I am in awe of the large animal veterinarian—no lie. I nursed vague dreams of entering the profession in my James-Herriot-loving youth, until someone told me vet school is more difficult than medical school. And that was that. Besides, I wanted time to ride.
It is clear from a glimpse into a day in the life of TSB author Dr. Bob Grisel that there certainly would not have been time to ride. In fact, we’re wondering how he managed to write his book EQUINE LAMENESS FOR THE LAYMAN! As anyone who has written and published a book can attest, the process demands long hours and, at times, lightning-fast turnaround. This can be challenging to accommodate in the most-normal-of-horse-person schedules. Even more incredibly, Dr. Grisel edited and narrated over hundreds of sample videos from the field to help educate the reader’s eye, all viewable via easy-to-scan links in the book. And he did it all while somehow making it to his daily appointments on time and being part of a family.
Whoa.
If you need convincing of his superhero status, just read on.
4:45 am I wake up to find a pair of warm, soft, two-year-old feet resting on my face. They would belong to our youngest son, who sometimes (always) sleeps in bed with his mom and me. Mom is already out of bed and has started brewing the coffee, which will comprise some (all) of my breakfast. Since they haven’t been able to make fruit and yogurt taste and act like coffee yet, the latter will have to do. In the meantime I jump in the shower and get dressed. My wife hands me a coffee cup the size of Rhode Island as I head out the door.
5:35 am I arrive at the office and fire up my computer. I quickly check the calendar to see what lies ahead for the day: surgery in the morning and lameness evaluations/treatments for the remainder of the day. Shouldn’t be too bad. I am hoping to make it back home before our young son goes down for the night.
A quick peek at my email reveals a message containing a photo from a new client who I’ll be meeting a little later in the day. Her mare recently developed a swollen knee and corresponding forelimb lameness. The owner is extremely worried, as the mare is apparently quite uncomfortable.
I also find a message from a client who is currently searching for a new horse in Holland. She’s found one she likes and wants a quick opinion. She’s already been waiting almost four hours for a reply (seeing as I’m based in Georgia, and they’re six hours ahead over there), so I figure I better take a look. The horse is displaying a mild combination lameness in the right front limb (looks like fetlock joint pain), so I suggest that she pay close attention to this limb during any potential forthcoming pre-purchase evaluation. I write down a few phone numbers and head for the door.
Janet (our Pharmacy Manager) has left my truck order of medications and supplies directly in front of the doorway in the hopes that if I don’t see it I’ll trip over it on my way out. Everything makes it into the truck, including some extra Advil for my (now) sore knee.
6:00 am I was hoping to leave a little bit earlier, as it has gotten more difficult to beat Atlanta traffic in recent years. The first appointment is near the Alabama-Georgia state line and takes almost two hours of driving time to reach. Fortunately, I have enough coffee to last me the rest of the month.
7:00 am While driving, I glance over at the passenger seat to find an egg sandwich that my wife made and placed there while I was in the shower almost two hours earlier. There’s nothing better than my wife! I begin to wonder which is more difficult for her: taking care of our two-year-old or taking care of me. But I quickly become distracted with the sandwich and stop thinking about it.
While eating, I receive a call from a farrier about a horse I saw the previous week in Raleigh, North Carolina, during an out-of-town work trip. We have a very productive conversation despite my inability to speak with a mouthful of egg sandwich. Perhaps it is my lack of talking that makes the conversation so productive(?)
Working with farriers has become one of the highlights of my job, although I doubt it is nearly as fun for them. Most farriers mitigate a menagerie of opinions on a daily basis: some from vets, some from owners, some from other farriers, and some from folks who have a cousin that is thinking about apprenticing with a farrier. I’m glad that farriers do what they do, because I certainly couldn’t do it. They are generally underrated and underappreciated in my opinion.
