I am going to do a pictorial review of some of the diseases of the vole and just talk around some of the things we see, some of which are subtle, some are not so subtle, and just give you an introduction and delve a little deeper in a couple of cases into some of the things that we see in folds. So I'm gonna start with perinatal asphyxia syndrome. This disease or syndrome has many, many different names, and so I, I'll just give you a couple of them so that we're all on the same page.

This has also been called neonatal maladjustment syndrome. It has been called hypoxic ischemic encephalopathy, hypoxic ischemic syndrome, and dummy fold syndrome. The reason I like perinatal as fixing syndrome for this is because.

It describes the pathophysiology and also it doesn't just concentrate on the brain and as we'll see as we talk about it. Although the signs from the brain are the most dramatic, there are other things which we need to bear in mind when treating these cases. So, predisposing factors for perinatal asphyxia syndrome are dystopia or difficult birth.

Delivery by C-section, any kind of resuscitation at birth, and any kind of premature placental separation, red bag delivery. Now I must say that the only photo in this entire lecture that isn't mine is the red bag delivery because I have never been cool enough when faced with a red bag. To go and get my camera.

So, so that's not my photo, but all the others are, . If you see a red bag like that, you need to open it quickly and get the fold out as quick as possible. The clinical signs can be from the subtle to the very marked, and at its most subtle, this disease just causes mild poor affinity for the mayor, not following the mayor around the field, poor, and that might be coupled with poor nursing activity.

Failure, which can lead to failure to thrive, usually these are picked up on on the farm, if they're professional people, they often pick up on these on the farm and, Just a little bit of nursing help, a little bit of separation from the herd. Putting in the stable, making sure they helped to nurse and they can be nursed through on the farm, often without much or any veterinary intervention. One feature of this disease which is important to look out for is illustrated on the top right panel here, and that is that it can affect, sometimes selectively, the swallow reflex and coordination of the tongue.

And you can see this fo is what we call tongue lolling, sticking out its tongue a lot of the time. Now, This is important because this can lead to poor coordination of swallow and can lead to aspiration pneumonia. This is especially important when we are nursing these voles, because if we are not very careful about the way we feed these voles, especially with a bottle, this can lead, as I say, to aspiration pneumonia, and then when we have two problems instead of one.

On the bottom left panel is again more severe, and this is a little video of a foal getting stuck in the corner. You can see he's somewhat uncoordinated and they tend to get stuck in the corner of the box, be weak, and this again leads to poor nursing activity, dehydration, weakness, and they go downhill. The important things on, on these kind of folds is to make sure that they get adequate fluids and nutrition.

And then on the right hand panel at the bottom, we have a comatose fold. So this is a kind of U shape of clinical signs. Because folds can show any of these clinical signs on the way down.

They may go straight to comatose, or they may show some of the other clinical signs on the way down. And then they usually show some of these clinical signs on the way back up. So if they've been severely affected, they get then, for example, the fall in the bottom right panel may turn into the hole in the bottom left panel as it's recovering.

The other thing to say is that. They usually if they're asphyxiated at the moment of birth, the nadir of clinical signs, the worst clinical signs are typically seen somewhere between 18 and 36 hours after birth. So they can look pretty good after birth, and then as the.

As the biochemistry and issues of hypoxia and reperfusion start to change the chemistry in their brains and in their other organs, they start showing the worst signs after birth. So some folds will look apparently normal for the 1st 6 or 12 hours, and this can fool some people. The thing that everyone talks about with these falls is seizure activity, and this is a panel shows a video of a foal with perinatal asphyxia syndrome, having a seizure.

The things to look at are the eye, which is showing the stagmus, there's a bit of swallowing there as well, and this fall is not sedated, it, it's slowing down. You can have seizures standing up and so it's, they're not always recumbent when having seizures. And and in the odd fold, they'll look fairly good, but, and the only thing that's noticed really is a seizure when they again typically hits 18 to 36 hours old.

