On this episode of StallSide, co-hosts Dr. Peter Morresey and Dr. Bart Barber welcome Dr. Alex Curtiss to talk about standing surgery—an approach that allows many procedures to be performed while the horse remains standing and sedated. Together, they walk through what these surgeries involve, the types of cases they’re best suited for, and how they compare to procedures performed under general anesthesia. From safety considerations to recovery time and overall outcomes, the conversation highlights why standing surgery has become an important advancement in equine veterinary care—and what it means for both horses and their owners.
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Today's episode of the Stall Side Podcast was brought to you by Rood & Riddle Veterinary Pharmacy.
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Bart,
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how are you doing today?
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I'm great,
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Peter.
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How are you?
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I'm good,
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thanks.
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Sitting up and taking nourishment,
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so it's a good day.
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Yeah,
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okay.
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That's good.
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So,
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a great guest on the show today.
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Yeah,
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we do.
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Dr.
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Alex Curtis,
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who is one of our own,
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has come back home,
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and we're very glad to have her.
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And we're going to bring her in and talk to her today.
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Yeah,
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it's going to be a very interesting topic.
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She's going to actually talk about standing surgery in the horse,
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and that's something that,
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come about the last 10 years or so,
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as standing anesthetic and regional block techniques got a little bit better.
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A lot of surgical techniques that,
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once upon a time,
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would have required general anesthesia.
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No,
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I love that.
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Sorry,
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just talking to her,
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I was surprised at how much stuff they can do,
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and I'm kind of excited to bring her in and talk to her about it,
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because just some things I wouldn't have thought possible,
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standing,
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they're doing standing.
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Oh,
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absolutely,
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yeah.
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It's going to come down to sort of surgeon skill,
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and also how familiar they are with the technique.
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But it does provide a lot of opportunities to do things for cases and horses that probably don't really lend themselves to having a general anesthetic,
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because of the fact they have to stand up afterwards.
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Yep,
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yep,
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there's a lot of advantages.
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There's some disadvantages too,
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but you've got to balance that out.
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So let's get her in and talk to her.
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That's all the case about picking your cases.
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So on Stoolside this week,
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we're talking to Dr.
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Alex Curtis about standing surgeries in the horse.
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Curtis,
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welcome to Stole Side.
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Thanks for having me.
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Thanks for joining us today.
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Glad to have you here.
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And glad to have you in Lexington,
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too.
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It's great to have you here.
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We're looking forward to being with you.
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Yeah,
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it's good to be back.
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It's been a good couple of months,
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so I'm happy to be here.
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Great.
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Alex,
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tell us a little bit about yourself.
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Well,
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I grew up in Maryland,
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with horses,
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around the racetrack a little bit.
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And then went to undergrad at Vanderbilt in Nashville,
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and then vet school at Penn.
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Then I came here for an internship in 2014 to 2015.
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And then I went back to Penn for a hospital internship and did my residency there.
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And after residency,
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I went over to New Zealand,
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spent six months there doing a season with a practice.
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A little bit of ambulatory,
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but mostly hospital.
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And then I came back and joined a practice with Patty Hogan in New Jersey,
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and I've been there for the last four and a half years.
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And then moved on,
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the opportunity came up to come here,
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and so moved on,
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and now we're in Lexington.
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So how'd you end up at Vanderbilt?
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You know,
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it was really interesting.
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I had a list of schools on my list to apply to,
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and my college counselor said,
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"Well,
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with this group of schools,
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why don't you add Vandy to the list?" And I did,
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and then I got in,
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and I went down and visited,
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and it was just far enough away from home that I couldn't get home,
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you know,
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for the weekend.
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I could get home for holidays,
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but it ended up really nice.
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It was before Nashville got really big and kind of overwhelming,
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and so it was a really nice town to go to school and,
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you know,
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go downtown.
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Did you meet any of Peter's relatives in New Zealand?
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Yeah,
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which practice did you work at?
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I was at Matamata on the North Island.
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Oh yeah,
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okay.
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Bed services at that time?
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Yeah,
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yeah.
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I used to work there.
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So I actually got hired on at Mark's Ewing,
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and then right before I arrived,
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Mark's Ewing and Matamata merged,
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and so we all came together and,
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yeah,
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went there July,
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so just before the season started,
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and then stayed through studying for...
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You know,
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I came back in November,
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December to study for boards.
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Yeah,
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would have been a good time,
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it's a good part of the world.
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It's a great town,
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great,
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I mean,
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everybody owns horses,
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horses and cows,
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so there's track in town,
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and it's just part of the culture,
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really good people,
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and really fun experience.
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Really,
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it just blown my whole vision,
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'cause I thought it was just sheep everywhere.
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Nah.
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No.
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I'm gonna have to go.
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When I first got there,
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there were cattle everywhere,
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and I couldn't figure it out,
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because there were cattle and horses on the same farm,
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and I guess the grass is just so good there,
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that they can't keep it in control if they don't have cattle grazing half the time,
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so...
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That's actually,
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this is like parasite control and pasture renewal,
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because the horses are so destructive on the pasture,
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you know,
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they run up and down the fence and they eat it down,
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so everybody would get their dairy replacements onto the horse farms,
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and actually graze them off,
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net removers of parasites,
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and then just,
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you know,
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spread the grass seedle around again,
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and that's it,
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yeah.
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That's how it works,
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so,
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you know,
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a little bit of innovation from New Zealand.
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Got him excited.
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Should try it over there,
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but yeah,
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the sheep are the devil.
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So what do you want to talk to us about today?
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So I thought I'd bring a little bit of chat about standing surgery options in horses,
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sort of a variety of things that we can do surgically in the standing horse.
