The Liphook Equine Hospital

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Hospital facilities

Referrals to the Hospital are conducted on a strictly ethical basis. We maintain close communication with both the referring veterinary surgeon and the owners of the horses. Comprehensive written reports are provided to the referring vet after every referral and explicit discharge instructions are given to the owners and faxed the same day to the vet. The Hospital is ready to take emergencies at short notice, 24 hours a day, 365 days a year and clinicians are always available to discuss cases by telephone. We encourage the exchange of follow-up information and remain available for consultation throughout the convalescent period. We are always glad to meet vets who wish to attend with their referred cases.

Lameness, poor performance, potential surgical and medical cases

These can be subjected to routine or in-depth investigations (as appropriate) using the Hospital's experience, expertise and wide range of diagnostic facilities.

As well as thorough clinical examination, diagnostic tests may include...

Digital Radiography
Powerful units allow the use of high definition file/screen combinations resulting in radiographs of the very highest diagnostic quality. Proximal structures such as the shoulder joint can be imaged successfully in conscious adults. Excellent images of soft tissue structures such as lungs are also obtained. In-theatre equipment enables good pelvic and myelographic studies to be performed. 		 
 

Craniocaudal view of stifle

 
  Radiograph checking position of vertebral stabilisation in a 'wobbler'
   

Nuclear scintigraphy ('bone scanning')
The Hospital has pioneered the use of scintigraphy over the last 25 years. A GEC Maxicam gamma camera is mounted in a dedicated scintigraphy room on a purpose designed, counterbalanced arm which allows images to be obtained over the whole body. Scanning is routinely performed on a daily basis with isotope generated on site. The majority of procedures are performed on sedated horses but the facility exists for scanning under general anaesthesia if necessary.
A 'bone scan' of a horse's pelvis.
 

Magnetic Resonance Imaging (MRI)

The Hospital has one of only two magnetic resonance units in the country that allows MR imaging of the lower limbs in standing horses without the need for general anaesthetic. The system is operated by a qualified radiographer with extensive experience of human MR imaging (Lesley-Ann Allen) in conjunction with Jane Boswell, one of our orthopaedic surgeons. MRI is an excellent tool for imaging the different structures in the lower limb and is particularly useful in horses with lameness arising from the foot. This modality complements other imaging techniques and is helping to unravel the "mysteries" of navicular syndrome.

Sagittal MR image of a horse's foot

 

A sedated horse having MR images taken of the lower limb.

 
Ultrasonography
The Hospital has seven ultrasound machines providing linear array scanning at 5.0, 7.5 and 10 MHz and sector scanning (with colour flow doppler facility) at 2.25 to 5.0 MHz. This combination allows a full range of musculoskeletal, abdominal, gynaecological, pleural and cardiac ultrasonographic techniques to be carried out. Ultrasonography associated with a precise biopsy guidance system is frequently employed for tissue biopsy including liver, kidney and miscellaneous internal masses. Liver biopsy has proved to be a very informative adjunct to the investigation of suspected cases of liver disease. Under ultrasound guidance the condition is rapid and of negligible risk and is usually performed on an out-patient basis.		  

 

 
 
Ultrasonographic image of a horse's liver
 
 

Taking a liver biopsy in a sedated horse

 
Videoendoscopy
V ideoendoscopes allow close and detailed visualisation of many otherwise inaccessible areas with the image displayed on a large screen for easy explanation to the client. Most procedures are performed with a 1.4m videoendoscope allowing inspection of the upper respiratory tract, guttural pouches, uterus, urethra and bladder, even in smaller patients. Our 3.0m videoendoscope allows examination of the entire oesophagus, stomach and upper duodenum and also the trachea and bronchi. The increasingly recognised prevalence of gastric ulcers in horses and their excellent response to treatment adds merit to the routine use of gastroscopy in suspicious cases. Also the increasing frequency of respiratory allergies (especially in spring and summer) leads to ever larger numbers of such cases being investigated in the hospital.		  
 

A horse being 'scoped'

 
 
 

Gastric ulcers seen via gastroscope

 
 

 

 
   
Skin diseases
An in-depth clinical and clinicopathological examination of problematic dermatological cases is usually carried out on an in-patient basis. Suspected skin allergies are investigated using a customised screen of at least 46 different intradermal allergens (additions appropriate to the individual history are available), the 'gold standard' technique for identification of allergens. Follow-up therapeutic hyposensitisation can then be applied in appropriate cases. 		 
 

