Stories from the Field
2013 HSVMA-RAVS Clinics in Peru

HSVMA-RAVS returned to Peru this summer to again provide free veterinary care to working horses. Read about last year's trip»

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Day 1 – Sunday, August 4, 2013
by Angie Gebhart and Dr. David Turoff

Travelers met from all over in Houston and Lima to begin our trip to Peru. As somewhat expected, customs in Lima took a long time to pass through. Maria Teresa, our coordinator from the non-profit VidaDigna, helps us with permits, and we generally have a good working relationship with the customs officials at SENASA because of the trip’s long-time in-country presence. It took us at least 5 hours to have all of our boxes inspected, which had been shipped to various trip participants prior to the trip to check as extra baggage. Everything cleared, but it seemed to have warranted double- and triple- inspection and communication with a superior over the phone. Many of us ended up missing our connection flights to Cuzco, but luckily there are at least one or two flights per hour from Lima to Cuzco, so we could jump on another with few problems.

Once landed in Cuzco, we met Dora and Ynez from Yanapana Perú, who were there to pick us up at the airport. We took a taxi to our hostel, “La Casa de mi Abuelo” (My Grandfather's House), and in its courtyard we combined the items we had brought with inventory left in storage from last year. The largest problem we had with supplies was that a bottle of Betadine had begun leaking in the Action Packer box and syringe packs had to be rinsed. We packed enough supplies for one day, as we will be working in Saqsaywaman, a short drive from Cuzco, tomorrow and returning to our hostel.

Several of us took naps that afternoon after not sleeping the night before while in customs, then many took a walk to “el centro” in Cuzco where we purchased necessities, souvenirs, and explored. We met Wassim, new to his position of director of social programs at Yanapana, and ventured to a restaurant for dinner. We sat in an upstairs, secluded corner on a couch, where conversation between new friends was facilitated. Trip participants include veterinarians from the U.S.: Drs. David Turoff, Stacy Tinkler, Chelsey Miller, and Lindall Soule. Veterinary students include Helen Sims, Mary Lindahl, and Melissa Fenn from the U.S., and Canadian student Maddy Kuan. U.S. farrier Brooks Varnum and teacher Angie Gebhart are also on board, as is Carlos Montoya-Medina, a Peruvian veterinarian who has joined the trip for several years as a student, and now as a vet. Peruvian veterinary students include Massimo Delli-Rocili, Mario Villalobos, Claudio Mayorga, from Nicaragua and Ian Penny. Plus, we couldn’t forget our in-country hosts from Vida Digna, Maria Teresa Guzzinatti, and from Yanapana Perú, Wassim Nawaz, Dora Quintana, and Ynez Polo.

We were lucky to enjoy Pisco Sours before bed to toast the horses we will see this week!

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Day 2 – Monday, August 5, 2013
by Melissa Fenn and Angie Gebhart

At our worksite today in Saqsaywayman, just a short drive up the mountain from Cuzco, we saw a total of 108 animals. Dental work was performed on 16 horses, and 24 animals were attended to by the farrier. A total of three castrations were completed. The scenery was beautiful on the side of the mountain and within walking distance of the famous Saqsaywayman Incan ruins. The majority of the horses we saw today are used for tourist rides within and around the ruins site, with many tourists riding directly through our worksite during the day.

We saw many saddle sores of varying severity. Approximately seven horses with saddle wounds were treated, and for the majority of these we recommended a treatment of sugar with a 1 percent betadine solution combined into a paste-like consistency and applying it topically to the affected area. The owners were encouraged to avoid working the animals until the sores were healed.

A severe saddle sore was present in the lumbar region of one patient. There was a large, focal hole present which appeared to be where an old abscess had blown out. There was significant inflammation spreading laterally on either side of the hole. The patient was sedated and the region was injected with lidocaine. The area was debrided and scrubbed with chlorohexidine. There was purulent material in the wound and the dorsal spinous processes on the lumbar vertebrae were visible. The wound was covered with gauze soaked in penicillin and covered in plastic wrapping, which was then adhered with duct tape to the patient. The owner was informed of the poor prognosis and that it was crucial that the horse not be ridden.