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You know,
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that part of veterinary medicine and the surgery field has really developed over the last 10 to 15 years,
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so I thought I'd chat a little bit about that.
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That sounds really good,
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because as you say,
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that's very topical.
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Yep,
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yep.
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So,
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you know,
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a lot of the standing innovation in the surgical world has come from Europe and the UK,
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but it's really infiltrated the States in the last 10 years.
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I did my residency at a place that did a lot of standing surgery.
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Dr.
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Richardson,
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who was my mentor there,
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really spearheaded that.
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Standing fractures,
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standing arthroscopies.
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So I've tried to carry that into my career,
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and it's something that I've become comfortable with and happy to offer our clients in the right cases.
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So what's driving this sort of move towards standing surgeries?
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Like,
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traditionally,
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horse is general anesthesia for most things.
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What's driving the standing surgeries?
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Yeah,
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I think in the beginning it was avoiding the risk of general anesthesia.
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You know,
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we are fortunate here at our practice that our anesthetic team is very experienced,
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and anesthetizing a horse is not really an issue or an area of concern.
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So I think that's what started it all,
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and as we got more and more comfortable,
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we felt that it was actually an improved way to do the surgery.
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There's some things,
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you know,
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doing tiebacks,
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doing backs,
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back surgeries,
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that's just a lot easier in the standing horse.
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So then that has materialized into just a lot...
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that being sort of the standard of care for certain surgeries,
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and a lot easier in the approach and the recovery and all of that.
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Okay.
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So facility-wise,
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how would it differ?
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Yeah,
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so I like to do...
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I'm about 50/50,
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50% of the cases I like to do in the stocks.
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So,
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you know,
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tiebacks I'll do in the stock,
00:06:42.000 - 00:06:44.000
a back procedure I'll do in the stock,
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but standing fractures,
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I actually do them out of the stocks,
00:06:48.000 - 00:06:49.319
just in a quiet,
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clean,
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you know,
00:06:51.060 - 00:06:52.180
stall,
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up in the clinic,
00:06:53.000 - 00:06:54.160
clean,
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flat surface,
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in just a quiet area.
00:06:59.000 - 00:07:02.000
But I think it's actually safer to do them out of the stocks,
00:07:02.000 - 00:07:03.389
so if anything happens,
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we can move away quickly.
00:07:05.000 - 00:07:06.000
Okay.
00:07:06.000 - 00:07:07.829
That's really sort of fascinating that you do them,
00:07:07.829 - 00:07:08.160
like,
00:07:08.160 - 00:07:09.000
out of the stocks,
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because restraint could be an issue in this situation.
00:07:11.000 - 00:07:16.000
So what developments have really helped the ability to actually do these horses standing?
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Yeah,
00:07:16.730 - 00:07:22.000
so we have a lot of interesting things we can do with the standing sedation.
00:07:22.000 - 00:07:22.259
So,
00:07:22.259 - 00:07:22.860
you know,
00:07:22.860 - 00:07:27.000
some cases are fine with just boluses of sedation here.
00:07:27.000 - 00:07:27.730
You know,
00:07:27.730 - 00:07:30.000
give them a little xylosine or detomidine as needed.
00:07:30.000 - 00:07:33.000
But we can also run them detomidine CRIs,
00:07:33.000 - 00:07:39.000
so constant rate infusions of these medications to just keep a steady state of anesthesia.
00:07:39.000 - 00:07:45.000
And morphine boluses to help them really stand still.
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And the local blocks.
00:07:49.000 - 00:07:52.000
We've figured out ways to block these horses really good.
00:07:52.000 - 00:07:55.000
So if I'm doing a distal limb fracture,
00:07:55.000 - 00:07:57.000
I can do a low four and a ring block.
00:07:57.000 - 00:07:59.000
And you take the pain away with the block,
00:07:59.000 - 00:08:01.000
and the horses kind of settle into the sedation,
00:08:01.000 - 00:08:04.000
and they really don't care that much about what you're doing.
00:08:04.000 - 00:08:06.000
With the throats,
00:08:06.000 - 00:08:10.000
there's been some developments in the past few years about cervical blocks,
00:08:10.000 - 00:08:10.230
or,
00:08:10.230 - 00:08:10.800
you know,
00:08:10.800 - 00:08:13.000
the nerves associated with the cervical,
00:08:13.000 - 00:08:15.000
to really block the throat well.
00:08:15.000 - 00:08:17.000
We'll block them in the throat,
00:08:17.000 - 00:08:18.000
we'll block their skin.
00:08:18.000 - 00:08:20.000
We can block them in a good plane of anesthesia.
00:08:20.000 - 00:08:22.000
They're pretty happy.
00:08:22.000 - 00:08:25.000
So I'm just sitting over here listening to you and thinking,
00:08:25.000 - 00:08:25.329
you know,
00:08:25.329 - 00:08:27.000
what are the advantages of laying the horse down?
00:08:27.000 - 00:08:28.000
Pain control is one,
00:08:28.000 - 00:08:30.000
you kind of took us through that.
00:08:30.000 - 00:08:34.000
But the other two really are immobility and positioning.
00:08:34.000 - 00:08:37.000
And so maybe you could address those two things.
00:08:37.000 - 00:08:37.730
How do you,
00:08:37.730 - 00:08:40.000
especially when you talk about the lower limb,
00:08:40.000 - 00:08:42.000
how do you overcome the positioning problem?
00:08:42.000 - 00:08:44.000
Because I'm telling you,
00:08:44.000 - 00:08:48.000
right hind pastern laceration in the field is not fun.