Intradermal testing in a horse with skin allergy

 
 
 

Taking a skin biopsy from a sedated horse

 
Respiratory disease
Expertise and facilities are available for a full and thorough examination and evaluation of horses and ponies with seasonal or non-seasonal respiratory problems. Arterial gas tensions, pleural pressure measurements, radiography, videoendoscopy and airway secretion sampling (bronchoalveolar lavage and tracheal wash) are all routinely performed where required. Considerable experience with both systemic and inhalation therapy optimises the chances of recovery.		  
   

A horse with a respiratory allergy receiving inhaled medication

 
   
Ophthalmic conditions
Appropriate medical and surgical management of ocular diseases frequently requires specialised equipment and around the clock monitoring and treatment. This is always available at the hospital where conditions such as recurrent uveitis, non-healing ulcers and ocular penetrating injuries are routinely seen. Additionally second opinions are given on request by referring veterinary surgeons regarding ocular abnormalities/variations detected during prepurchase examinations.
  Slit lamp biomicroscope being used to examine a horse's cornea.
   
 
Laboratory
A well-equipped in-house laboratory provides a vital back-up to the Hospital's services and is operated by a full-time trained technician. Referred samples are welcomed and the Hospital is an HBLB appointed laboratory for isolation of venereal pathogens. See The Laboratory.		  
    Julia Revill, The hospital laboratory manager
 


Surgical Cases

Over 900 operations a year are performed across the full range of procedures and techniques currently practised, from the routine to the innovative. All cases are welcomed and we are happy to view radiographs or otherwise discuss cases prior to a potential referral. Surgery is performed in a closed theatre suite which has filtered, conditioned air delivered under positive pressure. The theatre is run to an exacting standard of aseptic protocol by a team of trained theatre nursing staff, including qualified veterinary nurses. All the Hospital's surgeons hold post-graduate qualifications in surgery and two are recognised by the RCVS as Specialists in equine surgery. General anaesthesia is performed exclusively by a designated team of specially-trained veterinary surgeons who have access to controlled ventilation and blood gases monitoring.


Orthopaedic procedures
Approximately 250 arthroscopy procedures are performed per year using videocamera control and a diversity of instrumentation including motorised burrs and synovial resecting equipment. The Hospital carries a full range of AO/ASIF instrumentation and performs many internal fixation procedures yearly, from the simple to the complex, including, in appropriate cases, proximal long bone fracture repairs and cervical vertebral stabilisations for wobblers.

Abdominal surgery
Over 200 colic cases are admitted to the Hospital each year. Many respond successfully to intensive medical therapy but approximately 150 horses per year undergo an emergency exploratory laparotomy. Recent statistics showed an 85% survival rate for these cases, helped greatly by prompt referrals. Modern surgical techniques are supported by a team of intensive care nursing staff working through each night. Laparoscopy is used in some cases as an aid in the diagnosis and treatment of recurrent/low grade colic and also is now our preferred technique for performing cryptorchidectomy and ovariectomy (including GCT) procedures.

Laparoscopy
This is perhaps the most rapidly advancing surgical technique and has been developed for cryptorchidectomy and now ovariectomy in the standing sedated mare. This allows rapid return to work and is at last an answer for working mares that are constantly in season or that have severe temperament changes while they are in season. Further techniques have included laparascopic colopexy for recurrent large bowel displacement and is providing unique information in chronic abdominal investigations.

ENTsurgery
We offer a wide range of procedures involving dental and sinus surgery, laryngeal and palate surgery and, in selected cases, non-surgical treatment of ethmoidal haematoma and guttural mycoses.
Colic surgery in the operating theatre.


Arthroscopic surgery.

Surgery

Intestinal resection in a surgical colic case.

Surgery
   
'Keyhole' laparoscopic surgery under general anaesthesia.
     


Other Services

Stud Medicine The Hospital has the experience and expertise to deal with all aspects of stud medicine including the hospitalisation of mares for artificial insemination (AI) purposes, plus other gynaecological services including infertility treatment and caesarean section. See AI information (html or pdf)

Farriery Ross Eager FWCF and John Kavanagh FWCF work at the Hospital three days per week. Referrals to them for therapeutic shoeing can be taken through one of the Hospital's vets.

Physiotherapy Jenny Hadland MCSP SRP Grad. Dip. Phys. is a chartered physiotherapist and an 'A' category member of ACPAT. She works in conjunction with the Hospital clinicians and runs a clinic on the premises one day a week for both our in-patients and out-patients.

 

 

 
© The Liphook Equine Hospital 2006