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We Are Flying Solo

Showing posts with label vet care. Show all posts
Showing posts with label vet care. Show all posts

October 14, 2019

Good News And Better News

The good news:

On Friday, Dr. Bob got to give me a happy report.  He did not see anything concerning stifle-wise with Echo, no signs of injury.  What I saw/felt was due to loss of condition from a month off on a leggy young horse.  Prescription:  "Ride lots to rebuild strength." 

Huge sigh of relief from me.  And that is my favourite prescription.   

The better news:

We've been working for months on easing Echo's sacrum back to level.  A lot of months (like, here's the update from May).  It's not something you can, or more accurately, should, do in one big pop.  If you try that, it will just pop right back out again thanks to sore, tight muscles who are loath to give up a habit.  Which is why it's also important to incorporate muscle work in your chiropractic regimen. 

His last adjustment was in late August & we did finally nudge it the last little bit back to level then.  Both Dr. Bob & I held our breath & he suspected it may try to sneak back out again.  I continued my focused SoreNoMore massage on the hip knots I've come to know well & kept staring obsessively at it.
You can see the last remaining bump on the left in early Aug
Under saddle, I pleasantly discovered continuing improvements in Echo's right lead canter - he could now keep the lead on a slight downhill turn without swapping behind or using a half-buck to unload the weaker leg.  Standing behind him, I could see his HQ muscling becoming more even.  I hoped, but cautiously.

After more breath-holding on Friday as Dr. Bob professionally poked that sacrum, he announced IT STAYED!  Yes, I realize Echo probably heard me type that & is hard at work to undo it, but I'm still taking the win!  Dr. Bob also said he wanted to hire me out for muscle work -- I told him that I doubt I'd get many clients who were interested in having their horses massaged for 15 minutes at a time when my arms get tired, as it'd take me a month to do an entire horse.

We're long overdue for some good luck, so I'm going to enjoy a nice long exhale for now.    

October 5, 2019

Wound Wars: The Battle Of Proud Flesh

Proud flesh:  the nemesis of wound care.  When you have any open wound that can't be stitched (which seems to define nearly all horse wounds), you have to wait for them to fill in on their own with granulation tissue.  However, this tissue has a serious overachievement problem & inevitably multiplies into a cauliflower-esque explosion of cell growth that protrudes well above the skin surface.  It then blocks the migration of healthy skin cells that would otherwise move in to close the wound.

It is particularly problematic in areas of poor blood supply & high motion, like the lower legs.  Where 100% of my horses' wounds were.  Of course.

If the wound in located somewhere you can apply a pressure bandage, like a standing wrap, you can prevent proud flesh.  When those cells can't push outward, they seem to just give up & pout, giving the good cells room to do their magic.  This was awesome for 25% of our wounds, specifically, Solo's skinned cannon bone.
You can see by mid-Sept the bone is once more covered by a sub-layer & as of this weekend, new skin has covered more than 50% of the original area.  I'm keeping a non-stick pad coated with Dr. Bob's Magic Red Sauce + standing wrap on this until it's filled in more, as one less place I have to fight the evils of proud flesh.

Solo's hock has been the primary battleground.  High motion, impossible to pressure wrap, with a horizontal cut destined to pull apart - it was inevitable, really.  The Magic Red Sauce (I don't know all the ingredients in this concoction) is supposed to help both retard proud flesh & encourage epithelial cell growth, but its magic definitely has limits.

I was scrubbing madly with my dilute betadine, but it wasn't enough, so mid-Sept, I called Dr. Bob.  He knows I do surgery on endangered species (& they live), so he gave me permission to get aggressive.  Really aggressive.  I dunked the knife & scissors on my multi-tool in the beta-water & charged back into battle.
 
The one good thing about proud flesh is that it doesn't contain any nerves, just a zillion blood vessels.  So it will make an unholy mess when you hack (very carefully) away at it but your horse won't feel a thing.  This wasn't a super fun addition to the twice-a-day cleanings & it made them even longer, but Solo dozed patiently while I chopped off endless tiny tissue nodules, just trying to keep it roughly even with the skin surface.
Front
Looking good today (white is Corona)
Lateral side
Today's view, still a little proud flesh, but the skin will soon swallow it
After scrubbing, I would alternate between polysporin & Magic Red Sauce.  I am happy to say that after several weeks of battle, not only is the proud flesh on pouty retreat, but the front hole has finally closed, meaning no more diaper wrapping & ending the 2-roll-a-day vetwrap suffering!  There is still some fill in that hock, so it gets hosed daily, but has drastically reduced with today's cooler weather.

