News Updates from Countryside Equine Hospital

Wound Botulism

When Patch arrived at the hospital for examination, her condition seemed fairly ordinary. Her owner Heather McGinnis said she was being confined to a stall and small paddock because of a laceration she suffered a few weeks previous. Heather’s mother, DJ, had been caring for the mare during her

Patch after arrival at the Countryside Equine Hospital
Dr. Miller evaluating Patch upon arrival

convalescence, diligently cleaning her wound on a daily basis. Recently however, they had noticed Patch to be lethargic and not eating well. Patch walked off the trailer and down to the exam room like any other horse. Her initial exam revealed only some abnormal gastrointestinal signs along with an elevated heart rate which led the attending veterinarian, Dr. Jennifer Miller, to suspect she may be suffering from colic, for which she was treated and hospitalized. However, the situation quickly changed and suddenly Patch’s condition appeared life threatening.

Once in her stall in the ICU building, she began trembling all over and walking with a stiff stilted gait. Suddenly she appeared lame in the right front. Dr. Miller placed an intravenous catheter while technicians struggled to keep Patch standing. Pain medication and sedation were administered. Just as the catheter was placed she went crashing to the floor. Intravenous fluids were immediately started while she lay quietly on the floor as if she were sleeping, her head and neck curled back alongside her.

Patch after going down on hospital stall floor.
Patch in the ICU barn just after she had colapsed

After a few minutes, she raised herself to her feet, once again circling the stall with a very stiff gait, muscles trembling all over her body. Once again she went to the floor. Further blood work was performed which did not explain such bizarre symptoms.

The presence of Patch’s wound led clinicians to consider a systemic clostridial infection as a potential cause of her symptoms and she was immediately started on high doses of antibiotics. Clostridial infections can occur with any wound or puncture to the skin which would introduce the bacteria. The bacteria live in the soil and once in the body, reproduce quickly causing massive tissue damage and subsequent cardiovascular collapse with widespread organ damage. It can be deadly within 24 hours if not reated aggressively and immediately. However, ultrasound of Patch’s wound did not reveal the typical signs of a clostridial infection and she was not running a fever.

After a few hours of therapy, Patch seemed more stable and was able to stand quietly with only tremors of her tricep muscles present. A neurological exam was then performed which revealed some significant abnormalities. Her pupillary light response, the reflexural closing of the pupil when a bright light is shone into the eye, was quite sluggish. When her tongue was pulled out to the side of her mouth, she could not replace the tongue at all. When given a handful of hay, she could not grab the hay from you, could not chew the hay, and nor could she swallow. Suddenly Patch’s symptoms seem to be a result of something

Patch's wound upon arrival at the ICU.
The original appearance of Patch’s wound

affecting her entire peripheral nervous system. Diseases that could affect her ability to chew and swallow food include botulism, equine protozoal myeloencephalitis (EPM), and temporohyoid osteoarthropathy. However considering such widespread systemic symptoms would highlight botulism and possibly EPM.

Many horses are exposed to and diagnosed with EPM. However, diagnosis of botulism is very rare. The typical route of exposure to the botulinum toxin is through ingestion of spoiled, rotten forage. Improperly stored or baled round bales of hay are prime examples. Inclusion of an animal carcass in a bale of hay can harbor the botulinum toxin produced by the clostridial bacteria that inhabit the carcass. Improperly stored silage can harbor the bacteria and thus the toxin. Patch did not have access to a round bale and had been eating hay from the same batch of hay for the past year. In addition, of 14 horses on the farm, she was the only one with any signs. She was also not being fed any silage and her signs had come on rather slowly initially. Horses that ingest the toxin are affected quickly and often die because of eventual paralysis of their diaphragm and thus suffocation. There was one other plausible explanation for how Patch may have contracted the toxin.

The bacterium clostridium botulinum can invade and proliferate in a wound, producing and releasing the toxin into the bloodstream. So called “wound botulism” is quite rare and does not cause the massive local tissue damage that other clostridial infections do. The tetanus toxoid vaccine that is given yearly or when a horse is wounded is not directed against this particular clostridial bacterium and thus does not prevent the disease. Because the toxin is released slowly over time, symptoms appear gradually, sometimes insidiously, until a critical point is reached and the horse can no longer compensate. However, the potential for death is the same as any other route of exposure to the botulinum toxin. Without treatment, the toxin will eventually paralyze the entire muscular system of the horse, including the diaphragm and heart, resulting in death. Unfortunately there is not a sufficient test for botulism so it is usually a diagnosis made by excluding other potential diseases. Culturing the organism is very difficult as is detection of the toxin.

