Rood & Riddle Saratoga: Quick access, excellent care

Rood & Riddle Equine Hospital in Saratoga is a satellite facility for the main location in Lexington, Kentucky. All photos courtesy of Dr. Travis Tull.Rood & Riddle Equine Hospital, based originally in Lexington, Kentucky, opened its first satellite practice in September 2013 in Saratoga Springs, New York. At the time of purchase the main building was approximately 3,700 square feet and housed one surgical suite, two recovery stalls, an area for treating and evaluating horses, office space and storage. Since that time the practice, Rood & Riddle Equine Hospital in Saratoga, has added on more than 8,000 square feet while remodeling the existing building. The grand opening was in July of this year.

The addition included a new state-of-the-art surgical facility, an additional barn with housing for nuclear scinitgraphy, a radiology suite with a large ceiling-mounted generator and high-definition wireless digital plates, a laboratory and additional office space. The practice is a full-service equine hospital with 24-hour care and staffing, as well as ambulatory and podiatry divisions. It is located just off the backstretch of Saratoga Race Course, minutes from downtown in the heart of the Upstate New York horse country.

At Rood & Riddle Equine Hospital Saratoga, doctors do about 30 to 35 surgeries per month while offering emergency, critical care and internal medicine services. Not only do they treat thoroughbred racehorses but also standardbred racing horses, sport horses, western performance horses and other pleasure horses vanned in from the surrounding community.

Dr. Travis TullThe ambulatory division, headed by shareholder Scott Ahlschwede, DVM, has five-full time veterinarians and a veterinary podiatrist. Travis Tull, DVM, DACVS, is staff surgeon and remains at the hospital year-round while shareholder and surgeon Brett Woodie, DVM, MS, DACVS, travels back and forth from Lexington and manages hospital operations. Carrie Agne, LVT, ATSAVN, is the head veterinary technician, overseeing the nursing staff and assisting Tull during equine treatments and surgeries.

Facility operations

The main treatment area, which consists of two rooms with stocks and a host of diagnostic modalitie, is designed for basic treatments and procedures and diagnostic workups. This is where “we do endoscopy, standing procedures, ultrasound, lameness workups and bandage changes,” Agne says. The room closest to the surgery suite is primarily used for critical patients that proceed directly to surgery after a brief triage to assess such conditions as dystocia or severe colic.

Carrie AgneAdjacent to the two treatment rooms are three induction/recovery stalls that open into the surgical preparation area. “The first induction stall is where most of our surgeries are placed under anesthesia,” Agne says. The horses have their mouth rinsed of debris and are given sedation followed by intravenous anesthetic drugs. “We normally have four to five people-one on the head; one on the shoulder; one or two on the midsection and one on the hind end-to help drop the horse against the wall,” Agne says. This is a very controlled procedure. “From that point, the patients are gently rolled over onto their side, an endotracheal tube is placed, and we put the shackles typically around their fetlocks. Then we hoist them up onto the surgical table.

“The surgical table is pre-prepared so it is at the proper recumbency we have put the horse in,” Agne continues. Because horses are sensitive to low blood pressure due to their size and large muscle volume, they are placed on a ventilator and monitored continuously during the procedure with electrocardiogram, direct blood pressure readings and blood gas evaluation.

The transfer area opens into two surgical suites. One is dedicated to surgeries with a higher likelihood of contamination (such as colics, lacerations and abscesses), and the other is designed for surgeries with little such risk (such as orthopedic and elective procedures). “Each room has an air curtain ventilation system; two overhead LED surgery lights; oxygen, nitrogen and suction; a hoist for holding legs up or fluids for critical cases; and a hose system nearby to assist cleanup,” Agne says.

A temperature-controlled four-stall barn is located just off the back of the facility. An adjacent room in the barn houses the new nuclear scintigraphy machine. Nuclear scintigraphy uses small amounts of radioactive material to diagnose and assess the severity of a variety of conditions, including fractures, bone injury and soft tissue injuries. The bone scan room houses a large gamma camera with a computer system directly attached.

“The horses are sedated and the isotope injected intravenously,” Tull says. “One person will restrain the horse while another moves the gamma camera around the horse to obtain specific projections. The isotope is bound to a molecule that preferentially binds to areas of increased bone turnover, enabling the identification of areas of bone inflammation often prior to radiographic changes.”

Surgery: A foal is admitted for colic assessment and treatment

In emergent situations time is a critical factor not only for survival but also in how quickly a horse recovers. For instance, a foal was recently seen in the field by one of the Rood & Riddle ambulatory veterinarians for colic. The history was sudden onset of abdominal pain with rolling and kicking at the abdomen. After a quick evaluation and several series of analgesics and sedation, the foal was referred for evaluation at the hospital.