Echo's return to work was delayed by the fact that it took me an hour to do Solo's bandage when I got home from work, after which it was basically dark.  He is now back under saddle, though, for the past 10 days.  He is almost completely healed.  The friction burns on his chest have vanished under his new winter parka-in-progress, you can't even tell they were there.
Top is Sept 3, bottom is Sept 27
Proud flesh did rear its ugly head on his knee, so it also got the knife & is now gasping its very last, tiny breaths.  A few more Red Sauce treatments & it too will vanish.  The cut on the outside of his cannon is a small scab hidden in fur.

My knife hasn't been needed in several days.  Both boys are sound & happy.  So much so that my next story for you involves a lesson (OMG, a lesson!!?!) in which Baby Monster is making some very exciting progress.
Coming soon...

September 19, 2019

Tricks of the Equine First Aid Trade

Since I am currently using nearly all of the equine nursing tricks I've developed over the years, I wanted to share a few products I've adapted from the human world.  In many cases, this is much cheaper than buying "horse" labeled products, as we all know that's an automatic 300% markup. 

Horses & humans may both be mammals, but are NOT interchangeable, so product transference should always be done with caution.  I check with my vet before I try anything new.  And Dr. Bob himself has suggested several of them!

In my wound care kit right now:
  • Generic wound wash from CVS -- a mix of antiseptic & lidocaine, this stuff has become the first thing I grab for cuts & scrapes.  Dr. Bob first mentioned something like this when Solo got staples in his head last year, as the lidocaine reduces itching so they don't rub on everything.  I squirt on a clean cloth to apply & a bottle lasts me a long time (uh, usually).
  • Non-stick wound pads (biggest size available) -- fabulous for things on legs that get wrapped.  In the last post, you can see one sticking out of the wrap around Solo's cannon scrape.  I've found that if you leave a little sticking out above the vetwrap, it helps prevent the pad from sliding out the bottom.  They absorb without peeling off healing tissue when you change bandages.
  • Nitrile gloves (altho medium is of course too small for my giant man-hands) -- not sterile, but cleaner than my fingers & saves me from having to wipe 5 different kinds of goop off my hands.  I also like that the blue is easier for me to see when I drop it or it blows out of a trash bucket.
  • Polysporin -- a long time ago, a dr. told me that 10% of people develop allergic responses to Neosporin, so polysporin was a safer choice.  I don't know if this is applicable to horses or not, but I've used the poly ever since on full-thickness cuts & it works well.
  • Colored duct tape -- I always tape wraps/standing bandages that are worn unattended.  I try to get tape that is a different color than my standing wraps so I can easily see from a distance if it's still there, but I had blue left over from something else, so oops.  
  • Gorilla tape -- I usually only use this for hoof wrapping, for which it is a godsend, but I was about to run out of duct tape, so have also used it on standings.  It has not left a residue or caused any damage to my standing wraps.
The discolored gladware with 3 little syringes is my wound lavage kit.  NCSU vet school taught me this method when I had to clean out Solo's healing head-holes.  Add a little Betadine to water, so it's a diluted mixture, about the colour of weak tea or lighter.  Use the syringes to flush out the wound.  Syringes allow you to control direction & pressure of stream pretty well.  Because Betadine is cytotoxic, you never want to use it full strength on an open wound & even dilute, use only when needed to prevent infection/flush out debris.  It will stain whatever container you put it in, so pick something you don't plan to eat out of later.

Finally, the big fat syringe is just a dosing syringe with the tip cut off, making it easier to give dissolved stuff like SMZs without losing 1/3 of your dose stuck in the plastic tip.

What about you?  Do you have favorite products you've adapted to equine use?

September 9, 2019

A Healing Update - It's Never Simple

The first week post-carnage went fairly smoothly.  The Horse Gods saw this & felt it necessary to remind me that this is an unacceptable premise.  As if I need reminding.

