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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

April 17, 2020

Echo's Vet Update

Before I dive into the latest installment of Echo's vet addiction, I do want to send out my best to all of you.  I went back & forth, but decided that I wasn't going to write much, if anything, about The Virus -- it was already all the words on all the channels & I didn't think I had anything meaningful to add to all that noise.  The best any of us can do at present is to follow reputable safety protocols to the best of our ability & for your own sanity, turn off the news & the facebook (if you even watch it, I do not anyway as I don't need to add to my sources of anger).

We are fine (at least as much as we ever are) here -- my job is secure & I can do much of my office work remotely to the extent that my limited rural internet access allows.  Our field work is reduced, but we will still be working on mission-critical projects; there is plenty of room for social distancing in the river though.  I generally don't go many places outside of work anyway; I hate grocery shopping so much I only go maybe once a month (basically when there is literally nothing left in the house), & as an introvert, I don't encounter other humans often.  I remain grateful to have the horses at home, so not many changes for us.  I definitely feel for all of you who can't see your horses right now & am hoping that ends as soon as possible! 

If you are in a position to help others, but are not sure what to do, you can follow this link to a summary page from Charity Navigator of groups which are accepting donations to help with everything from medical supplies to food to financial assistance.  Sending even a dollar from your living room is risk-free for you & can make a difference to someone else.
Click to find a reputable charity helping those in need
Turning back to my problem child...

Earlier this week, I took Echo back to the vet, as his shoulder was just...lingering.  I had started doing stretches & massage about a week prior to that following a phone consultation with vet.  That treatment did bring about some improvement & Echo was moving a bit more freely with a little less limping, but I wasn't comfortable proceeding without a better idea of what exactly we were dealing with.

Also..."Echo's Vet Update" should probably be the new name of this blog.

Turns out he did indeed partially tear his triceps muscle.  Good news:  that muscle is enormous, covering the entire scapula, so there is plenty of "extra" to do the job it needs to do.  Also good news:  it will heal without any functional limitations.  Also good news:  he is at the point in healing where he can start to go back to work as he needs to use it to continue making progress.
Equine shoulder; From horsesidevetguide.com
Less good news:  muscles heal slowly & giant muscles heal even slower.  It will probably 5-6 months until it is completely healed.  He may have a permanent divot to add to his existing scar collection, but at least it won't affect anything.

In the balance, while it's not great, it could be so much worse.  At least we can start doing things again, while is a huge relief to us both.  I will, as always, be conservative -- I got on a couple days ago & we just did walk work & stepping over poles.  Of course, Echo is already happily trotting & cantering around in the pastures on his own.  I'll never know exactly what happened -- maybe it was a kick, maybe he just slipped, maybe it was both.
His lump 10 days ago
I did put him back on the Equioxx, carefully, after we finished other meds, & am relieved that he is having no issues with it, so he has that mild anti-inflammatory support as we work through the physical therapy process.  He also completed a week of Ulcerguard & his stomach is much happier, so he's back to eating his meals (although still at the slowest....speed.....possible).

Farrier also put the hoof testers on him last week & he had no reactions, so it looks like the coffin bone bruise is healed up too.  At least it helps me to gauge lameness without the compounding factor of that foot on the same leg as his shoulder.

I'm sure Echo will find new things to do, but it still felt good to cross at least a couple of the more recent issues off the list.  And even though I hate any injury in my horses, it's going to happen one way or another, because horses, so I'm still grateful when it is at least something that will heal, because I've dealt with enough things that won't & that is much worse.
Shaking off gnats while regaining weight, shine, & getting less lumpy every day
Baby steps for Baby Monster, but we will begin re-building that topline once again.  It should be easier this time since he has more skills than he did a year ago - some of them are even useful.

April 6, 2020

Bute Vs. Equioxx: Tradeoffs

Because it's a good time to learn about things, right?

I recently had the unfortunate but useful opportunity to compare the results of the two most commonly used equine NSAIDs (Non-Steroidal Anti-Inflammatory Drugs; bute & Equioxx) on the same injury -- Echo's shoulder.  There are pros & cons to each.  Because I firmly believe in making the most informed decisions possible, let me share with you what I learned.

Background

Heat, pain, & swelling are the result of the body's inflammatory cycle.  One of the primary mediators of this cycle is a group of prostaglandins created by cyclooxygenase (COX) enzymes, which convert a substance interestingly named arachidonic acid (does it have spiders in it?).  There are different varieties in this group, referred to by number:  horses have COX-1 & COX-2, while humans have additional variants.  NSAIDs aim to break the inflammatory cycle by inhibiting the production of these enzymes, during which the body can break down harmful prostaglandins which have already formed (which takes about 12 hrs).

As you might suspect, COX-1 & COX-2 have different functions.  COX-1 plays important roles in things like maintaining stomach mucous coatings, keeping blood flowing through kidneys, & coagulating blood.  COX-2 is only found at low levels in normal tissues, but levels surge when that inflammatory process begins & COX-2 feeds that cycle. 
A simplified illustration from previcox.com; click to embiggen
Drugs

Bute refers to phenylbutazone, our old friend which has been around for decades.  It's cheap & fairly effective for pain management.  Given orally, it takes about 2-3 hrs to absorb from the belly & peaks in 3-5 hrs.  Persisting about 12 hrs, bute blocks both COX-1 & 2 production.

