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Ambulatory

AMBULATOIRE

The team has 8 equipped vehicles at its disposal, of which 5 can develop X-rays on the spot, many additional examinations can be realized at home (fibroscopy, ultrasonography...). We can therefore manage a maximum of cases of medicine, reproduction, traumatology and follow up the post-hospitalization in your home.

The appointments need to be taken at the secretariat (8 am – 6.30 pm non-stop from Monday till Saturday).
Outside of this timing the on call service can help you if necessary for managing the urgent cases. Because of the instability of the ambulatory activity, the timing of appointment for outside can be liable to modifications (especially in case of emergencies). However the secretariat remains at your disposalfor all additional information.

Consultation

CONSULTATION

Certain motives of examination (orthopedicfor example) or type of examination needinga particular material ( X-rays from the backor head, fibroscopyof the guttural pouches, gastroscopy, echocardiography, nitrogen, etc.) can force us to move the patients to the clinic; this for technical or practical reasons or for a better proceeding of the consultation.

Also for this purpose the appointments will take place at the secretariat (8 am – 6.30 pmfrom Monday till Saturday)

Hospitalization

HOSPITALIZATION

The patients can be hospitalized for different reasons.

The most common reasonis for a surgeryor a programmed examination, in this casethe horses arrive the previous dayso that the pre-surgical examinations can be donein a calm environment (blood sample, examinationby the anesthetist, X-rays oradditional ultrasonography, etc.).

The hospitalizations for urgent reasons (colic’s, traumatology, neonatology) are always possible and at any time, you just need to inform the secretariat during the opening hours orif necessary, the veterinary on call on the same number. The functioning of the hospital is as such that a veterinarian is always present in the hospital for dedicating the first aid even if the veterinarian on cal lis already busy outside.

Our team remains at your disposal during the period of hospitalization of your animal, visits are possible but only by appointment and accompanied by the employees of the hospital. Sure you will understand that some specific materials and dangerous substances as well as the critical situation of the patients and sometimes dangerous obliges us to limit the access to the stables.

Sales & Transactions

SALES AND TRANSACTIONS

We are implementing several examinations proceeding for sales, often with the seller and this for all the disciplines.

The examinations can go up to 40 X-ray pictures, ultrasonographof the tendon and endoscopywhile standing or during exercise.

One or several veterinarians are present during the principal French horse auctionsand even foreign auctions.

Do not hesitate to appeal to their services on the spot.

Surgery

SURGERY

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Orthopaedic surgery

Arthroscopy

Arthroscopy is commonly use to evaluate joints and is a minimally invasive procedure. This endoscopic technique (with a small camera) is possible to visualize the cartilage, the joint fractures ("chip") and the bone/cartilage fragments (such as OCD). By means of special instruments (gnawing, elevatorium, shaver, etc.), the joint problems are corrected by only 2 or 3 small incisions. The most explored joints are the pasterns, hook, carpus and stifle joints. While smaller articulations (distal interphalangeal, proximal interphalangeal) and the capsules (navicular, biceps) can also be evaluated.

Arthroscopy

arthro 1 - curettage of condylus of the metacarpal
arthro 2 – cutting out of an osteochondral fragment of PI
arthro 3 - fragment of osteochondritis dissecans of the tibia

Tenoscopy

Endoscopy of a tendon sheath is based on the same principle and is possible to evaluate and treat the tendons enclosed in this sheath (digital sheath, sheath of the carpus and the tarsal bone). Tendon problems (deep flexor, superficial flexor, manica flexoria) does not heal that well when it is located in the synovial sheath. Thanks to the tenoscopy, an incision can be made for the damaged tendon and the healing will be much faster.

Moreover, the tenoscopy presents a major diagnostic advantage because the injury of a tendon intra-synovial is often not visible with an ultrasonography exam. Besides, in case of synovial infection (infection of an articulation or a sheath) coming from the blood of a foal or secondary to a penetrating wound, the flush of the joint under arthroscopy makes it possible to visualize and remove foreign bodies that would not have been visualized without the endoscopy.

Tenoscopy

tenoscopy 1 - curettage of wound of the tendon
tenoscopy 2 – incision of the profound flexor tendon of the finger

Desmotomy

A desmotomy shows the section of a ligament. A desmotomy is performed in case of a clubfoot (desmotomy of the adhesion of the carpus) and the entrapment of the patella (desmotomy of the middle patellar ligament). Angular disorders of the foal (foal with knock-‐knees,paws,etc.) The foals can have malformed limbs. This is due to problems at the height of the growth plate (from where the bone grows in the length). If the plater cannot solve the problem, a surgical elevation of the periosteum can be done. In case it is very advanced or at the height of the pastern (from which the growth plate closes very soon) screws can be placed in order to stop the growth at one side.

