Common Problems and Their Signs
The ability to recognize abnormalities depends greatly on a person's knowledge of what is normal. The greater someone's knowledge of normal anatomy, physiology, behavior, and environment of a given animal, the more likely that person is to recognize subtle differences that might be the beginning of a disease process. There can be great differences between individual animals, and care givers need to recognize that fact. For example, there are some horses which almost never lie down, and there are some that lie down frequently. If a horse which never lies down suddenly starts lying down frequently, it could be a sign of trouble.
In addition to having knowledge of the basics, one must develop strong powers of observation in order to maximize the chances of recognizing the abnormal. The inability of the horse to communicate directly is the greatest hurdle we have to overcome as care givers. The purpose of this article is to review the common illnesses that affect the horse and to highlight their clinical signs. Most of the problems mentioned in this article have had entire articles devoted to them over the past few years; more information can be obtained from previous editions of The Horse. In this article, problems are grouped by the organ system affected.
A necessary place to begin this discussion is with the difference between the words sign and symptom. The word “sign” always is used to describe the manifestations of illness in animals, whereas the word “symptom” commonly is used in human medicine. The word symptom means those abnormalities or problems that are conveyed verbally from patient to doctor. Given the horse’s inability to communicate verbally, the use of the word symptom is inappropriate.
The Oral Cavity
Bad Teeth--This might be one of the most insidious problems we deal with in the horse. There are a variety of teeth abnormalities, with many of them leading to the same clinical signs—poor body condition from varying degrees of malnutrition. The key function of the teeth is to break up the ingested fiber into small enough sections so the bacteria contained in the gastrointestinal system can ferment it. The fermentation of fiber into fatty acids is the main mechanism by which the horse gets nutrients from fiber. The end result of bad teeth is longer fiber that the bacteria cannot break down. Nutrition suffers, and an insidious weight loss commonly occurs.
As the fiber length increases, it can become more difficult for the gastrointestinal tract to move the ingesta along and impaction colic can occur. Any horse which suffers from chronic weight loss and/or chronic impaction colic should have his teeth checked. The types of dental abnormality might differ, but generally include sharp points and the development of hooks on the first and last cheek teeth. The development of hooks prevents the full length of the cheek teeth from coming into contact and disrupts the grinding function.
In the older horse, the development of a “wave” or “step” mouth is common. This condition occurs when an opposing tooth is short or lost and the opposite tooth continues to erupt to the point where the teeth do not occlude properly. Equine dentistry has made great advances in the past few years with the development of many special tools to aid in the correction of these problems. The yearly examination of your horse’s mouth by a trained professional can head off many tooth-associated health problems.
Sinus problems--The most common sinus problem is infection due to a tooth root abscess. The clinical signs include a warm, painful swelling of the bone over the sinus area and a very bad-smelling nasal discharge. A sinus infection is slow to develop, usually is a chronic problem, and typically requires the identification and removal of the causative tooth. The tooth root can be infected as a result of a crack in the tooth due to trauma or a leak in the center of the tooth called a “patent infundibulum.” The patent infun-dibulum is a common defect occurring in the first molar tooth in older horses. After removal of an affected tooth, multiple flushing of the area typically is required to obtain resolution of the sinus infection.
Wolf teeth--Typically, the first cheek teeth you come to in a horse’s mouth are the second premolar teeth; the first premolars (first cheek teeth, referred to as wolf teeth) mostly were lost in the evolutionary process. When the first cheek teeth are present, they are small and somewhat abnormal looking. Many times these teeth do not cause a problem, but they grow right where the bit goes in a horse’s mouth. The clinical signs in a horse where a wolf tooth is causing problems include head shaking and bitting problems. In some horses, the wolf tooth does not penetrate the gum. These vestigial wolf teeth can cause a great deal of irritation as the bit bangs on the soft gum tissue between it and the tooth. These horses usually have a mound of inflamed (red, warm, and painful) tissue just in front of the second premolar tooth, and the hard wolf tooth can be palpated under it. The treatment of problematic wolf teeth is removal.
The eye is a wondrous organ that is beautifully complex and simple in its structure and function. The issues of what a horse sees truly are complex. The reality is that despite all the science, hypothesis, speculation, and interest, what exactly horses see and how they perceive their world will most likely remain a mystery.
