The 4 Stages of the Stack Bandage

For those of you in the equine veterinary world. . . this post will be extremely entertaining.  For those of you not in the equine veterinary world. . . this post will also be extremely entertaining.
"Why didn't she just say that everyone would find this post entertaining?"

I would like to introduce you non-horsey folks to a concept called, "The Modified Robert Jones Bandage." A modified Robert Jones bandage is the single most common bandage used in the equine hospital.

These are your materials, and they are applied in the following order;

1) Combi roll or thick roll cotton

2) Brown Gauze

3) Vetrap

4) +/- Elastikon

The finished product, depending on the leg, location and reason for the wrap, usually resembles this distal extremity, hind limb bandage.

Most horses are very used to having a wrap or boot of some kind on their leg.  Sometimes they are placed for shipping, as in the case of this fashionable little fellow . . .

. . . and most commonly for protection during exercise . . . .

Still, while most horses are used to some sort of bandage on the lower portion of their leg, they are often unaccustomed to having a bandage on the upper, or proximal portion, of the limb.

This is where our story begins; 
The majestic horse. . . .
Graceful. . . .
Elegant. . . .
Athletic. . .
and completely accident prone.

There is a saying that if you place a horse in a padded room, he will find a way to hurt himself and it is 100% truth.  I attribute a great deal of that truth to the fact that horses are prey animals, and as such, their first instinct is to run.  Unfortunately, if you are living in a 12x12 box stall, there isn't a whole lot of room to run. Yah, those walls come up pretty quick.  The majority of horses that I see injured in a truly traumatic event, who are also kept out on a large pasture, are injured by barbed wire.  I don't blame that on the horse.  I blame it on the wire.

So what happens when a horse injures their carpus (knee)?

or tarsus/hock (ankle)?

Well that's when you have to place a STACK BANDAGE. A stack bandage is just one modified robert jones placed above another, in an ascending fashion, with some overlap of the bandages.  This does several things.  It covers the affected area and it also decreases the mobility in the limb.  This is particularly important if you have a wound over a high motion area or a joint, like this one on the dorsal (front) aspect of a horse's hock. . .

The problem with these bandages is that you are taking a flight animal and essentially immobilizing or greatly reducing the mobility of one of their legs.  How well do you think that goes over?  Well it goes over something like this. . .

First, the horse is sedated to apply the bandage.  I call this the "blissfully unaware" stage.

Stage 1: Blissfully Unaware

Secondly, as the sedation begins to wear off the horse enters stage 2 or the "Recognition" stage.

Stage 2: Recognition

Thirdly, the sedation is blasted off its receptors by a surge of adrenaline and the horse enters the third, "Escape" stage.

Stage 3: ESCAPE!

Stage 3 or "Escape" stage, can go on for a prolonged period of time.  The horse seems to be convinced that there is a lion or bear attached to its leg.  Rather than attempting to use the limb, it chooses holding the leg up at a nearly 90 degree angle to its body, which inevitably causes it to fall away in the opposite direction.

I have literally seen entire rooms destroyed by a horse in the "Escape" stage as it levitates its limb around the room while simultaneously trying to run away from it.  The best thing to do is to try and get these horses moving forward.  There are rare occasions where a horse does not make it past "Escape" stage and the bandage has to be modified further.

However, most horses at least make it to their stalls, where they enter the fourth stage, "Resignation" stage.

Stage 4: Resignation

Horses in "Resignation" stage may be resigned to the situation, but they are still convinced that there is a lion attached to their leg.  Horses in this stage often will not move, even for food, and it is important to make sure they are within reach of food and water.  Upon moving, "Resignation" horses may lapse back to the "Escape" phase, as they are further reminded of the bear on their hind limb.

Then one magical day, you walk into the stall and the horse is walking around and acting like nothing ever happened.