00:08:48.000 - 00:08:48.620
Yeah,
00:08:48.620 - 00:08:49.440
I think,
00:08:49.440 - 00:08:50.090
I mean,
00:08:50.089 - 00:08:52.000
the more and more you do in the distal limbs,
00:08:52.000 - 00:08:55.000
the more and more you get comfortable with sort of being low to the floor.
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You do have to be down there.
00:08:57.000 - 00:09:03.000
We do here have the great advantage of the stocks that raise up and lower.
00:09:03.000 - 00:09:03.279
So,
00:09:03.279 - 00:09:03.910
you know,
00:09:03.910 - 00:09:05.130
with the tiebacks,
00:09:05.129 - 00:09:11.000
we can raise the horse pretty high so that I'm not hunched over or bent trying to look in the incision,
00:09:11.000 - 00:09:13.000
which is great.
00:09:13.000 - 00:09:15.000
But with the fractures,
00:09:15.000 - 00:09:15.629
you know,
00:09:15.629 - 00:09:16.000
there is,
00:09:16.000 - 00:09:18.000
you've got to get down towards the ground.
00:09:18.000 - 00:09:21.000
And as you do more and more,
00:09:21.000 - 00:09:23.000
you get comfortable with that.
00:09:23.000 - 00:09:25.000
A condylar is low to the ground,
00:09:25.000 - 00:09:28.000
a P1 proximal phalanx is really low to the ground.
00:09:28.000 - 00:09:31.000
And it's just something with the draping and everything,
00:09:31.000 - 00:09:34.000
you just get more and more comfortable with.
00:09:34.000 - 00:09:36.000
Mentioning the distal limb fractures there,
00:09:36.000 - 00:09:37.000
so the horse is actually,
00:09:37.000 - 00:09:41.000
how much load is the horse putting on the limb when you're actually doing the repair?
00:09:41.000 - 00:09:41.730
Yeah,
00:09:41.730 - 00:09:43.000
so what we do is,
00:09:43.000 - 00:09:44.059
they're standing on it squarely,
00:09:44.059 - 00:09:45.000
typically.
00:09:45.000 - 00:09:48.500
That's helpful to get the screws in straight and,
00:09:48.500 - 00:09:49.000
you know,
00:09:49.000 - 00:09:51.000
have everything go routinely.
00:09:51.000 - 00:09:55.000
And what I like to do is when it's time to compress the fracture,
00:09:55.000 - 00:09:56.200
which is when you really,
00:09:56.200 - 00:09:58.000
really need to tighten the implants,
00:09:58.000 - 00:10:06.000
I'll have a technician or whoever's helping in the room just gently push the horse's shoulder or hips away to unload it,
00:10:06.000 - 00:10:07.129
so that you can really,
00:10:07.129 - 00:10:11.000
really tighten your screws maximally and really get the best compression.
00:10:11.000 - 00:10:16.000
And these fractures I'm talking about doing are not displaced or comminuted.
00:10:16.000 - 00:10:16.799
They're simple,
00:10:16.799 - 00:10:18.159
non-displaced fractures,
00:10:18.159 - 00:10:24.000
so the amount of reduction that we need is not what you would need in a displaced fracture.
00:10:24.000 - 00:10:27.000
So you can get them pretty well tightened.
00:10:27.000 - 00:10:28.000
Okay.
00:10:28.000 - 00:10:29.000
So you've mentioned distal limb.
00:10:29.000 - 00:10:32.000
How far up the limb do you feel confident that you could repair a fracture?
00:10:32.000 - 00:10:32.799
You've talked,
00:10:32.799 - 00:10:33.120
like,
00:10:33.120 - 00:10:34.000
a bit lockdown.
00:10:34.000 - 00:10:34.340
Yeah.
00:10:34.340 - 00:10:35.000
I also do shin,
00:10:35.000 - 00:10:37.149
so dorsal cortical stress fractures,
00:10:37.149 - 00:10:38.000
I do standing.
00:10:38.000 - 00:10:41.000
And those I prefer to do standing.
00:10:41.000 - 00:10:41.850
You know,
00:10:41.850 - 00:10:43.000
on the table,
00:10:43.000 - 00:10:47.000
you're either upside down or off to the side.
00:10:47.000 - 00:10:47.470
Standing,
00:10:47.470 - 00:10:48.509
they're in their normal,
00:10:48.509 - 00:10:48.929
you know,
00:10:48.929 - 00:10:50.000
anatomical position.
00:10:50.000 - 00:10:54.000
I can sit on a stool and put a shin screw in in 10 minutes.
00:10:54.000 - 00:10:56.000
So that's very helpful.
00:10:56.000 - 00:10:58.000
That's very fast.
00:10:58.000 - 00:10:59.000
Getting away from the distal limb,
00:10:59.000 - 00:11:00.139
you mentioned about,
00:11:00.139 - 00:11:01.000
sort of like,
00:11:01.000 - 00:11:01.679
throat surgeries,
00:11:01.679 - 00:11:02.000
right?
00:11:02.000 - 00:11:02.299
So,
00:11:02.299 - 00:11:03.700
positioning-wise,
00:11:03.700 - 00:11:05.500
and sort of the advantages,
00:11:05.500 - 00:11:05.889
like,
00:11:05.889 - 00:11:07.000
anatomically,
00:11:07.000 - 00:11:08.139
you know,
00:11:08.139 - 00:11:09.000
with the horse not lying down.
00:11:09.000 - 00:11:11.000
What's your take on that?
00:11:11.000 - 00:11:11.490
Yeah,
00:11:11.490 - 00:11:11.809
so,
00:11:11.809 - 00:11:18.000
the biggest surgery that we talk about with airway surgery is the tie-back or prosthetic laryngoplasty.