The equine eye functions to collect and “focus” incoming light—and therefore an image—and transmit that focused image to the brain. The anatomy of the eye consists of the cornea, iris, aqueous chamber, pupil, lens, vitreous chamber, retina, and optic nerve. You should familiarize yourself with the easily visible outer structures of the eye by observing them with a penlight or other light source. As will be discussed later, a very consistent sign of ocular disease in the horse is pain, but occasionally it is not the first sign. Therefore, paying some attention to the eye and becoming familiar with what is normal can help head off problems.
The cornea is composed of several layers, with the outer layer acting as a protective barrier and the inner cell layer functioning to move water out of the cornea. The maintained dehydration of the cornea is the essential mechanism by which it is kept clear. The outer surface, or epithelium, only allows limited penetration of water. If the outer protective epithelium is damaged (scratched, etc.) or the inner layer becomes diseased or damaged, the in-between layer will take on water and have a bluish/white patch of edema. The development of this edema or loss of clarity of the cornea is a sign of trouble.
The pink tissue surrounding the eye is called the conjunctiva. You should look at this tissue and learn to recognize the normal pink color. When this tissue becomes inflamed, it appears red and swollen and can be an early warning sign of ocular abnormality.
A unique structure of the horse’s eye is the third eyelid. The third eyelid (nictitans) is in the inside lower corner of the eye socket. In the normal horse, it generally is tucked away out of sight. When the horse blinks, the third eyelid sweeps across the eye like a small windshield wiper, helping the tear film keep the cornea surface clean. There is a constant quantity of tear being secreted onto the eye. This tear film serves to lubricate and moisten the corneal surface and, in addition, also provides a certain degree of immune protection.
Immediately behind the cornea is a fluid-filled chamber called the anterior (front) chamber. The fluid in this chamber normally is crystal clear and allows an unrestricted view of the iris. If the fluid between the cornea and iris becomes cloudy, it is a sign of inflammation within the eye.
The iris essentially is everything brown surrounding the black pupil. Horses do not have the variety of color to their irises as people do, but occasionally you will come across a horse with a bluish/white or other variation iris.
You should note the dark brown “punching bag”-looking structures on the upper edge of the iris—those are part of the normal anatomy. They can enlarge and obstruct the pupil when abnormal.
The iris is what controls the size of the pupil in response to the brightness of the ambient light (or your flashlight). The iris has many small blood vessels in it, so trauma to the eye can make it bleed. You can notice the presence of blood (often seen as a red haze) in the anterior chamber. Technically, the iris is classified as part of the uvea (pronounced U-V-uh). Uveitis (pronounced U-V-itis), which also is called periodic ophthalmia or moon blindness, is an inflammation of the uvea (more on that later). The iris is the part of the eye affected by uveitis.
The lens is a clear structure of Jello-like consistency. It sits directly behind the pupil and functions to focus the incoming light. The cornea and lens function together in focusing light and an image on the back of the eye. The image is focused upside down and backward, similar to how the lens of a camera alters to become the image on film. It is the brain that flips the image around so that it makes sense to the horse. The lens should be clear, so if there is a white opacity behind the pupil, it probably is a cataract. (A cataract is another term for an opacity of the lens.)
Behind the lens is more clear jelly-like substance called the vitreous. Finally, on the very back surface of the eye, is the retina. It is the retina that collects the focused image and transmits it to the brain via the optic nerve. Most of the image perceived by the right eye is processed by the left side of the brain, and vice-versa. The optic nerves cross and go to opposite sides of the brain.
Acute Ocular Pain--Any degree of ocular pain should be considered an emergency until the cause has been identified. Many injuries to the eye are minor. However, some infections have an extremely rapid progression, and the sooner a diagnosis is made and an appropriate treatment started, the better the prognosis. The signs of ocular pain are squinting, tearing, a pupil that’s too small for the amount of ambient light, and an increased sensitivity to light. Ocular pain in the horse can be caused by many problems, but two common ones are a scratch or a developing ulcer on the cornea or anterior uveitis (moon blindness).
In many cases, the eye cannot be examined without veterinary assistance due to the pain and strong upper eyelid muscle. The horse will need to be sedated in most cases, plus be given an injection of local anesthetic to paralyze the upper eyelid and facilitate examination. In either case, it is important to seek veterinary care quickly. If there is a scratch or ulcer, it must be decided if it is caused by a foreign body, such as a splinter or plant awn that is stuck in the conjunctiva or third eyelid. If there is a foreign body and it is not removed quickly, the ulcer will continue to progress. If there is a foreign body in the cornea, it needs to be removed quickly.