Fractures

Due to the size and the character of the horse it is not the ideal candidate for treatment of fractures. However since a decade, the osteosynthetic material (plates, screw, pins, etc.) has been adjusted to the considerable weight of horses. The fractures of particular bones can now be treated with success (phalanx, tibia, ulna).

fracture 1 - condylus middle fracture of the metacarpal spiroidal (tibia bone)
fracture 2 and 3 - osteosynthesis with placement of compressed screw over the entire length of the metacarpal and according to the direction of the line of the fracture (spiralshaped)

Surgery Bronchial tubes

Surgery of the superior respiratory system

Sinus

The sinuses of the horse have a considerable size and are often the centre of the problem. Sinusitis can be primary or secondary. The infection problems of the teeth are the first cause of secondary sinusitis; however the cyst of the maxilla or other more malicious tumours can also cause sinusitis. In order to remove masses (cysts, haematomas of the ethmoidal bone, dental tumours) or extract teeth (premolars, molars), a small "window" can be created in the bones of the head so that the problems can be visualized and treated.

Pharynx

The palate of the horse consists of a hard and a soft palate. Sometimes, the soft palate moves on top of the epiglottis and since the horse can only breathe through the nose, it could get asphyxiated very fast. The dorsal dislocation of the soft palate is a major cause of bad performance in racing. The surgical solutions are the staphylectomy, the thermal palatoplasty (laser) and the myectomy. Since several years an advanced technique of the larynx (Tie- Forward) is used with very promising results. This technique consists of an advancement of the larynx, projecting the epiglottis more forward on the soft palate, preventing the latter to pass on top of the epiglottis.

Larynx

One of the major respiratory problems of the horse is the cornage or hemiplegia of the larynx (at the left most of the time). While racing, the horse makes noise (horse "cornard" (having difficulties to breathe) and cannot breathe correctly while in high speed (collapsus of the larynx). To correct this real "handicap", several surgery are available. The ventriculoc or dectomy is the drawing back of the ventricul larynx and of the vocal cord. This can be realized by an incision at the height of the larynx or with a minimally invasive procedure i.e. with a laser in endoscopy while the horse is standing. The laryngoplasty is the placement of a prothesis in order to "open" the larynx by pulling the arytenoid cartilage. A new technique, the "neuromuscular transplant" also gives promising results. With this technique, a nerve is transplanted on the cricoarytenoid dorsal muscle (that is refuted during horning). After some months, the muscle can be contracted again and re-opens the larynx correctly at a high speed. The epiglottis can also cause problems (entrapment, cyst under epiglottis, ulcers). Once more, the laser under endoscopy can solve these problems in a minimally invasive way and while the horse is standing

Respiratory System

The respiratory system

The endoscopy is a common examination to trace a respiratory weakness, the infection problems
or pulmonary bleeding could need more elaborated investigations such as the biopsy of the
windpipe or broncho-alveolar lavage, these examinations are done in the clinic.

The examination of the pharynx can have those problems traced of the type of soft palate, pharyngitis, horning,
etc. When these problems occur during a physical effort, we have at our disposal a built-in
endoscope (DRS dynamic respiratory system)which allows us to register the picture of the
pharynx while the horse is racing so that we can have a more refined diagnose before surgical
intervention is needed.

Intestinal surgery

COLIC'S

The horses have a very long digestive tube (small intestine of 25 meters!) and of a very large size (large intestine and cecum of 30 to 40 litres) that is extremely free in the abdomen. Therefore they are susceptible to digestive pains (colic’s). Approximately 90% of the colic’s will be treated in a medical way (paraffin oil, infusion); however in some cases surgery will be necessary to save the life of the horse. The small intestine can suffer from torsions, strangulations (for example because of a lipoma) or a hernia (inguinal for a stallion).

Sometimes, a resection of a part of the intestine is necessary. The large intestine being relatively free in the abdomen could be displaced around the cecum or between the spleen and the kidney (nephrosplenic entrapment). Surgery can re-position and empty the intestine. Thanks to the improvement of the diagnostic techniques (ultrasonography, measurement of lactates in the abdominal liquid, etc.); the choice of the candidates to surgery is better oriented. Improvement of anesthetic techniques (ventilation, fight against the hypovolemy and the acidoalkaline disorder) also makes it possible to increase considerably the assessment of the colic’s.