00:11:18.000 - 00:11:20.000
And it's a very...
00:11:20.000 - 00:11:20.889
it's a tough surgery,
00:11:20.889 - 00:11:22.000
it's a finicky surgery.
00:11:22.000 - 00:11:27.000
You need to be quite accurate with your approach and your surgical...
00:11:27.000 - 00:11:31.000
the placement of your sutures and how much you're going to tie the horse back.
00:11:31.000 - 00:11:37.000
And one thing that's a really big advantage is when the horse is anesthetized,
00:11:37.000 - 00:11:39.379
obviously they have a tube down their throat,
00:11:39.379 - 00:11:47.000
and we are looking down their throat also with an endoscope to see how much abduction we're obtaining with the arytenoid,
00:11:47.000 - 00:11:49.000
how much we're tying it back.
00:11:49.000 - 00:11:52.000
And it's a very fine line of what's the perfect abduction,
00:11:52.000 - 00:11:52.899
what's too much,
00:11:52.899 - 00:11:54.000
what's not enough.
00:11:54.000 - 00:11:55.610
And so in the standing horse,
00:11:55.610 - 00:11:57.049
everything is upright.
00:11:57.049 - 00:12:01.700
The left side that we're typically working on is symmetrical to the right,
00:12:01.700 - 00:12:06.000
and you can really judge your abduction in their normal physiologic manner.
00:12:06.000 - 00:12:08.200
So their right side is typically moving,
00:12:08.200 - 00:12:11.000
you can see how much the right side normally abducts,
00:12:11.000 - 00:12:16.000
and you can adjust your left-sided tieback appropriately to that spot.
00:12:16.000 - 00:12:18.289
You also have a better idea of things,
00:12:18.289 - 00:12:19.000
you know,
00:12:19.000 - 00:12:21.000
the esophagus is quite close to that surgery,
00:12:21.000 - 00:12:25.000
and so the horse will be swallowing during the surgery.
00:12:25.000 - 00:12:26.000
You can see where it swallows,
00:12:26.000 - 00:12:27.629
you can see the structures where,
00:12:27.629 - 00:12:29.000
in the anesthetized horse,
00:12:29.000 - 00:12:31.000
everything's anesthetized.
00:12:31.000 - 00:12:31.440
Right,
00:12:31.440 - 00:12:31.809
yeah,
00:12:31.809 - 00:12:33.000
nothing's moving.
00:12:33.000 - 00:12:34.370
And then the other thing is,
00:12:34.370 - 00:12:34.879
you know,
00:12:34.879 - 00:12:36.000
without the tube in,
00:12:36.000 - 00:12:41.220
the larynx is quite deep in the throat when you're approaching it from the outside,
00:12:41.220 - 00:12:42.000
from the skin,
00:12:42.000 - 00:12:43.000
and so without the tube,
00:12:43.000 - 00:12:47.279
you can actually manipulate the larynx closer to the incision,
00:12:47.279 - 00:12:49.000
and really see what you're doing,
00:12:49.000 - 00:12:52.000
where you're placing your sutures for optimal placement,
00:12:52.000 - 00:12:54.000
and that sort of thing.
00:12:54.000 - 00:12:54.299
Okay,
00:12:54.299 - 00:12:56.000
so you're talking about soft tissue.
00:12:56.000 - 00:12:57.009
What about,
00:12:57.009 - 00:12:57.740
sort of,
00:12:57.740 - 00:13:00.000
bony surgeries in the skull?
00:13:00.000 - 00:13:02.000
Essentially sinuses and things like that?
00:13:02.000 - 00:13:02.250
Yeah,
00:13:02.250 - 00:13:02.500
yeah,
00:13:02.500 - 00:13:03.169
sinus surgeries,
00:13:03.169 - 00:13:04.000
that's a huge thing.
00:13:04.000 - 00:13:04.299
So,
00:13:04.299 - 00:13:05.000
you know,
00:13:05.000 - 00:13:06.000
first of all,
00:13:06.000 - 00:13:07.000
starting with the team here,
00:13:07.000 - 00:13:11.000
we can do all of our imaging of sinuses standing,
00:13:11.000 - 00:13:13.000
so obviously we start with radiographs,
00:13:13.000 - 00:13:15.159
but then we can go on to skull CT,
00:13:15.159 - 00:13:20.000
which is by far and away the gold standard in imaging pathology in the skull.
00:13:20.000 - 00:13:21.549
So you can do that standing,
00:13:21.549 - 00:13:24.000
and then once you've identified the problem,
00:13:24.000 - 00:13:25.700
you can move the horse,
00:13:25.700 - 00:13:26.399
you know,
00:13:26.399 - 00:13:30.000
into stocks and do all sorts of sinus surgeries.
00:13:30.000 - 00:13:31.820
So everything from sinoscopies,
00:13:31.820 - 00:13:36.000
which is just a small hole into the sinus to see what's going on,
00:13:36.000 - 00:13:38.000
you can get some small instruments in there,
00:13:38.000 - 00:13:40.000
maybe get a biopsy,
00:13:40.000 - 00:13:41.000
to big sinus flaps.
00:13:41.000 - 00:13:43.000
Those are done standing.
00:13:43.000 - 00:13:47.000
And the big advantage of a sinus flap is the horses tend to lose more...
00:13:47.000 - 00:13:49.000
It's a very bloody surgery.
00:13:49.000 - 00:13:52.000
There's a lot of vasculature in the sinus,
00:13:52.000 - 00:13:53.799
and then when there's pathology,
00:13:53.799 - 00:13:55.000
there's even more.