We saw two sick horses today with differing symptoms. One patient arrived with a history of a cough, dark nasal discharge and an increased respiratory effort with exercise. A re-breathing exam was performed and lung sounds were present and tracheal auscultation was within normal limits. 10 mL of exceed was administered IM and a dose was sent home for the owners to administer. The second patient presented with the owner’s concern of the horse being off feed and not drinking in the past 24 hours. The horse recently was moved from a different mountain area and the owner had the patient for approximately two weeks. The horse was depressed, had a heart rate of 52 beats per minute and a rectal temperature of 103.5 degrees Fahrenheit. Mucous membranes were slightly pale and tacky and there was a decreased capillary refill time. A re-breathing exam was performed and there were bronchovesicular lung sounds with no evidence of crackles and wheezes. Gut sounds were decreased. The patient was sedated and a rectal exam was performed and all findings were within normal limits. A nasogastric tube with water was passed. 10 mL of exceed were given IM and 7 mL of banamine IV. The owner was advised to carefully observe the patient over the next 5 days and to not allow them to work. The importance of providing adequate water and food was emphasized. Approximately another three to five patients presented with nasal discharge, but all other findings were within normal limits.

Approximately three patients presented with sarcoids in varying areas such as the prepuce, inguinal region and hind legs. One of the patients had a sarcoid removed from its prepuce; the rest were not treated. A patient presented with a ruptured abscess on the left flank. It was infused with a mixture of TMS and water.

Several horses presented with carpal injuries, primarily from falls. One patient with an open wound had NeoPolyBac (a topical antibiotic) applied and dispensed to the owner with instructions of applying twice daily.

A possible squamous cell carcinoma was noted on the upper eyelid of one patient. It was explained to the owner to minimize sun exposure if possible.

The most interesting dentistry case of the day was a horse with hooks on the upper 6’s that were very close to making contact with the lower gums. It took only five minutes to correct, but without attention could have been severely detrimental to the animal’s well-being. Another horse which had received dental care last year was presented again, and the previous year’s records were utilized to ascertain that the horse did not suffer from an apparent sialolith, but instead was packing feed on the left side of the mouth because of a sagittal fracture. The tooth was not pulled because the root was attached and there was no indication of sinusitis. Because of the owner’s yearly presence, he was asked to return for dental care the following year.

Surgery went very well today despite one case in which it was very difficult to place the catheter. Anesthesia was not as smooth as we would have hoped, but the horse awoke without complications. We also had a discussion that more saline was necessary to flush the catheters, which was purchased at a pharmacy in Cuzco, and we discussed this method versus using a double drip.

At the farrier station, many horses presented with missing, loose, or cracked shoes. These were pulled and a trim was performed, while explaining to the owners that the hooves were now level, balanced, and ready for new shoes. The importance of selecting larger shoes that fit the hoof completely was explained. Several young males gathered to observe the farrier work and practice with the rasp; one owner who showed particular interest was given a rasp, and several other owners purchased basic farrier tool packs brought to the worksite by VidaDigna and Maria Teresa.

There were just a handful of kids present, but they were very appreciative of the horse care coloring books they received, and returned often to show off their progress in decorating the donkeys and horses on the pages.

Overall, we observed good horsemanship throughout the day, and several owners that were very involved in their animals’ treatment and diagnosis. As our workday was beginning to wrap up at about 5pm, a few groups of several horses each presented. We vaccinated and dewormed as many of these as possible, but most of these horses in the last group would rear and strike if approached at the mouth or shoulder. After packing up, we drove back to Cuzco to pack up our supplies for our second workday tomorrow. We also organized the rest of our supplies to be sent to Mollepata, our third worksite, by truck tomorrow morning while we are working. We enjoyed a typical Peruvian supper of “pollo a la brasa” (roasted chicken) and discussed our upcoming trek to Salkantay.

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Day 3 – Tuesday, August 6, 2013
by Maddy Kuan and Angie Gebhart

We traveled to Lucre today, up the mountain from Cuzco about a half an hour by bus, where we saw 20 animals. Of them, five were horses and the rest were burros. Four castrations were performed, two animals required dental work, and six had their hooves trimmed.

