Equine ER

Farewell, and thanks for the ride! Plus, words of wisdom from an underdog

2010-10-24T14:40:00Z

Dear Readers:

After two years, I've decided to end the Equine ER blog on TheHorse.com to focus on other projects. This is my last post, and I want to thank you for your readership and your comments.

Of all the comments I've gotten from blog readers, the one that stands out the most was about losing a horse and the impact of "their (empty) stall in your heart." Here it is again:

In over forty years of horses in my life every day, and over twenty-five of them as my living, I learned that no matter how much business they are, they still work their way into our hearts. ... Unfortunately, like most people who have had long-term dealings with horses, mules or donkeys, I have suffered the loss of some special wonderful friends. Honestly, you can fill their stall in the barn again, but their stall in your heart forever remains empty. I suggest that when you lose an equine friend, remember the good times you had, but keep in mind there are so many more out there who will nuzzle you, if given half a chance, and are waiting their turn to brighten your life.

I was also moved by the responses from readers to that post, found here.

I was hired by Eclipse Press, the publishing arm of Blood-Horse, to write the book Equine ER, starting in spring 2008. For a year, I followed around a crazy pack of equine vets at Rood and Riddle Equine Hospital in Lexington, Kentucky. This blog started here while I was writing and reporting the book, documenting that experience, and stayed on after Equine ER came out, featuring original content and book excerpts.

I'll continue to blog regularly on my own Equine ER site, and that blog will soon become part of leslieguttman.com.

Meanwhile, as many of you know, the World Equestrian Games recently finished here in Lexington. I met some amazing people covering the Games for The Horse (blogging) and for public radio. One of them was Cindy O'Reilly, one of only two women in the driving competition. Cindy was an underdog competitor for a number of reasons: She had only been training seriously for WEG for four years or so, unlike other competitors with decades of experience. She had an all-mare team, and numerous people thought that an all-girl team would prove too temperamental to train. Plus, Cindy's horses weren't your classic fancy sport horses; they were sturdy home-breds who had grown up together – Thoroughbred-Percheron crosses.

Anyway, Cindy set her mind four years ago on getting to the World Equestrian Games. She trained relentlessly. She created a book of pictures and articles about her and her horses, and looked at it every night, visualizing herself making it to WEG. And she eventually qualified to do so. I hope this doesn't sound sappy, but even though she came in 20th, she honestly was a winner for having made it there. She told me she hoped her story would inspire other underdogs. She said:

"It's so easy to let your dream fall out of your pocket. And then you can't even find where that dream has gone. You didn't even know you lost it. You need to find it and put it back in your pocket. It doesn't matter what people say, or what they tell you. If you think you can accomplish that dream, you can."

Here's to whatever your dreams are. All the best, Leslie Guttman

Postscript:

The archive of this blog will stay up for several weeks and then remain on TheHorse.com, accessible by clicking on the Blogs link in the main navigation.

Thanks so much to everyone I've worked with at TheHorse.com on this blog: Stephanie Church, Christy West, Megan Arszman, Dawn Garner, as well as those who have moved on: Chad Mendell, Erin Ryder, and Kimberly Brown. Special thanks to Jackie Duke, editor of Eclipse Press, for hiring me to write Equine ER, as well as everyone at Blood-Horse who has worked so hard to make the book successful.

Happy Birthday Equine ER! E-book giveaway!

2010-09-20T13:17:00Z

Today we’re celebrating Equine ER’s first birthday – the nonfiction book by Leslie Guttman, published by Eclipse Press, came out roughly a year ago.

As a special gift to readers of this blog, we’re giving away the Equine ER e-book free for a limited time. Email equineer@leslieguttman.com up until midnight PST TONIGHT (9/21/10), and you’ll receive the e-book this week.

Again, that is the electronic book we’re giving away, NOT the print book, the e-e-e-book. E as in Equine ER. (Sorry for the overkill; just want to be clear.)

(Very important: The e-book will be coming to you as an attachment. Check your spam box this week if you don't see it in your inbox.)

