Mobile Veterinarians (Mobile Veterinary Equipment)
In the early days of the large animal veterinarian, all medical supplies had to either fit into the back of a small car or a satchel. A bucket of cold water, a rough piece of burlap, and a hard bar of soap were the only things available for washing up.
When veterinary medicine advanced, diagnostic equipment was the stuff of hospitals, so veterinarians had to make referrals or wait to see the patient at a clinic.
Today's ambulatory equine veterinarian's truck, car, or SUV is thoroughly modern, filled with cutting-edge diagnostic equipment and conveniences such as refrigeration, hot water, and computerized billing.
A Contemporary Vehicle
Nowadays, veterinarians arrive in style in a truck fitted with a fiberglass truck bed insert.
"It's basically a mobile clinic," says Nick Evens from Porta-Vet. "It's designed to take the clinic to the animal. It has temperature-controlled water and power for pumps to spray the water to hose things off or for the veterinarian to wash up. It has heated compartments so drugs and injectables don't freeze. There is also a refrigerator for vaccines that need to be kept cool."
The insert's drawers, dividers, and storage spots keep equipment and drugs organized and within reach.
Evens says that many equine veterinarians are realizing they don't need a truck and are instead choosing vans or SUVs. The inserts for these vehicles are cabinet-type units with drawers.
Office management technology and software has generally been customized for the small animal clinician, but now companies are producing equipment and software for the ambulatory large animal practitioner.
Equine veterinary software now collects data specific to horses, such as height, registration number, name, sire, dam, and markings. It can store horse locations, owners, and trainers, and it also allows veterinarians to perform searches by fields, for example, all the horses located at a particular stable.
Ask your ambulatory veterinarian what frustrates him or her the most about the job and the answer will probably be paperwork. Time constraints and emergencies can allow paperwork to build up. Paper forms need to be brought back to the office and entered into the accounting system, taking up valuable time. These delays can often result in forgotten charges, late billing, and even lost lab reports.
However, mobile veterinarians can now use systems similar to handheld computers. With one of these devices your veterinarian can log on, select your name, then store the unit inside a pocket as he examines your horse.
After the exam, he can input the charges into an electronic travel sheet. He can print the invoice by pointing the unit at a portable, battery-powered printer. He can even interface with his office computer's software so the field data and office computer's data are the same.
Ordinary laptops can also be fitted with synchronization features, which transfer field information to the practice management database. Veterinarians are now able to spend more time with the animals and their owners rather than writing invoices in their truck, and they are catching up with paperwork at the office or home.
Portable Diagnostic Devices
Palpation is one technique veterinarians use to diagnose. But ultrasound can allow the veterinarian to confirm or alter his diagnosis, see how a soft-tissue injury is healing, or follow the gestation of a foal by allowing him to "see" inside the mare.
"Ultrasound is the use of high-frequency sound to produce a two-dimensional picture of soft tissue," says Steve DuMond from Classic Medical. "The ultrasound probe pulses the sound beam and listens for the returning echo to create the 2D picture similar to a fish finder."
In the past, if a veterinarian wanted to ultrasound a horse, it had to be trailered to a hospital or clinic. Since 1981, mobile units have been available that allow the practitioner to scan the horse at its home.
The 30-pound box-style mobile machines are a world away from the historic 300-pound cart-bound ultrasound machines. In our age of technology, ultrasound systems have gone small and digital.
Today, software and specialized ultrasound probes can change an ordinary laptop into a powerful ultrasound imaging device.
Ease of use and mobility are becoming bigger issues with today's mobile practitioners using ultrasound. With some of the older portable box ultrasounds unpacking and set up can be time consuming. The new PC laptop ultrasound systems are quick to set up and ready to use.
"The mobile vets already have so many things to carry," says DuMond. "With a small notebook ultrasound, they can do their ultrasound study, save it to the hard drive, e-mail, print, or burn it onto a CD-ROM. They can quickly view, measure, and label the image right on their computer screen."
This is a plus for the horse owner who would like to have a copy of the image as well. Both stills and moving images can even be e-mailed.
"The vet can do a whole study of high quality still images on a pregnancy," explains DuMond. "Or he can also make a video clip of the fetal heartbeat to document that there is a viable fetus. The veterinarian can save up to 30,000 images (on the laptop ultrasound unit), which can also be useful for comparing scans over time."
