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Orthopedic emergencies
Continued from page 696 consist of both superluminous diodes and true laser diodes. Typical radiant power levels used in LILT are in the low milliwatt range, and in many LILT units the light can be delivered either continuously or pulsed. The output should be expressed in terms of wavelength, power density, energy density, pulse duration and pulse repetition rate. At appropriate energy densities and treatment parameters, LILT can alter the pain threshold. LILT has the potential t o significantly alter the neurochemistry ,:of the central and peripheral nervous systems; this suggests that there may be one or more neuropharmacological
Involve insufficient production of nitric oxide. Treat the cause, not the Symptoms!
9 G a s t r A i d for healing and preventing gastric ulcers 9 P u l r n o n A i d for treating and preventing bleeders (EIPH) 9 N u t r a W o u n d to ;~romote rapid wound healing 9 N i t r O x i d e for treating and preventing laminitis F o r full information, call E q u i n e Division Toll free 888-422-8398 www.totalhealthenhance.com
738
substrates for laser-mediated analgesia. LILT can alter electrically evoked potentials, in terms of latency (or velocity) and amplitude. In wound healing LILT accelerates the resolution of inflammation. It increases growth factor release from macrophages, following temporary increase in membrane permeability to calcium ions. It enhances synthesis of ATR It increases mast cell numbers and degranulation following injury. It increases proliferation ofkeratinocytes, fibroblasts and endotheliocytes. It increases angiogenesis and collagen synthesis. It increases myofibroblast activity resulting in more rapid wound contraction.
Orthopedic emergencies DI'. Alicia L. Begone described the management of equine orthopedic emergencies, those that may result in the death or elective euthanasia of the animal for humane purposes. In most instances, these injuries include loss of mechanical function of the limb, such as suspensory apparatus disruption (breakdown injuries), fracture, tendon transection or rupture, ligament rupture, and joint luxation, but will also include life-threatening joint injuries/ infection and lacerations of the limb neurovascular supply. She emphasized that the practicing veterinarian should be prepared to handle these injuries in a safe and effective manner. In most instances, the owner is severely distraught and may not be able to provide much assistance. The veterinarian usually does not have time to gather first aid material, splints and bandages, or appropriate medication. Preparation and organization of materials for these emergencies should be done ahead of time. always be available, portable, and in one place. On receiving the telephone call for such emergencies, it is important to ascertain if the horse has been caught or is down, unable to rise, bleeding profnsely, with a dangling limb, and/or unable to bear weight. Answers of
"yes" to these questions make this call a serious and definite emergency, the owner/caller should be instructed to gather assistance of people, preferably with experience around animals and those not distraught with the sight of blood or injury. If the horse is loose, it should be gently caught and kept from moving to prevent further damage. This requires some judgment, because chasing a horse with a broken limb is certainly not preferable to leaving them loose if they are standing quietly. This should also be briefly explained to the caller. If bleeding is severe and the horse is Calm and tolerant, the limb can be wrapped with a clean pressure wrap to assist with arresting the bleeding. A soft pillow or towel with an ace bandage may suffice. If this is painful to the animal and causes the horse to resist, it is probably better to leave the limb alone~ These points may seem obvious to the practitioner, but to many individuals not exposed to these frightening situations, common sense may not prefail. An organized, carefully constructed "speech" to the client m a y make all the difference in the ultimate survival of the animal. Many catastrophic injuries are reparable or treatable if the finances and desire are there, but in many cases this initial management of the horse may create a situation that has no hope of success. Initial management of injuries includes safely gaining control of the animal and assessing and treating systemic shock. If hemorrhage is life threatening, it must be controlled. If the limb is nonfunctional it should be stabilized. Any open orthopedic injury should be treated by cleaning the tissues, protecting the exposed tissues, and administering systemic antibiotics. A commercial splint is available (Equine Regular Leo, Saver Splint, Kimzey Welding Works, Woodland, CA) that can immobilize and relieve weight bearing for cases of phalangeal fi'acture, flexor tendon rupture, fetlock breakdown, and lower joint luxations and subluxations. Hock and carpal"
JOURNAL OF EQUINE VETERINARY SCIENCE
luxation and radius fracture in foals can be stabilized by wooden or metal splint incorporation in a bandage. Tibial fractures can be stabilized with a modified Thomas splint. Injuries that expose a joint or infectious arthritis require emergency diagnosis of joint involvement, and subsequent joint lavage, intra-articular antibiotics, and systemic antibiotics. For further treatment of septic arthritis, the cases can be referred to a hospital for joint drainage. The appropriate emergency treatment of these injuries is often the determining factor in whether the injury remains in a condition that can be successfully repaired.
