Dances with Death

Jan Bard

 

This story is about a mare, a bacterium, a breeding farm's worst nightmare, and the ordeal it took to create a happy ending.

The mare is Zippos Classic Lass, a AQHA mare that came to be bred to our appaloosa stallion, Sir Wrangler (www.sirwrangler.com).  Classy is a daughter of Zippos Irish Coffee by Zippo Pine Bar, and the cross promised to be a Western Pleasure champion.  Classy was owned by Jerry and Sybil Failing and shown by their 13-year-old daughter.   Serena rode her for 3 years and showed her 4H and Open, winning in all events.  But, the most important part Classy played, was the role of Serena's best friend.  She was the most loving horse she had ever owned.


Classy came to us, Joe and Jan Bard, in the spring and was bred to Wrangler.  She was a very easy mare to be around, and quickly became a favorite.  Two weeks after her arrival to the farm, we found her in the evening, with a cold sweat over her back and rump.  She was "playing" with her water and not drinking. 

This is a very BAD sign.


Our veterinarian, Dr. David Smith, diagnosed an infection, and started Penicillin.  The next morning her HR (heart rate) was 100 (normal 40-45), temperature 104 (normal 100.5), and she had profuse diarrhea.  She was in SHOCK (loss of perfusion to the tissue) with bluish tinged gums (should be pink).  Since I work as a Respiratory Therapist at Virginia Mason Hospital in Seattle, I knew what this meant.  I took her to the Northwest's finest Horse Hospital.


Classy was turned over to their fine care.  The first thing they did was a peritoneal tap to see if the intestine had ruptured.  Fortunately, it had not.  She was cultured and diagnosed with a colitis caused by CLOSTRIDIUM PERFRINGENS.


C. Perfingens is an anaerobe bacteria that is present in the environment and in the lower intestine as part of the normal flora.  It exists in a vegetative state.   Underlying illness, impaired blood flow and wound contamination from soil, are some of the predisposing factors that cause the bacteria to change.  The organism morphs and produces enterotoxins which invade the surrounding tissue, causing epithelial cell damage (tissue necrosis), gas formation (gangrene) which leads to abscesses that form in the gluteal muscle, anemia (blood destruction from the continued release of hemolytic toxins), and severe diarrhea.  Death comes quickly and violently!   We never established WHY Classy alone got sick.


Classy spent 5 days at the hospital on 50 liters of IV fluids per day, Penicillin, Metronidazole and Gentocin antibiotics, probiotics and a myriad of ingredients gavaged (into the stomach) twice daily.  She showed no improvement would not eat or drink, and the diarrhea was projectile every 15 minutes!  The decision was made to put her down.


The Failings persuaded us to bring her home.  Our daughter, Linze, and I made arrangements to get her.  The veterinarian looked at me and said "what do you think YOU can do?  She will be dead in two days!"  I said that she can be dead at our place, and if you want to help me try to save her, I would appreciate it.  So he gave me directions for care and supplies.  When we took her from the stall, she was so weak, she wobbled.  But when she saw the trailer, she whinnied!  She DIDN'T want to die!  So, I had a few ideas I would pursue.


I "qualified" for ideas.  In my job, I work with many patients in septic shock.   Joe and I also had the privilege of knowing an animal nutritionist, Herb Short, who taught us about healing.  Herb died in his 90's a couple years ago, but we still use his advice on both our horses and us!  So, this was my three-part plan:

Heal the blood vessels:  One of the first damage in sepsis is the destruction of the lining of all blood vessels, thus allowing the serum to leak out.  Classy had a "shelf" of edema on her underline.  The 50 liters of fluid given further promotes leakage.  It is a vicious cycle, there needs to be enough fluid in the vessels to carry the red blood cells to nourish the organs, so you HAVE to give fluids.  Our plan was to give IV- SOD (superoxide dismutase).  This enzyme is naturally occurring and lines the vessels.  I would decrease the total IV fluids and judge by seeing she still had urine output (decreased already).


Heal the intestines:  Tough job!!!  Our vet, Dr. David Smith, inserted an NG (nasogastric) tube and sewed it to the side of her nose.  We also had to keep a tight fitting halter on and tied the NG to it, also.  With this, we could give her nutrition.  She still wouldn't eat or drink.  The antibiotics had to be continued until 5 days after no fever.   They are specific to Clostridium and can kill it.  The toxins that are released are what cause continued damage, however.