If Patch was suffering from botulism, her condition was very serious and would continue to deteriorate unless treatment was immediately started. She was given plasma intravenously that was immunized against the botulinum toxin to try and prevent any circulating toxin remaining in her blood from binding with muscle

cells and further inhibiting their function. Additional antibiotics were given to address this specific bacterium. The bulk of her therapy however consisted of supportive care, including intravenous fluids and tube feeding because she was unable to drink or eat. Because the toxin binds irreversibly to the muscles cells, the muscle does not regain function until the cell is able to repair itself or is replaced, which can take months in some cases. Patch was also tested for EPM; but because results are not immediately available and it is one of the few neurologic diseases for which there is a treatment, Patch was started on treatment for EPM until test results could be received.

With aggressive treatment and the love and prayers of her owners, their family and friends, Patch began to improve over the next 48 hours, standing for longer periods of time, lying down less and moving about her stall more. The EPM results were negative. This combined with her response to supportive care and treatment helped solidify the diagnosis of wound botulism. Over the next week, she improved greatly. She was able to be turned out for an hour and started to drink water and eat a gruel consisting of senior feed. She could not however eat hay yet.

Once eating and drinking, Patch was able to leave the hospital and return to the care of her owner, Heather, and her mother, DJ. She is currently continuing her recovery from this terrible disease and is now

Patch is now back at home!
Patch and her owners Heather, and her mother, DJ are all glad to be back at home!

eating hay and is able to be turned out all day with her pasture mates again. Her attitude is great and she runs and bucks in the paddock when she is out. Dr. Miller and her owners are elated that she is making such a remarkable recovery from such a deadly disease.

A vaccine for botulism is available. However it is usually only recommended for horses eating round bale hay, silage, or in areas of the country where the disease seems more prevalent. It is a yearly vaccine given after an initial series of two injections 3-4 weeks apart. Foals can actually acquire the toxin from the bacteria proliferating in the gastrointestinal tract and it is sometimes referred to as “shaker foal” syndrome because of the trembling of the muscles. The hallmark symptom in adults is the inability to prehend &/or chew food, reduced tongue strength and control, and delayed or sluggish pupillary light responses. If you would like more information about botulism or the vaccine, or would like to be updated on Patch’s condition, please call or email us.

Countryside Veterinary Services
Phone: (865) 983-3155

'Country vet' Phillip Hammock has tended to world's best-known race horses

By Laura K. Ward, Special to the News Sentinel | Knoxville News Sentinel Posted June 25, 2012 at 4 a.m.

Veterinarian Phillip Hammock uses a endoscope to examine the throat of Pay Day before surgery earlier this month at Countryside Veterinary Services in Louisville, Tenn. (J. Miles Cary/News Sentinel)

Photo by J. Miles Cary // Buy this photo

Veterinarian Phillip Hammock uses a endoscope to examine the throat of Pay Day before surgery earlier this month at Countryside Veterinary Services in Louisville, Tenn. (J. Miles Cary/News Sentinel)

Veterinarian Dr. Phil Hammock Photo by J. Miles Cary, Knoxville News Sentinel // Buy this photo

Veterinarian Dr. Phil Hammock

If thoroughbred horse racing is the "Sport of Kings," then Phillip Hammock is proof there is room at court for a country boy from Tennessee.

Regarded by racing insiders as one of the top equine surgeons in the world, Hammock has literally had his hands on some of racing's fastest company.

From Rachel Alexandra, the "super filly" named 2009 Horse of the Year, to Curlin, North America's top money earner of all time, cashing out his racing career with a record $10.5 million in purses, Hammock's professional passion is stoked by the staggering athleticism and complexity of his 1,200-pound patients who corner and fly like a Bougatti Veyron.

Hammock knew Funny Cide long before he won the 2003 Kentucky Derby.

Yet the unassuming Louisville, Tenn., equine surgeon offers the same gentle attentiveness to an old quarter horse from rural Tennessee as he would an expensive thoroughbred.

"It makes no difference to me if a horse just won the Kentucky Derby or is a child's beloved pony," Hammock said.

"When they're my patients, they are all equal in my eyes. They're valuable to their owners, which mean their lives and well-being are invaluable to me."