The two other things to say about seizures is one that it's not. That common sign of perinatal asphyxia syndrome, I don't see that many seizures, and I see quite a lot of falls with perinatal asphyxia syndrome. And the other is that it's not the only clinical sign of perinatal asphyxia syndrome.

This slide is testing the system, as we said when we were setting up and it's also a neonatologist's nightmare. Here's fivefolds, all having a seizure, all with, due to a different clinical syndrome, so. The big panel is our perinatal asphyxiate syndrome.

On the right of it is a fole with bacterial meningitis. On the bottom left, we have a fall that has flipped over and has cranial trauma. Intracranial haemorrhage in the middle of the bottom, we have a vole with hyponatremia, and that mouth movement, and you might be able to see a little bit of swallowing going with that as well, but especially that mouth movement, it's pretty typical of hyponatremia.

And then on the right, a panel is a fold with bilirubin toxicity of the brain, conectres, and that's a rare complication of Neonatal is erythrolysis. So 5 folds, 5 different causes of seizures, and 3 of them went home. The perinatal asphyxia syndrome, the low sodium, the hyponatremia, and the conecttrous bilirubin toxicity of the brain all went home.

Sometimes you don't see complete seizures. And so this is a video of a partial seizure in a fall with asphyxia, and you can see just, it's just affecting the muzzle. There's no nystagmus, but you can see the uncoordinated contraction of the muzzle movements there.

This is what I was talking about earlier. This is not just a disease of the. Brain and central nervous system.

Anything that is affected by low oxygen tensions can also be affected by this syndrome, and this is a gastroscopy. You can see here the gastroscope entering through the cardia, that's the lesser curvature. And then just above the cardia is a shelf of sloughed endothelium, then on the left we have this blood and here we have auto digested .

Epithelium. So this is the gut epithelium, these black strands of gastric epithelium, which has been auto digested because of asphyxia to the stomach which has caused the epithelium to lose integrity, fall into the acid and get digested. Pretty gross.

This manifested itself clinically by diarrhoea, and to me that's important because these more severely affected falls, we can quite often see a non-infectious diarrhoea in, and some of these falls, we really struggle when we try and use milk as nutrition, and we can end up putting these falls near the severely affected falls that are in the hospital on parental nutrition. As a way to allow their guts to heal before we start putting milk in the system, and this can actually end up cheaper than persisting and persisting and persisting with milk and just having endless diarrhoea. Everyone, everyone, when I talk about perinatal asphyxia syndrome, has seen the YouTube video from Davis, John Madigan and asked me about the rope trick, putting a rope on these folds, you.

There's plenty of videos on YouTube how to do it. This is an example, so it's put round to squeeze the fold. It's also called squeezing folds, put put round the chest, and it is used to squeeze folds, and the claim is that it greatly improves the prognosis for perinatal asphyxis syndrome.

What it does do is definitely it does calm folds, and you can use this on some, even many folds to perform minor procedures and things, or reduce the amount of sedation you use for minor procedures. What it doesn't do in my hands is change the prognosis for perinatal asphyxia syndrome. And there is a paper out which was.

Run, which was a survey paper, so there's inherent biases in there anyway, and what they found in that paper was that. If you use the rope. They maybe accelerate initially the recovery from perinatal asphyxia syndrome, so they improve earlier, but they don't actually leave the hospital any earlier and the percentage that survive and leave the hospital or, or, or survive and become normal doesn't actually improve, so.

I think there is a place for it. I think we need to learn about case selection, and it's certainly not a panacea, but every single time I get a phone admitted with this, the owner will always ask me if I'll use the road trip because they've seen it on Facebook or YouTube. So The trick to perinatal asphyxia syndrome is mainly nursing.

Because none of the specific treatments we have are very good for fixing the brain and time really is the key. So if we can support the fall through the critical phase, it will get better. This isn't the case with this next condition, which is septicaemia.