00:13:55.000 - 00:13:56.580
So in a standing horse,
00:13:56.580 - 00:14:01.000
there's typically less blood loss than an anesthetized horse.
00:14:01.000 - 00:14:01.710
Okay.
00:14:01.710 - 00:14:03.000
What about the eye?
00:14:03.000 - 00:14:03.629
Because,
00:14:03.629 - 00:14:04.000
you know,
00:14:04.000 - 00:14:06.000
let's say there's a lot of eye surgeries,
00:14:06.000 - 00:14:07.250
we see a lot of eyes around here,
00:14:07.250 - 00:14:08.000
very delicate.
00:14:08.000 - 00:14:10.000
Does that lend itself to standing surgeries?
00:14:10.000 - 00:14:10.590
Yeah,
00:14:10.590 - 00:14:18.000
I think eye surgeries are a thing that's really grown in the last 15 years as far as standing surgeries.
00:14:18.000 - 00:14:21.000
So I don't do a lot of the intricate eye surgeries.
00:14:21.000 - 00:14:22.919
We have two ophthalmologists here,
00:14:22.919 - 00:14:25.000
and that's their area of specialty.
00:14:25.000 - 00:14:26.159
But removing an eye,
00:14:26.159 - 00:14:28.000
I do all enucleation standing.
00:14:28.000 - 00:14:29.490
You can get them really,
00:14:29.490 - 00:14:31.000
really well blocked.
00:14:31.000 - 00:14:33.009
A lot of times that's older horses,
00:14:33.009 - 00:14:35.000
horses with other infirmaries,
00:14:35.000 - 00:14:36.450
and,
00:14:36.450 - 00:14:37.000
you know,
00:14:37.000 - 00:14:38.000
it can go very routinely.
00:14:38.000 - 00:14:40.000
You can bring a horse in to remove its eye,
00:14:40.000 - 00:14:42.179
but you can walk it into the stall,
00:14:42.179 - 00:14:44.000
or walk it into the prep room,
00:14:44.000 - 00:14:45.860
and have that eye out within an hour,
00:14:45.860 - 00:14:48.000
and the horse walking back to the stall.
00:14:48.000 - 00:14:48.679
You know,
00:14:48.679 - 00:14:50.240
I do eyelid lacerations,
00:14:50.240 - 00:14:50.960
standing,
00:14:50.960 - 00:14:51.610
you know,
00:14:51.610 - 00:14:53.000
minor procedures.
00:14:53.000 - 00:14:55.200
But I think they're doing a lot of corneal surgeries,
00:14:55.200 - 00:14:56.000
even standing.
00:14:56.000 - 00:14:56.429
Well,
00:14:56.429 - 00:15:01.509
we talked about earlier that that is a group of horses that are typically much,
00:15:01.509 - 00:15:02.000
much older,
00:15:02.000 - 00:15:06.000
and having them get up from general anesthesia has a lot of risks.
00:15:06.000 - 00:15:06.379
Oh yeah,
00:15:06.379 - 00:15:07.000
absolutely.
00:15:07.000 - 00:15:09.000
And you mentioned back surgeries,
00:15:09.000 - 00:15:10.000
like kissing spines and that,
00:15:10.000 - 00:15:11.000
so talk us through that.
00:15:11.000 - 00:15:11.519
Yeah,
00:15:11.519 - 00:15:12.990
so kissing spines,
00:15:12.990 - 00:15:16.509
so overriding dorsal spinous processes,
00:15:16.509 - 00:15:21.000
sort of became a hot topic probably 10 years ago.
00:15:21.000 - 00:15:24.000
We've learned a lot about the disease process.
00:15:24.000 - 00:15:24.500
You know,
00:15:24.500 - 00:15:29.000
just because you don't have radiographic signs doesn't mean the horse has the true disease.
00:15:29.000 - 00:15:31.970
We have to combine that with our clinical exam,
00:15:31.970 - 00:15:35.159
and sometimes advanced imaging like bone scans,
00:15:35.159 - 00:15:36.000
or blocking even,
00:15:36.000 - 00:15:42.000
to really determine that those abnormalities in the back are causing the clinical signs.
00:15:42.000 - 00:15:44.000
But then if it is determined that they are,
00:15:44.000 - 00:15:46.000
there are several surgeries.
00:15:46.000 - 00:15:49.000
The one I prefer is the cranial wedge ostectomy,
00:15:49.000 - 00:15:53.000
where we're taking a piece of the bone out that's overriding.
00:15:53.000 - 00:16:00.000
And I truly believe these cases go much better standing when they're laying on their side,
00:16:00.000 - 00:16:02.000
all their weight's on the back,
00:16:02.000 - 00:16:04.000
and it's really hard to get...
00:16:04.000 - 00:16:07.000
It's a procedure that's entirely radiographically guided.
00:16:07.000 - 00:16:08.330
And so it's honestly,
00:16:08.330 - 00:16:08.889
in a 1,
00:16:08.750 - 00:16:10.500
200 pound horse,
00:16:10.500 - 00:16:16.000
it's really hard to get a radiographic plate under the horse when it's anesthetized,
00:16:16.000 - 00:16:16.980
and your images,
00:16:16.980 - 00:16:20.000
and it just goes very smoothly with their standing.
00:16:20.000 - 00:16:25.000
And these are horses that are already very triggered to back pain,
00:16:25.000 - 00:16:30.000
but we did one yesterday that we blocked,
00:16:30.000 - 00:16:32.629
just put a bunch of block in the back,
00:16:32.629 - 00:16:35.000
got him really well sedated on a CRI,
00:16:35.000 - 00:16:36.120
and he did great,
00:16:36.120 - 00:16:37.000
he hardly moved.
