The Other Reason Solo Lived

Some of it was just plain luck.  There were so many places things could have gone further awry & they didn't.  Luck is blind, we didn't earn it, but I am grateful for it nonetheless.

But the other big reason Solo is here today is...because he is Solo.  Because he LET us help him. I wouldn't have blamed him if he didn't.

He spent weeks in a stall, with daily harassment by vets, students, me, all staring, poking, treating, injecting (thankfully, IVs reduce this).  Yes, he went for walks, hung out in the round pen, & enjoyed baths, but there was a lot of standing around too.  Those drainage holes had to be cleaned & debrided in stocks daily.  He had frequent oral exams & scoping.

All of this could make any horse pretty darn angry & resentful.  Heck, it would make ME pretty darn resentful.  But Solo never got angry.  He always pricked his ears when someone entered his stall & stood quietly while they inspected him.  He walked obediently into the stocks every time.  He let me clean & flush the holes in his head un-sedated & accepted his vital meds.

A week before discharge - clearly (not) suffering

Solo remained the gentle, forgiving horse he has always been, the horse who is always optimistic that the next time will be better (a quality his owner fails at).  This really was a key element in his survival.

To be honest, it wasn't an angle I had considered in great detail before this, but it definitely will be a conscious question in decisions about ANY horse's care in the future:  is this horse mentally up to working WITH me through whatever challenge he is facing?

We don't always know for sure, & of course we can't predict everything that's going to happen but I feel a responsibility to give a hard, honest look at the question, to the best of my ability.  I.e., I would absolutely not ask my 5-yr-old uber-sensitive TB to deal with something like this.

This issue has also been incorporated into my training.  I am spending purposeful time with Echo, working on skills specifically related to vet care.  For example:

• Practicing wrapping ice packs & other strange feeling things onto each leg & foot -- particularly with his hinds, which he is super fussy about
• Putting my hands, empty syringes, shining flashlights, into his mouth (& teaching that it's different then him putting his mouth around my hands, LOL)
• Standing in buckets (we haven't gotten to this yet, shame on me)
• Working around him in the dark wearing a headlamp & dropping or tossing things, having phone timers/alarms going off
• Standing in the cross-ties when Solo has wandered out of sight (he's gotten surprisingly good about this)

These little things become such important skills, as you all know if you've ever had to be an equine nursemaid.  I'd taken them for granted because Solo has always been pretty cooperative.  Seeing how much my buddy's life depended on them opened my eyes.

Solo has a long history of being subjected to strange things by his owner...

I wrote these three treatises in hope that they help someone else if faced with something similar.  I had to make a lot of decisions without much information, which makes it even more difficult.  As I've stated before, this is NOT something I would do for any horse -- the final bill, well, I can pretty much guarantee it was higher than whatever you might guess.  That still paled in comparison to the investment of energy, heart, & time this all took.  None of it was undertaken lightly.  The right decision for you & your horse may be different than mine, but I hope at least you have a better idea of what the options might look like.

Epilogue

These days, Solo & I go for a trail ride about once a week, exasperated accompanied by our Baby Monster.  We move slower than we used to, but that's just fine with Solo, who firmly believes that all of life should go at the pace HE chooses.  The small lump of his tracheostomy scar, barely there unless you're looking for it, is all that remains of his ordeal.

Spring 2018

Every time those orange ears are framing my view, my heart overflows.  With disbelief that we made it through.  With love for my best friend.  And gratitude.

For an incredible team of vets, including residents, students, & staff, who went above & beyond & literally came running in the middle of the night when he needed them.  I was at the hospital every single day, except for two days I had to run an unavoidable work project; I was always treated with respect & included as an integral part of the team.

For all of you, who followed our story & sent well-wishes, which meant so much & still do.  I'm sorry I wasn't better at chronicling in the meantime.

For the support & assistance of my mom & Erica.  We wouldn't be here today without you.  For my neighbour, who helped me take care of Encore while his friend was away. For kind friends who picked up my slack at work & for my boss, who was far more understanding than I expected.

And of course, for Solo.  My one, true heart.  Thank you for fighting & thank you for staying.  I know one day, we will have to say goodbye, & I know I will never be ready, but I am so grateful it's not today.