If you read American studies, septicemia is always the most common or second most common disease of falls. It seems much less common in UK, Ireland, Europe. And it it reflects that in general infectious disease seems to occur in horses quite a lot more in America than it does in the UK and Ireland.

So, How do foals get infection? Well, On the bottom left panel is a really nasty looking umbilical stump, and a lot of people concentrate on the umbilical stump as the portal of entry. It is a possible portal of entry, but it's probably not the major one for two reasons.

One is that the blood supply to it is actually shut down, so there isn't that much capacity for infection to enter there and get carried around the body. By the bloodstream because the blood supply is actually shut down, and 2, you often see lots of falls with septicaemia where the umbilicus is 100% normal. Probably the major route for infection is the fecal-oral route, and it reflects in some ways our management of fos.

So. In the wild or in the field, mares falling outside will typically. Deecate in one area of the field and select a clean area of the field to lie down and fall.

In when we fall indoors, we don't have that option. And mares will lie down on beds on which they've previously defecated and quite a lot of bacteria can grow up in those beds. So then the mare lies down, folds, gets up, the foals starts seeking behaviour around the stifle folds and around the udder and can get .

The gut is open, the foal hasn't absorbed Colostrum yet, so. It, it's a very good portal for infection to enter the fold in those very early hours of life. One trick to try and reduce this is to try and clean the udder and the stifle folds immediately after the mare gets up after falling.

And what I use is dilute chlorhexidine solution and then washed it off with some water and I I I think that gives the foal more of a chance or a less bacterial load than its very first suck. Clinical signs of septicaemia. Now they're usually related to changes in the circulation, and so the top left panel shows injection of the mucous membranes.

Changes in the coagulation system, so the bottom left panel. At the middle left panel and the top right panel show changes in the coagulation system. So this is at the bottom left showstication of the oral pina.

Now, it's not that often that you see this, but when you do, it can be either very subtle or dramatic, as in this case. But definitely pay attention if you see petiation of the pinai. On the top right panel, there's patication of the muzzle.

In the middle of the bottom, there's high femur, blood within the anterior chamber of the eye, and again this can be related to changes in the coagulation system. On the top. Middle, we have antigen antibody complex in the anterior chamber of the eye, and this is less common but can be seen.

You can also see pus in the anterior chamber of the eye, hypopyon. And then on the bottom right panel, we see changes in the circulatory system, in the integrity of the capillary endothelial system, and this is capillary le syndrome, so that the fold develops edoema. And this is generalised edoema.

The first places you really notice this are just behind the elbow, just behind the triceps muscle, you can feel thickening of the skin, and then it can spread to the whole fold like this. Despite these clinical signs, most that I'm showing you here, most falls with septicaemia show no overt clinical signs, at least initially. The only clinical signs they'll show tend to be pretty similar to the clinical signs of perinatal asphyxia syndrome.

Start going less affinity for the mare, start going off, suck a bit, then if they're left, they will get sicker and sicker and and so. Show less liveliness and, and then eventually, become recumbent. It, these other clinical signs are actually rare to appreciate or rare to occur.

Local sepsis. Infection likes going out in joints, and any fold that is lame, that is less than 28 days, has a septic joint until proven otherwise. Just run that movie once more.

If you work with non-professional owners, you'll often get told that the mayor stood on the foal, or or the foal got up awkwardly, and that's why it's lame to me, I have to, that's a rule out after I have 100% ruled out infection. One very useful test for these voles is to measure serum mamyloid A and It's a great test in this situation because there's the signal is quite high when there's infection. So normal in a fall is less than 30, and you get usually over 100 and sometimes like 67, 800 in a fall with infection.

It's not a 100% test, but it's a very good help in determining is this likely to be infection. You can get, you can get complete quantitative done at labs, or you can get various semi-quantitative tests, I think, stable lab do one and plus vital do another one that can be done at the store site. You wanna get on these early before they start showing.