OMBILICAL HERNIA

Foals often present ombilical hernias . Usually those regress during the first months of the foal. However, in case the hernia persists or is of a large size, a surgery is recommended in order to avoid herniated small intestines which could be catastrophic.

Urogenital surgery

Castrations Male horses can be castrated in different ways. With young horses, the castration of the horse standing is mostly chosen, because a general anaesthesia is not necessary in this case. When the horses are older (as from 4 years), a closed castration (or surgical) is recommended.

Cryptorchidy Horses are species that are particularly susceptible to the cryptorchidy (presence of one of the two testicles not descended in the scrotum). The testicle can be in an inguinal position (withdrawn without penetrating the abdominal cavity), abdominal or inguinal-abdominal. These 3 conditions need a surgery under general anesthesia. Since some years, the abdominal testicles can be removed in a minimally invasive way, in laparoscopy on the standing horse.

Penis

The penis of the horse can be affected by tumours. In case the tumours are too big or aggressive, an amputation of the penis needs to be done. The horses can tolerate very well this surgery and can have afterwards again a normal life.

Laparoscopy

The laparoscopy is a technique which makes it possible to explore the abdomen with the use of a small camera. The most common surgeries that are realized are the pulling back of the abdominal testicles and the ovariectomy (removal of an ovary that is mostly a tumour). Prevention of the colic’s: with stallions, in order to prevent the relapse of the inguinal hernia without castrating the horse, a technique of closing the inguinal rings has been set up on the horse standing.

For horses that already underwent a colic surgery for a nephrosplenic entrapment, the relapses can be prevented by forming a nephrosplenic space by means of a laparoscopy. Bladder New born foals (particularly the males) can suffer from a rupture of the bladder. This is a major emergency and the foal must be operated as soon as possible. The bladder is sewed up by means of a laparotomy. Adult horses can have calculus in the urine, mostly in the bladder. If the size of the stones is big, they have to be removed by laparotomy.

Other surgeries

Other surgeries...

Skin tumours

Skin tumours occur frequently with horses. The most frequent is a tumour with multiple representations called sarcoidosis. Numerous new treatments (chemotherapy, immunostimulants, etc.) are available for the treatment of those tumours that have been neglected for a long time in the past. Those techniques are combined in general with surgical excision.

Coelioscopies Laparoscopy

Celioscopy Laparoscopy is a technique that makes it possible to visualise the inside of the abdomen minimally invasive (by means of a camera as with the arthroscopy). The camera (more correctly named laparoscope) measures 30 cm so that crucial and very profound zones can be reached (groin ring, foramen omentum).

The camera is introduced in a tube initially inserted with a trocar. In order to have a good visualisation and to take the least risks for the internal organs, the abdomen is distended with gas (CO2). Two other (or more) passages are placed by means of the 2 other tubes. Those will serve for the instruments. The most useful instruments are tweezers (also very long) and an instrument for coagulation, the LigaSure that makes it possible to coagulate the blood vessels up to 7 mm.

This makes it possible to extract easily testicles without having to place a tubal ligation intra or extra corporal. In case of a castration of the testicle intra abdominal or excising a growth on the ovary, after dissection with the LigaSure, one of the very small « passages » is enlarged in order to remove the previously cut ovary in pieces inside the abdomen. This way, the ovaries of 40 cm can be evacuated by an incision of less than 10 cm! In practice the horse is standing under sedative and local anaesthesia. That way the risk of the general anaesthesia is avoided.

Medicine

MEDECINE

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Colic's

colic's

The colic's

Serious colic horses often need to be hospitalised, even if some of them do not need surgery, for multiple examinations ( trans-rectal palpation, naso-gastric tubing), infusions and additional examinations such as removal of the abdominal liquid, abdominal ultrasonography, etc.

All this extra information makes it possible to refine the diagnosis, the assessment and also the possibility to decide whether or not a surgery needs to be done.

Neonatology

As from their first days in life certain foals suffer from severe diseases, some are due to their immaturity (asphyxiation, prematurity, incapability to eat or get up, immature organs, etc.), others are of infectious origin (blood poisoning, diarrhoea, liver infections of umbilical origin, septic arthritis, etc.).

The same way as for a nursing child, these foals can be in a situation that can deteriorate very fast, this is why we have to hospitalise them in intensive care so that regular examinations can be done, day and night, let them be on the drip during a precise rhythm, let them have the food via naso-gastric tubes in case the foal cannot be nursed or even via the veins if the intestines are immature.

The foals will stay in a heated location next to their mother in adapted stables. Moreover we have an endoscope with a very small diameter that allow the exam of foals even when newly born.