We appreciate you reading this blog and all your comments over the past two years. Your recent comments have included:

1) Readers discussing various reasons behind their horse’s flight response being triggered, including: “a) golf-ball-sized hail on a tin roof, b) dogs running (above) in a hay loft, c) my horse’s own shadow!”

2) A passionate debate over Thoroughbred breeding after an Equine ER book excerpt discussed a mare on Foal Watch with a history of extremely problematic pregnancies. One reader argued in the discussion that “breeding a mare that can produce quality offspring that enhances the horse market is not greed. Especially in this case where the owner is investing in veterinary care to ensure the safety of the mare and foal.” Another reader countered by saying, “… but to risk the mare’s life and possibly the foal inheriting the same problems? Is this quality breeding?”

3) Equine ER author Leslie Guttman is a quote collector, and another reader liked the quote Leslie picked up from a horsewoman on Equine ER's New York book tour. The quote was: “Without limitation, there is no freedom." – Thomas Aquinas. The reader wrote: “If only parents and animal enthusiasts would apply that concept …”

Meanwhile, if you have come to this blog recently, there is an Equine ER video series on YouTube that was produced by Leslie during the writing of the book. Search for Equine ER on YouTube or check out one of the videos here.

This blog is going on break until after the World Equestrian Games (WEG), which starts Sept. 25 and ends mid-October. See you after we get back and don’t forget to check out The Horse’s special team coverage of WEG.

Foaling season: Did the newborn filly survive?

2010-09-06T15:28:00Z

Last week in our excerpt from the book Equine ER chronicling 24 hours during foaling season, an exhausted vet received an emergency phone call informing him that a foaling mare was in trouble. He rushed back to the clinic. The foal was delivered, but whether she would live was in question.

On the gurney, intern Dr. Julie Wolfe clamped and cut the newborn filly's umbilicus, and Dr. Bryan Waldridge inserted nasotracheal tubes and assisted the foal’s breathing with an ambu bag.

While techs wiped the filly clean and rubbed her to facilitate breathing, Wolfe and a tech got a catheter in the foal’s neck to administer any medication if she ran into trouble.

The foal’s heartbeat was strong. Soon, she was breathing on her own.

Dr. Bryan Waldridge talks to a client on a break during foaling season.

Less than twenty minutes later, Wolfe was helping the new filly learn to walk down in ICU. A nursemare was being arranged; the foal’s mother was considered a risky candidate for nursing because of previous health problems. The foal was so cute she looked like a stuffed animal from FAO Schwartz: small, red, two long, perfectly matched white socks, a blaze down her forehead in the shape of a dagger. It’s hard to remember something so adorable is actually an investment that can be $100,000 or more for someone. As the foal tried to walk, she kept getting too close to the wall, almost bumping into it several times. When Wolfe put her hands on her, her skin rippled, having never felt a human’s touch.

Waldridge stopped by the stall before he went back home.

“I like little red horses,” he mused, looking at the foal.

Wolfe wanted the baby to take a rest, but the foal wanted to keep walking.

“She doesn’t listen,” Wolfe said.

“She’s female,” Waldridge replied.

“That’s why I like fillies.” Wolfe said, “They can push through anything.”

The two vets watched the foal, and the other mares in the unit watched their foals. Another foal would arrive in critical respiratory distress at 4 a.m. for Waldridge during an ice storm, followed by a mare two hours later with severe colic for surgeon Rolf Embertson. The foal would be saved. The mare with colic would fall down on the frozen asphalt after exiting the trailer, unable to rise. Interns would have to put her on a glide (emergency sled) and drag her in to surgery, slipping and sliding all over the place. After surgery, that horse would also live. The rest of the weekend would bring more emergencies, more lost sleep. But right now inside the ICU unit, it was calm, and outside, the sky contemplated darkness.

This concludes our excerpt chronicling 24 hours during foaling season. If you're coming to Lexington, Kentucky, for the World Equestrian Games, author Leslie Guttman will be signing copies of Equine ER at the event. More details to come. If you want to reach Leslie in regard to the book, now in a second printing, email equineer@leslieguttman.com. Thanks for reading.