Clinical signs quite as marked as this and the. Problem with them getting left is the infection erodes into the bone and in this right-hand panel, the infection's gone into the calcaneus and that fault did not have a good outcome. Obviously If you feel the joints and one is hot, swollen, you're, you're immediately suspicious of it is suspicious of infection in that joint, but sometimes it can be quite subtle, especially in joints such as the acetabular femoral joint, the hip, or the calfing joints.

This can actually be dealt with in the field, and most of the folds that I've dealt with, with infected joints, even in a hospital situation, I don't often take them to the theatre, usually theater's pretty busy at that time of year, and we do it cleanly just outside the stall. Leave the mayor in the stall, give the foal a short acting ketamine anaesthetic or heavy sedation. Clip and prep the joint and then I, I'm not a surgeon, I can feel for the bit that's swollen.

And pop a needle in it, and it, it, it works very well for me, despite me only having a vague understanding of landmarks. So this is a stifle joint with . Obvious infected joint fluid coming out.

This is just showing feel for the bit that's spongy. Pop the needle in Take a sample. Once you've got one needle in.

Then sorry, once you've got one needle in, then it's actually quite easy to get a second needle in for a flush, connect to a fluid bag, a 1 litre bag, any sterile fluid with a sterile fluid line, connect it all sterilely, squeeze on the bag, and then feel for the bit that gets hard and pops out, and that's where you pop your next needle in. So this is just showing the elbow joint again. Just feel for the bit that's spongy.

And there you can see, flushing the elbow joint, and again this is done in front of the stall, usually I put 1 to 2 litres through, swap the needle from 1. Portals to the other portal to get a good flush, and you can make a dramatic difference to these cases by doing this early. Shoulder joint, again, that's showing you the landmark for the shoulder joint is that you go in, usually to the front of the shoulder joint.

Again, if there's infection in there, it's pretty easy to get into, if there's not infection, it can be quite hard. And hip. The hip can be tricky in either case.

I sometimes use ultrasound to try and help me and at least the way I think about horses, it's always further back than I expect, so using ultrasound to try and find the landmarks can be very helpful for me. The coughing is also important because, as I said earlier, it's hard to feel effusion of the coffin joint, so really pay attention if it's hot or if it feels iffused, and especially if you've felt other joints and ruled them out then. I suspect the coffin joints.

And in contrast to adults, which often don't have a great prognosis, if there's infection of the coffin joint, fals can do very well following early intervention in the coffin joint if there's infection, and this, this fold did great. So preventing septicaemia, well, the classic way to try and ensure that the foal has adequate immune system, it, and has had adequate ingestion of Colostrum is via the taking a blood sample and measuring for IgG. This is usually done between 18 and 24 hours after birth, often if it's 12 or 13 hours after birth, you'll get a good enough reading to .

Have a good idea whether the foal has ingested enough colostrum, and sometimes the hours of the day just mean that if you wait till 18 hours, you don't really want to be testing at midnight and then you've lost all the windows till 8 a.m. The next day.

So sometimes I'll do these things earlier, as I say, between 12 and 13 hours of age, rather than delaying till the next day. This DVM stat in a study by Steve Dea was the most accurate stool site measure of IDG and in Ireland, these are supplied by labstock, which is a local lab supplier company. Most of my professional studs own one of these, which is a Brooks sugary Ffractometer.

They are sold for home brewing, so in, in the offseason, they have an alternate use, and now the price has come down dramatically. The price is like 30 or 40 quid on Amazon, and they are used to screen which folds need help right at the beginning, so. Take a couple of drops of Colostrum, put them on the refractometer, and then look through the refractometer at the the reading.

Anything over 20 is adequate. Over 25 is very good colostrum and good enough to store. If it's less than 20, it's poor colostrum and down at 15 it's essentially milk.

So, a number of my studs are. Using this to, measure the quality of the colostrum and then choosing, trying to supplement colostrum early from banks colostrum that they bank themselves, and then using this to. screen which folds they're going to measure IGGs on later.

