The life of an equine intern
I am one of the equine interns working in the Centre for Equine Studies at the Animal Health Trust, Newmarket. My journey to get to this point has been long, at times hard, but overall pretty amazing. I was not one of those children who always wanted to be a vet and did not spend my childhood sticking plasters onto my toy animals (or real animals for that matter!) as I know some of my friends did. A horse rider from a very early age, I have grown up with horses and they became a passion for me but I did not consider the veterinary profession until much later. I was a keen student at school and loved science in particular. When it came time for me to consider further education and career options I knew that I wanted to take science forward but was not sure in what form. The defining moment came when I went to a small animal veterinary practice to do a week of work experience. I knew as soon as I left after my first day that it was what I wanted to do for the rest of my life, and so I decided to train to become a veterinary surgeon.
I was lucky enough to be offered a place to study veterinary medicine at Cambridge University and began my training in September 2010. It was an amazing 6 years and I learnt more than I ever thought possible. I loved being taught about all species but I knew that, due to my horsey background, I really wanted to be an equine vet. In my final year I spent two weeks seeing practice at the AHT and this inspired me to apply for the internship here. After completing a practical day and a formal interview I was offered a job, I could not believe how lucky I was to be given such an amazing opportunity!
I arrived at the Centre for Equine Studies on the 1 August 2016, nervous for my first day but ready for the work to start…….
I have now completed six months of my internship and I cannot believe how the time has flown. The transition from inexperienced vet student to qualified vet has been challenging but I feel very lucky to be developing my clinical skills and gaining experience under the watchful eye of the AHT’s brilliant equine clinicians. As an intern I am responsible (along with my colleague) for the day to day health and well-being of our inpatients. The Animal Health Trust is a renowned orthopaedic referral centre and so the majority of patients we see are here for lameness investigations, however we also have clinicians who specialise in oncology, ophthalmology and neurology and so we see a wide variety of cases. A typical day for the interns will begin at about 7.30 am (earlier if we have a lot of in-patients) when we perform daily checks on all the horses, administer any medications needed and prepare for the day ahead. Hospital rounds (during which the interns meet with the clinicians and discuss the progress of each patient) are at 8.30am and following this the clinical work for the day begins. A typical day will involve admitting and working up new cases and continuing to work with any other patients that may be resident in the hospital. The clinical work will continue until approximately 5.30pm, after which the interns will administer any evening medications and check all patients. We then assess any images (for example x-rays) that have been acquired during the day and present our findings to the clinicians at imaging rounds (all the while hoping that some of our answers are right!).
The duty intern is required to check the patients again later on in the evening and take care of any other out of hours procedures that might be necessary. At the weekend the duty intern is also responsible for the care of all in-patients who will be remaining in the hospital. This involves checking all the horses twice daily, performing any bandage changes or other procedures that the patients might need and informing the duty clinician that all is well. Our other responsibilities include discharging any patients that are ready to go home and admitting any new horses who arrive.
In addition to my in-patient duties I assist with the lameness investigations. This usually begins with a detailed clinical examination of the horse in the stable, followed by the clinician examining the horse on the trot-up and lunged on both hard and soft surfaces. The majority of the horses we see will then also be ridden (unless they have not been broken or are deemed to be unsafe). Seeing the horses ridden is a critical part of the lameness examination as many ‘poor performance’ problems will only manifest when the horse is ridden. The lameness examination is usually followed by nerve blocks (using local anaesthetic to desensitise nerves supplying different areas of the leg) to determine the location of the pain.
When the pain has been localised, the areas are imaged using x-ray and ultrasound. One of my duties as an intern is to acquire the x-rays, and to make sure they are as good as they can be! We are also lucky enough to have advanced imaging modalities such as MRI (magnetic resonance imaging) and scintigraphy available to us. We have both high-field and low field MRI scanners at the AHT; we use the low-field scanner most frequently as this allows us to image the lower limbs under a standing sedation (which poses a lower risk than a general anaesthetic) very effectively. It is the intern’s job to prepare horses for MRI, which involves placing a catheter into the jugular vein to allow us to administer sedation easily and removing any shoes (as having thick metal shoes near a very powerful magnet is not a good idea!).
Scintigraphy, colloquially known as ‘bone scan’, is useful to scan large areas of the body, looking for ‘hot spots’ where bone is more active, which can be suggestive of injury. We inject a radioactive substance into the blood stream that is distributed throughout the body and binds to bone, more so if the bone is actively remodeling, as can occur after a bony injury and this shows up as a "hot spot". Our most common patients are racehorses, particularly those with suspected fractures and so we are often very busy in bone scan during the racing season! As an intern I am responsible for positioning the camera that allows us to take these images.
Here at the AHT we are lucky enough to have recently acquired a therapeutic laser that can be used as part of the treatment regime for a variety of injuries in horses. One of my duties as an intern is to perform the laser treatments, which involves using a hand piece to deliver the laser beam to the right area of the horse. The beam is a form of high energy light that is thought to speed the healing of damaged tissues within the body. In addition to the laser we also offer shockwave treatment here at the AHT and this is another job that the interns are responsible for. Shockwave therapy delivers pulses of high pressure mechanical energy to defined areas of the body and we use commonly on our equine patients to treat tendon injuries.
I have learnt a huge amount during my internship (and I have no doubt that I will continue to throughout the next 6 months!) and I feel I have gained valuable experience and skills. I still get huge satisfaction from completing a set of x-rays or finishing a bone scan and being responsible for the care of the in-patients is very rewarding; there is no better feeling than spending time with a patient, being part of their story (albeit briefly) and hearing good news from them a few months down the line. I am looking forward to the next six months at the AHT as I have no doubt I will enjoy them as much as I have enjoyed the previous six, however I am now starting to think more about the future and the next stage of my career. I am hoping to go into general practice following my internship; I am looking forward to the challenge of getting out on the road to help a greater range of the equine population! Following this I hope to come back and work in a referral hospital, I have a passion for equine orthopedic work and hope to pursue this further in the future. But no matter what I end up going on to do, I know I could not have had a better start to my career as an equine veterinary surgeon than I have here at the AHT.