The eye is not a sterile environment. If the conjunctiva is cultured, a great number of bacterial and fungal organisms can be grown—all of which can act as a source of infection for an abrasion, scratch, or ulcer. In addition, most of the foreign bodies that commonly end up in the horse’s eye are plant materials or dirt and have high contamination potential.
If the horse is developing uveitis, it is an emergency. With uveitis, the inflammation is on the inside of the eye in the anterior chamber. When inflammation occurs inside the eye, it is important to make an attempt to control it as soon as possible in an effort to decrease the potential of complications that can permanently affect vision. The treatment for uveitis is very different than that for a disease in the cornea, so it is important to get a veterinary opinion.
One extremely important thing not to do is randomly choose an eye ointment from another horse, small animal, or yourself and place a gob of it in a runny, painful eye. The use of an inappropriate ointment in the horse’s eye can have devastating consequences—eye ointments containing steroids have been shown to have an association with the development of severe fungal eye disease in horses. A horse with a painful eye should be placed in as dark a stall as possible for comfort, then be evaluated by a veterinarian as soon as possible. In most cases, the treatment for eye ulcers should be uncomplicated. However, because certain infections have the ability to strike fast and furious (particularly Pseudomonas and the fungal infections), an extra degree of concern for a horse with a painful eye is warranted.
Eye Lid Lacerations--Lid lacerations often are a preventable problem. By scouring a horse’s environment for any potential offending object and by being observant (i.e., checking out those portable stalls at competitions before putting your horse in them), you can prevent many such injuries. In the event that you do have the misfortune to find half of your horse’s eyelid hanging by a thread of skin—don’t panic. Fortunately, the horse’s face has a great blood supply. As a result, even the most grotesque of lid lacerations has a fair chance of healing if repaired promptly.
The important thing is, as with any wound, the sooner it is repaired, the better the prognosis for uncomplicated healing. An eyelid laceration, no matter how small, should be evaluated immediately due to the importance of the eyelids in protecting the eye. Even small defects in the apposition of the upper and lower lid margin could predispose the horse to future trouble. In addition, whatever trauma caused the lid laceration could have caused difficult-to-detect damage to the eye itself; the eye should be thoroughly examined after lid trauma.
Blunt Ocular Trauma--Any type of accident or head injury could traumatize the eye even if it doesn’t appear so. Injuries could result from trailer accidents, spooky horses hitting their heads on a wall or other solid objects, an eye being hit with a polo ball or mallet, and horses hitting their heads in starting gates, etc. If the eye is hit bluntly, although there is no external damage (i.e., lacerations), there can be a more obscure problem. Blunt trauma can induce uveitis. If you are aware that a horse has hit its head, the eyes should be evaluated for any evidence of cloudiness or blood in the anterior chamber. The onset of this type of uveitis can be delayed and very gradual, so the eyes should be monitored carefully for several days.
Another problem that can occur with head trauma is sudden blindness. If the blow is hard and very sudden in the appropriate direction, the eye, which is relatively mobile in it’s socket, can move far enough and quick enough to “snap” the optic nerve, causing swelling and damage. This type of injury occasionally is seen when people hit their heads on steering wheels during automobile accidents. The damage is not always permanent, and rapid evaluation and administration of anti-inflammatory drugs can improve the prognosis for vision.
Eye Lacerations/Punctures--Numerous objects can lacerate, puncture, or rupture the eye. The prognosis for repair of these injuries is variable and depends on the degree of damage and the amount of contamination or infection. The damaged eye should be evaluated immediately by a veterinarian to maximize the chances of successful repair. The more time that passes, the greater the chance of infection setting in and complicating repair attempts.
Periodic Ophthalmia--Otherwise known as recurrent uveitis, uveitis, or moon blindness, periodic ophthalmia can be a devastating disease of the equine eye that we really don’t know much about. The hypothetical causes have been sporadically researched over the years, but we aren’t much closer to understanding this inflammatory ocular disease. The term moon blindness comes from the ancient belief that the disease was associated with the changes of the lunar cycles. The “recurrent” or “periodic” part of the disease is because of the propensity of this problem to recur in a rather unpredictable manner. The uvea is an anatomical name for certain parts of the interior eye, and “itis” means inflammation; so uveitis is an inflammation of the uvea. The uvea includes most of the interior parts of the eye that have a large blood supply. This is especially true for the iris or colored part of the eye surrounding the pupil.