And, you know, ideally we'd measure IGGs on all the folds, but this is a, a good compromise if they're not willing to do that. So this is middle of the night, me giving Colostrum in the middle of the night, and this is the way to try and prevent septicaemia. The earlier you give it, the better for the foal.

It also maybe shuts down pinocytosis in the foal. And so if I'm delivering a foal, I'll often tube it with clos from very early, maybe even before it's stood, because that means that. I can get home earlier.

I don't have to wait for it to nurse because I know it's Ted Clostrum, and then I can just be called back if there's a problem. So prematurity. Clinical signs of prematurity, domed head on the top left, lacks tendons, and they can be much more lax than shown here on the top right.

They can have their fetlocks on the ground, floppy ears, fine hair coats, and most importantly, when we're talking about production of. Athletes is ossification of the small tarsal and carpal bones. So, the, in the foal, the ossification of these bones is very late in pregnancy, typically happens only in the last 3 to 5 days.

And on the left of these two radiographs, you can see just a shadow of the small tarsal bones, and this is the cartilaginous structure. And the problem with these is as soon as the animal bears weight on that, that will deform those bones and the. A horse will not be an athlete, so this is something that makes treating premature animals in the fall very tricky.

The other thing that's very tricky is that surfactant comes very late into the lungs in the foal as well. So if we get premature animals, it can be pretty tricky to keep, keep them alive and then they don't become athletes, so, so two reasons to, to, to not like premature foals. So if we're presented with a premature fo, I will take x-rays of the one hock and the lungs at admission before I've done any other interventions to assess the prognosis and have a serious heart to heart with the owner before I proceed to further interventions such as fluids and oxygen, etc.

This is showing the increased respiratory rate. This fall's got a bit of, this is a premature fall, with floppy ears and showing the increased respiratory effort. Now, some premature foals can do absolutely great, and you can see this is quite a small size foal for their smare.

And maybe counterintuitively, the folds that do the best are the folds that come from obviously infected uterus. So the . Foal needs some kind of stimulus, cortisol stimulus in the last few days of pregnancy to mature.

Now, if the foal is under stress because there's infection of the uterus, this actually matures up the foal. So a foal foals are typically born at 335 to 345 days. If a foal is born at, say, 305 days with a.

And it's no, no problems beforehand, totally unexpected, really normal looking placenta. The prognosis is it's not great. Whereas if the fall's born at 3 or 5 days out of disgusting fluid with a obviously infected placenta.

Yes, that infection may have spread to the fall and that may cause problems, but it will also have matured up the foal because of the stress of being in that infected environment. And those falls on the whole do much, much better than the falls which come out with no obvious lead in time to stress the fall and mature it up. Couple of things on the blood work with premature folds.

First off, the white cell counts, the neutrophils come in very late, so they can look like they're septic, that they are hypo that they have low white cell counts and low neutrophil counts, but this is a function of prematurity rather than sepsis. Two things to look at to help you decide between septic fos and premature foals. One is the glucose, often premature als have problems mobilising glucose from brown fat and so they can be extremely hypoglycemic, as illustrated here.

And the other is typically septic foals will have . High serum amyloidase rather than the normal serum amyloidase seen on this blood, so this is the blood of a premature foal. Moving on, colic is extremely important in fals, and the one thing I'd say, there's two kinds of things to know about colic.

One is, Just because it's a phone. We treat it kind of the, the same way. We, we look at heart rate, we look at gut sounds, we look at mucous membranes, pass a tube.

The other thing is orals tend to colic the same way, they just kind of roll up on their back, and it's quite hard to judge severity by the way that they are colicing. The most effective tool for trying to sort out what's happening with the folk colic is abdominal ultrasounds. It's not always available.

You can use a normal reproductive scanner to look at folds, and you can get diagnostic pictures with that. If you see distended loops, obviously that is often an issue. But don't, don't forget the basics.

If the foal is less than 36 hours old, the most common cause of colic is meconium infection. So in the history, we ask if the foals passed faeces. If a foal hasn't been given enemas, we may give an enema.