Psychological:  We needed to give her a reason to live!  Since our other daughter, Sydney, gives riding lessons, she had many children that would talk to Classy.  They kept her company, and when she started feeling better, they took her on very slow walks and encouraged her to eat the grass.  Classy always loved kids and she could look outside of herself and feel better.

We also arranged to let the Failings have one of Wrangler's weanlings, a little beauty named Hailey.  They spent so much money and had no horse.  We, of course, knew we had the high probability of not saving Classy, but if we could, we would own Classy.  Poor Classy became known as the "dead horse!  then the "dead horse walking!"  as she got better.

Now for the treatment:


IV (we had to change it every three days, and be VERY careful to keep it sterile for all the injections);

 

NG tube:  mixture of MSM

Much more could have been given, but these were the most important, and my kitchen table, renamed the medicine table, would hold no more!  Supplies were obtained at cost from our veterinarian outlet, at nutrition stores, and from our personal vitamin stock!  Some of the knowledge of nutrition was also gained by my work at the hospital.  We found that without nutrition through the stomach, the mucosa deteriorates, and bacteria can translocate through the wall, thus causing systemic infections.  All our critical patients, esp. on ventilators, get tube feedings with specific ingredients, after 48 hours.    I continued to pick the brains of my cohorts at work, the doctors, the nurses: friends, and the Internet for more ideas.  I took the week off work, and we went to work, round the clock!


Classy's blood values were checked often.  These numbers tell the real story that was happening inside.  When she left the hospital, these were the major labs that were abnormal: Total Protein 3.1 (normal 6g/dl) and Albumen 1.3 (normal 2.5).  This signified her malnutrition, or lack of intestinal function. CK- Creatinine kinase-  1645 (500u/L. normal).  Signifies skeletal or heart muscle damage. Cholesterol-39 (normal 75mg/dl)-  decrease in starvation Hematocrit -53 (normal 40%)- increases in dehydration.

 

May 15th-As Linze and I left the hospital with Classy, we had a weak, trembling horse with profuse diarrhea (every 15 minutes) that left her with a protruding, red, edematous rectum.  Her tail was wrapped in a long plastic glove.  She was on continuous IV fluids (50 LITERS/day!), her HR 60 and Temp 102.  We didn't know the outcome, but would try.  She was happy to come "home" and we set up the stall for the IV to run continuously.  She would not eat or drink.

May 16th our vet, Dr. David Smith placed an NG tube and we started giving her nutrition via the stomach.  I decreased the IV to 30 L. Ringers with all the additives.  Antibiotics (AB)and IV SOD given BID (twice daily).  Kids talked to her and we left the radio on during the day.  At 10pm the lights were turned OFF. Blood work- Total protein 2.7 and albumin 1.0.  WORST!

May 17th-Hetastarch, KCL, and Amino Acids added to the regime and Ringers decreased to 20 L/day.   HR 54 but decreased for the FIRST time to 48 in the evening with a corresponding drop of T.103 to 101.1.  The kids came to lead her outside and encouraged her to eat the spring grass and drink.  Not interested, yet.

May 18th-Down to 10 L Ringers, diarrhea decreased to every two hours, and she wanted to eat!  She chose dandelion greens, ONLY!  Her labs were total protein 2.7, albumin 1.0

May 19-  Still on full AB's and SOD.  Would not drink until gavaged with 1 quart of NG supplements, then she drank about 2 gallons of water!  Until then, she would only "play" with water, by this time a not cute action!  Flakiest alfalfa offered constantly, would nibble only handfuls.

May 20-  Temp 100. HR 44.  Off IV fluids, grazed an hour on dandelions and swamp grass, eager to get outside.  Discussed with the Hospital the starvation labs.  Classy needed plasma, and they were frankly surprised the mare was still alive.   They suggested I bring Classy to them for a check up, since I had to get the plasma.  While I waited in the office, the doctor was in the trailer checking the horse!  He came in with blood drawn and an order to bring her in the clinic for an IV change.  This was also the day the Banamine was stopped.  He wondered why she had bumps all over her rump?    He also instructed me on giving the plasma.  It was 2 units of frozen plasma, and it had to be thawed carefully.  Sometimes there are reactions, and sure enough, par for Classy, there was!