Foaling season: an exhausted vet, an emergency phone call

2010-09-06T14:05:00Z

After working over 36 hours straight, a tired vet gets an emergency phone call in our continuing excerpt from the nonfiction book Equine ER chronicling 24 hours during foaling season at one of the country's top equine hospitals.

Down in the intensive care unit, Dr. Bryan Waldridge’s extra-large filly had fought her colic for twelve hours and won. She was weak but stable. The puffy foal across from her was learning how to nurse (“starting to figure out the udder zone,” Waldridge said). It was now early Saturday evening. Waldridge had been working virtually 36 hours straight. He went home, and as he was getting ready to grab a shower, the clinic rang: Come back. Dystocia.

Foaling season brings babies with multiple problems from dystocias.

An hour is considered the maximum time to get a foal out alive (with rare exceptions) from the time water breaks, and by the time this mare got to Rood & Riddle, it had already been twenty minutes. Tucked inside its mother, the foal’s head was pointed down toward its chest and then turned toward one shoulder, instead of the normal position of head extended between front legs reaching forward (with back legs pointing straight behind).

The hospital staff went into what I thought of as the dystocia ballet. The choreography unfolded: Within three minutes the mare was anesthetized and hoisted in the air. Three to four more minutes passed during which Dr. Travis Tull reached into the mare’s uterus, took hold of the baby’s mandible (lower jawbone) with his thumb and forefinger, and positioned the head correctly. Straps were attached to the baby’s front feet, which were already protruding from the mother. As two interns pulled on the straps, Tull used his hands to guide and ensure that the head remained extended in the pelvic canal. In a few more seconds, the baby was out.

At a nearby gurney, Waldridge and Wolfe waited in white jumpsuits that made them look like workers in a nuclear power plant. The jumpsuits are made of a biosecure material that helps ensure nothing contaminates newborns. Tull’s team quickly handed over the filly and she was placed on the gurney. Wolfe clamped and cut the umbilicus; Waldridge inserted nasotracheal tubes and assisted the foal’s breathing with an ambu bag.

While techs wiped the filly clean and rubbed her to facilitate breathing, Wolfe and a tech got a catheter in the foal’s neck to administer any medication if she ran into trouble.

Note: If you're coming to Lexington for the World Equestrian Games, author Leslie Guttman will be signing copies of Equine ER at the event. More details to come. If you want to reach Leslie in regard to the book, now in a second printing, email equineer@leslieguttman.com. Thanks for reading.

Foaling season: A horse waking up from anesthesia can be dangerous

2010-08-23T14:15:00Z

Last week, a 1,400-pound warmblood got his leg caught in a gate in this excerpt about 24 hours during foaling season from the Eclipse Press book Equine ER by Leslie Guttman. Today, interns get rattled as the warmblood comes out of anesthesia with a strong flight response.

In the recovery stall, interns Leslie Christnagel and Milosz Grabski waited for the horse to wake up to help him out of the anesthesia while I talked to Dr. Alexandra Tracey, another intern, as she cleaned up. At Rood & Riddle, to “recover” a horse from anesthesia, one rope is tied to the horse’s halter, another to its tail, and both ropes go through metal rings in the wall to act as a pulley system. One person (in this case Grabski) waits at the hind end of the horse holding the rope at the ready, while another (Christnagel) sits on its neck, looking for signs that it is waking: eyes become alert; the horse begins to swallow; the tongue regains its tone. Shortly after these signs appear, the horse usually begins to try to get up. Both people help by pulling on the ropes to stabilize the animal as it gets to its feet.

A horse coming out of anesthesia can be a handful. Here, farriers worked on a knocked-out horse whose feet were badly in need of trimming.

It sounds easier than it is. Recovering a horse is a dangerous and unpredictable task. Horses are creatures of flight; their first instinct upon waking up confused in a strange place is to try to get out of there as quickly as possible. A horse often becomes conscious of its surroundings before all of its body wakes up, and it will try to rise, usually front end first. It could hurt itself, but because a horse can’t rise without lifting its head, the recoverer on the neck can slow the process by holding down the head. Finally, some horses coming to have a stronger flight response than others and try to rise before the telltale signs of waking appear.

