theory is that the counter-irritation of the firing speeds the healing of the primary problem. It was first used in about 500 AD, and even then there were doubts about its efficacy. Now, 1,500 years later, there is very little science-based evidence for it, and it is not taught in veterinary curricula in the United States. Many veterinarians frown upon its use as a treatment.
I like the way Dr. Doug Thal phrases it on HorseSideVetGuide.com, “If pin-firing is suggested as a treatment, you should question the logic of using this age-old treatment. Surely there are other treatments that are superior and cause less pain and suffering to the horse.”
But back to Mike… although someone at the track took X-rays of his more recent injury, Jennifer doesn’t have access to them, and she wants to know if there is any healing. She knows the injury involves a right front sesamoid (the small bones at the back of the ankle or fetlock). She has managed Mike on stall rest for the last six to seven weeks.
I examine Mike, and he is baseline lame on his right forelimb. His range of motion of his fetlock is reduced by at least 50 percent. The X-rays show a fractured sesamoid bone. This bone serves as an attachment for the suspensory branches and is part of the boundary for the fetlock joint.
Small bones in the body are also generally termed “sesamoids.” They are located at joints and are embedded within a ligament, tendon, or muscle, and serve as a fulcrum over a joint. These include the navicular bone in horses’ feet, and the patella (also known as the “kneecap” in people). Humans have sesamoids in the joints of our knuckles and feet. When horses’ sesamoid bones are fractured, healing will not be apparent on X-rays because the bone fragments are always pulled apart by the stress of the suspensory ligament, which basically continually pulls the two bone pieces apart. This concept of healing holds true for the navicular and the patella as well, as they also get pulled in two directions.
Most likely, Mike had an injury of his left forelimb. He then compensated by over-using his right forelimb, which resulted in his right forelimb not holding up. A fractured sesamoid with concurrent damage to the suspensory ligament is one stage of breakdown injury in racehorses. Jennifer and I talk at length about a variety of treatment options and costs. Ideally, the smaller bone fragment at the top of the sesamoid should be removed arthroscopically. It sounds like a previous veterinarian had also talked to Jennifer about trying to repair the facture (which could involve a screw or a wire and would be much more difficult and expensive), or simply resting (which she has already done, and won’t actually repair the primary damage).
6:00 pm I started my day helping future veterinary students with recommendation letters. As my day begins to wind down, I will say goodbye to Kayla—she is starting veterinary school on Monday. We are sad to see her go but already so proud of her future.
7:30 pm At the end of the day, I have a euthanasia at home for a 31-year-old horse whose people are also aging out of horses and horse care. Montana has some tough weather in the winter, making it extremely difficult for an older horse with dysfunctional knees to make it through the snow. He also has dysfunctional teeth, and making wet mashes to feed him in the winter here, as you can imagine, quickly ends up as popsicles. It’s not winter yet, but these nice folks have re-homed their two younger horses and don’t want their beloved old man to be alone when the others leave the farm this weekend.
I have a 35-minute drive from my office, so I take my dear husband, Sid, as my technician. It’s been busy, so I haven’t seen him much this week, and I’d like a chance to talk to him and catch up. Sid only knows how to tech for nighttime emergencies such as down horses, colics, and euthanasias. Lacerations are tougher…the blood makes him queasy.
I pick him up and call to coordinate with the local company that takes care of burial and cremation options for pets.
Sid and I arrive just before the person who will pick up the old horse’s body. I hug the wife and console the husband. I then sedate their horse. When I give the final injection, he goes down quietly. I then cut his tail to wash and braid with ribbon so his people can remember his long life and the good times they had together. They really loved him.
10:00 pm We arrive back home. Tia is ecstatic to see us. After a quick dinner, I fall into bed. Peso is already there underneath his blanket.
I hope I can get some writing done tomorrow morning!
Dr. Stacie Boswell’s book THE ULTIMATE GUIDE FOR HORSES IN NEED is available from the TSB online bookstore, where shipping in the US is FREE.
CLICK HERE for more information or to order.
Trafalgar Square Books, the leading publisher of equestrian books and videos, is a small business based on a farm in rural Vermont.