Talk of Hammock's talent — either as renowned surgeon or East Tennessee veterinarian — makes him uncomfortable, and quiet.

"I'm just a country vet from Tennessee," he says, shrugging his broad shoulders. "I fix horses when they break. And the good ones, the fastest ones, always break themselves."

Boyhood at Bull's side

Dial back the years to Phillip Hammock's childhood, and you see a destiny perfectly defined.

As a boy, he ran the roads of Gallatin, Tenn., with his grandfather Bull, a high school janitor and self-taught country vet who could not read or write.

Studying the tops of his muddied cowboy boots, both hands crammed down in the pockets of his jeans, Hammock remembers where it all began — standing in the seat of Bull's Ford pickup, his 6-year-old face shining with eagerness, off to tend to a sick cow or cut horse.

"Bull was everything to me," Hammock recalls with a slight break in his voice. "I never had a bad day when I was with him. He was one of the smartest men I ever knew."

Time spent with Bull is etched deep into Hammock's professional credo. The sacredness he holds for his calling is part and parcel of his approach to his work.

"Every day, my patients teach me something new. I'm blessed to do what I love for a living, because I can't do anything else," he says with a laugh.

Hammock's life is about the things you can't see. Like the horses he heals, what looks ordinary on the surface is inescapably complex and simple, all at once.

He is an old soul rambling around in a 46-year-old frame, and the lines around his eyes, the set of his jaw give him the look of a hard-luck rancher.

But his hands are his "tell."

Strong and immaculate, they are the instruments by which a horse's physical fate can be won or lost.

Today, Hammock is still on the road "tending horses."

Bull's old Ford truck has given way to a well-worn Range Rover, a modified mobile vet unit, crammed with state-of-the-art medical equipment.

He still lives on a farm in Tennessee, just a little farther down the road.

"Thirty years ago, I laughed and said Tennessee was a good place to be from," Hammock muses. "Who knew I would travel around the world just to end up here."

'They've got more history than time'

From a surgical residency at University of Illinois to a two-year stint at the Dubai Equine Hospital, where he developed a working relationship with Sheikh Mohammed bin Rashid Al Maktoum, the Ruler of Dubai and his Darley Stable, Hammock's return to Tennessee seems all a part of his winning strategy to find an open spot on the rail of opportunity and ride hard for the finish.

He maintains a mind-throbbing schedule of surgeries and exams at his base camp, Countryside Veterinary Services in Louisville, Tenn., just outside the shadow of the University of Tennessee College of Veterinary Medicine, where he put meat on the bones of his calling.

Days he is in residence, the clinic's parking lot boasts a steady stream of beat-up horse trailers, shuttling everything from scrubby, backyard horses to beloved show ponies for Hammock to lay hands on — like a tent revival where the sick come en masse to be healed.

Photo by J. Miles Cary // Buy this photo

Veterinary technicians Abby Crane, left, Jennifer Rieger and Jennifer Willis wheel Pay Day to a recovery stall after surgery at Countryside Veterinary Services in Louisville, Tenn. (J. Miles Cary/News Sentinel)

He divides his time between Countryside and his clients' racing farms in Kentucky.

The contrast between his patients in Tennessee and the million-dollar race horses at the track is startling.

At Countryside, Hammock treats and operates on mostly older horses — veterans of show ring or stockyard, whose injuries and battle scars are a testament to a life well-worked. The gentleness in Hammock's tone reflects the soft spot and deep respect he has for these aging athletes.

"They're like the old-timers in the NFL — the Brett Favres and John Kasays," explains Hammock. "They've learned to live and work around injuries that would drive a young horse insane. They've got more history than time on their side."

Today, an older quarter horse with blocky body and sore hooves has made the pilgrimage to Countryside for digital X-rays. During the exam, the worried owners make small talk with Hammock about everything from fishing sweet spots to the Vols.

The vet's eyes never leave the horse, and the conversation they are having is inaudible.

A broad, well-scrubbed hand starts with a gentle rub to the horse's head, slides down the neck and muscled topography, outlining the art of the equine anatomy Hammock holds so dear.

"Easy son, easy," whispers Hammock, his voice deep as a well.

The horse's ears flicker as if he understands and his wide eyes soften.

Soon, the horse's nose is resting on the vet's back as he bends over to position the hoof in question for the X-ray.

His words are like breathing pure oxygen — they go straight to the head, making the world all warm and whiskey colored.