You quite literally saved my life, buddy.  I'm overjoyed that I could finally return the favour.

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Solo's Aftercare

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...    

Aug 2017: Home, healthy, tape-free, & oh-so-content

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What Happened To Solo (Punctuation Mark Of Choice) - The Bullet List

This post took me far longer than it should have to put together, in part because it required reliving some horrible times.  You can read here for the original post when Solo was still in hospital in 2017.  As stated there, I never could have done this without generous assistance from my mom, as well as a donation from our amazing friend, Erica, I thank you both.  We also received a care grant from the vet school since our case qualified for "high educational potential."  I would not have done this for any other horse..but it is Solo.  And he said he wasn't ready to go.    

Today I sit & watch the horses relish grass.  Solo glances over towards my chair in the shade to check in & the ripple of gratitude between us is an almost tangible pulse of energy.  "This is what we held on for, buddy," I tell him as he blows a contented snort of agreement into the breeze.

Because his 2017 case was so rare, I'm going to try & run through the executive summary of the roller coaster from hell.  As both a horse owner & a scientist, I know the value of case history & felt the acute lack of it as we tried to figure this thing out.  There is virtually nothing in peer-reviewed literature outside of one paper on ~30 horses in Europe, because there have been so few cases where it was identified, diagnosed correctly, & treatment was attempted.  Symptoms were all over the map, & if I hadn't known Solo as well as I do, I'm not sure we'd have gotten as far as we did.

Without further ado, since there is enough material to base a Master's thesis on (& one is more than enough for me), here is the bare timeline.  If nothing else, I want the information to be out there for other owners & vets.  I saw Solo's file in the arms of a student...

Not a record I wanted to set

*Before proceeding, be aware there are unappetizing photos below.  Some things I did not take photos of because I never want to remember them.  But I wanted to document improvement as long as I felt we had some.  NCSU did an amazing job with pain management & my heat-intolerant horse did at least get to spend much of the summer in a climate-controlled barn, away from flies.*

Final NCSU Diagnosis:  Septic sialoadenitis with associated abscessation & draining wound.  Associated necrotic plaque within left gutteral pouch, mid-stylohyoid.  Cultured Fusobacterium, Prevotella, Klebsiella, and Enterobacter.

So It Begins

Thurs, June 15: While feeding dinner, I noticed Solo eating really really slowly, rather listlessly, & there was significant swelling developing rapidly around his throatlatch. I thought it was choke at first, but it didn’t fit; I made the first emergency call to Dr. Bob. Phone fiasco resulted in 4 tries, with me finally blurting, “PLEASE, WE NEED HELP!” (as Dr. Bob is awesome, he asked no further questions & said he was on his way).

It had been hot, I knew Solo was dehydrated, but I couldn't get anything in him. We had to tube him to deliver water, oil, & electrolytes, during which he got a bloody nose, resulting in my crossties resembling a crime scene.  No throat blockage, it looked like an allergic reaction, so he got dexamethasone, but it took about an hour (in the dark) of watching him sweat (xylazine...) & roll & generally scare the life out of me for things to begin to settle. 

The next day.  Horses have a lot of blood.  That fan never recovered.

Dr. Bob waited with me, bless him forever, leaving my farm close to midnight with instructions to give dex injections twice a day over the weekend to prevent re-occurance & call if anything changed.  We were both unsettled by the oddity of it all.

June 18:  Sunday evening feeding, Solo walked up next to me, looked sadly down at his food, then leaned into me, telling me it hurt again. Swelling reappeared, I spent most of night on phone with our clinic's other vet on call, Dr. Michelle & giving repeated shots of dex, as we thought the "reaction" had kicked back in.

He was dehydrated again after another hot day, so every hour I was holding tiny, wet, salty grain mixes under his nose, begging him to nibble on them (he gamely did). He finally took a big drink around 1 am, seeming better.  I allowed myself a few hours sleep before meeting the vet again the next day.

