A Guerrilla Guide to Vet Care- First Aid 101

Let's face it, the cost of veterinary care makes or breaks a lot of horse ownerships. New horse owners are often overwhelmed and horrified by the first significant injury to their horse even if more experienced eyes do not think the injury nearly as worrisome as the newby thinks it is. They call the vet and $500 later they realize the experienced eyes were right- just a cut on the ankle not lacerated tendons or punctured joints.... But sometimes a relatively insignificant seeming injury can turn into a catastrophe with huge vet bills and extended loss of riding time- and this even the vets can miss. When one of my horses showed up for breakfast Monday morning with lacerations up and down her front legs, it occurred to me that maybe I should share how I handle first aid with my herd of twenty horses.

Owning multiple horses will make anyone phobic of the word, V-E-T. I often have the cost of veterinary care conversation with my mother who owns two horses- one who was competing seriously in 2011, and another who recently under went stem cell surgery- about the economics of horse ownership. Shivers go down her spine when she looks out into the field of horses at my farm and considers the costs she has spent on just two horses. However, I try to explain to her it's like comparing apples to oranges. My vet bill on 10-15 horses was no grater than her vet bill on two horses and the reasons have everything to do with the circumstances, first aid and attitudes. The circumstances and attitudes would take several posts to go into but first aid is simple and useful for everyone.

My First Aid Kit

I have a trunk, purchased at Home Depot, and stocked with numerous containers purchased at Walmart, that sits in the center aisle of my barn. That trunk is like a horse ambulance stationed on site. I am not in any way saying that this is a substitute for a licensed veterinarian and I will tell you that every experience with a vet is an education. But I simply can't afford to call the vet unless it is life threatening or career ending. That's the facts. So, what I stock in that trunk is like a life-line.

As a child I went to numerous pony club rallies where we had to have a first aid kit in our team tack room that the horse management judges came through and checked. We had a list of what that first aid kit should contain and often times we would get points off for not having anti-microbial ointment, sheet cotton, or bandage scissors. But after years of horse ownership, I have to tell you the US Pony Club "List of Equipment" is a treasure of knowledge and to this day I have the items listed in my trusty trunk.

Petroleum Jelly

Digital Thermometer (or Veterinary Thermometer with Thong & Clip)

Liniment or Body Wash

Isopropyl Alcohol

Antibacterial or Antimicrobial or Antiseptic Scrub

Topical Antibacterial or Antimicrobial or Antibiotic Agent;exp? _____

4” Sterile Wound Dressing

1 roll Gauze (2” min. width)

2 Flexible Stretch Adhesive/Cohesive Bandages

1 Lb. roll 12” Absorbent Cotton

Bandage Scissors (capable of cutting bandage)

1- roll Adhesive Tape (1” minimum width) (Coflex is a great brand)

4 Leg Bandages with appropriate Padding for 4 Stable Wraps

I also have added several other standbys that you must purchase at a pharmacy or request directly from the vet or order through a vet supply company.

A large container (500 tabs) of Trimethazone Sulfa tabs (TMZ's or SMZ's)

A vial of Banamine 

18-20 gauge needles

3ml-12ml syringes

A large container of Phenylbutazone powder

Antimicrobial Eye Medication

Antimicrobial plus steroid Eye Medication (do not administer without a vet's approval)

1 hemostat

Micanazole (anti-fungal medication)

1 container of DMSO 

1 container of Ichthamol

Preparation H

Witch Hazel

Liguid Ivory Soap

Poultice

Vetrocyn (a wound spray that I love)

1 drawn shot of tranquilizer (vet's choice)

Duct tape

Clean towels

As a horseman/woman's experience grows, they may find a wound dressing they prefer, or add a few items; but these basics will get you through the first aid for 80% of the injuries you will have with horses. I do not have the time in this one post to go through every item and it's uses. But I can promise that if I chronicle the medical problems that happen at the farm over the next year, I will likely cover the use of most of these items.

Thanksgiving Weekend and the Mysterious Wire Cuts

As I said at the beginning of this post, my inspiration for covering this subject happened when I came to feed Monday morning and found one of my horses standing by the fence with cuts up and down both front legs. She was walking gingerly and the nature of the cuts appeared as if she had gotten her front legs caught in some type of wire or vine. Our horses are in a large pasture (40 acres) with cattle fencing along the perimeter. Although this fencing is not ideal for horses, we have hot wired the fence-lines to keep the horses off the fence. Because the horses have a large area, I have had no problems with this fencing. But my first thought was that she had somehow caught her legs in the fence. I walked the fence-line- no sign of disturbed wire. The only conclusion I could come up with was that she had found something in the pasture to get caught up in-possibly a vine. In a smaller space we would have known immediately the culprit, but on a large farm like this we may never know.

