⚠️ TRIGGER WARNING ⚠️ GRAPHIC PHOTOS AND DESCRIPTION - This blog includes photos and description of a postmortem surgical exploration performed by a board certified and licensed veterinary surgeon.
We began by introducing our surgeon, Dr. Jessica Bramski, clinician and certified bodyworker, Katrina Sanders, and farrier Melody O'Brien.
Dr. Jessica Bramski DVM, DACVS (LA) was born and raised in upstate NY. She obtained her doctorate from Ross University School of Veterinary Medicine, completed a surgical internship at Rood and Riddle in Saratoga, NY and Large Animal Surgery Residency at the University of Georgia. After remaining at the university as a clinical instructor for one year, she made the move to Reno, NV. Dr. Bramski pursued a career change to Small Animal emergency and critical care by joining the team at Animal Emergency and Specialty Center. In pursuit of lightness and harmony, Katrina Sanders strives to instill awareness of both human and horse biomechanics, learning theory, and temperament while maintaining traditional or classical philosophies. By combining classical knowledge with scientifically supported data, horse and human can become partners, working together towards the goal of enlightened horsemanship. Melody O'Brien is a practitioner, mentor, and clinician with Progressive Hoof Care Practitioners. Her business, Whole Health Hoof Care & Trimming, founded in 2010, is rooted in the understanding that healthy hooves depend on consistent, non-invasive trimming, proper and balanced nutrition, and plenty of movement. She strives to educate and empower horse owners to care for their horses in a way that optimizes their overall health and well-being.
After introductions were made, we discussed the subject's known history. The subject was an approximately 12 year old mustang gelding gathered from the Devil's Garden Plateau near Alturas, CA. The large scar on his right hindlimb from his hip to his hock was present as a healed scar when he was gathered so it's origin is unknown. Generalized atrophy of the right hindlimb, loss of control placing the right hind foot, and occasional difficulty standing after lying down were noted as the reason for his scheduled euthanasia. Due to his aversion to human handling and the impending winter, the decision was made to euthanize him before his symptoms worsened or he suffered a potentially catastrophic fall in the snow and ice. Dan and Kathy Yriarte also answered questions regarding his training history at this time.
Dr. Bramski went over her plan with the 25 or so individuals present. She would dissect down the right hind and open each joint from hip to hoof, describing structures and common injuries and defects seen along the way. She started by removing the skin down to the muscle facia from hip to hock on the right hindlimb, peeling back from the flank (cranial) towards the tail (caudal). Thickening of the facia under the scarred skin was noted, but remarkably there was very little damage to the muscles themselves. Unfortunately without additional tools and significantly more time, a definitive diagnosis for the atrophy in the limb was not attainable. The primary theory was nerve damage higher up in the sacral region that we could not reach.
Once the scarred area was fully explored, Dr. Bramski dissected out the hip joint for everyone to see and feel. It was so impressive! The shear size and muscle attachments were incredible to see up close! While describing each muscle and it's function in detail, Dr. Bramski worked her way down to the stifle, the equivalent of the knee in a person. A long the way she revealed just how thin the wall of the abdominal cavity is near the flank and why punctures in this area and lower can be emergency situations. Once she had dissected out the stifle joint, she was able to show us how the mechanism that enables horses to sleep standing up works. She also discussed and demonstrated some of the disorders and injury of the joint including locking stifles and what that surgery would entail.
She proceeded distally towards the hock and opened and explored that joint, again allowing participants to feel and explore while explaining common injuries, defects and repairs. Continuing down the limb, she exposed all of the major tendons and ligaments that control the lower limb, including the superficial and deep digital flexor tendons and the suspensory ligament. Again, stopping to allow everyone time to look, touch, and ask questions. Finally she opened the fetlock joint, describing the ligament attachments and small bones that comprise the joint. After answering questions and allowing everyone to take a closer look, we rotated the body into dorsal recumbency (on his back) and stabilized the subject with straw bales.
once in position, Dr. Bramski opened the abdomen with a long incision through the ventral midline.
Once the abdominal cavity was opened, she extricated the cecum. The cecum required puncture to release the built up gas and create space. The smell of the fermentation and decay was powerful and something you will never forget! We were all glad to be outside as we waited for the odor to slowly dissipate. Next she pulled out several loops of bowel and described in detail the enormity of the equine digestive tract and how delicate it truly is.
She then described and demonstrated well over 20 different colic presentations, clearly describing the frequency of occurrence, common symptoms, treatment options, and likelihood of recovery. When describing a nephrosplenic entrapment (a condition where loops of bowel get trapped by the nephrosplenic ligament), willing participants were able to, with Dr. Bramski's guidance, reach into the abdomen and feel the space and ligament, as well as the kidney and spleen.
All throughout the demonstration, Dr Bramski shared stories and experiences with actual cases and examples of both extreme presentations and remarkable recoveries.
We wrapped up with a brief question and answer period and much gratitude from participants as Dr. Bramski replaced the bowels and closed the abdomen.
This was an incredible experience and Dr. Bramski was so generous with her time and knowledge! It was a safe space for asking questions and exploring situations that face so many horses owners, but the side so many horse owners aren't able to see first hand. We hope that being equipped with better knowledge and understanding will help horse owners feel empowered to make more informed decisions regarding their horse's care and treatment.