I found this article from Idaho Equine. I love it when vets look outside the box to try to help any animal… it is as if this idea just picks at them until they figure out a solution. THANK YOU, vets, all over the world, who follow that niggling feeling and tracking down an answer!
Idaho Equine Investigates a Novel Solution to an Old Problem
April 10, 2019
As equine veterinarians, we often wear many different hats. We are scientists, counselors, horse trainers, grooms—basically whatever the specifics of each case require. One hat we don quite frequently though is our MacGyver hat. Large animal veterinary work often requires us to come up with unique solutions to problems. Due to our patient’s size, there is often not an actual instrument or piece of equipment that exists to deal with whatever issue we are facing. Much of our medical equipment comes from human medicine, so it is easy to see why equipment made for humans isn’t always the right size or shape for treating something 5 times larger. It is definitely one of the most challenging aspects of our job, but when we come up with novel solutions to problems the reward is immense.
Dr Liz Scott pulled off a pretty amazing feat of MacGyver work recently. For years, Dr Scott has been searching to find a better solution for treating mares with chronic Strep. zoo pyometra. Pyometra is an infection (from either a bacteria or fungus) that causes pus and fluid to collect in the uterus.* It is usually treated by flushing the mare’s uterus with fluids and medications to treat the infection using a tube that is passed through the cervix. However two things that are unique about pyometra that is caused by the Strep zoo. organism make these cases particularly challenging to treat: 1) this organism is almost impossible to completely clear from the uterus once it is there. Multiple antibiotics and antiseptic solutions have been used throughout the years, but none have proven very effective at completely eliminating the infection. 2) this organism in particular tends to cause significant scaring of the cervix, which creates a dangerous situation in which large amounts of pus and fluid collect in the uterus because there is no way for it to escape. Occasionally, mares have even suffered from uterine rupture and death due to large amounts of fluid accumulation. Uterine ruptures are often fatal and that is why Dr Scott has worked for so long to try to come up with a better way to treat these mares.
Unfortunately, due to the sheer size of a horse and the location of the uterus, you can not just spay them like a dog or cat to deal with this issue. A significant portion of the uterus sits within the pelvic cavity of the horse making it physically impossible to remove all of the uterus through an incision into their abdomen. So, up until now, our best way of treating these mares was to repeatedly go in and break down the scar tissue in the cervix or to surgically remove a small section of the cervix so that we could drain the fluid and treat the uterus. We had one mare who came to us every few months for over a decade to manage this condition.
Dr Scott had long thought that if she could find some kind of stent that would keep the cervix open and allow the fluid to be expelled from the uterus, she could not only save these mares from dying from a ruptured uterus, but she could also save the owner’s a great deal of money avoiding repeated, chronic treatments. Unfortunately, no such stent for horses exists. However, at the ACVIM convention, Dr Jamie Higgins saw a device designed for dogs that she thought might be just the thing that Dr Scott had been searching for.
Dr Scott and Dr Higgins placed the device in a mare for the first time last summer, and so far it is working like they had hoped to keep the cervix open to allow the mare to get rid of the extra fluid in her uterus on her own. The hope is that this device will provide a long-term solution for this mare and allow her to avoid chronic treatment.
While this treatment would definitely still be considered experimental (this is the first time it has ever been attempted to our knowledge) the results 7 months after placing the device are very encouraging. We hope that it will ultimately save more horses and provide a better treatment option for these challenging cases in the future.
* Pyometra is similar to endometritis because they both can be caused by fungus or bacteria (including Strep. zoo) in the uterus, however there are some important differences. Endometritis is much more common than pyometra, and with endometritis the infection does not affect the deeper tissues and thus is easier to treat than pyometra. Cervical scaring and chronic, non-responsive infections are not common with endometritis.
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