As I talked to Tracey, out of the blue, Christnagel yelled, “You GUYS!!!” The warmblood was trying to get up without the vets having gotten good notice. He was lifting and turning his head toward the wall as he tried to rise, taking Christnagel with him and encircling her with his neck. He was too strong for her to hold down. The danger existed of him throwing her into the middle of the stall and then stepping on top of her. When he turned his neck away from the wall for a moment, Christnagel darted out and grabbed his halter rope. In the next five minutes or so, with the help of the interns, the horse staggered to his feet and urinated.

The owner came in. “He got up pretty quick,” Tracey told her with a straight face. As the owner cooed baby talk to the horse, her husband waited outside the stall with a resigned look. He rolled his eyes at me and said, “It’s out of control. One time during a storm, she wanted to bring him into the basement, and I said, ‘That is not gonna happen.’ ”

Next: What happened to the struggling foal in ICU? Plus, an emergency phone call for an already-exhausted vet.

Note: If you're coming to Lexington for the World Equestrian Games, author Leslie Guttman will be signing copies of Equine ER throughout the competition. More details to come. If you want to reach Leslie in regard to Equine ER, now in a second printing, email equineer@leslieguttman.com. Thanks for reading this blog.

Foaling season: One surprise after another

2010-08-16T13:50:00Z

"Paging Dr. Embertson ..." Unexpected emergencies, veterinary interns high on sugar, and more from our chronicle of 24 hours during foaling season at one of the country's top equine hospitals, in this excerpt from the Eclipse Press book Equine ER by Leslie Guttman.

No matter what time of day, the hospital is full of sounds: scrubbing, scrubbing, and more scrubbing … workers clean operating rooms, barns, stalls, entryways, and examining rooms. Hay rustles as horses feed, water drips from hoses and faucets, hooves clip across asphalt as clinicians conduct lameness exams. You hear the crinkly sound of granola bars being unwrapped by famished interns and externs (staff veterinarians never eat, as far as I can tell), the gabbing of a flock of birds that nests in the three evergreen trees by Barn 7.

Dr. Rolf Embertson, right, at work.

The P.A. system constantly interrupts conversations, as it did after Saturday morning melted into lunchtime during these twenty-four hours: Dr. Rolf Embertson was being paged. A 1,400-pound warmblood had arrived from Indiana. He had gotten a leg caught in a gate. The laceration wasn’t serious, but it needed to be stitched up. In the admissions office, his owner, bossy in her worry, wanted an MRI. The admissions staff told her regular X-rays would probably suffice, and they did.

In the surgery area, interns readied the horse for Embertson. On the gurney, the warmblood looked even bigger than he did when standing.

“The table needs to be brought up,” said Dr. Leslie Christnagel, who was running the anesthesia, to Dr. Alexandra Tracey.

Tracey bent down and pressed the button that raised it electronically. The table jerked, rose, and then came off its hydraulic wheels a bit, as occasionally happened, tilting the table slightly and putting the horse on an angle that didn’t look right for surgery. Everyone jumped.

Embertson walked up.

“It looks like that horse is going off the table. We need to drop him down,” Embertson said. (An intern from a previous year told me Embertson often pointed out to interns what they felt they already knew, and they loved to tease him for it. This intern’s nickname for the chief surgeon is Captain Obvious.)

The interns fixed the table, and Embertson put on his headlamp and sat down on a chair in front of the horse’s injured leg. With a scalpel he peeled back the skin of the laceration, and then with surgical scissors, he started removing any tissue that was dead, contaminated, or traumatized. Tracey and Dr. Milosz Grabski assisted him.

The interns were high on sugar. The hospital’s weight-loss contest had ended the night before, and they had spent the last fourteen hours or so eating as much chocolate as possible. As they all worked, the giddy intern threesome speed-talked to Embertson about everything from Dr. Alan Ruggles’ self-confidence (“His favorite phrase: ‘One time I was wrong, but it was a mistake.’) to Christnagel’s engineer boyfriend texting her about his breakfast getting ruined in the toaster (“The biojelly Pop Tarts have a thermal expansion issue.”).

