Solo's Aftercare ~ We Are Flying Solo

When we got home from the vet school, Solo & I still had a lot of work to do. The catheters keeping the abscess tracts draining had to be cleaned & checked several times a day. He also needed his metronidazole (antibiotic) & misoprostol (for the colitis; also, this stuff is crazy expensive) at eight hour intervals.

What It Entailed

The catheters needed to be secured to something so they wouldn't get pulled out, so we used a fly mask & elastikon to keep them close to his head & positioned correctly for draining. I finessed the taping pattern with time to reduce the amount needed.

Also cut the throat strap off this halter

NCSU also gave me a great elastikon-saving tip: a new roll of elastikon is stretched way too tight for safe use on most horse applications, so you need to unroll the whole thing & re-roll it with less tension. When you do this, go ahead & cut it in half long-ways -- now you have twice as much of this expensive tape!

The whole rig needed re-doing once a day, what with all that delicious goop draining out. It went pretty quickly once I got it down. I'd remove all the tape & mask, wipe off any drainage goop, put fresh vaseline on his chin to protect it from scalding, then tape it all back together. Thankfully, Solo was very patient about all of this.

Patient but not above dirty looks

His medication was a much bigger production. Long-time readers will recall this horse is incredibly picky & won't eat powdered drugs in his food. Metronidazole is foul-tasting stuff & we were worried we weren't going to be able to get it in him, as he was refusing to allow straight oral dosing as well. However, this is when it is worth having an army of vet students.

Meds + chaser (right)

Before he came home, his vets & I put our heads together. His favourite treat is candy canes & in a pinch, very sweet peppermints (not regular peppermints for his highness). I found an enormous tub of the latter at Walgreen's & brought it to the hospital, where they proceeded to ~~bribe~~ train Solo to accept his medicinal torture.

When he was discharged, they showed me what they had achieved: he would now turn his head to me & take the 2 med syringes (meds + peppermint), which was then followed by syringe #3 of all-peppermint chaser. That was worth the bill right there. Genius.

To keep track of all this, I built a database in my phone (hey, I'm a scientist, what did you expect), which turned out to be an awesome tool. I found an app called Memento which is extremely simple to use & made a datasheet to track my tasks, including pulse & temp. It allows you to add photos & export the data, so I could print & show it to our vets at follow-up visits.

Timeline

July 29 to August 4 (six days post-discharge): Catheter care & meds. I usually did these about 7:30 am, 3:00 pm, & 10:30 pm. My home vet came every 2nd day to debride & flush drain tracts & replace catheters, as per NCSU orders.

August 4: First NCSU follow-up. Catheters removed, drain packed with antibiotic-soaked gauze, which I am to remove the following evening. Scoped guttural pouch & drainage tracts, all healing well. He has extremely restricted range of motion on left side of his jaw (he can't yawn normally, does a weird sideways version), likely from scar tissue. Solo & I are both thrilled to be done taping his head together.

My flushing syringes set up

I now need to flush the tracts once daily with diluted betadine until they are closed. I am issued a handy little catheter tube for this after I pass my skills test. It's a delicate business as you don't want to squirt too hard & disturb healing tissue & I'm definitely glad I've had practice doing tricky procedures on small, sensitive animals.

August 7: Our home vet does one last debridement & check, things look good.

August 11: We are done with metronidazole, woohoo! Solo has been eating very slowly, even when I wet his food, but he has a good appetite & grazes happily.

Almost healed, minimal drainage

August 18 (20 days post-discharge): Drainage tracts now healed, leaving only a small surface cavity. Yay, no more flushing!!

August 21: Second NCSU follow-up. No signs of tracts on ultrasound (woot!), tongue ulcers are still healing but doing well. Weird mass still in guttural pouch on scope, we biopsy again (still just granulation tissue & goo). Range of motion in jaw slightly improved, but not much. We begin physical therapy of biting apples. I started with the smallest ones I could find.

August 26 (28 days post-discharge): We are done with misoprostol, no more drugs!!! Apple PT is slow going, I can only do it every other day at first because he gets sore easily. Chewing is fine, just opening & stretching that scar tissue is soooo hard.

Moar apples & slurpy noms plz

Apple PT continued into December -- and it worked! Today, Solo yawns normally & crunches anything he wants with no concerns.

We had our final NCSU follow-up check in January 2018, five months post-discharge, at which point the mystery mass in his guttural pouch was finally gone. Everything is completely healed, his tongue is ulcer-free, his albumin levels are normal, & his jaw is ~90% normal range of motion. There were a lot of smiles in the exam room that day.

Summing It Up

This aftercare was a solid month of multiple-times-a-day, hands-on care, plus four more months of PT follow-through. I consider myself a skilled caretaker & I have a very high comfort level with detailed & sensitive procedures - I do surgeries on endangered fishes at work (they lived). It was still a lot of work & success required every ounce of my attention & organization.

Setup for my phone database

I am also very lucky to have Solo living with me. It's a lot easier to just walk out the back door when you have to give meds at 11 pm. I did have to leave for four days in August to run yet another unavoidable work project, during which time I was doubly lucky that I have a wonderfully kind & equally skilled trainer neighbour who flushed out Solo's hole-y head pus & gave him his meds. She didn't even make fun of me for leaving her a data sheet to fill out.

We did have minor complications, including an additional vet call. I am forever grateful for the support of Dr. Bob & our NCSU vets who let me call & email all sorts of excessive details & questions. Their support was generous & kind.

There is another major factor which contributed to our success, but this post is already very long, so it shall be continued...