Emergency Hospital Admission

June 19: Dr. Michelle came out, didn't find anything apparent, we debate allergy testing pending blood panel results. Solo had been grazing & acting relatively normally, but later in the day, he stopped eating, swelling began to come back, & he wasn't drinking. By evening, the only thing clear is that we don’t understand what’s going on & he needs to go to NCSU emergency services.

He is admitted after ultrasound reveals abscess & needle aspiration brings out the stink of anaerobic bacteria.  Upper airway scope, including gutteral pouches, was clear.

Initial drainage

June 20: First abscess opened to drain through incision on back of his jaw.  Detailed oral exam revealed:

• A hole of necrotic tissue under tongue where one salivary gland (horses have six) drains in,
• Big ulcerations on both sides of his tongue & in mouth,
• Severe tissue necrosis around abscess. 

IV antibiotics, daily lavages of damaged tissue, packing of wounds with antibiotic-infused gauze, & butorphenol (horse morphine) all begin.

The most difficult part of treating this is now revealed:  this area is full of vital blood vessels (carotid, jugular), nerves that supply the face & tongue, & a myriad of other structures that you can't risk nicking via cutting.  Imagine an abscess wrapped around someone's brain stem & you have an approximation of the area we were dealing with.

Gross but pain-free

June 24 (five days in hospital): Secondary abscess under tongue discovered & opened to drain through chin.

• Has direct connection to necrotic hole under tongue, smells like a rotting corpse. 
• Low gut motility problems developed due to opiod painkillers, hydration a struggle. 
• Appetite is good, but eating is difficult & inefficient due to mass internal mouth carnage.

Translation:  he needed to poop more to avoid impaction, but had to eat more to make poop.  Bacterial culture/sensitivity results indicate Fusobacteria species (ubiquitous in mammalian mouths, guts, soil, the world, not a problem except when they get into places they are not supposed to be, common in human sore throats & tonsil infections) responding to the antibiotic metronidazole.

I thought we'd hit the lowest point.  We hadn't.

It Gets Much Worse

June 28 (nine days): At 1 am, our resident, Dr. Fowler calls to request permission for tracheostomy; Solo is in respiratory distress due to severe pharyngeal compression found on scope. This was a very bad call & a very bad night.  I thought we'd hit the lowest point.  We hadn't.

Prior to this, Solo's ability to eat was improving, he could go out for walks & be in the round pen. Skull radiographs on June 29.

Still the sexiest patient there

July 1 weekend: Solo spiked a high fever on Saturday morning & additional abscess pockets are found & opened (all draining from primary incision on jaw). Second round of bacteria cultures ordered.  This was even more disheartening as there had not been any systemic problems until the fever, it was all localized to his poor necrotic head.

July 3 (two weeks):  Following his afternoon treatment, I noticed Solo staring at his belly, which I'd never seen him do, & I alerted his team of potential colic.

• Hadn't been drinking or pooping well
• Immediately tubed, given water & Epsom salts
• Back in stall, I then saw the ominous flank twitching & fur standing on end that is Solo's sign of a systemic allergic reaction (which I've only seen once before)
• Sedated & walked in case it’s a pain response.

I then noticed his tongue is swollen & blueish, hanging out of his mouth while he stands head down.  I poked it & it was hard like a bar of soap.  It's late evening by now, we're all exhausted, I didn't know what to think, so I asked Dr. Fowler if sedation ever causes that.  He took one look & immediately called Dr. Prange, one of our lead surgeons, back in (who fortunately lives ten minutes away).

Bizarre mas on hyoid bone

Scope reveals

• Total airway collapse due to swelling; if he had not already had the trach tube in, he would have suffocated.
• Also found a mass in his left guttural pouch.  No idea where it came from or what it is, but it wasn't there in the beginning.

Dr. Prange & I had a very, very sombre conversation.  I thought we'd hit the lowest point.  We were pretty close.

Fighter

July 4:  Incredibly, unbelievably, Solo recovered after overnight solumedrol for the reaction & was chowing down on his alfalfa when I arrived.

• Most recent culture indicated Pseudomonas (nasty, resistant anaerobe, common to infections in long-term human hospital patients). 
• It was luckily responding to gentamicin in sensitivity tests. 
• Solo's eating was improving, his fever finally began to subside.