Clinical signs for this disease actually can be broken down into those observed during an acute flare-up of the disease and those observed that indicate the disease has occurred in the past. The primary sign of uveitis is pain shown by squinting, tearing, and an increased sensitivity to light. Other observed signs are a very constricted pupil (even in a dark stall), cloudiness within the eye (will be difficult to see the iris and pupil with a distinct haze present), and potentially the presence of solid material (protein) attached to the iris. As inflammation occurs within the eye, irritating chemicals are produced and released into the fluid in the anterior chamber (the space between the inside of the cornea and the iris is called the anterior chamber and is filled with a clear fluid). In addition to the inflammation chemicals being released, white blood cells and protein leak from the inflamed blood vessels into the anterior chamber fluid—which creates the haze in the anterior chamber. In severe cases of uveitis, the white blood cells settle and collect in the floor of the anterior chamber.
One of the proteins that leaks into the anterior chamber is called fibrin, which is a fluffy, cotton candy-like substance that is a precursor to a dense connective tissue scar. If the fibrin production in the eye is heavy and goes without treatment, it can cause a significant amount of scarring within the eye. Matured fibrin can “glue” the iris to the lens, thus preventing it from opening in low light situations or covering the lens and greatly affecting vision. If left untreated, the inflammation within the eye can have a devastating impact on vision.
The signs of prior uveitis can be more subtle and require extensive examination of the outer and inner areas of the eye. This examination is an important part of a purchase examination due to the recurrent nature of uveitis. Unfortunately, it is impossible for your veterinarian to predict if the uveitis will recur or not. The disease might never happen again, or could recur next week. There really is no way to predict it. All your veterinarian can do is attempt to determine how uveitis damage currently affects vision and document the extent of the lesions. The most subtle of signs is a darkening of the iris to a deep dark chocolate color with or without obvious scarring of the iris. In advanced cases, the iris can appear very “moth eaten” and scarred. The edge of the iris might be irregular and roughened.
Remember, the punching bag-like gizmo (nigra bodies) on the iris is normal and must be differentiated from abnormal irregularities.
The surface of the lens (within the area of the pupil) might have a piece of brown iris stuck to it (or the iris itself) or other scar tissue from previous inflammation. Sometimes there are white strands of scar tissue inside the anterior chamber.
The most crucial part of the examination with respect to purchase exams is looking deep inside the eye. It is possible to have none of the other tell-tale signs and have significant scarring in the back of the eye. The lesions caused by uveitis in the back of the eye (where the light-sensing retina is located) are reflective scars surrounding the optic disk (optic nerve as it enters the eye). These lesions often are referred to as “butterfly” lesions, as they often appear in the shape of a butterfly. The scarring in the back of the eye, depending on the degree, can cause a visual deficit or blind spot.
In more chronic cases of uveitis, the iris can become scarred and light in color. The border of the iris might be irregular and “glued down” to the lens. The lens often is made opaque (does not let light through) by the presence of a cataract. The eye itself might appear abnormally large and firm or abnormally small and soft. Vision might be severely impaired.
In advanced cases, the cornea might not be healthy and could have an ulcer. In all cases, one eye or both eyes might be affected.
The Gastrointestinal (GI) System
GI tract problems are the most common maladies affecting the horse. The word colic is used as a catch-all term for abdominal distress; in Greek, colic means “affecting the bowels.” Fortunately, many bouts of colic are mild and pass without extensive treatment. However, colic can be unpredictable and progress rapidly. Time can be of the essence in such cases if advanced treatment or surgery is to be successful.
Colic can occur for unknown reasons, but there is an association with alteration of management practices and colic. Sudden changes in feeding habits should be avoided; many colic cases show a history of switching hay types (usually from a low-quality grass hay to a high-quality alfalfa) or sudden increases in concentrates (grain). The digestion mechanism of horses involves a fermentation process that has a very delicate balance. Anything that alters that balance could increase gas and/or acid production and predispose the horse to GI problems.
Any changes in feeding habits (including access to new pasture) should be made gradually. When changing types of hay, make sure to get the new hay before the old hay is gone and gradually add the new to the old when feeding. Bringing your own hay and feed to shows might be worth the trouble just to avoid adding one more stress to the traveling horse.
Water, in addition to being vital for life, is important for the health of the GI system. Water actually is the most important nutrient. A complete lack of water will kill a horse long before a lack of any other nutrient.