Embertson finished up and anchored in a drain to draw off excess fluid. Then he pulled the two biggest edges of the skin toward each other over the open wound and the drain. A gap existed in the middle. “It’s going to be a little tight,” the vet said. Then, slowly and carefully, he sutured the wound, solving the puzzle of how to close the gap with the existing skin step-by-step. He did so by looking for different angles to align and by finding which parts of the skin stretched and which did not. In the end, the wound was almost completely sewn up. Only a tiny gap, less than an eighth of an inch, remained on one corner.

Now it was time for the horse to go into a recovery room. Although the interns didn't know it yet, trouble awaited them ... sometimes, a horse coming out of anesthesia can be dangerous, and this horse was one of them.

Next: An intern yells for her colleagues for help. And over in ICU, did the struggling foal survive?

Foaling season: Things aren't always what they appear

2010-08-09T13:15:00Z

In our continuing excerpt chronicling 24 hours during Foaling Season from the Eclipse Press book Equine ER by Leslie Guttman, we check in with two patients whose conditions are being closely watched by their veterinarians: A mare about to deliver with a history of problematic pregnancies and a foal in the intensive care unit trying to recover from a difficult delivery.

At 4 a.m. the Foal Watch mare started to have her baby. To everyone’s relief, it was quick and easy, like cracking an egg. Dr. Albert Solé Guitart, an intern, delivered the baby, with help from interns Julie Wolfe and Sarah Gray. Wolfe checked in on Dr. Waldridge’s big filly in ICU next door right after the birth, around 5 a.m. She was colicking. It was mild, but Wolfe was a little worried. Wolfe muzzled her so she wouldn’t nurse anymore. Keeping anything more out of her stomach would allow her system to rest and give it the time it needed to try to start successfully working on its own again.

A foal recovers in the intestive care unit during foaling season.

At 5:30 a.m. I caught up with Dr. Birthe Pegel, an intern, doing rounds. She was checking on a big, dark bay show horse recovering from two surgeries for severe colic. The horse was one of the rock stars of his world. He was so temperamental, his own groom was coming into the hospital regularly to spiff him up; the horse wouldn’t let anyone else do it. He had an entourage that visited regularly. Fans had found out the horse was in the hospital, and a false rumor had surfaced he was dead. Sometimes famous horses are admitted into the clinic under assumed names, like two-footed celebrities in regular hospitals, although this one had not.

The horse was trying to bite Pegel. He didn’t like to be touched, and she was listening to his gut through her stethoscope for any sounds of potential problems (for example, gas distension, especially in the colon, makes a pling sound like a Jamaican steel drum). Pegel finished up and checked on a few other patients. Then I followed her up to the conference room for the weekly meeting of the interns’ Journal Club, where one of the staff veterinarians conducts a seminar on a particular subject. This week, Dr. Bonnie Barr was discussing neonatal equine medicine. As Barr set up her slide show, interns attacked the big bag of assorted bagels she had brought for breakfast.

Barr started out discussing septicemia and went on to discuss numerous other topics related to neonates. Toward the end of her talk she said, “Each foal is its own pharmacological situation … in coming up with a treatment plan, it’s important to be assessing very frequently. Things can change. Sometimes, changes can be subtle. If a tech calls you and says, ‘This foal’s doing this,’ don’t blow them off. Little things can turn out to be big problems.”

At the exact time Barr was saying this, Dr. Waldridge’s big filly down in ICU took turn for the worse. Her colic went from mild to severe. She started rolling on her back, a sign of intense pain. She had an ileus, meaning her intestine had stopped moving. Fluid was building up in her bowel, stretching the intestinal walls. Waldridge put her on fluids and various medications intravenously. She’d have to be constantly monitored; she was not only prone to septicemia, she could die from a rupture. A little thing had turned into a big problem.

Note: If you're coming to Lexington for the World Equestrian Games, author Leslie Guttman will be signing copies of Equine ER throughout the competition. More details to come. If you want to reach Leslie in regard to Equine ER, now in a second printing, email equineer@leslieguttman.com. Thanks for reading this blog.