Cardiology

During the auscultation of the heart of a horse, sometimes anomalies can be heard such as heart murmur (leakage at the heart valve) or irregularities (arrhythmia).

It is convenient in this case to search for the cause so that we are able to give you a sports assessment.

In that case, an electrocardiogram or a cardiac ultrasonography will be carried out. Certain heart treatments ( such as defibrillation) need hospitalisation of the horse for several days with intensive care.

Pharmacy

PHARMACY

Our new clinichas a large pharmacy that allows usto have a large assortment in stock of therapeutic molecules but alsofood supplements and even specialized foodfor certain phases of convalescence. For security reasons, the access to the pharmacy is reserved to the members of the team.. We would like to inform you that neither prescription nor delivery of the medicines can be performed at the counter without having consulted before hand the animal concerned, this is in accordance with the law and more in particular the treaty prescription/established issue by the French National Order of Veterinarians. The food supplements are not subordinated to this obligation of prescription, however the advice of the veterinary to direct you towards products the most adapted to the pathologies of your animals are necessary. Most of these products are available with us or on the Internet at the following address:

Orthopedy

ORTHOPEDY

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Orth Consultation

Consultation

The orthopedic consultations are one of the principal activities of the clinic, they are preferably performed at the clinic.
The objective is to find the cause of lameness.
The high-level performance requested to our athlete’s make these problems happen frequently and multiple, it is therefore about localizing the sources of pain, to evaluate them by scanning and to decide what the importance of the lameness is. After wards it is the time to take a therapeutically decision and to find out the sports assessment.

This way this type of consultation will be composed ofa static phase where the veterinarian will look while the horse is standing for the anatomic anomalies, they are as of heat or inflammation.
Subsequently comes the dynamic phase of the examination where the patient will move in different positions, on different floors. Bending tests of different articulations will be done and sometimes, you will be asked to stretch the horse.

It may be necessary to remove temporary the sensibility in a precise region by means of local anesthetic placed on a nerve bundle or in an articulation. This allows to judge the improvement of the locomotion and to quantify the importance in this region where the lameness of the horse is.

When all the possible information will be gathered, the investigation can start thanks to different additional examinations.

Additional examinations

The two principal additional examinations for orthopedic problems are radiology and ultra sonography.
By diffusing it, the first one allows to obtain information about hard tissues, namely the bones and joints, the second informs usabout the soft tissues, mainly the tendons, ligaments and cartilage.
Those examinations are complementary and sometimes both will be necessary.

The clinichas several X-Rays and ultrasonography machines systemsof a high quality, all digital; it also has ahigh power generator for X-rays on a hanging pillarallowing to realize pictures of the vertebral colomn.

We also have a thermal camera allowing to visiualize deeply the zones of heat that are not detectable with the hand.

Treatments

Once the diagnostic is valid, the decision will be taken to whether or not treat the patient.

Unfortunately not all the pathologies can be softened with success, sometimes a sports re-orientation is necessary,or otherwise a period of rest can be required.
For the patient of which we can soften the limb, different therapeutics are offered of which some are very recent or even renewed.
- Treatment by general way (anti-inflammatory, tiludronate, glycosaminoglycane, etc.)
- Treatment by intra-articular(corticoids or hyalauronic acid, IRAP of the lastgeneration, stem cells, etc.)
- Treatment by local injection (back, sacroiliacby ultrasound guidance, intralesionel during tendinitis with
autologous plasma, PRP, stem cells, bone marrow, etc.)
- Treatment by supplementations (chondroitin, minerals, etc.)
- Local treatment (shock waves, nitrogen, vesicatories, etc.)

These choice sare taken in consultation withthe veterinarian, the owner and manager of the horse (horse rider, trainer, etc.) in function of sports assessment, of the sports potential of the patient, of his terms and of the rules on the molecules considered as doping substances.

Pathologies

Pathologies of the foal

The foal is not only a "small horse",it represents its own pathologies:

Angular deviations
Young foalsare born sometimes "bent" or "stooped". In his first weeks of life, it tends to get betterin most of the cases. However with certain foals, the cartilaginous growth plate of the bone produces more on one side (internal or external) then on the other side. In case the deviation is of a low level, the application of a resin orsoles internally or externally is determined. If the problem is more advanced, an elevation of the periosteum may be performed. Finally, when the deviation is very important, screws must be placed in order to stop completely the growth on one side.
Retraction of the flexor tendons

The foal scan show retractions of the deep flexor tendon (club foot) or superficial.In the less advanced cases, a placement of extension and painkillers could be sufficient, but sometimes a desmotomy of the adhesion of the carpal boneis determined.

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