8:00 am I arrive at the first call to find the owner and attending veterinarian at the barn with our patient, a 27-year-old gelding requiring enucleation (eye removal). The horse is an extremely sweet and classy animal, and truly adored by his owner. I always feel an increased sense of responsibility when working with an animal that fully trusts me. I also worry about performing general anesthesia on a horse this age, as there are some aspects of induction and recovery that we can’t always control as veterinarians.
Eye surgery. Photo courtesy of Dr. Bob Grisel.
10:30 am Fortunately, everything goes well with the surgery and anesthesia; the horse is back in his stall and looking for breakfast by the time I get my truck packed up to leave. I didn’t get much blood on my clothes, but I change them anyway so that the next client doesn’t think that I just came from a gang fight.
Thirty-five minutes to the next appointment, which is scheduled for 11:30 am. I have time to complete one follow-up phone call to a Raleigh client who informs me that his horse is doing much better since my visit last week. Always good to hear!
11:10 am I arrive at the next barn, which is a frequent stop for my practice. I have two lameness evaluations there: the first is a horse “due” for hock and coffin joint injections; the second is a new horse that apparently can’t canter in either direction.
After examination, I decide that the farrier (a good friend of mine) can probably fix the second horse’s issue via some angle adjustments in the hind feet. The owner is very relieved to hear that “no needles are required.” I make a plan to call the farrier on my way to the next appointment, which is only 15 minutes away.
Coffin joint injection. Photo courtesy of Dr. Bob Grisel.
1:15 pm I am fairly shocked to be driving to my 1:30 pm appointment and still on time. In addition to calling the farrier for the horse I just saw, I also call my wife to see what kind of mood our youngest is in: This will directly affect the way my wife’s day goes, which in turn directly affects the way my day goes. She informs me that he woke up in a great mood…Perfect! Apparently “face-warming” his feet overnight was helpful.
1:30 pm I arrive at the next appointment to learn that the client was unable to be present for the evaluation. I call her to confirm that I had received her email with the photo of the swollen knee earlier in the day. I always try to connect with the client at some point(s) during the visit to make sure that we stay on the same page throughout the diagnostic and treatment processes. She says there has been some concern about both of her mare’s knees since she was purchased several years antecedent to this recent injury.
I confirm that the swelling is associated with the lateral digital extensor tendon along the top and outside aspect of the right carpus (knee). Although this type of injury can be ugly, it is rarely a cause of lameness in my experience. It is possible, however, that an affected horse might display mild non weight-bearing lameness if the damage is very severe.
The good news is that this horse exhibits purely weight-bearing gait deficits during active examination, telling me that the knee (and associated swelling) is not our problem. The bad news is that now I have to call the owner (whom I’ve never met) and explain that her horse has another issue altogether. Fortunately the conversation goes better than expected, and I’m able to leave for the next call 30 minutes early. Yeah! Ahead of schedule!
2:45 pm The extra 30 minutes vanish like a magic trick as I find myself sitting in an Infamous Atlanta Traffic Jam (IATJ). The 50-minute drive turns into 75 minutes due to an accident on the opposite side of the highway (I try not to speculate how this could be, but it be). It’s times like this that my mind often drifts toward thinking about our oldest son, who is a Chinook helicopter pilot in the Army National Guard. I start crunching numbers with respect to how feasible and cost-effective it would be to slide my veterinary truck box into the back of that chopper and fly between appointments. I haven’t come up with a concrete solution yet, although it is not from a lack of working at it.
I finally force myself to stop thinking about “Equine Heli-Vet Services” and make a few more follow-up phone calls to clients. I also check in with the first client of the day to make sure that our old friend is still recovering well from surgery.
4:00 pm I arrive to the next appointment (still on time), where there are two horses waiting on me. The first appointment is for a recheck evaluation and shock wave therapy on a chronic hind medial suspensory branch tear. Our clinical and ultrasonographic reexaminations suggest that the tissue is healing well, although this type of injury tends to be very stubborn. After some discussion, I am able to coax my client into waiting another six weeks prior to rechecking the horse and considering limited turnout/ exercise. The client asks me to relay the highlights of our examination to her farrier… something I will try my best not to forget to do while I’m driving.