The first step in addressing the injury was to bring her in the barn and wash her legs. I use the liquid Ivory Soap to clean everything and these wounds were no exception. Once the legs were clean and still wet, I trimmed the hair around the wounds (all of my horses are very fuzzy since its winter). I used scissors because the legs were wet but I could have dried them with a clean towel and clipped the hair with clippers. The left front legs had the worst cuts with a deep scrape along the outside of the pastern and a slice beneath the fetlock. I carefully examined the extent of both cuts by gently spreading the margins to see the  depth of the wound and whether there appeared to be any debris still stuck in the wound. Although she was uncomfortable, I never pressed so much on the wound to cause great pain**. The wounds appeared clean, not deep enough for stitches (although vet's rarely stitch if the wound is over 6 hours old). So, I took the mare back into the wash racks and sprayed the wounds with water for a full 10 minutes. After washing with water, I took gauze soaked in betadine and scrubbed the wounds lightly. Then I left her to dry.

** A side note on the need for tranquilizers- Different horses have different levels of pain tolerance and whenever you examine a wound, it is important to assess the level of pain you are dealing with. With hind legs I am much more wary of working on a wound without the horse being drugged. However, many vets have been kicked by a drugged horse, so caution is always important. I have the drawn dose of tranquilizers to use in an emergency such as this (although in this case, I didn't need them.) However, I do not recommend any use of tranquilizers unless you have been carefully instructed by your vet on the method of injection and the nature of the tranquilizer; and you and your vet feel comfortable with your use of the tranquilizer. I do not use tranquilizers very often. I am drug-phobic actually and I prefer using patience with the horse until they understood you are trying to help them. However, sometimes it is a matter of keeping the horse from further injuring itself; or necessary to get the horse properly cared for.

The other injury that the mare appeared to have was a cut and swollen tendon on her right leg. The swollen tendon was of greatest concern to me. I cold-hosed the tendon for 10 minutes, cleaned the cut (which was minor) with betadine and decided to create a "cast" for the tendon using poultice. I added water, witch hazel and a small amount of the poultice (bentonite clay mixture) and mixed until the poultice was the texture of silt. Then I thoroughly soaked the gauze in the silt making sure that the gauze held a fair amount of poultice. I layered the pieces of gauze up and down the length of the tendon, smoothing them out and making sure that the gauze evenly surrounded the tendons. When I had a good 1/8-1/4" of poultice gauze along the tendons, I took a roll of 4" gauze and gently wrapped the leg from knee to cupping just below the fetlock. After the gauze roll was completely wrapped onto the leg, I followed up with vet wrap and carefully (no wrinkles, even/light pressure) wrapped the leg making sure that the vet wrap only extended the same length as the gauze. 

There are two major concerns that I have with these injuries. I am concerned that the cuts do not become infected or start growing proud flesh. Because they are low on the legs, they are likely to be exposed to all sorts of troublesome microbes in tall grass or muddy footing. Also the incidence of proud flesh is likely given their location. Proud flesh (excessive granulation of the tissue) is something that can occur in the healing process. I do not like to cover wounds for long periods of time. Instead I choose to repeat cold hosing and washing for a minimum of 10 minutes several times a day. I have found that this hydrotherapy  in conjunction with application of the vetrocyn spray, limited exercise in short grass, no mud and administration of the TMZ tabs twice per day are sufficient to handle most wounds. If I begin to see the proud flesh, then I will apply Preparation H to the wound and wrap it with a light pressure bandage usually of gauze and vetwrap. The pressure of the bandage seems to be one of the best ways to limit proud flesh.

The other major concern I have is to make sure that the swelling in the tendon is reduced and no tear has occurred. A vet would probably ultrasound the tendon to determine whether any tears have occurred, then recommend some sort of support bandage. In this case the horse was sound and I determined that the biggest concern was to keep her from overusing the swollen tendon. The cast supported the tendon and I limited her exercise to walking in a small paddock to prevent further damage. I also administered 1 gram of phenylbutazone twice per day.

Early Results

The cuts have quickly begun to heal. I continue to wash and clean them with a cold-hosing that lasts 10 minutes up to two times per day. I have not noticed any indication of proud flesh but it usually sets in about the third to fifth day if it is going to happen. I left the cast on the tendon for two days, removed it and the tendon showed no signs of swelling. I left the cast off for a few hours and the swelling returned. So I recast the tendon and will continue to keep some sort of support on it for probably 1-2 weeks depending on the swelling. I have found that a polo bandage is a good transition from the cast as well.

She is a relatively quiet horse, so the limited exercise has not been a problem for her. I can let her out in the small paddock and she will graze quietly. Because I have not had the tendon ultra-sounded I will err on the conservative side with exercise. When the tendon shows no sign of swelling or heat, then I will probably give it a few more days before returning to her normal turnout and work. It is something I will keep an eye on into the future. Tendon injuries can be sneaky and any sign of heat or unsoundness in that leg will need to be treated with extra caution. If I feel uncomfortable about it's progress, I will get the tendon ultrasounded for peace of mind.

Accidents happen with horses in spite of all of our best efforts to protect these delicate creatures. The key to keeping vet bills down is to respond with good first aid and have your medications on hand for when something occurs. I would guess that at least 50% of the expenses horse owners incur are because a horse-owner has not educated themselves on basic first aid and had the necessary medications on hand. However, I am in no way discouraging an owner from calling the vet. If you can afford to, it is always better to get a professional's opinion on a medical issue. I often recommend a client call the vet because it will give them peace of mind, but I always insist that they be present for the vet visit. I did not gain the confidence and skills in my first aid without a lot of visits and education from my vets.