Both horses were wrapped for the first week & I was pleased with their progress.  Then Friday morning, I came out to feed breakfast & Solo was suddenly non-weight bearing on that hind leg.

He is a seriously stoic horse, so my panic level shot to maximum while I coaxed & pleaded him in hobbling hops back to the shed.  I took his temperature (normal), pulse (slightly elevated at 44 bpm, but not extreme), & unwrapped his bandages to check for any signs of infection.  Nothing appeared to be any worse than it had been 12 hours before.  Solo was eating & drinking & pooping with a happy face, he just did not want to move that leg.
Doing fine the first week
I called the vet & parked the hose over Solo's hock.  There was still a fair amount of swelling around the hock, but it's a pretty ugly wound, so that's not unexpected.  Dr. Bob talked me off the ledge (he's getting way too much practice at this).  He agreed infection was unlikely & thought Solo had probably just tweaked one of the many bruised tendons/ligaments sometime during the night.  He increased his SMZ dose to be cautious & if we didn't see improvement by Monday, we might try a heftier antibiotic.

I hadn't thought of that possibility, but I now think he is probably right.  Solo could have slipped or torqued it getting up.  I'm glad to say that he is improving -- he's walking, albeit slowly, as well as standing on it, including resting on that leg, which alleviates many of my concerns about the joint.  I also think, based on how he moves, all that delicate healing skin on a high motion area is pulling, especially as it dries & gets tighter, which probably doesn't feel great & he's protecting it.  I know he didn't run around, Solo is a careful guy.

The cuts are healing very well.  Everything is closed except for a small hole at the front, which is good for drainage (only a small amount now).  We're sticking with the SMZs - after Solo had TWO resistant bacteria show up while he was at the vet school in 2017, I am uber-conservative with antibiotic use in all circumstances.  Well, plus, I'm a biologist & I know better.  Only when prescribed, only when truly necessary, & the lowest level possible, as appropriate to the situation.
Front view, this morning, before hosing - WEIGHTBEARING!
Side view this morning (day 9), base layer is closed
It will take a while for the cannon bone scrape to fill in completely, but it has clean margins & it doesn't worry me.  I will keep wrapping until the hock is closed & dry since flies are still out in force.  Why not, I've already purchased my body weight in Co-Flex/VetWrap since one bandage job takes a whole roll.
This is what is under the standing wrap
Echo is doing just fine.  Well, aside from making me crazy by trying to stick his nose into every. single. damn. thing while I'm tending to Solo.  Children.

He's been wrap-free & bute-free since Friday & his last dose of SMZs is today.  The cut on the outside of his leg is pretty much closed & his chest is all healthy skin again except one stripe which will soon be done.  Nothing on his chest actually cut the skin, these were friction burns & they were not sore after the first day or two.
3 days ago; today it's now all healthy, normal skin
3 days ago, that one stripe is still healing
The scary-looking hole behind his knee filled in very quickly.  I'll have to stay on top of proud flesh since I can't pressure-wrap the area, but it's not painful at all.  No swelling & he should be back in work this week.  I just keep Dr. Bob's Magic Red Sauce on it & slather Corona & Swat on the rest to keep the bugs out. 
2 days ago, drying out & filling in
Thanks to everyone for your well-wishes, as always, they mean a lot!  I know horses are experts at mangling themselves no matter what, but I'm going to be angry at myself for a long time for missing that jumper wire.  I did a lot of modifications to the fence when I moved in & thought I had removed all of those, but I was wrong.  However small the odds that the horses would hit the fence at that corner, out of all the corners -- it happened.  Shame on me, but it won't fool me twice.   

I'm cautiously optimistic that the worst is behind us.  Thanks to Erica for helping me finish the last of the fence repairs yesterday!

Cross all the things for us & hopefully the next update will have NO ooze or vet calls. 

Hey, let me have my dream.

September 2, 2019

Emergency Vet -- A Two-Fer

I was working outside on Saturday when I heard the fence wires suddenly start jangling in a bad way.  I had just put the horses in a small side paddock to munch on some fresh grass while I worked on their fields.  I whipped my head around to see Echo flailing about as the top wire dropped (it has breakaway points for this reason) & both horses took off to the other end of the paddock.