There seems to be an increased risk of impaction colic during the cold winter months that might be associated with decreased water intake. It has been shown experimentally that the offering of “room temperature” water during the winter months can double the water intake of some horses. Horses should have access to fresh, clean water (from clean buckets!) as often as physically possible.
Severe Abdominal Pain--There are many signs associated with abdominal pain. The most obvious signs are looking at the belly (flank watching), pawing incessantly, kicking at the belly, and rolling. Other signs of abdominal pain consist of lip curling, inappetence, stretching or posturing to urinate, depression, and flipping or “flagging” of the tail. (The signs listed in the last sentense might not be associated specifically with abdominal pain.)
When a horse demonstrates signs of abdominal pain, a veterinarian should be consulted. Many cases of colic are mild and could be related to excess gas in the intestines; but more serious causes can be difficult for the lay person to distinguish due to the variability and intensity of signs in the individual horse. If the signs are a reflection of a serious problem, time is extremely important if advanced treatment or surgery is an option.
If the horse is rolling violently, it is best to make them rise and keep them walking to prevent self-injury. The horse should not be allowed to eat until veterinary evaluation has been made.
Grain Overload (Overeating)--The most common situation resulting in grain overload is the horse or pony which often is the escape artist in the barn, frees himself in the middle of the night, and hits the jackpot with a 100-pound bag of sweet feed. This problem also can be the result of excessive quantities of grain or corn to a group of pastured horses—since one of them is the alpha (dominant) horse of the herd, that horse will eat more than you intended.
The two major problems associated with grain overload are the development of laminitis and rupture of the stomach. If you are suspicious of grain overload, and the horse is showing signs of colic, getting veterinary assistance is extremely important. Horses cannot vomit, so if there is an indigestion causing a build-up of fluid and/or gas in the stomach, there is a great risk that the stomach will rupture if a nasogastric tube is not inserted by a veterinarian.
Unfortunately, horses with a stomach rupture cannot be saved.
Even if the horse is not showing abdominal pain, prompt veterinary attention still is very important so that appropriate therapy can be started. The therapies are aimed at reducing the risk of laminitis and GI distress. Obviously, the horse should not be allowed to eat while waiting for evaluation.
Food/Water From the Nostril--If milk is coming from the nostril in a young foal, either a cleft palate, which is rare, or botulism should be suspected, and a veterinarian should be consulted. In the adult horse, the most common cause of food or water coming from the nostril is “choke.” This is an esophageal obstructive condition, commonly caused by feed material (either hay or grain) that obstructs the esophagus, typically in the lower neck region. I have seen choke caused by foreign objects such as a wood chunk, a ball of twine-like material, a solid alfalfa cube, and large clumps of beet pulp. One great predisposing factor to choke is poor dentition (bad teeth).
Most cases of choke require veterinary intervention. It is important to recognize the problem. If there is suspicion of a choke situation, all feed and water should be removed from the stall—the horse should not be allowed to eat or drink anything until veterinary evaluation has been performed. With the esophagus obstructed, there is a chance that some of the food or water the horse is attempting to consume will be inhaled. Aspiration pneumonia is a common complication of choke. In addition, all bedding material should be removed from the stall so the horse will not attempt to eat straw or shavings when the hay is removed.
Inappetence--There are a wide variety of illnesses that can cause inappetence (lack of appetite); it is a very non-specific clinical sign. When faced with an animal which won’t eat, you can obtain the body temperature, heart rate, and respiratory rate and note other signs. Has the horse been defecating? Is there evidence of unobserved abdominal pain, i.e., a messed up stall or bedding on the animal? Has the horse been drinking normally? Is there feed material in the nostrils or other nasal discharge? This information should be provided to the consulting veterinarian.
Acute Diarrhea--Diarrhea in the horse can develop quickly and progress rapidly. Whether the cause is Salmonella, Potomac horse fever, or something else, horses with diarrhea can become extremely dehydrated in a very short time.
It is important to note that in the early stages of a developing enteritis (inflammation of the bowel), diarrhea might not be a prominent clinical sign. Some horses with enteritis show signs of abdominal pain with the development of “toxic” mucous membranes (dark or bright red with a prolonged capillary refill time) and severe dehydration before developing diarrhea. It is important to recognize the signs of a horse in trouble and to seek veterinary assistance.