And don't forget also to do a rectal rectum. Just take one gloved finger, loop it up very well, pass it up the rectum and feel for any meconium. Now some meconiumactions will not resolve, no matter how many enemas and things you give them.

This is a radiograph of an abdomen of a foal and. Here there is a soft tissue opacity, which is meconium in the right dorsal colon. This meconium is a high meconium in action.

The gas that builds up behind it causes severe, severe colic, and in the end, these ones need to go to surgery for massaging, for a surgeon to maybe put some fluid in there, massage it through and allow it to pass through cause that just forms a plug and will not pass. One of the most common diseases of falls I deal with is diarrhoea and. It can be quite marked in young foals, it's almost always associated with septicaemia, so young foals are less than 7 days old.

If they have marked diarrhoea, they, it's almost always associated with bacteria in the bloodstream, so they definitely need antibiotics. Between 6 to 9 days old, if it, if the foal is standing bright, nursing and is not showing any other clinical signs, and that often if it's kind of that yellow kind of nutritional type diarrhoea, which I showed you on the previous slides in perinatal asphyxia syndrome, then that can be fo heat diarrhoea. But we need to be careful that.

If the foal is clinically affected by the diarrhoea, it's highly, highly unlikely. In fact, it isn't er foal heat diarrhoea, and sometimes things get passed by because it's assumed that it's full heat diarrhoea when it's infectious diarrhoea. False can push pretty hard when they've got diarrhoea, and on the left hand panel you can see a very swollen anus.

False can actually prolapse the. Anus still rectum when they are having diarrhoea. And on the right is an unusual case that this vole was so irritated that it rubbed its vulva and we got this vulval wall coming out.

This was hard swollen vulval mucosa there. We put honey on it and it, manuka honey, and it resolved itself. Rotavirus is an extremely important cause of diarrhoea in the fall, and this is a rota fast test rota strep showing a positive result.

Although it's written in textbooks that it occurs between 7 and 28 days of age, I've seen it as young as 2 days of age and older than 28 days, maybe 35, 42 days of age. It's important not because we treat them very differently, but because it rapidly spreads and it also stays in stables and will affect the next animals entering that stable, so. You know, if you're limiting your diagnostics on a full diarrhoea because of trying to save money, rotor test if there's multiple animals on the premises, rotor test is one of the few that I would recommend you do every time.

The most effective way of dealing with severe diarrhoea in foals is to stop feeding the fire. And if you continue to put milk in these guts, you're feeding the fire and they continue to have diarrhoea, so. The most effective way we have found of stopping the diarrhoea is separating the foal from the mare and feeding the foal through a vein.

If it's, if it's young enough, if it's less than 28 days, it will need some kind of nutritional support through the vein. The younger it is, the more nutritional support it will need. Initially, this can be glucose, it definitely will need fluids to replace the fluid losses and in young foals we use total parental nutrition.

On the farm, you can actually interrupt the nutritional supply by just muzzling the foal, and this can be again effective just break the cycle. Remember that these folds might be squirting a lot of diarrhoea out of their back end, so you will need to provide fluids, especially if you keep this on for longer than 4 hours. With just fluids, especially if you're able to spike the fluids with a little bit of glucose, you can probably get away with 12 to 24 hours on the farm if you're providing fluids.

If you're not providing fluids, don't leave a muzzle on for more than 4 to 6 hours. Sometimes we have side effects of maltreatment, and it involves with severe diarrhoea, they have neutropenia, they have received quite a lot of antibiotics, and sometimes we see this as a sequel, this is candidisis of the tongue, and responds really well to either . Fluconazole, orally, or, or you can also use topical antifungals.

I've seen this a few times in fos that received a lot of antibiotics, usually fos that have had severe severe enterocolitis. Ruptured bladder Presents usually 3 to 5 days of age, even though the bladder ruptures at birth because it takes that long for urine to build up in the abdomen to cause clinical signs to occur. They get slow, they get off nursing, and they have this large pendulous abdomen.

