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Cassandra R Cromer - Externship Grant Report
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Dear Theriogenology Foundation Board Members,

I want to extend my sincere gratitude for being awarded the Theriogenology Foundation Externship Grant. It provided me with the priceless opportunity to extern for a longer amount of time to become a part of the theriogenology team at Rood and Riddle Equine Hospital (RREH) in Lexington, Kentucky. By requiring a letter of recommendation from a mentoring practitioner, I, unlike all other externs at RREH, was assigned to work with the theriogenology department, and a specific practitioner: Dr. Maria Schnobrich, VMD, ACT. All other externs were on their own to mold their experience at RREH, find a mentor, and plan their schedules.

Dr. Schnobrich provided time to answer questions in regards to cases, discussed current theriogenology related literature, hosted wet labs, and supervised my hands-on experiences. The application process also allowed me to build a relationship beyond merely securing dates, spanning to career advice and internship goals, with the internship/externship coordinator, Starlee Smith. The Theriogenology Foundation Externship Grant created a first impression that facilitated a personalized, dedicated, and diverse theriogenology externship.

     

 

My goal for the RREH externship centered around the role of a theriogenologist compared to a general practitioner who specializes in reproductive medicine. Lexington, Kentucky is a unique location to analyze the two because of the diverse and dense horse population that supports the veterinary market. Thoroughbreds dominated the caseload, but Standardbreds, Warmbloods, Saddlebreds, and Western Performance horses formed a large portion of the work.

While riding with Dr. Schnobrich, I observed “general” reproductive medicine. These procedures included: rectally ultrasounding mares to follow follicular growth, fluid formation, edema appearance, cervical tone, uterine/ovarian cysts, and pregnancy determination/growth, uterine lavages, uterine culture/cytology, drawing blood for serum progesterone levels, and administration of exogenous hormones to manipulate the mares’ natural estrous cycle. I even performed venipuncture on breeding stock German Shepards for serum progesterone!

Prior to this externship, I had observed the above diagnostics with general ambulatory practitioners in Lexington. However, the complexity and depth of concept the theriogenology team used to analyze the procedures (and their results) was something I had not observed before. They utilized their training in the science of theriogenology to uncover why the mare was struggling to conceive; they had a broad base of knowledge from recognizing reproductive literature from all species and called upon their own team each of whom had a very different background and passion within the industry.

Once we returned from the farms, premiere advanced reproductive techniques were used. Embryo flushes dominated the in-house work while I was at RREH, and occurred at all hours of the day. During these procedures I set-up, ran the flush line, and helped scan for an embryo under the microscope. Often these flushes required synchronization with a recipient mare from their very own recipient herd. I managed the cycle book, where each recipient mare’s reproductive history was documented. I was also included in the discussion of selection of a proper match for an embryo donor.

At the time of a transfer, I prepped the mare and assisted the clinician during the transfer. A few times, the flushes resulted in freezing of the embryo which I was able to assist in. I also gained an appreciation for recognizing the stages of embryo growth thanks to materials given to me and visualization under the microscope. In addition, I assisted wtih oocyte aspirations for intracytoplasmic sperm injection (ICSI), oviduct flushes to attempt to clear oviduct blockage, hysteroscopies, and artificial insemination.

     

 

Stallion medicine and care had remained a bit of a mystery as I gained interest in theriogenology. Rarely in school have stallions (or any intact male animal) been mentioned beyond anatomy and spermatogenesis. My time in the breeding shed has been limited, and my only stallion handling experience was in Dr. Doug Antczak’s Havemeyer Fellowship Program. While with RREH, I assisted with breeding soundness exams, phantom collection training, stallion collection, sperm morphology/motility, freezing sperm, and cryptorchid management.

Dr. Schnobrich hosted a wet-lab on epididymal flushing, a procedure gaining popularity among colt/stallion owners. She and Dr. Charlie Scoggin, DVM, ACT, also placed emphasis on calculating the concentration and number of doses for shipping semen. Dr. Scoggin is a stallion expert, and by riding with him several times, I gained a new appreciation for stallion care and medicine. Before this experience, I had no intention of incorporating stallions into my career, but knowledge of how breeding sheds operate, recognizing stallion issues, and how to properly train a stallion to breed are all integral parts of conceiving a foal.

A unique opportunity arose for me to be able to extend my time at RREH by nearly three weeks; I graciously and gladly took the opportunity. An additional three weeks, created time for me to shadow general ambulatory practitioners. I was able to ride along with five different clinicians, including Dr. Tom Riddle. While riding with Dr. Riddle, I was exposed to fetal sexing, a procedure I had never seen before. Due to his specialty, I observed ultrasounds of more mature fetuses, as the genital tubercle does not appear until around Day 55 of pregnancy. The first time I saw a Day 60 fetus in lateral, where the skeletal structure made up the complete outline of a horse, I got chills. Learning from Dr. Riddle was a priceless experience and one I am very grateful he agreed to. By riding with other ambulatory clinicians, I saw how equine reproductive medicine can mirror production animal medicine- efficiency and time management rule.

I honed several skills outside of reproductive medicine while I was externing. By living on the grounds, I was required to go to night emergencies. I observed several colic work-ups and medical colic management, a metacarpal laceration repair, a third degree post-foaling perineal tear, and a severe rib fracture repair on a neonate. For two days, I was given the chance to tech for Dr. Spike-Pierce, who primarily does foal conformation exams, yearling sales radiographs, general radiographing, transphyseal screw removal, and lameness exams; no repro.

Prior to assisting Dr. Spike-Pierce, I had no interest in foal conformation or radiographs. However, after being absorbed in her passion for her career and her patient teaching, I am hooked on taking/reading radiographs and working with managers for limb angularities/deformities in foals. It is because of Dr. Spike-Pierce that I learned one of the most important lessons in veterinary medicine; always perform a thorough physical exam, even if you have a solid history from a reputable, experienced manager.

Rood and Riddle completely exceeded my expectations in terms of hospitality, teaching, gaining hands-on experience, mentorship, and observation of elite level medicine. The theriogenology team welcomed me with smiling faces, patient minds, and passionate personalities. By becoming fully involved, from prepping to cleaning and sterilizing, I am confident that the lessons and concepts I learned will be invaluable. I learned that sometimes reproductive problems don’t always originate from reproductive organs; lameness or chronic pain or subclinical metabolic diseases can all inhibit reproductive health.

After discovering severe pelvic pain on a “problem” sport horse mare, Dr. Etta Bradecamp, DVM, ACT, said, “A mare must be productive, before she can be reproductive;” meaning her body must take care of itself before she can care for another. Time and time again, I saw that while being a specialist provides the clinician with cases focused around what they love to do, it does not mean the whole horse should not be considered.

   

Initially, I was considering pursuing an internship focused on reproductive work, but because of the phenomenal medicine I witnessed at RREH, I believe my internship program should expose me to as much medicine as possible. This will insure I do not lose sight of the mare while treating her uterus. My desire to pursue a theriogenology residency has been solidified, and I now have industry leaders as my life and career mentors. Dr. Schnobrich has agreed to help me design a research project to help prepare me for the demands of a residency program. I have been asked back to RREH next summer, and I cannot wait to build on previous experiences after I have had several clinical rotations.

Thank you, Theriogenology Foundation Board Members, for allowing me to have this tremendous opportunity.

Best,

Cassandra R. Cromer

Class of 2018

Cornell College of Veterinary Medicine

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