Radiology has also become more portable and compact. A stationary unit requires special expensive wiring because the power requirement is 240 volts. A hand-held portable unit requires only 110 volts.
"High-frequency portable units are often better than stationary units because they are more flexible and easy to use," says Joe Hecker from Diagnostic Imaging Systems. "Radiation shielding requirements are less, for one thing. And the newer, high- frequency units create more pulses of X ray and cut down on exposure time, which is a big issue with portable units if there isn't enough power (inadequate power causes problems with proper exposure). With the new machines, we have that power available and exposure time is reduced, which cuts down on (the X ray capturing) patient motion."
Digital X ray creates a more detailed image than traditional radiographs as it allows the practitioner to manipulate the radiograph on a computer, whereas before, if more or less contrast was needed, a veterinarian would have to re-shoot the radiograph.
With digital, the veterinarian can look at the image on the computer, adjust the contrast, and enlarge areas, picking up the subtle changes of bone. And since digital X ray produces an image on a laptop in less than a minute, owners can receive a diagnosis on the spot.
There are different types of digital X ray, but the most popular is the CR (computed radiography) Digital Navigator, which uses technology that Fuji pioneered 30 years ago. The system is basic, easy to service and understand, and it is very rugged, which is a plus with large animals.
The plate is inserted into a regular cassette, much like a conventional X ray. After the image is shot, the plate is removed from the cassette, inserted into the computer, and an image appears.
"There are so many benefits with digital," says Hecker. "For the vet there are no supplies to buy, no chemicals, no films, no dangerous waste, and the plate is reusable 10,000 times. The client gets an immediate diagnosis, and treatment can start right away. The image can be burned onto a CD-ROM for the client to keep. The CD-ROM includes viewing software so they will be able to see the image on their own computer.
"The image can also be e-mailed to another person without having to manually duplicate radiographs. Accuracy is also greater with digital. You can enlarge the picture, check density of structures (for instance, measure a cyst), adjust the brightness, contrast, and dynamic range, and measure angles of displacement."
Watching a faithful companion suffer is devastating for a horse owner. For the past few years, veterinarians have been able to give many animals with osteoarthritis, soft tissue injuries, and other musculoskelatal disorders a new lease on life through the use of extracorporeal shock wave therapy (ESWT).
Known as lithotripsy in human medicine, ESWT was first used to dissipate gallstones and urinary calculi (solid, crystalline concretions, such as kidney stones) in people, and later it was found to be useful in overcoming musculoskeletal disorders such as tennis elbow and heel spurs.
Shock wave therapy works to relieve pain and stimulate healing via high-intensity soundwave carried through the skin by direct contact, much like low-intensity ultrasound, which will be discussed in a moment. ESWT transfers a much higher level of sound energy than ultrasound.
Researchers believe ESWT causes disruption at the cellular level, stimulating neovascularization (proliferation of blood vessels in tissues not normally containing them) and new cell development. It also alleviates or reduces scarring and processes associated with chronic inflammation.
ESWT allows physical improvement of the joint site so that there is less inflammation, better range of motion, and more comfort for the patient.
This was great news for animal owners, but until recently, it wasn't widely available because the machines were huge, fixed to one spot, and expensive. The wider availability of lower cost, mobile focused shockwave units has allowed more veterinarians to take advantage of this technology.
Ultrasound is often assumed to be only a diagnostic tool. Although diagnostic ultrasound and therapy ultrasound are two completely different concepts, the way the machines work is similar.
"A portable therapy ultrasound system pulses continually and warms the tissue," says Evens. "The body responds by pumping blood, which in turn creates a curative effect. The therapy ultrasound also micromassages and opens up the cell membranes to get topical medicine to penetrate into the cells better or faster."
Veterinarians will often buy the machines and rent them to the clients to use to help heal soft tissue injuries.
For more information on mobile therapies see www.TheHorse.com/8207.
Technology is advancing at a rapid pace.Who knows what new equipment might be inside our veterinarians' vehicles in the future?
About the Author
Sharon Biggs Waller is a freelance writer for equine science and human interest publications. Her work has appeared in several publications and on several websites, and she is a classical dressage instructor.
POLL: Managing Working Horses