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July 11, 2019

How To Add Suspension To Your Dressage In Five Minutes

Are you wishing you could add some more spring to your horse's trot in the dressage arena? 

We've all spent countless hours trying to lift our horses' backs & generate more impulsion by using a certain plane of the ankles while precision-scootching seatbones into a receiving hand & holding the muscles between your 5th & 6th rib at 45 degrees of tension. 

Or something like that.   

Last weekend, I found a much easier solution.

I present to you Exhibit Echo.  As voiced by Echo. 

We are trotting around at Trainer Neighbour's, everything is pretty normal.  Until...

Why HELLO, Interesting Bear-Doggeh, WHAT R U?
BEAR-DOGGEH! I CAN HAZ A PLAY!?!! 
TAA-DAAA!  Look at that supension!  So uphill!  All we needed was an Interesting Dog in the arena!

Of course, Echo didn't stop there.  Interesting Dog apparently looked like a super-fun playmate:

We do like this, Bear-Doggeh, first u prepare...

...then u lift feets like this...
...then u WHEEEEEEEE!!!
Ah, the steps of riding a Baby Monster.  Who is 5 going on 2.  But since he is a good Baby Monster, two strides later, he was right back to a normal rhythm.  Sometimes the WHEEEE just can't contain itself, but he is so darn cute & completely non-threatening about it, it just makes me giggle.

Interesting Dog (appropriately named Grizz) never moved.  Maybe he's into playmates with fewer sharp edges.

June 30, 2019

Make Your Own: SmartPak Edition

On a somewhat lighter topic, Cob Jockey posted about her solution for reusable supplement containers.  I have also recently begun doing this, so here is another easy option I found.

A bit of background:  I find it somewhat amusing, but encouraging, that the horse community is slowly going back in this direction after a heavy transition to SmartPaks.  I myself have used SmartPaks for a long time -- they were very convenient, particularly while boarding, with clear labels, & I never had to worry about torn baggies or mis-measured feeding during my frequent work travel.

However, as many of you know, I am also a conservation biologist, so I am hyper-aware of the breadth of issues disposable plastic involves, from manufacturing to transport to disposal endpoints.  SmartPak wells are technically labeled as recyclable, but now that much of Asia has finally decided they no longer wish to be responsible for our trash, much of the "recycling" in the US is not actually being recycled at all

Even without this change, I was becoming more & more uncomfortable with the amount of plastic waste generated each month by SmartPak containers - which also come wrapped in plastic wrap with what looks like foil lining on top.  I spend many of my work days in streams & rivers & it is rare that I don't see assorted plastic flotsam littering banks, bridge crossings, & root tangles.  It blows out of trucks, off barges, or is just plain thrown in the ditch.  I find animals with plastic wrapped around appendages, trapped inside discarded containers, & worse.
I couldn't find my pic of dead turtles wrapped in monofilament, so here's one that was thrilled to see me -- you're welcome
It was while eating lunch one day that I stumbled upon a solution that has cost me $0 extra & is saving me money on the supplements themselves too.  I still purchase the supplements in buckets from SmartPak, which is cheaper on a per day basis & I still get free shipping, along with the great service they have always given me.  I'm excited about the bonus of extra buckets -- if I reach capacity at the farm, I can always use them at work, where we convert buckets into traps for burrowing crayfish species.

Down the road from my office is a KFC where I sometimes grab lunch (I am well-known for my healthy food choices).  In the $5 box meals, they have begun using small reusable containers for sides like mashed potatoes -- they are even helpfully labeled "REUSABLE," although I'm sure many people still throw them away, sigh.  They also come with a cookie.  Win.
Sunglasses provided for scale
These are the perfect size for a couple equine supplements & I've begun amassing a collection.  I like that they are compact (4" diameter by 1.25" high), so they stack easily in my SmartPak drawers & I can shove them in my pockets.  The lids have little tabs so they are easy to open, even with gloves on, but still snap shut securely.

I have 8 so far (we've been doing field work a lot lately, when I pack lunch), so I can load a week at a time.  I keep the big buckets in the house so they are climate-controlled.  It takes less than 2 minutes to load them up, then I take them to the feed shed next time I go out.

I haven't labeled them since I'm just using them for Echo so far, but you could easily sharpie them or make tape labels if you wanted something less committal.  So far, I have dropped them, sat on them, & stepped on them (my clumsiness is so useful for product testing) & the lids have stayed on & dents have popped right back out. 

I ran them through the dishwasher initially to get the potato & gravy smell out, but haven't washed them since as I'm putting the same thing in every week & it's dry.  I've just been putting Echo's TractGuard in them, but am now switching both horses' SmartHoof pellets over to these containers & both supplements fit with room to spare.
TractGuard + SmartHoof pellets = not full

Now Solo will need a set -- I guess I better eat some more potato-flavoured slop!  I am trying to resist the temptation to raid the KFC dumpster...

How about you?  Have you repurposed a container that you love?   

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