If you blot on one side, you can feel the flu on the other. People talk a lot about the cardiac changes. They only occur with severe electrolyte changes, maybe potassium over 7, which doesn't seem to occur that often.

So although we should be wary of it, we, it's not that my most immediate worry in falls with, . Ruptured bladder. So I used to use a teak cannula, this is me in my younger shinier days.

I used to use a teak cannula to evacuate the abdomen and that involved me kneeling down like that for a long period as we evacuated the abdomen, and my knees probably aren't up to that anymore. And I found a better way. What I do with these folds now is put in an indwelling urinary catheter, put a Foley catheter into the bladder, allow it to drain out to the .

Leg and provide fluids to replace the fluids and electrolytes that the foal has lost. This can be done for 18 to 24 hours prior to surgery, which is illustrated on the bottom right, with folds with really, really small holes in their bladder. You can actually treat medically, keep an indwelling Foley catheter in for 3 to 7 days, and that will actually allow the bladder to heal, and you can treat them without having to go to surgery.

But that's the rare case. Normally they, they will require surgery, but don't rush to surgery, fix the fluid balance, fix the electrolytes, drain the abdomen before going to surgery. Yellow folds No Photoshop was used on these photos, these are extreme cases, just showing you where to look, so.

The oral mucous membranes, which is the top middle of the usual place we look, but sometimes it's easier to see yellow discoloration in the sclera, bottom left, in the vulval mucosa, top left, especially if the oral mucosa are pigmented. Sometimes we see stercobilinogen coming out in the faeces, so you can see these horrible yellow faeces, orangey yellow faeces, and If there's intravascular hemolysis, which is not in every case of neonatal isourethrolysis, then you can see the urine coming out red. So these are folds which have an incompatible blood group with the mare, so the stallions's passed on a blood type, usually AA or QA, can be other blood types, and the mare has antibodies against that.

For that reason it's usually 2nd or subsequent fall, and these falls . The immune system attacks their red cells and the bilirubin from their red cells gets out into the. Mucous membranes and that's why we see these clinical signs.

These can be great falls to treat because you can go from zero to hero very quickly. These falls can be very depressed down. You need to take blood from the mare, get it washed, which can be tricky.

There are some labs which offer washing, it can take 4 to 6 hours to get it washed. Sometimes we have to take blood from a gelding, or cold blood gelding as a bridge. But get blood from the mare, get it washed 3 times to take off all the plasma that contains the antibodies, the red cells from the mare are safe, put it into the mare.

Put it into the foal and the foal recovers very quickly. In the good old days, we used to have oxyglobin, but it it was incredibly expensive. It would provide a bridge while we were waiting for the.

Red cells to be washed. Now unfortunately I can't get it anymore and I don't think my clients could afford it anymore either. Congenital problems, always watch out for congenital problems.

So there's a few illustrated on this slide. The first, top left is a contracture of the carpe. That is pretty common congenital problem to find.

They can be difficult folds to manage if they can't get up. And casting or splinting of them if they're beyond 90 degrees, if you can't open the legs more than 90 degrees, don't start treatment, that's classified as arrogroposis, and you won't be successful in treating them, . Even when they're at this degree, they can be very difficult to, to treat and nightmare cases to manage with casting or splinting.

You can get the reverse, this is, bottom left is contracture of the extensor tendons, and again these are quite tricky cases to manage. We were not successful in this case, and, they, they're much rarer than the top left, the contractor, and on the right hand panel we can see rhinos. Again, if it, if it's mild, the folk can nurse, the folk can eat.

It's just a cosmetic problem. If they're severe, the, the folk can't, eat or, or nurse, and if there's great deviation of the nasal passages, they also may well not perform well as athletes. This slide illustrates cleft palate.

So this is an endoscopy via the nose of the foal and is showing a cleft palate. So the two curled walls you see either side are the palates, which should be joined and under the. The epiglottius there.