Moist wound healing Dr. David Platt, a British equine veterinary surgeon, described advances in second intention healing. In the initial phase of healing there is platelet aggregation to bring about hemostasis. Then there is fibrin clot formation that serves as the initial scaffold for stabilization of the acute wound. Then there occurs a migration of leucocytes as a part of the inflammatory phase, after which vascular endothelium migrates into the stabilizing clot along with fibroblasts. Epithelium then covers the maturing scar and the wound enters a period of remodelling. During healing the epithelium is regenerated as an outgrowth of cells
740
from the epithelium at the edges of the wound. A sheet of epithelial cells migrate under the fibrin clot, or scab, and are protected by the scab. This provides an optimum environment for regeneration of epithelium. However, the protection afforded by the fibrin clot is compromised in large wounds because the clot dries out too much. Dr. Platt described studies showing that a moist wound dressing enhances the healing process by keeping the fibrin clot from drying out. One way the healing environment changes is by allowing the temperature at the wound surface to remain higher. With a moist wound dressing, the temperature is 30-34~ , while with a dry wound and no dressing, the temperature at the wound surface ranges from 19~ to 23~ A good healing dressing allows for more oxygen and nutrients to penetrate into the healing surface. It has been found that there is more rapid epithelial migration under the moist wound with a healing dressing than with the dry wound. When the surface scab of a dry wound is disturbed, or removed, the underlying new epithelial layer is disturbed, resulting in pain and delayed healing. With a moist wound dressing, removal does not disturb the underlying cells~ and there is no delay in healing. The ideal dressing should provide an environment at the surface of the wound in which healing may take place at the maximum rate, according to Dr. Platt. The wound dressing should allow the wound to be bathed with moist exudates. It should keep the wound free of clinical infection and toxic
chemicals. It should keep the wound free of particles of fiber, maintain an optimal healing temperature, allow free gaseous permeability, not disturb the wound surface when the dressing is changed, maintain an optimal pH value, effectively control the moisture content adjacent to the wound and should be impermeable to micro-organisms. Dr. Platt tested a variety of wound dressing products to see how they compared as an ideal product. Those tested were Jelonet, Melolin, Opsite, Lyofoam, Sorbosan, Dermagel, and Granuflex. He found high epithelial cell viability with pH-balanced propylene glycol hydrogels. A product of this type sold in the United States is Derma Gel.@ He showed slides of a number of equine wounds that healed rapidly with the use of Derma Gel.
Alternative and complementary therapy The keynote speaker was Dr. William E. Jones speaking on the subject of alternative and complementary therapy. He pointed out that alternative therapies were used by 40% of all Americans in 1997 and they are now spending as much on alternative medicine as on conventional medicine (excluding that spent by HMOs). There is a vast array of alternative therapies, each with their own group of followers. Most of these therapies have a support organization that promotes education and use of the therapy. These therapies range from the more popular acupuncture and chiropractic to the little know therapies of "juice therapy" and "sound therapy." These are all described
JOURNAL OF EQUINE VETERINARY SCIENCE
Involve insufficient production of nitric oxide. Treat the cause, not the Symptoms!
9 G a s t r A i d for healing and preventing gastric ulcers 9 P u l r n o n A i d for treating and preventing bleeders (EIPH) 9 N u t r a W o u n d to ;~romote rapid wound healing 9 N i t r O x i d e for treating and preventing laminitis F o r full information, call E q u i n e Division Toll free 888-422-8398 www.totalhealthenhance.com
738
substrates for laser-mediated analgesia. LILT can alter electrically evoked potentials, in terms of latency (or velocity) and amplitude. In wound healing LILT accelerates the resolution of inflammation. It increases growth factor release from macrophages, following temporary increase in membrane permeability to calcium ions. It enhances synthesis of ATR It increases mast cell numbers and degranulation following injury. It increases proliferation ofkeratinocytes, fibroblasts and endotheliocytes. It increases angiogenesis and collagen synthesis. It increases myofibroblast activity resulting in more rapid wound contraction.