Equioxx is a brand name of firocoxib, a newer drug that is known in the canine world as Previcox.  It was developed for the treatment of osteoarthritis.  It's also given orally by owners, but is much slower to take effect.  It takes at least 24 hrs for levels to begin to peak & does not reach steady state for 4-6 days.  It also has a half-life of 44-46 hrs, so it takes an additional two days minimum to disappear after you stop giving it.  Firocoxib is a selective COX-2 inhibitor, which means it preferentially blocks COX-2 but still has a minor effect on COX-1.

Choices & My Observations

It just so happened that I was able to directly compare the two as Echo was on bute for the first week of his shoulder pain, then on Equioxx for a second week.  Pros & cons:

Bute Pros:
  • Much more effective pain control (side note: I've heard the same from others)
  • Significantly more rapid action - both to start & finish.  The latter can be especially important if you need to take a lame horse to the vet the next morning & you need the pain unmasked for an exam.
  • Relatively cheap
  • Easy to give -- even picky Solo will usually eat it on his food.  If they start refusing it after multiple days, I just dump it in a syringe with a little water & shoot it in their mouth.
Bute Cons:
  • Blocking both COX-1 & 2 is what brings about the higher incidence of GI issues with bute.  This is why I switched to Equioxx, as Echo had already been on bute a lot for his foot bruise & I was beginning to see ulcer signs.
Equioxx Pros:
  • Primary benefit is its selective COX-2 action:  this spares the GI tract some abuse, as well as protecting other COX-1 processes (cartilage maintenance is another one not mentioned above).
  • Also pretty easy to give as a tablet -- Echo snarfed it up when I put it in my hand with a little grain.  I've also heard of people stuffing them in cookies or gumdrops.  Just don't let other humans eat the gumdrops.  I've also heard of that happening once, LOL.
Equioxx Cons:
  • I saw significantly less pain control that definitely seemed better suited to something milder like arthritis.
  • Slow action, both to kick in & withdraw.  
  • Not cheap -- I did find (too late for me) that it was significantly cheaper online than through my vet.  Vet also did say that he did the math & it was actually cheaper per hour of pain control than bute was.  I believe him, but almost $2 a pill still hurts me.
Related note:  Equioxx & Previcox are both firocoxib.  Because Previcox can be cheaper, many people use it for their horses & just divide pills themselves.  However, be aware, it is now illegal, through the FDA, for a vet to give Previcox for a horse.  This is because accurate dosage for firocoxib is important to avoid adverse effects & it's very easy to over- or under-dose when manually dividing dog tablets.  This legal change occurred around 2016, when the tablet form of Equioxx became available; here is a good explanation.  I'm not going to call the drug police on you, just informing. 

One more note:  I learned from the Equioxx package insert that all NSAIDs have the potential to also block the prostaglandins which control body temperature.  This isn't common, but is something to keep an eye on if something goes awry.

Take Homes

Just like pretty much all of life, there are tradeoffs with each option, but I hope this will help you better understand which might work best for you.  I still consider bute my first line tool in acute pain control due to its strength & speed.  However, if you need to give an NSAID for a long period of time or are treating a horse who already has ulcers, Equioxx may be a more appropriate choice to protect GI tracts.

If you really want to dig in, here is a really nice paper from the Journal of the American Vet Med Association from 2017 on the COX enzymes & use of selective COX-2 inhibitors.

March 31, 2020

Disaster Horse Votes No To Boring

Without doubt, we are in tumultuous times.  Echo the Disaster Horse did not want to be left out of this & had no interest in my plea to be boring.  Not that I thought he actually would.

Right after my last post, he galloped around the pasture like an idiot & re-aggravated whatever he did to his shoulder.  Two weeks later, he still has some lingering soreness.  Vet says it's possible he bruised a nerve, which will take a little longer to heal.  I wish that was our biggest concern.

About 9 days ago, last Sunday morning, Echo was just looking kinda sorry for himself at breakfast.  I took his pulse on a whim & it was a bit elevated, so I took his temp & discovered he had a fever of 101.8 F.  He was already on Equioxx, so I consulted vet & he said go ahead & give bute if the fever gets higher.  At 102.1 F, I went ahead. 

The bute did control the fever well & Echo perked up, but then Monday night, I went out to give the horses their midnight snack of alfalfa cubes only to find the poor kid was completely covered in hives.  As in, his whole body looked like furry cottage cheese & his neck felt hard as a rock, I have never seen anything like it -- even his butthole had hives on it.  He was extremely tolerant of me shoving my shaking hands up his nose to make sure he still had an airway while I dialed the vet emergency line yet again. 
Gee, mom, you didn't actually want to sleep ever, did you??
A few doses of dex took care of that & we never did determine exactly what he reacted too.  It wasn't fire ants (no bites), he had no changes in food (not even a new bag) -- the best guess is maybe a wasp sting but invisible aliens are equally plausible.  At this point, I had no idea what was going on & took him in to the clinic to figure out what the heck to do before I had an aneurysm.