It can be frustrating working with these horses.  Here you are trying to immobilize their limb and they are doing acrobatic feats just to get away from your stack wrap.  Its important to remember that they are a flight animal and that they simply don't understand.  Everyone gets frustrated with them at times.  Especially when you take the magic worm-hole and go straight from stage 1 "blissful ignorance" to stage 3 "Escape" in the middle of trying to wrap the leg.  Usually in these moments all the bandaging material goes flying, becomes ripped or falls to the ground and you are left to start all over again.  Still, if it wasn't challenging, anyone could do it right? 
That's why we became horse vets right?!
We bandage the unbandagable!

Until next time!

Sitting on a colic

Well, I'm sitting here in medical records. What am I sitting on? Literally or figuratively? Literally I'm sitting on a stool at a computer. Figuratively, I'm sitting on a colic. That means, I'm waiting to see if it needs to go to surgery or not.

Now on some level, every colic is exactly the same.  For those of you who don't know, a horse that is colicking is a horse with a belly ache.  I could go into all the details of extra-gastrointestinal reasons for colic, gastrointestinal reasons for colic, colic of the small intestine, colic of the large intestine, strangulating vs. non-strangulating but suffice it to say that a colic can be caused by many things.

Likewise, the horses show up with varying clinical signs. This last weekend I received 5 colics. . . . I'm just going to let that sink in with you. 5. 5 colics. Okay lets move on. So I had these 5 sick horses show up over the weekend and this was what they looked like.


Horse 1: Looked a little crampy, a little bit sweaty, and needed sedation to stay comfortable.


What Horse 1 looked like (not actually horse 1)

Horse 2: Looked like it was put out at having been dragged out of bed at this hour. Couldn't, for the life of it figure out what we were doing or why.

What horse 2 looked like (not actually horse 2)

Horse 3: Arrived agitated and threatened to do several of us bodily harm because he was scared. Became painful enough to kick out while in the stocks. . . very nearly taking my femur with him, and needed sedation to calm down.


What horse 3 acted like (not actually horse 3)

Horse 4: Showed up in a full body sweat. This horse was attempting to throw itself down onto the ground in fits of pain and was refractory to all but the strongest of pain medications we could give it intravenously.

What Horse 4 looked like (not actually horse 5)

Horse 5: Arrived at 5am (sad face). This horse was more worried about the muzzle we put on its nose, than its belly ache.

What Horse 5 looked like (not actually horse 5)

So there you have it, the spectrum. Generally speaking we think of horses with worse lesions being more painful. "Wow, did you go to vet school to learn that kind of logic doc?" BUT! These are horses. . . so that's not always the case!

Lets look at our 5 horses and where they are at. . . 5-6 days later.

Horse 1: Horse one is doing well. She is happy eating in her stall as we speak and should be going home relatively soon. That sort of makes sense.

Horse 2: Horse 2 is still in the hospital as well. However, it looks like either secondary to or as the primary cause of her colic, she may break with colitis. She has developed fevers and is quite sick. Unexpected, is it not?

Horse 3: Horse 3 never acted colicky after his initial presentation. We sent him home very quickly because there was nothing that needed to be done. 1 day later, he was back and has since demonstrated the "colic" behavior that the owner described.  However, this behavior may not in fact be colic at all but seizure or some other type of hyperesthesia (hypersensitivity).

Horse 4: This horse was so painful we were drowing her in pain medications. She needed to go to surgery but the owner really couldn't afford it (understandable because the average colic surgery is approximately $8000 dollars). We didn't give her much of a chance with her level of pain and I was sure I would get a call around 2am to come and put her down.  Yet, when I walked in the next morning, there she was, standing, bright, alert and comfortable. Well bust my buttons was I surprised. She continues to do well.

Horse 5: Discharged 2 days later with no complications and happy as can be.

Suffice it to say, you just never can be 100% certain with a colic. They'll surprise you.
So as I sit here. . . I wonder. . . where will this horse come out? Will we have to take him to surgery? Will he buck up and come through on his own? How much longer do I have to sit here, before I get to go to bed? Can I sleep on a stool in an upright position?