The Tunnel & The Light

July 6:  Another blow; Solo was trending dull again, not wanting to chew.  We were at a loss, knew something was missing, but had another terrible conversation.  There were few, if any, options left.  This was indeed the lowest point.  And then...

As I helped support Solo's head in the treatment stocks (staff shortages & waves of emergency cases had everyone stretched thin), Dr. Prange discovered a big abscess, possibly the original, encapsulated in very thick tissue on the inside of the mandible. Opened with a burst of foul necrotic tissue, gaseous buildup, & pus, this pocket connected to the primary drain tract.  We hoped it was our missing piece & as the weekend rolled around, we finally started to see real improvement. A foley catheter was also run up Solo's nose to drain saliva pooling from the gutteral pouch (a clever invention which worked brilliantly).

You can see the nostril button anchoring the drain - & no more IV!

Setbacks & Progress

Packed & healing

July 14 (four weeks):

• Mild colic behaviour, needed another tubing, 
• On 15^th, low albumin levels pointed to right dorsal colitis. 
• No displacement of colon, began sucralfate & misoprostol, no more hay. 
• Improvement of abscess issues continues with daily lavages.
• Eating well, begins going to paddocks.
• Injectable anitbiotics discontinued & amikacin gel on packing started. 
• Vetericyn gel added in gauze July 16.

July 24 (six weeks): After noting some dullness the previous weekend, ultrasound revealed a final (we hoped & thankfully it was) abscess Monday morning, which opened into pharynx (which was a whole lot better than if it had erupted into gutteral pouch).

• Nasal catheter was removed, no more buildup was occurring in the pouch. 
• Instead of gauze packing, pair of foley catheters placed in drain tracts to hold them open. 
• Third culture of new abscess material was ordered.

The Home Stretch

Catheters taped on

July 28: Scope revealed drain tracts healing, less unhealthy tissue (yay!). Solo was on pasture full time for most of the week & enjoying profusely, flirting with the mares, getting fat on clover.  Bacterial culture did show an extremely resistant aerobic Klebsiella, but in the absence of any clinical issues, we did not attempt treating (it would have involved even more expensive medications with questionable success).  I learned how to place catheters & flush myself for home care.

July 29 (seven weeks):  Discharge! With a big bag for daily catheter care, metronidazole, misoprostol, & follow up in a week.

We still had a ways to go.  But he was home.  And he was happy.

And he was alive.

A most wonderful sight

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Hope And Home

Before proceeding, I cannot say thank you enough for all of your kind words & support - I have read & re-read them, each one a mini-life buoy amid some seriously rough seas.  I even read your well-wishes to Solo, I think he definitely appreciated them (at least he appreciated that I cannot read to him & squirt nasty medications in his mouth at the same time).

Normal is an unbelievable treasure

Posting delays inevitably result as I struggle to fit work, which forced me to travel last week, & 8-hr intervals of equine nursing duties into days with insufficient hours.  But I can tell you that Solo is home.  Beautifully, wonderfully, shiny-ly (it's a word now) home.

He's gone back for his first hospital follow-up, during which we got to get rid of the catheters that had been keeping the abscess drain tracts open.  The endoscope revealed much healing & no additional signs of new infection, which was a first...& a very welcome one.

We've just finished (I hope) the course of antibiotics.  I am flushing those tracts daily & he has to stay on a special gastric medication until his albumin levels return to normal, as he developed some colitis in the hospital due to the combined stress & intensive pain management medications.

Home.  Free.

But Solo is feeling good.  He looks fantastic.  Grazing with Encore, napping in the shade, rolling heartily after a tasty meal - all without my having to tape his head together anymore (perhaps I will be able to show you all the phases in a future missive).  He gets to be a horse.  And while I am physically, mentally, & emotionally exhausted, while we still have hurdles to clear & work to do, this is a very very very good thing.

Because when I look out my window, I see what I feared lost, so many times, on so many trips to Raleigh, in so many hours with that cold vise of fear around my chest.  I see all the best parts of me embodied in a chestnut larger than his own life:

A Haiku For Hope  

Softly shines again

That heart who defines for me

Every part of Home.