00:16:37.000 - 00:16:37.889
You mentioned weight,
00:16:37.889 - 00:16:40.000
and that's probably a fact with some breeds of horses,
00:16:40.000 - 00:16:40.269
right?
00:16:40.269 - 00:16:41.000
Unless you have a draft,
00:16:41.000 - 00:16:42.000
you probably want to...
00:16:42.000 - 00:16:42.419
So,
00:16:42.419 - 00:16:51.000
what sort of surgeries would you do in a draft horse that you would do recumbent in other breeds?
00:16:51.000 - 00:16:53.169
I think anything you can do with those,
00:16:53.169 - 00:16:53.759
you know,
00:16:53.759 - 00:16:54.090
2,
00:16:53.960 - 00:16:58.000
000 pound drafts standing is probably advantageous for their health.
00:16:58.000 - 00:16:58.450
I mean,
00:16:58.450 - 00:17:03.000
you have concerns of myopathies and neuropathies when they're anesthetized.
00:17:03.000 - 00:17:03.450
So,
00:17:03.450 - 00:17:10.000
a lot of the tiebacks these days are done standing on draft horses.
00:17:10.000 - 00:17:10.440
Really,
00:17:10.440 - 00:17:11.000
anything,
00:17:11.000 - 00:17:12.000
mass removals,
00:17:12.000 - 00:17:13.139
eye surgeries,
00:17:13.139 - 00:17:15.169
anything you can apply standing,
00:17:15.170 - 00:17:18.000
it's best to do that on a draft horse.
00:17:18.000 - 00:17:20.000
What about abdominal surgeries?
00:17:20.000 - 00:17:20.409
Because,
00:17:20.409 - 00:17:20.859
you know,
00:17:20.860 - 00:17:21.710
most of those are like,
00:17:21.710 - 00:17:22.179
you know,
00:17:22.179 - 00:17:23.000
midline or something.
00:17:23.000 - 00:17:27.000
But what would lend itself to a standing procedure in a horse?
00:17:27.000 - 00:17:33.150
So the biggest ones that we typically do standing are laparoscopic procedures,
00:17:33.150 - 00:17:35.000
so cryptorchidectomies,
00:17:35.000 - 00:17:38.000
if a horse has an abdominal testicle that needs to come out,
00:17:38.000 - 00:17:40.070
or ovariectomies,
00:17:40.070 - 00:17:43.000
where a horse has an abnormal ovary that needs to be removed.
00:17:43.000 - 00:17:47.409
We do those routinely here under detomating CRIs and a laparoscopic procedure,
00:17:47.409 - 00:17:48.909
where we're just...
00:17:48.909 - 00:17:49.359
I mean,
00:17:49.360 - 00:17:52.990
your incisions at the end of it all are going to be quite small.
00:17:52.990 - 00:17:55.299
You're just putting a camera in the abdomen,
00:17:55.299 - 00:17:58.409
inflating their abdomen with air so you can see everything,
00:17:58.409 - 00:18:01.000
and removing either the testicle or the ovary.
00:18:01.000 - 00:18:01.400
Yeah.
00:18:01.400 - 00:18:04.000
What about sort of chronic colic investigations?
00:18:04.000 - 00:18:04.730
Yeah,
00:18:04.730 - 00:18:14.099
that and chronic behavioral abnormalities have become very routine to put the laparoscope in the abdomen.
00:18:14.099 - 00:18:21.149
You can look for any sort of adhesions if they've had past colic surgeries,
00:18:21.150 - 00:18:27.000
any scar tissue associated with previous castrations that might be tugging on that inguinal area.
00:18:27.000 - 00:18:33.619
And there's some cases where the mare's reproductive tract can lend itself to behavioral problems,
00:18:33.619 - 00:18:35.159
both with the ovaries,
00:18:35.160 - 00:18:45.960
but some mares have these persistent bands associated with their uterus and their broad ligament in their abdomen that really we can only image laparoscopically.
00:18:45.960 - 00:18:48.009
So it's both a diagnostic and a treatment,
00:18:48.009 - 00:18:50.000
because then you can break those down.
00:18:50.000 - 00:18:50.329
Yeah,
00:18:50.329 - 00:18:52.009
I had this chronic colic years ago,
00:18:52.009 - 00:18:53.529
and the laparoscope was put in,
00:18:53.529 - 00:18:59.990
and there was this big mass at the mesenteric root that was affecting the blood supply of the horse that was chronically colicking.
00:18:59.990 - 00:19:01.000
If you put that horse on its back,
00:19:01.000 - 00:19:03.069
you never would have been able to see it.
00:19:03.069 - 00:19:04.880
But putting the laparoscope in,
00:19:04.880 - 00:19:07.410
so it was actually like a Strangles abscess,
00:19:07.410 - 00:19:10.000
and it was presented as a chronic colic.
00:19:10.000 - 00:19:10.640
So yeah,
00:19:10.640 - 00:19:13.000
I'm a big fan of that sort of approach.
00:19:13.000 - 00:19:13.529
I mean,
00:19:13.529 - 00:19:16.529
to remove an ovary under general anesthesia,
00:19:16.529 - 00:19:18.109
the horse is on its back,
00:19:18.109 - 00:19:22.000
you're almost at the extent of where your arm can reach.
00:19:22.000 - 00:19:26.000
So it is standard of care to do those laparoscopically.
00:19:26.000 - 00:19:26.420
Well,
00:19:26.420 - 00:19:29.589
and not to mention the aftercare from that is so much,
00:19:29.589 - 00:19:31.000
so much different.
00:19:31.000 - 00:19:31.480
Yeah,
00:19:31.480 - 00:19:36.000
much rather have a laparoscopic incision than a full abdominal.