If a horse has diarrhea and is still drinking, make sure there is an ample supply of fresh, clean water. In addition, to replenish the electrolytes (sodium, chloride, potassium, and bicarbonate) lost due to diarrhea, a bucket with an electrolyte solution can be offered along with a bucket of plain water (see sidebar at left).
The Respiratory System
The early recognition of a respiratory disease is important since early detection can prevent a potential crisis. For example, we were going to transport a mare from New York to the West Coast a few weeks ago. Three days before the scheduled departure, a slight cloudy nasal discharge was noted. At that time, there was nothing else obviously wrong with the mare—she was bright, alert, and active with a good appetite. Further evaluation revealed a mild fever. When the trachea (windpipe) was “squeezed” in the middle to upper part of the neck, she coughed. At that time, we decided to delay shipping. If the original nasal discharge had not precipitated an evaluation, the mare easily could have been shipped, putting her at risk for significant exacerbation of the respiratory problem.
Respiratory conditions related to transportation are common. It is very important to pay close attention to your horse’s health prior to shipping. If the horse is showing any signs of a potential respiratory infection (fever, cough, increased respiratory rate, or significant nasal discharge), he should not be transported until evaluated by a veterinarian. In addition, shipping a horse with some contagious respiratory conditions—such as strangles (Streptococcus equi) or a viral infection—can put other horses on the trip or at the destination at risk for disease.
Should your horse develop any of the aforementioned signs of a respiratory disease, further evaluation is important. Allow the horse to rest until the veterinary exam is made; exercising a horse with a respiratory disease can increase the chances of a relatively mild problem developing into something serious.
Increased Respiratory Rate--An increased respiratory rate is a sign of an infectious respiratory disease, but it also can be a sign of other problems. If the horse has been exercising, is he cooling out properly? One of the major ways horses dissipate heat is via sweating. If a horse does not sweat enough, or is having trouble cooling out after vigorous exercise, then the increased respiratory rate might be an indication of heat stress—this will be discussed later.
An increased respiratory rate also can indicate severe anemia. Are the horse’s mucous membranes pale? Has there been exposure to red maple leaves (which are toxic)?
Another cause of an increased respiratory rate can be an allergic response. Has the horse just received any medications or vaccinations? Is there evidence of the animal having been bitten or stung by an insect or attacked by a snake? These types of reactions can be mild, or they can be the beginning of a full-blown anaphylactic (allergic) reaction that requires immediate veterinary attention for the animal to survive (more on anaphylaxis later).
Severe Heaves (COPD) Crisis--Chronic obstructive pulmonary disease (COPD), commonly called heaves, is an emergency situation. If you own a horse which has been diagnosed with heaves, great care should be taken to avoid allergens that can cause a reaction. A management program for the horse should be discussed with your veterinarian and strictly followed.
Heaves is an allergic condition that has some degree of variability between horses and, therefore, has some degree of variability of what exacerbates the condition.
A horse I was caring for last summer was stabled indoors most of the summer (this animal’s heaves was worse on pasture). The barn was next to a field that was allowed to flower and go to seed before being bush-hogged. About 24 hours after the field was mowed, the horse had an extreme respira-tory crisis that required days to adequately control. This might have been prevented if the horse had been relocated prior to mowing the field or if the field had been kept short (and not allowed to flower) with more regular cutting.
Horses experiencing a heaves crisis have extreme difficulty in moving air in and out of the lungs (similar to a human having an asthma crisis). The respiratory rate is elevated, there typically is great flaring of the nostrils, and there is a significant movement of the abdomen in an effort to assist breathing. Sometimes these horses have to work so hard at breathing that they are not able to eat or drink. Veterinary care with drug therapy is required for control of this problem.
(Part II, article #142, will have the musculoskeletal system and wounds, including lameness, laminitis, tendon injuries, EIPH, and foot punctures/abscesses.)
About the Author
Michael A. Ball, DVM, completed an internship in medicine and surgery and an internship in anesthesia at the University of Georgia in 1994, a residency in internal medicine, and graduate work in pharmacology at Cornell University in 1997, and was on staff at Cornell before starting Early Winter Equine Medicine & Surgery located in Ithaca, N.Y. He is also an FEI veterinarian and works internationally with the United States Equestrian Team.
Ball authored Understanding The Equine Eye, Understanding Basic Horse Care, and Understanding Equine First Aid, published by Eclipse Press and available at www.exclusivelyequine.com or by calling 800/582-5604.
POLL: Groundwork Practice