Orthopedic emergencies DI'. Alicia L. Begone described the management of equine orthopedic emergencies, those that may result in the death or elective euthanasia of the animal for humane purposes. In most instances, these injuries include loss of mechanical function of the limb, such as suspensory apparatus disruption (breakdown injuries), fracture, tendon transection or rupture, ligament rupture, and joint luxation, but will also include life-threatening joint injuries/ infection and lacerations of the limb neurovascular supply. She emphasized that the practicing veterinarian should be prepared to handle these injuries in a safe and effective manner. In most instances, the owner is severely distraught and may not be able to provide much assistance. The veterinarian usually does not have time to gather first aid material, splints and bandages, or appropriate medication. Preparation and organization of materials for these emergencies should be done ahead of time. always be available, portable, and in one place. On receiving the telephone call for such emergencies, it is important to ascertain if the horse has been caught or is down, unable to rise, bleeding profnsely, with a dangling limb, and/or unable to bear weight. Answers of
"yes" to these questions make this call a serious and definite emergency, the owner/caller should be instructed to gather assistance of people, preferably with experience around animals and those not distraught with the sight of blood or injury. If the horse is loose, it should be gently caught and kept from moving to prevent further damage. This requires some judgment, because chasing a horse with a broken limb is certainly not preferable to leaving them loose if they are standing quietly. This should also be briefly explained to the caller. If bleeding is severe and the horse is Calm and tolerant, the limb can be wrapped with a clean pressure wrap to assist with arresting the bleeding. A soft pillow or towel with an ace bandage may suffice. If this is painful to the animal and causes the horse to resist, it is probably better to leave the limb alone~ These points may seem obvious to the practitioner, but to many individuals not exposed to these frightening situations, common sense may not prefail. An organized, carefully constructed "speech" to the client m a y make all the difference in the ultimate survival of the animal. Many catastrophic injuries are reparable or treatable if the finances and desire are there, but in many cases this initial management of the horse may create a situation that has no hope of success. Initial management of injuries includes safely gaining control of the animal and assessing and treating systemic shock. If hemorrhage is life threatening, it must be controlled. If the limb is nonfunctional it should be stabilized. Any open orthopedic injury should be treated by cleaning the tissues, protecting the exposed tissues, and administering systemic antibiotics. A commercial splint is available (Equine Regular Leo, Saver Splint, Kimzey Welding Works, Woodland, CA) that can immobilize and relieve weight bearing for cases of phalangeal fi'acture, flexor tendon rupture, fetlock breakdown, and lower joint luxations and subluxations. Hock and carpal"
JOURNAL OF EQUINE VETERINARY SCIENCE
luxation and radius fracture in foals can be stabilized by wooden or metal splint incorporation in a bandage. Tibial fractures can be stabilized with a modified Thomas splint. Injuries that expose a joint or infectious arthritis require emergency diagnosis of joint involvement, and subsequent joint lavage, intra-articular antibiotics, and systemic antibiotics. For further treatment of septic arthritis, the cases can be referred to a hospital for joint drainage. The appropriate emergency treatment of these injuries is often the determining factor in whether the injury remains in a condition that can be successfully repaired.
Moist wound healing Dr. David Platt, a British equine veterinary surgeon, described advances in second intention healing. In the initial phase of healing there is platelet aggregation to bring about hemostasis. Then there is fibrin clot formation that serves as the initial scaffold for stabilization of the acute wound. Then there occurs a migration of leucocytes as a part of the inflammatory phase, after which vascular endothelium migrates into the stabilizing clot along with fibroblasts. Epithelium then covers the maturing scar and the wound enters a period of remodelling. During healing the epithelium is regenerated as an outgrowth of cells
740
from the epithelium at the edges of the wound. A sheet of epithelial cells migrate under the fibrin clot, or scab, and are protected by the scab. This provides an optimum environment for regeneration of epithelium. However, the protection afforded by the fibrin clot is compromised in large wounds because the clot dries out too much. Dr. Platt described studies showing that a moist wound dressing enhances the healing process by keeping the fibrin clot from drying out. One way the healing environment changes is by allowing the temperature at the wound surface to remain higher. With a moist wound dressing, the temperature is 30-34~ , while with a dry wound and no dressing, the temperature at the wound surface ranges from 19~ to 23~ A good healing dressing allows for more oxygen and nutrients to penetrate into the healing surface. It has been found that there is more rapid epithelial migration under the moist wound with a healing dressing than with the dry wound. When the surface scab of a dry wound is disturbed, or removed, the underlying new epithelial layer is disturbed, resulting in pain and delayed healing. With a moist wound dressing, removal does not disturb the underlying cells~ and there is no delay in healing. The ideal dressing should provide an environment at the surface of the wound in which healing may take place at the maximum rate, according to Dr. Platt. The wound dressing should allow the wound to be bathed with moist exudates. It should keep the wound free of clinical infection and toxic
chemicals. It should keep the wound free of particles of fiber, maintain an optimal healing temperature, allow free gaseous permeability, not disturb the wound surface when the dressing is changed, maintain an optimal pH value, effectively control the moisture content adjacent to the wound and should be impermeable to micro-organisms. Dr. Platt tested a variety of wound dressing products to see how they compared as an ideal product. Those tested were Jelonet, Melolin, Opsite, Lyofoam, Sorbosan, Dermagel, and Granuflex. He found high epithelial cell viability with pH-balanced propylene glycol hydrogels. A product of this type sold in the United States is Derma Gel.@ He showed slides of a number of equine wounds that healed rapidly with the use of Derma Gel.
Alternative and complementary therapy The keynote speaker was Dr. William E. Jones speaking on the subject of alternative and complementary therapy. He pointed out that alternative therapies were used by 40% of all Americans in 1997 and they are now spending as much on alternative medicine as on conventional medicine (excluding that spent by HMOs). There is a vast array of alternative therapies, each with their own group of followers. Most of these therapies have a support organization that promotes education and use of the therapy. These therapies range from the more popular acupuncture and chiropractic to the little know therapies of "juice therapy" and "sound therapy." These are all described
JOURNAL OF EQUINE VETERINARY SCIENCE