Long story short, blood work came back showing a possible bacterial infection (origin unknown).  Even though the fever had quit by Wednesday, vet prescribed a course of SMZs, which we've just finished.  In addition, & completely unsurprisingly, he also has some acute ulcers from the on-and-off bute over the last few months for his foot bruise.

Baby Monster, you be killin' me.

I have UlcerGuard on order & will be stalking the tracking number, since Echo is now off his feed & he doesn't have weight to spare.  After the last 10 days, I'm off my feed too!  Until it gets here, I'm offering him soaked alfalfa cubes & anything else he will pick at -- at least I have grass coming in & he is grazing some. 
Alfalfa slurpies
I have been itching to get him back into work, as he has lost all that muscle & weight I put on him last fall & he just does better overall when he is doing SOMEthing.  But I don't have the heart to ask him to do anything extra with a sore belly sloshing around, especially when I can't even give him any painkillers.  I'm even afraid of the Equioxx now, which will take a whole 'nother post to get into.

I am absolutely grateful they are at home with me right now & that Echo can at least keep himself mobile since they live out.  I think Solo is also grateful Baby Monster is wayyyyy less annoying right now.  And at least I can keep a close eye on him since I am working from home most of the time right now.

I hope you all are staying safe out there & I hope all your horses stay very very boring! 

February 18, 2020

It's Not An Abscess

Echo decides to prove yet again that my paranoia is not unfounded.

We finally made it to the vet today for spring shots & the planned radiograph I mentioned previously.  It was supposed to be last week, but the rain prevented the machine from coming out to play & it was so wet, I couldn't get the trailer hooked up & out without tearing up half my property.

Turns out, Echo's prolonged on again/off again soreness on his left front is in fact due to some bone bruising on the medial wing of that coffin bone.  Which Dr. Bob also referred to as "crushing" & "micro-fractures."  Which I did not really appreciate because I don't care what the vet-land rules are, but these words do not all mean the same thing to me & shave several years off my life!  I am just going to call it bone smooshing because that is descriptive without being quite so terrifying-sounding.
Smooshing is right where the #4 is on this coffin bone
This type of injury happens when a horse's heel impacts something hard, such as a rock or a hard piece of ground, with too much force or just the right angle or it's Tuesday.  Fortunately for Echo & I, his smooshing is right at the tip of the bone.  Which means it will heal, is already healing, & he should be fine.  If you get smooshing farther forward on the bone (like by 3 or 5) or extending up into the joint, that is when it becomes a Really Bad Thing.  I am hopeful I never have to learn any further detail about that.

Since this has been going on since early December, Echo is already a "fur piece" down the healing road.  Having had a gnarly bone bruise, I am familiar with their slowness; Dr. Bob said this type of thing can range from 6-8 weeks for a mild one (like Echo's) up to 6 months for something more severe.  So we should be on the "improving" side of the curve & we should see continued gradual progress over the next month or so.

Also fortunately, my gut management instincts (& repetitive haunting of Dr. Bob's phone line) guided the correct course of action over the winter, even though I wasn't certain of the cause.  He's done very little work, which consisted entirely of walking & an occasional short trot for feels on soft ground.  He's been able to move freely in the pasture, which is what needed to happen for circulation which then fuels healing. 

And for the last month or so, as he's moving more & when we get more frozen ground cycles, both front feet have been protected with full support across the heels & frogs.  The exact devices will get their own post, because farrier & I have been learning about new technology, but right now, he's wearing a pair of EasyCare's flip flop boots & they are working pretty well.
One of his expensive slippers
These allow his heels full lateral freedom (which is his particular Princess Pony Foot demand), but provide a thick, sturdy pad under his entire foot while still providing good traction in mud or frosty grass.  All the details will come in the next post.

Until then, he has been cleared commanded to go back into more consistent work under saddle on the flat (with bute as needed) to use that 5-yr-old energy most constructively (although I am sure he will still engage in many spring frolics) & help the rebuilding process.  I am sure I will be ultra paranoid conservative about it, but I suspect I shall receive no arguments from Echo other than "SO WHYYYY IS ALL-CANTERZ A BAD IDEA????"

Definitely not as "benign" as the abscess I was voting for, but on the upside, it involves no wrapping & will be far less messy.  Another plus:  this was the only foot I didn't have radiographs of yet, so now I have images of all four (yes, horse owners celebrate weird things).  Joint spaces were clean & lovely, navicular bone was fine, soft tissue had no issues, & all the other pieces were where they were supposed to be.  And while it's been frustrating to watch his muscling disappear, I'm just glad that it's not permanent (at least not this time).

Answers bring a great deal of peace of mind, even more so when they are not catastrophic.  We'll see how the next 30 days go, but I'll be thrilled if they are completely uneventful...  
I know he's just hatching his next plot...but at least he will do it shini-ly

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