00:19:36.000 - 00:19:38.559
So where do you think this is going to go?
00:19:38.559 - 00:19:38.990
I mean,
00:19:38.990 - 00:19:42.150
you have actually covered a lot of procedures,
00:19:42.150 - 00:19:47.000
which most people listening would probably think that the horse should actually be under general anesthesia for.
00:19:47.000 - 00:19:50.000
So where do you think the next thing is going to be?
00:19:50.000 - 00:19:50.500
Yeah,
00:19:50.500 - 00:19:52.309
that's a good question.
00:19:52.309 - 00:19:52.880
I mean,
00:19:52.880 - 00:19:54.940
I think there's been a lot of,
00:19:54.940 - 00:20:01.269
there's a lot of recent literature about things you can do standing versus anesthetize.
00:20:01.269 - 00:20:05.430
And I don't know if some of those procedures are the best,
00:20:05.430 - 00:20:07.000
the best option for the horse or surgeon.
00:20:07.000 - 00:20:07.309
I mean,
00:20:07.309 - 00:20:08.950
we have to take care of our bodies too.
00:20:08.950 - 00:20:09.299
So,
00:20:09.299 - 00:20:10.000
you know,
00:20:10.000 - 00:20:12.119
there's some talk of standing,
00:20:12.119 - 00:20:14.000
cough and bone fracture repairs.
00:20:14.000 - 00:20:15.029
And that's,
00:20:15.029 - 00:20:15.559
that's,
00:20:15.559 - 00:20:16.049
if the,
00:20:16.049 - 00:20:17.799
if P1 is close to the floor,
00:20:17.799 - 00:20:19.000
P3 is really close to the floor.
00:20:19.000 - 00:20:19.359
Yes,
00:20:19.359 - 00:20:22.000
can't get much closer than on the floor.
00:20:22.000 - 00:20:23.000
Yeah.
00:20:23.000 - 00:20:23.609
You know,
00:20:23.609 - 00:20:26.339
standing tie forwards have been talked about,
00:20:26.339 - 00:20:27.089
but that's,
00:20:27.089 - 00:20:30.700
you're in an incision that's straight under the horse's jaw.
00:20:30.700 - 00:20:33.000
That's really hard on our bodies.
00:20:33.000 - 00:20:34.000
So I don't know,
00:20:34.000 - 00:20:35.079
sort of the next,
00:20:35.079 - 00:20:39.069
obviously there's a lot of things that can be done standing.
00:20:39.069 - 00:20:44.990
I don't know if there are more things that we're going to figure out that go better standing.
00:20:44.990 - 00:20:47.000
But it will be interesting to see.
00:20:47.000 - 00:20:47.420
Yeah,
00:20:47.420 - 00:20:49.660
and I think you picked on this before,
00:20:49.660 - 00:20:51.269
like general anesthesia,
00:20:51.269 - 00:20:51.900
you know,
00:20:51.900 - 00:20:58.000
like the fear of general anesthesia shouldn't necessarily drive standing procedures in all cases.
00:20:58.000 - 00:20:58.880
But I mean,
00:20:58.880 - 00:21:02.000
I think the aged horse is actually a classic.
00:21:02.000 - 00:21:02.309
That,
00:21:02.309 - 00:21:02.779
you know,
00:21:02.779 - 00:21:04.210
if you can avoid dropping them,
00:21:04.210 - 00:21:05.000
that's good.
00:21:05.000 - 00:21:05.480
Yeah,
00:21:05.480 - 00:21:07.720
the case I really like to do it on,
00:21:07.720 - 00:21:10.180
when I'm thinking about fractures,
00:21:10.180 - 00:21:13.720
is that non-displaced lateral condylar fracture,
00:21:13.720 - 00:21:18.069
where the fracture line propagates a bit up the cannon bone.
00:21:18.069 - 00:21:19.799
It's not one that breaks out immediately,
00:21:19.799 - 00:21:20.970
especially in a hind leg.
00:21:20.970 - 00:21:24.000
They just make me a little bit anxious.
00:21:24.000 - 00:21:26.630
And so if I can take that element out,
00:21:26.630 - 00:21:29.430
recovery from general anesthesia,
00:21:29.430 - 00:21:33.369
with those where you just don't know where that line is going,
00:21:33.369 - 00:21:36.000
then that's going to be my choice.
00:21:36.000 - 00:21:39.200
And I can do as good a job on the repair,
00:21:39.200 - 00:21:40.319
standing,
00:21:40.319 - 00:21:42.000
as anesthetized.
00:21:42.000 - 00:21:45.000
And would there be cost advantages?
00:21:45.000 - 00:21:46.440
That is a good question.
00:21:46.440 - 00:21:48.500
I don't know that there should be.
00:21:48.500 - 00:21:53.000
Some people do charge slightly less because you're avoiding the anesthesia.
00:21:53.000 - 00:21:55.019
But you have to have a very well-trained team.
00:21:55.019 - 00:22:00.000
You have to probably have one or two more people than if you were anesthetizing a horse.
00:22:00.000 - 00:22:02.099
And then there's a risk to the people involved.
00:22:02.099 - 00:22:02.630
You know,
00:22:02.630 - 00:22:06.799
if you're doing a hind condylar on a three-year-old colt standing,
00:22:06.799 - 00:22:11.000
that's a bit riskier to all of us than a general anesthesia.
00:22:11.000 - 00:22:13.069
And it's a learned skill.
00:22:13.069 - 00:22:13.599
You know,
00:22:13.599 - 00:22:15.000
not many of us do them.
00:22:15.000 - 00:22:17.000
So that's a good debate.