A colic surgery being performed at Rood & Riddle Saratoga.“They got the foal to our facility within about 40 minutes,” Tull says. “The foal was quite painful when it arrived. Rapid evaluation and triage was performed and, based on the history of significant abdominal pain, with multiple loops of distended small intestine apparent on ultrasound, exploratory laparotomy was recommended.

“Exploratory surgery demonstrated a small intestinal volvulus, which occurs when the small intestine twists around its mesentery, the tissue that connects it to the internal body wall and, more importantly, carries the blood supply,” Tull continues. “The small intestine was carefully untangled to correct the volvulus. The contents of the small intestine were then pushed back into the cecum where there was room for the ingesta to pass on through the GI tract. After we were satisfied with the success of that portion of the procedure, we continued exploring the GI tract and completely lavaged it with several liters of sterile fluid. The abdomen was closed routinely.”

Luckily in this particular patient there was no compromised small intestine from loss of blood supply requiring removal of intestine. “The major reason we were able to obtain a good outcome in this particular foal was how rapidly the initial colic signs were identified, and how quickly the referring veterinarian sent the foal in to the hospital,” Tull says. “From start of colic signs to surgical intervention was less than two hours. That can make a big difference.” The foal recovered well and was home again five days after surgery.

Additional procedures highlight Rood & Riddle's important work

“It's not just colic where time is an important factor in outcome,” Tull continues. “Recently during training a galloping horse pulled up abruptly and was placed on the ambulance and driven directly to the hospital. After the horse was cooled down and a given a good physical examination, ultrasound was utilized to identify a pelvic fracture, and standing radiographs of the horse's pelvis were taken with the high-definition wireless digital radiography system confirming the diagnosis.”

In certain cases unstable pelvic fractures can lacerate major blood vessels in the abdomen, leading to a major hemorrhagic crisis. Previously, radiographing the pelvis in adult horses would have required general anesthesia. But the hospital's current system enables the doctors to obtain standing diagnostic images. The proximity of the practice and the ability to image the pelvis standing allowed a rapid diagnosis and prevented the horse from having to be transported a long distance with an unstable fracture.

Lavage of a horse's hoof after the patient stepped on a nail.Aside from the breeding population and racing component of Saratoga Springs there is a large population of pleasure horses that benefit from a centrally located referral hospital. “Late one afternoon recently a family was bringing their 20-year-old retired pleasure horse in from his pasture and noticed he was limping,” notes Tull. “Further inspection demonstrated a hole in his hoof in the region of the frog, and a nail in a board nearby with blood on it. They got him on the trailer and brought him in to the hospital. The wound was cleaned a radiograph taken with a sterile probe in place. The nail had penetrated through the frog and entered the navicular bursa and the distal interphalangeal joint, important synovial structures within the hoof. The horse was taken to surgery that night, the nail tract cleaned and debrided, and the navicular bursa and distal interphalangeal joint flushed copiously with sterile fluid.”

Hoof radiograph showing a sterile probe into the wound.A regional limb perfusion, a procedure where a tourniquet is placed above the hoof and antibiotics placed within a vessel resulting in a high antibiotic concentration in the region, was also performed during the procedure. “The goal when a synovial structure is penetrated is to remove contaminants and bacteria to prevent a life-threatening infection from occurring,” Tull says. “The sooner wounds like this are treated appropriately, the more likely the horse will avoid infection and chronic lameness. This patient received intravenous antibiotics, further regional limb perfusions performed standing, and a special shoe with a treatment plate custom-made by the practice podiatrist. He made a full recovery and is sound and living the good life of retirement.”

Proximity makes Rood & Riddle essential to Saratoga Race Course, surrounding community

Regardless of vocation, horses in the upstate New York community now have access to an equine hospital with advanced diagnostic capabilities and 24-hour staffing. The veterinarians and staff have extensive training and are passionate about equine health.

“Proximity to rapid treatment makes a big difference in survival and recovery of horses in emergent situations,” Tull says. The location of Rood & Riddle Equine Hospital in Saratoga Springs in relation to the Saratoga Race Course and surrounding horse community makes it essential for rapid, safe, efficient and excellent treatment of horses, be they in need of emergency treatment, advanced diagnostics, medical care or lifesaving surgery. Being able to walk, easily van, or get horses to the facility quickly has already helped save equine lives and will assist numerous horses in the years to come.

Ed Kane, PhD, a regular contributor to dvm360 magazine, is a researcher and consultant in animal nutrition. He is an author and editor on the topics of nutrition, physiology and veterinary medicine with a background in horses, pets and livestock. Kane is based in Seattle, Washington.

Click "Next" to see pictures of the Rood & Riddle Saratoga facility.

The main treatment room at Rood and Riddle Saratoga.

The radiology room, which includes nuclear scintigraphy capabilities.

The instrument room.

An induction stall near surgery.

Radiology recovery.

The veterinary equipment room.