This is the best way to diagnose them in in vivo. It's really, really hard to open the mouth far enough to look at it via the mouth when the foal is alive. This is showing when the same file once we had euthanized it and you can just about open the mouth wide enough to see it once it's euthanized, but it's the tongue always gets in the way and these can be soft, soft palates, cleft palates can be really tricky to diagnose via the mouth and endoscope is the best way.

This is a treeite coli. Trick with diagnosing this in this file was that finger came out completely clean. So, thought it had a meconium impact.

You can put my finger into the rectum, took it out. There was no staining whatsoever. So we did a double contrast radiograph and you can see a blind ended sac there in about the middle of the radiograph.

That is the small colon which is non-joined. This al also had a cutaneous defect. This is the same fall and it had a ventral cutaneous defect.

This is one that we've just published in equine Veterinary Education. This is a hypospadius, so the urethra failed to close, and instead of a tube to the end of the penis, this, we got this open mucous membrane here. They, I've put a urinary catheter into the bladder to illustrate and you can see that the skin hadn't closed all the way up to the anus.

We got in a surgeon from Great Ormond Street Hospital, which is a children's hospital in London, and this is his specialist surgery in humans, and he performed the surgery, and this is the fall, a month after surgery, wasn't pushing out its penis to urinate, but had a complete sheath and was healed well and performed normally and was able to race. Lastly, just showing you, that with severe intensive care, so this is a fold that was delivered by C-section, I forgot to breathe, was on the ventilator for 72 hours, had marked signs of perinatal asphyxia syndrome, got better, was able to stand on its own. Top panel is the foal on the day it went home.

And the bottom panel is the foal racing at Royal Ascot. In the 2 year old Chesham listed states. And That is all I have just now.

I'll be glad to answer any questions. Brilliant, thank you very much, Kevin. A great collection of photos and videos.

So we've got one, question just regarding what would be crucial pieces of, of kits or just tips for, ambulatory vets that mainly to deal with these on farms rather than having, as like facilities they could hospitalise. Would you, would you be happy for referring? The biggest difference you can make to a fold is carrying 2 litres of Hartmann's lactated ringers with you, a giving set, and any, any old shortstay catheter.

If you sit, the biggest difference you can make to a fall is give it immediate fluids, so, . There's very few folds that you can cause problems with, with giving emergency fluids, giving 2 litres of fluids, and there's a lot of folds that you can greatly improve the outcome. The one caveat is if there's uncontrolled haemorrhage, so if it, if there's bleeding somewhere that you can't control, don't give it emergency fluids, otherwise.

Almost every other case it's better to give fluids than not to give fluids. So that's the one piece of kit I would, I, I, I would recommend. The other thing I'd say is.

Years back when I first started out, we were telling referring vets not to give antibiotics because we were worried that it would interfere with our tests and things. Now we know that if it's infection, the earlier you give antibiotics, the better, so . If you suspect infection in a fault, this is different from advice in adults, but if you suspect an infection in a fall, they're so vulnerable, give it antibiotics and, and then, you know, work out what you've got.

Yeah, so sooner rather than later in that case. Yes. Yeah.

And then another question regarding, just, protecting the fall if the mayor's on NSAIDs, is that still thought necessary to be given the fall, omeprazole, if the mayor is on any on no steroidals? I give folds very, very little omeprazole now, and there's quite a bit of evidence that the acid barrier is there for a reason and that it protects the gut against bacteria coming in, so the stomach acts as a barrier to prevent bacteria coming in, and it certainly in the hospital situation, if you give antacids such as omeprazole, you actually increase the risk of diarrhoea. Also.

So I, I don't give much non-steroidals to foals themselves, but I give very little antacids now tools. That was very interesting. Brilliant.

So, well, that's, that's all the questions. So thank you again for, a really, really interesting and very illustrated talk, and we'll hopefully move on to Carolyn. So thanks, Kevin.