We found vampire bat bites on two donkeys who were otherwise healthy, aside from crusted drainage from the bite wounds. The bats apparently come every night and suck blood from the same donkey at the same site. Thus, the wounds did not have a chance to heal. We first shaved the area surrounding the wound. Then, we scrubbed with either betadine or chlorhexadine scrub and gauze several times, then lavaged the area with saline. Antibiotic ointment was applied, and given to the owner to apply twice a day. They were also advised to apply Vicks VapoRub or some other strong smelling substance to disguise the scent of the open flesh.

Two horses owned by the same owner presented with mucopurulent nasal discharge and sneezing. Upon physical examination, coughs were elicited and fluid sounds could be heard in the lung field, indicating the entire respiratory system was affected. One horse had a rapid heart rate of 56 bpm. We ran him around the field, and noted an increased heart rate of 68 bpm, and increased respiratory effort. Parasites with lung migration or an infectious respiratory disease were the two top differential diagnoses. With regards to the parasite, it is suspected that close proximity to donkeys is a major cause because they carry and shed the parasite asymptomatically. The horses were given doses of dewormer and a course of antibiotic treatment to take home. Castration was nto advised.

Most animals with farrier work had easily maintainable feet, with few animals needing extreme hoof correction. We were reassured of the good effects of our work when an owner whose horses were presented to us last year returned to our work site and purchased basic hoof care tools for his horses and potentially for others.

We really appreciated the worksite today, which was furnished with electricity and water. It was also located on a large soccer field with a pool nearby and shade tents. On the ride to and from the community, we were lucky to have the coordinator of events for the town of Lucre riding along with us to explain other campaigns that the municipality is currently leading. She also taught us to say some words in Quechua, like horse, which we learned is a language with many spellings and pronunciations.

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Day 4 – Wednesday, August 7, 2013
by Helen Sims and Angie Gebhart

We awoke early today to pack all of the rest of our supplies into two vans and leave the hostel in Cuzco by 5:30am. We traveled by vans to Mollepata, stopping to admire views of Salkantay, the peak we will soon hike. Arriving at about 7:30am, we unloaded our supplies into the spacious courtyard of our new hostel Inta Wasi and enjoyed breakfast by our trail cook Yolanda. A few of us shopped in the women’s textiles cooperative that is assisted by Yanapana to purchase scarves, hats, and gloves for the trek.

Several horses awaited us when we arrived at our worksite, a large, grassy field at the bottom of the main hill in Mollepata. It offered plenty of space, which comes with benefits and challenges. A total of 77 horses presented for our first of three workdays here, but seven horses left with their owner before treatment for various reasons, promising to come back tomorrow. Seventy horses were vaccinated and given dewormer. Eight horses were castrated, 12 had dental work done, 14 horses were attended to by the farrier and 12 horses had vampire bat bites that were treated.

Two horses that presented for castration were not castrated. One because the doctors decided that the horse was too thin; the owners were told that he needed to be in better body condition in order to be castrated next year. The other stallion was 2 years old and the owners decided to wait another year to castrate.

Vampire bat bites were cleaned with scrub (either betadine or chlorhexidine depending on the attending doctor) and antibiotic ointment was applied. Most bites were found on the neck and back. Many horses only presented with one bite, but some horses had many. The most bites found on one horse was five; this owner was given antibiotic ointment to continue treating the bite wounds at home. Owners were also educated and told that they could put eucalyptus oil or menthol on their horses to help prevent future bites. It was reassuring to hear that many owners brought their horses’ wounds to the attention of the veterinarian before the physical exams were underway.

Four horses presented with severe tack sores: ONe from a saddle and three from a crupper or similar type of tack that sits under the base of the tail. These wounds were cleaned with chlorhexidine scrub and treated with a mixture of antibiotic cream and triamcinolone. Owners were told that the tack that caused the injury cannot be used until the sore heals, risking infection of the spinal cord, paralysis and death. In cases where the sore was very bad (two cases) the owner was given some of the mixture (antibiotics and triamcinolone) to take home and use once daily.

Sarcoids were noted on one horse in the inguinal region and prepuce. They were not treated.

Two owners were concerned about lameness issues in their horses. On examination, one horse was found to have decreased range of motion due to arthritis in the right front knee. The other was lame in the right hind. Owners were advised that heavy loads and difficult treks may shorten the working lifespan of these horses.