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Not The Solo Update I Wanted To Post

Solo has been fighting for his life over the past five weeks at the NC State University Large Animal Hospital.

After all this time since the last post (if there is anyone still out there reading, bless you), I wanted to tell you about how he recovered from his tendon bows & went back to frolicking with joy with his big-little "brother" in the fields.  Because he did.

Feeling good yesterday in the "horse-pital" paddock

But in mid-June, following a horrific series of emergency vet calls & midnight vigils, I had to take him in to hospital in Raleigh for an emergency admission.  When it began on a Thursday evening, we thought it was an allergic reaction, but the next Tuesday, we discovered he has an extremely rare infection of one salivary gland.

As in, this is only the 2nd case they have seen on the Soft Tissue service in 15 years.

We will never know the exact cause, it can be anything that irritates the opening of the gland under the tongue, a grass seed, a piece of food, a...?  Like any injury in the mouth, once there is an opening, all the bacteria which normally live in your gut & the soil & the world, get into spaces they are not supposed to be.  The result was large, infected abscesses that are still draining through two surgical incisions under his jaw.

To say it has been a difficult road would be a gross understatement.  Two weeks ago, we were having the conversation about euthanasia, twice.  Solo, however, has remained true to his nature:  his heart defies the limitations suggested by his body.  I drove to Raleigh twice expecting to have to say goodbye to my best friend, but Solo shocked us all & said no, he was far from done.

I do have photos of the progression of the drain tracts, infection, & incredible healing, but they are extremely graphic, so I will not post them directly without a warning (I could link them, but the site I used to use for that no longer offers that service).  I drove home many times after helping with treatments, covered in blood, pus, necrotic tissue, & steeped in reeking anaerobic bacteria. 

Packed main drainage incision last weekend, looking really good

Today, I watched my horse hang out in a paddock, graze on clover, talk to his horsey neighbours, & enjoy a good roll.  It was a gift beyond measure that brought the good kind of tears to my eyes as I smelled his warm fur in a hug.  Even more so because there have been far too many of the other kind of tears in the past month.

He is very close to being able to come home:  as soon as the drainage tract no longer requires packing, I can take over his care.  He is feeling like himself again, fat, sassy, no pain meds for the past week, & eating & pooping & drinking well.

The most difficult part is the currently impossible financial situation, made even more complex because this entire thing has been once of uncertainly & creeping increments.  With no case history in the scientific literature, we had no way of predicting how things would go.  With stutters & complications, there have not been any big "opportunities" to have any kind of budget plan (if that is even possible with horse anything).  And now, we are beyond invested, better beyond expectation, & cannot risk attempts at short cuts. 

I haven't figured that part out yet.  I am enormously grateful to kind contributions made by our wonderful friend, Erica, & my mom.  Huge thanks to my neighbour, who has been sheltering Encore during all of this.  Whenever I get half a chance to breathe between this & the busiest time of year at work, I will have to look into options, as I've already put my own medical care & everything else short of electricity & fuel on hold.

I get the best people

There aren't words to encompass my gratitude towards the incredible team who worked alongside us with compassion, insight, phenomenal communication, respect, & sheer brilliance:

• Drs. Timo Prange & Callie Fogle
• Drs. Alex Fowler, Laura Marley, Kelly Shaw & Arlie Manship
• Solo's Interns - George, Megan, & Emily (& now Leland) 

As well as all the techs & hospital staff going out of their way to give Solo baths, scratches, treats, hold his food when it hurt too much to eat off the ground, take him for walks, & so much more...

This is not something that I would do for any horse, nor has it been embarked upon lightly.  But I have never in my many years among horses &  people, experienced a relationship like this one.  Solo is 21, but looks half that; he remains strong, healthy, & even his student interns have noted his determination & enthusiasm for living.

If Solo had told me he was done fighting, I would have let him go, that was a promise I made to him long ago.  And a responsibility of care that I have carried out for other beloved friends when it was time.  But he didn't.  And he has always been there for me, even through the darkest time of my life that defied expression.  He quite literally saved my life.

So as long as there is breath in me, I will be there for him.  And I will do everything I can to return the favour.  

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