00:22:17.000 - 00:22:17.390
Yeah,
00:22:17.390 - 00:22:19.630
back to that pasturing laceration.
00:22:19.630 - 00:22:23.000
Those are a lot cheaper to send in the clinic than me doing them.
00:22:23.000 - 00:22:23.349
Yeah,
00:22:23.349 - 00:22:26.000
but that's just a question people are going to ask.
00:22:26.000 - 00:22:27.410
You're avoiding anesthesia,
00:22:27.410 - 00:22:30.000
but it's a higher skill level to do these procedures.
00:22:30.000 - 00:22:30.420
And again,
00:22:30.420 - 00:22:31.000
facilities.
00:22:31.000 - 00:22:37.000
And that's really going to put the pressure on people handling that horse and interpreting how that horse is responding to what you're doing.
00:22:37.000 - 00:22:38.210
Yeah.
00:22:38.210 - 00:22:42.509
Because as quick as they can respond negatively to the things that we do,
00:22:42.509 - 00:22:43.390
you're right,
00:22:43.390 - 00:22:47.000
this is not necessarily safer for the surgeon every time.
00:22:47.000 - 00:22:47.329
Yeah,
00:22:47.329 - 00:22:48.519
and the value is the same,
00:22:48.519 - 00:22:49.000
right?
00:22:49.000 - 00:22:50.000
Oh yeah.
00:22:50.000 - 00:22:51.000
You have the same outcome.
00:22:51.000 - 00:22:52.000
Same outcome.
00:22:52.000 - 00:22:53.240
Good quality fracture repair,
00:22:53.240 - 00:22:53.880
whatever it is,
00:22:53.880 - 00:22:55.000
and we're all after that.
00:22:55.000 - 00:22:55.359
So no,
00:22:55.359 - 00:22:57.000
I think your point is valid.
00:22:57.000 - 00:22:57.430
I mean,
00:22:57.430 - 00:22:58.829
you're paying for result,
00:22:58.829 - 00:23:01.000
not necessarily the road to get there.
00:23:01.000 - 00:23:02.000
Exactly.
00:23:02.000 - 00:23:02.730
Great.
00:23:02.730 - 00:23:03.140
Well,
00:23:03.140 - 00:23:06.000
so I did kind of interrupt you earlier.
00:23:06.000 - 00:23:07.509
So what are your hobbies?
00:23:07.509 - 00:23:09.000
What are your interests?
00:23:09.000 - 00:23:13.000
What do you like to do outside of putting fracture repairs back together?
00:23:13.000 - 00:23:13.390
Well,
00:23:13.390 - 00:23:15.029
classic equine vet fashion,
00:23:15.029 - 00:23:16.000
I ride horses.
00:23:16.000 - 00:23:19.000
And married an equine veterinarian.
00:23:19.000 - 00:23:19.400
Yes,
00:23:19.400 - 00:23:19.880
yes.
00:23:19.880 - 00:23:22.000
So we talk a lot about horses.
00:23:22.000 - 00:23:25.000
I do have a young event horse.
00:23:25.000 - 00:23:26.000
It's kind of a nice story.
00:23:26.000 - 00:23:30.720
He was a two-year-old that came off of a New York track with a small injury,
00:23:30.720 - 00:23:32.000
a minor injury.
00:23:32.000 - 00:23:32.380
But,
00:23:32.380 - 00:23:33.069
you know,
00:23:33.069 - 00:23:41.000
at Hogan Equine we did a lot of pro bono work for the horses that were retiring through the retirement programs.
00:23:41.000 - 00:23:45.000
New York Take the Leap is the one that we worked with primarily.
00:23:45.000 - 00:23:47.140
And so I got to do his surgery,
00:23:47.140 - 00:23:49.000
take out the fragment.
00:23:49.000 - 00:23:51.000
I think I castrated him as well.
00:23:51.000 - 00:23:53.380
And then when everything was said and done,
00:23:53.380 - 00:23:55.000
I decided to take him home.
00:23:55.000 - 00:23:56.059
So I've had him,
00:23:56.059 - 00:23:58.000
he's a seven-year-old now,
00:23:58.000 - 00:24:01.000
and he's been a pretty good event horse.
00:24:01.000 - 00:24:01.380
And so,
00:24:01.380 - 00:24:01.730
yeah,
00:24:01.730 - 00:24:03.000
brought him to Kentucky.
00:24:03.000 - 00:24:06.000
Don't see him as much as I was seeing him.
00:24:06.000 - 00:24:09.000
I think he's alive and doing well.
00:24:09.000 - 00:24:10.000
Great.
00:24:10.000 - 00:24:11.000
Wow.
00:24:11.000 - 00:24:12.000
This has been a great,
00:24:12.000 - 00:24:13.000
great discussion.
00:24:13.000 - 00:24:14.000
I mean,
00:24:14.000 - 00:24:16.000
it's definitely learned a lot here about what's possible.
00:24:16.000 - 00:24:16.359
Yeah,
00:24:16.359 - 00:24:18.000
and appreciate you coming in.
00:24:18.000 - 00:24:18.369
Again,
00:24:18.369 - 00:24:20.000
we're thrilled that you're here.
00:24:20.000 - 00:24:21.000
It's great to have you.
00:24:21.000 - 00:24:21.420
Yeah,
00:24:21.420 - 00:24:22.000
great.
00:24:22.000 - 00:24:23.000
It really is.
00:24:23.000 - 00:24:25.000
And that was Stoolside for this week.
00:24:25.000 - 00:24:30.000
We've been talking to Dr Alex Curtis about standing surgery and its potential in the horse.
00:24:30.000 - 00:24:32.000
See you next time.