An observation that many veterinarians and students shared was that many owners today were resistant to receiving dental or farrier care for their animals. It is probable that this resistance was because of the time commitment (there was a long wait time today) but in other cases, the owners were wary of the sedation and seemingly intrusive nature of the dental work. Although we explained and provided examples of the value of this type of animal care, we suppose this is a notion that will take time to change, only when owners themselves see the value for their horses.

After supper at our hostel, we enjoyed an explanation of the esoteric tourism trips that the owner leads. A kind man with a grandfatherly attitude, he told us about the importance of the Incan culture, now extinguished, in his life, and how it can still be applied to modern spirituality. Lastly, we enjoyed a bottle of Nicaraguan “ron” courtesy of Claudio and discussed changes we could make for increased efficiency tomorrow. It was recommended that we keep separate record sheets for each horse. Although we note each animal’s name (to encourage personalization and care of the horses), age, color, estimated weight, and body condition score, we really only take detailed records of those horses that require castration, farriery, or dentistry besides the standard tetanus toxoid and ivermectin. To avoid running back and forth to the intake clipboard to weights and ages, each team will record this information on the individual records. We also created coolers of vaccines and dewormer to bring around with us so that we do not have to continue returning to refill them. Lastly, the challenge remains that so many “arrieros” (wranglers) bring strands of 10-20 horses with only a few ropes. Not only does this slow down the process of physical exams, but we also cannot expect a single owner to wait with a single horse for dentistry or farrier work. We recommended keeping a space to tie the animals that are waiting for each station, but the issue remains of too few ropes and animals that don’t tie.

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Day 5 – Thursday, August 8, 2013
by Mary Lindahl and Angie Gebhart

A total of 125 horses were presented to the clinic at Mollepata for our second workday. Of these, approximately 120 were vaccinated and dewormed. The farrier attended to 17 of them; the dentist worked on 14; and seven were castrated. 19 horses had vampire bat bites that were treated. Additionally, three horses had saddle sores that were treated.

The castrations went smoothly with few surgical complications. There were a few anesthetic complications, including catheter placement problems. All animals recovered well.

The bat bites were treated by clipping or shaving the affected region as necessary; cleaning the area with chlorhexidine scrub and water; and applying antiseptic ointment. The owners of the affected horses were advised to keep the area clean and apply eucalyptus oil or similar to dissuade bats from biting the same area.

The saddle sores were first cleaned and debrided, and then antibiotic cream or antiseptic ointment was applied. The owners were advised to keep the area clean and to rest the horse from work that requires any tack which would affect the wound.

In addition to the horses owned by local residents, 25 horses owned by the company Mountain Lodges of Peru were seen. Of these, one had a vampire bat bite which was treated, and six were seen by the farrier. One had a right hock effusion that was treated with oral phenylutazone. The horse was sent home with more Bute (Chelsea).

Finally, there was one case of as scirrhous cord resection. The owner had castrated this donkey approximately one year ago, and there was a history of a draining tract and s swelling on the scrotum. The resection went successfully without any surgical complications.

At the farrier station, many interested onlookers asked questions about the tools. One particularly apt man was given a rasp donated by our farrier, Brooks, and was taught how to use it on his horses. The potential for trimming others´ horses for money was also emphasized, as we explained how farriers make a living in the U.S.

In the last hour before dusk, as the last horses were being vaccinated and the final dentistry cases were being treated, a group of girls that had been watching intently all day joined in a game of Memoria about horse terms, learning about why it´s not a good thing to see ribs on a horse or why dental work for horses is critical. The excited yells as the girls matched the horse pictures was value enough, but they also left knowing the term veterinarian—a word that many didn´t know before, but will hopefully be associated with the positive memory they had in the community that day.

Lastly, everyone from our group gathered in the municipality building before supper for a question-and-answer session before supper. There were about ten arrieros (mule drivers) present, along with a representative from SENASA and the leader of the organization of arrieros. The questions that were brought to Dave, Stacy, and Carlos´s attention included concerns about bats and the transmission of rabies, how to change owners´ minds to focus more on preventative medicine especially maintaining appropriate animal body conditions, and questions about dewormer usage in the community. The charla, or "chat," ended with a discussion of the case of strangles that we observed last year, with questions of how this can be prevented and treated in the future.