Three exams and two surgeries later, Hammock stops to check his phone and glance at his laptop. He texts, types and returns calls, looking up every few seconds to scan the surgical suite. He is ticking off lists in his head before he hits the road for Kentucky.

Knowing a horse's mind and body

From Florida to California, Hammock travels far beyond the bluegrass to care for a multitude of top racehorses that belong to his devoted clients.

He makes himself as accessible to them as if he lived next door.

For discriminating owners who have horses in Hammock's care, there is no second opinion. They pay him to be brutally honest in a sport where chimerical expectations are the norm.

Every year, from March through late May, Hammock works at numerous thoroughbred auctions across the country, vetting potential race prospects that are selected by his clients' bloodstock agents.

It is in the crucible of these auctions, such as Keeneland and the Ocala Breeders' Sales, that top-rated agents like John Moynihan obsessively scout and separate the wheat from the chaff of juveniles.

Photo by J. Miles Cary // Buy this photo

Veterinarian Phillip Hammock talks with Hannah Moore about her barrel-racing horse, Pay Day, as the horse heads to surgery earlier this month in Louisville, Tenn. Hammock, a board-certified veterinary surgeon at Countryside Veterinary Services, has provided medical care for many of the world's top thoroughbred horses. (J. Miles Cary/News Sentinel)

Moynihan acts as a kind of equine consigliere to the billionaire wine family empire of Kendall Jackson and Stonestreet Stable — one of the top three racing stables in the world.

At this spring's Keeneland sale of 2-year-olds in training, Moynihan culled through the 161 thoroughbred hopefuls that were brought to perform for hundreds of deep-pocket buyers and brokers like him.

"My clients entrust a lot of money to me to buy nice race horses," said Moynihan. "Having someone like Phil Hammock on my side who can tell me exactly what a horse is and not what we hope it will 'be' is invaluable."

The relationship between Moynihan and Hammock is an easy one. Both men are financial devotees to these equine athletes and are equally matched in their uncompromising ethics and drive.

"Phil is incredible with horses," Moynihan said. "He just knows when to look a little deeper into an issue because it's the right thing to do for the horse — not the owner or trainer. He instinctually understands how a horse works mentally and physically, and that kind of knowledge you can't duplicate."

Only three prospects have made it to Moynihan's short list, and there is still a long way to go before the auctioneer's hammer drops. The odds of a 2-year-old making it to the starting gate, much less a graded stakes race, would make even the savviest handicapper swallow hard.

Close to 85 percent of the crop will never make it off the training track. Injury, poor training and lack of money can end a horse's career as quickly as it began.

"It's pretty much a supply and demand game," Hammock said. "Three quality race horses in a breeding establishment can pay for an entire stable full of 'so-so' horses. If there is a good horse for sale, somebody will be there to buy it. But there's no room at the top for breeding or selling bad horses. Period."

At home in the track barns

A few hours before the Keeneland auction starts in Lexington, Ky., Hammock circles back through the shed-row barns to check a last-minute addition to Moynihan's list.

Along the way, trainers, and agents throw up their hand to wave at him or shout hello, while a few younger vets, relatively new to the game, stop Hammock to chat and ask for advice.

Their camaraderie is genuine and with each question, Hammock is thoughtful and serious. Like the seasoned head coach of a winning team, he has his followers.

He listens and exchanges ideas then ends by saying, "Let me know how it turns out."

And he means it.

He heads down a long stretch of stalls to the back barns where a big bay filly stands and waits. Moynihan wants more X-rays of her legs before he makes a decision on whether to bid or not.

Lugging his equipment by himself into the aisle, Hammock nods to her groom, and the anxious patient steps from the dark stall into late afternoon light. She is regal and painfully breathtaking.

Eyes wide and fixed on the vet, her nostrils flair, pulling in the cool spring air.

She gives the impression of a young queen surveying her counsel. Her thin, polished skin twitches and glows with a kind of indescribable power that flashes like lightning.

She is what the game of horse racing is all about — she is chance and fate all at once.

Hammock makes eye contact with her and faintly smiles. For a moment, the two are totally taken in by each other.

After a long pause, Hammock reverently approaches his patient head down, steps slow.

Resting his hand on her statuesque frame, he connects with her on some quiet level only they understand.

In a voice that is barely audible Hammock purrs, "It's gonna be all right, girl. It's gonna be all right."

And suddenly it all is.

Laura K. Ward is a North Carolina-based freelance writer who reports on equestrian issues.

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