21 May-Her reaction was to increase her HR to 66, temp to 103!  She trembled and wouldn't drink.  She was gavaged with 1 1/2 L with additives, and given 5 L IV Ringers.  She was dehydrated with the skin being able to be pinched and not pop back into shape.  Her L front leg was swollen.

22 May- Back on course.  HR 40, T 99.2.  Skinny, won't drink, but wants grass.  Bumps starting to abscess, taking silver dollar size pieces of hide off! 

23 May-HR 44, T 100.6  Joe turned her out on a small pasture and the NG tube was pulled out!  Wouldn't drink in creek, but didn't play with the water, either.  Still with skin pinched, but eating 1/4 flake of alfalfa, now.  Tried to give NG nutrients by mouth, but Classy fought too much.  IV still in tact, so continued SOD, Penicillin and metronidazole.  The AB can be DC'd (discountinued) after 5 days of no temperature.  So now we decided it was sink or swim.  She had her first cow pie today!  Leg edema reduced, also.

24 May-IV access bad, drew labs, gave SOD IM.  Antibiotics DC'd.  Drinking a little water again and eats grass.  Cow pies firmer!  Total protein 3.4, Albumin 1.1  CPK 180.  These were only a few of the dozens of labs.  Always people would show up to walk her and encourage her to eat!

25 May-Vital signs good, drank 10 gulps twice!  Skin under tail and perineum raw and peeling.  Cleaned and applied Nolvasan to area.  Cleaned all 10 abscesses on rump.  Will continue SOD IM.  Ate grass all day.  She does get some water from the fresh grass.

26-27 May-Continued to clean fragile skin.  Drank some from bucket and had 3 formed soft cow pies.  Gave electrolytes.  Interested in her surroundings and watched us repair fence.

28 May-Started 1 cup Equine Sr and ate 1/2 flake alfalfa.  Abscesses finally dry, but ridges, like craters, left.  Only shots left are SOD, and these continued through June 6th.

May 29-30- Started to drink like she was trying to catch up!  Worried that we created stress diabetes!  Skin under tail still raw, cleaned and treated.

31 May-  Diarrhea returned, but VS normal.  Left outside overnight, first time.

1 June- Winstrol V, an anabolic steroid, was given to increase her desire to eat!  This drug is used for severly debilitated horses, and Classy had ribs and backbone showing.  Her rump was sunken, and she had lost 100 pounds!  Labs showed Total protein 3.5 and Albumin 1.2, among many values that were still low.

2 June  Gave her Flaxoil , Msm, Vit C.and Glutamine via syringe.  VS normal.  Diarrhea still, but feels better.

4 June-  Big swelling under ears, dropping to jowl!  I presumed it was poor lymph drainage or guttural pouch swelling, but still gave her Banamine, msm, Flax, minerals, glutamine and SOD.  She is now HUNGRY and will eat a flake.

5-6 June- Jowl swelling in lower jaw.  Continue to give SOD, Msm, and 1/2 can Equine Sr.with additives.  Looks good, normal vitals signs, and will let her be a horse, now.

 

Throughout the summer, Classy regained her weight, and she was started on a rehabilitation program.  Her gaits were poor due to muscle loss, and Syd used her for some mild "lessons". The kids that lead her through the rough times now climbed on and paid strict attention to Syd's directions.  They would trot a couple minutes followed by 5 minutes of walking.  This was all Classy could do to start, and gradually worked up to full riding at the end of the summer.  She spent a few sessions with a chiropractor, which helped alot, also. Classy entered her first show and won first with one of HER kids!

 

ll in all, a time consuming, nerve wracking experience that worked.  I am NOT a vet., or a doctor, but had some opinions.  I told my family, I would spend $1500 on supplies, after which that was it.  We got to that point, and Sydney said she would contribute another $1500.  To give up was NOT an option!

 

I appreciate all the help and was in contact with Classy's owner, Sybil, who kept me "company" during the trek.  Classy is now a family member and will be bred to Sir Wrangler in 2003.