I notice that the second horse has an enlarged right temporomandibular joint (between the skull and jaw bones). I often see this in conjunction with an ipsilateral lameness in the hind limb (on the same side of the horse). The theory is that a horse with a hind-limb lameness may be unwilling to bend in the direction toward the affected side, thereby forcing the rider to use more rein tension along the respective side. The latter action is often implicated as a common instigator for unilateral (one-sided) “TMJ.” In the case of this horse, we decide to treat both his right hind lameness and temporomandibular pain, the latter via intraarticular injection(s). I am expecting that he’ll feel much better pursuant to the treatment(s).
TMJ injection. Photo courtesy of Dr. Bob Grisel.
6:30 pm On my way to the next appointment. Somewhere along this trek I decide to change my shirt again, as the last one is getting fairly damp and dirty. I also leave a voice message for the farrier of the horse with the suspensory branch issue (I didn’t forget!).
6:50 pm Arrive at my 7:00 pm appointment, which involves a horse that has historically responded very well to Pro-Stride (i.e. IRAP and PRP) treatment for chronic arthritis in his neck. We decide to retreat him as preparation for a rigorous upcoming show schedule. The procedure entails ultrasound-guided injection of the articular facets, a technique that I developed as a young surgery resident 25 years ago and first presented at the AAEP Convention in 1996. It’s still very much fun to do after all of these years (perhaps a little like playing video games). All goes well and I’m back on the road within 90 minutes.
9:05 pm I arrive at my last call only to learn that the client hasn’t made it to the barn yet (some excuse about getting stuck in traffic… go figure). While I wait, I am able to review and run the following day’s appointment schedule from my phone, with the hope that I can stay relatively punctual again. Ann, our office manager, has already filled in the schedule for me; I only have to organize it. Easy!
I also find enough time to respond to another client who sent some video footage of a horse that we treated the previous month…she wants to confirm that all is going as expected. I respond with a thumbs-up!
9:20 pm The client eventually shows up and explains that he needs an “emergency pre-purchase” examination on a horse, who is otherwise being shipped back to Virginia first thing the following morning. I can’t say that these are my favorite cases. The horse is thin, debilitated, and quite lame in both the left front and right hind limbs.
The examination is cut short when we find a P1 subchondral cyst in the left front fetlock joint during initial radiographic examination (we imaged the left front limb first, suspecting a problem there). Fetlock cysts of this nature can be very challenging to manage over the long term, and my client judiciously bows out of the deal.
As a result of the abbreviated examination, I am on my way home by 10:30 pm. I’ve got 40 minutes to get there!
10:40 pm While driving, I call my son (the helicopter pilot). We talk most evenings, and I find it very relaxing (“unwinding”) to speak with him after work. Our conversation is usually limited to dirt bikes, sports cars, and helicopters. He is the inventor of the term “Ketchup Day,” which has historically been used in our family to denote my first day home, following an extensive out-of-town work trip. The term has now been in use for well over 20 years.
The Grisel kids! Photo courtesy of Dr. Bob Grisel.
11:15 pm As I pull into the truck bay beneath our house, I am ecstatic to see my wife and youngest son walking though the door together…he is still awake and appears to have gotten taller since I last saw him! A quick dinner and shower for me and then straight to bed for the three of us. The rest of the texts, emails, etc. will have to wait another day. I’m hoping to sleep well tonight, as tomorrow is Monday and the start of a whole new week.
11:22 pm My last thought as I drift off to sleep: “Rats! I got the feet again!”
Dr. Grisel’s book EQUINE LAMENESS FOR THE LAYMAN is available now from the TSB online bookstore, where shipping in the US is FREE.
CLICK HERE for more information or to order.
Be sure to read the other installments of TSB’s “Horseworld By the Hour” blog series:
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