Since I only saw the end of the action, I'm not sure exactly what happened, but my educated guess is that Solo kicked out at Echo while he was up against the fence.  Solo got a hind leg over the top wire & Echo somehow got one front leg over it.

As soon as I caught them, I saw that I needed an immediate Dr. Bob inspection (of COURSE, it's a weekend, that's how horses do).  I was cautiously optimistic there wasn't anything catastrophic, as both were trotting & walking around in proper mechanical order (albeit full of adrenaline), but with ugly things - & these were definitely ugly - around joints, I am always very cautious.

To make it more fun, I don't know if you've ever tried to do first aid on two horses while trying to keep a phone in the good reception spot so the vet could call you back.  Well, it's impossible.  A HUGE thanks to Trainer Neighbour who came over & helped me juggle all the things until the vet arrived!

Both horses were really damn lucky.  Warning:  photos follow. 

Echo put a gnarly hole behind his left knee, but it is in a "safe" valley between vital structures.  We can't wrap it due to location, but it is already filling in rapidly.
Right after it happened Sat
He has a full thickness cut on the outside of his cannon, but it is just skin, I will wrap until it closes just to keep it clean as well as to reduce swelling there & below the knee.  Some wire chafes on the tops of both forelegs look bad, but no cuts there.  Thanks to youth, he's not even stiff.
Keeping Corona & Swat in business
I am so very grateful it is not Sacred Leg which doesn't like touching, otherwise I would be far more miserable.

Solo's right hind got the worst of it.  He exposed a chunk of cannon bone above the fetlock, which looks dramatic, but those usually heal up pretty well.
I really never wanted to see my horse's bones...
The front of his hock suffered two full thickness slices while pulling the wire down, but all the tendons are ok, just bruised.  I don't have fresh pics of those, we were too busy tending. 
Side view ~14 hrs later (Sun am)
A blood vessel got nicked & ruptured when I initially hosed it, so I was reminded yet again that horses have a lot of blood.  I think I could have done a transfusion when I rinsed out the initial bandages (below) in the bathtub yesterday.

This morning, those cuts were already nearly closed & all the tissue looks healthy so far.  My main job is to keep everything clean to prevent infection & try to keep the bugs off where I can't wrap.  Both will get a full course of SMZs along with bute for swelling.  Dr. Bob had me put some of the green Epsom salt gel in Solo's hock bandage, to try to draw out fluid into the diaper wrapped around it.  I've never used that on a wound before, just feet -- I'm pretty impressed!
Front view Sun am, healing up
What Went Wrong & What Went Right?

It was mostly a freak accident in just the wrong place.  My property came with hi-tensile wire fencing, which my neighbour built very well.  I have lined much of it with a strand of HorseGuard tape, but this section was not lined.  I'm glad it wasn't, because I think added tape might have made things worse in this case.

The wire itself is heavy-gauge & as I have learned during a couple other times Solo has bounced off the fence, this is an important safety feature which helps it roll off before cutting.  Unfortunately, just about anything will cut when you put an entire horse's weight on it.  I have seen horrific injuries from wood, electrobraid, PVC, mesh, thin tape -- horses are just way too good at carnage.

One of the multiple breakaway points did give when it was supposed to, which created the slack needed for the horses to get out & undoubtedly prevented much worse injury.  However, one point that should have released didn't & I found afterwards that there was an old jumper wire hidden in a bush that I had missed which prevented that release.  That's on me, as I'm sure that led to Solo's hock cuts.  I cut that off & reinspected all the other connections so it will never happen again.
It finally stopped bleeding, still tweaking my bandage setup
Despite the emergency bill & the stress of double first aid, I'm very grateful that things weren't worse.  No one needed stitches or sedation.  Both horses are sound, will heal fully, & are experienced at letting me clean & poke & wrap sore parts without kicking my head off.  After I do my penance of a couple weeks of nursing, everyone should be well on their way. 

Go hug your horses & check your fences.  Don't forget to look under the bushes.

June 22, 2019

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.

June 15, 2019

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

May 30, 2019

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 & vetsI 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 15th, 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