Foaling season: Anything can happen

2010-08-02T12:58:00Z

Our look at 24 hours during foaling season continues in this excerpt from the Eclipse Press book Equine ER by Leslie Guttman. Today, we visit the ICU.

Earlier that evening, a Thoroughbred foal had come in for Dr. Bryan Waldridge after a difficult delivery on the farm that owned her. Although at first the newborn filly had stood well and nursed at home, she had since regressed, unable to do either.

She was a big baby, the largest foal I’d ever seen, with a heavy coat. (Dr. Bonnie Barr once told me that nature’s intelligence always impresses her: Foals born in the colder months always have the thickest hair.) The foal didn’t get enough oxygen during birth and her gastrointestinal tract wasn’t quite mature enough to move the milk through in a normal way. Her body needed a little time to catch up. She was being fed intravenously, and Waldridge was going to try to get her to nurse again. She had also been given plasma to help boost her immune system.

In the ICU Waldridge had just gotten the foal’s bloodwork back from the lab.

Foaling season means long hours for equine veterinarians in the Kentucky Bluegrass.

“It’s all pretty good,” he said, handing the results to Dr. Julie Wolfe, an intern. “Her IgGs are better than 16.” He was referring to the antibodies a foal receives from its mother in her colostrum, the special milk produced within the twenty-four hours following birth. Waldridge meant 1,600 milligrams per deciliter; above 800 is considered good.

“That’s awesome,” Wolfe replied.

Across from Waldridge the foal tried to get up off the bed. (Foals in ICU sleep on mattresses made for people, this one was a Tempur-Pedic.) “There she goes!” the vet said.

But the foal collapsed back on the mattress. “That thing’s gigantic,” said the vet. The foal splayed its legs and then slid off the bed. Waldridge walked over and went into the stall. “C’mon, baby. Gotta get you up.” With a heave, he quickly got her to her feet. The foal tottered over to her mom. Because of her height, she had to bend her head down to try to nurse. She latched on and started to feed. Upright, her legs looked almost as sturdy as an adult horse.

“God, you need a forklift for that thing,” Waldridge said. “She must weigh 130 pounds.” (The average weight of a newborn Thoroughbred foal is 100 to 120 pounds.)

It was Waldridge’s third foaling season at Rood & Riddle. The vet has a Saturday Night Live sense of humor (favorite movie: Blues Brothers) and a relaxed Southern manner that dovetails with a thirsty, scientific mind. He’s published papers with colleagues on everything from stomach cancer in llamas to how to determine at-risk pregnancies in mares. He was the first of his family to leave Kentucky when he went to veterinary school at Auburn and was there for five years as a professor before coming to Rood & Riddle in 2005. [Editor’s note: Equine ER, from which this post is excerpted, was published in 2009; Dr. Waldridge has since left Rood and Riddle.] In the ICU that night I asked Waldridge if he had to prepare himself psychologically for the demands of foaling season. “You just know for five months you can’t do anything,” he said. “I thought I worked hard before.”

The ICU is an enclosed, rectangular room, about 50-by-60 feet, surrounded by stalls. (Two smaller rooms branch off the far end, holding medications, supplies, and the mattresses, pillows, and pads used for the foals, as well as a washer and dryer to launder their bedding.) A long station sits in the middle of the large room; from it, doctors and techs update charts, make phone calls, and consult with each other. One of the first nights I sat at the station, a tech told me about the time a mare delivered a foal that looked like a mythical creature, with two heads and seven legs (it did not live). The rule in ICU is anything can happen.

Waldridge finished checking on his other patients and went home. Twenty-five feet away in the adjacent barn, a mare heavy with life paced in her stall. She was on Foal Watch. She had been pregnant now a full year. Eleven months is considered the standard length of time for equine gestation, although the reality is that can vary depending on the mare. Still, the mare’s owner considered her way overdue and was anxious because of her history of problematic pregnancies the past four years: a Cesarean, a dystocia, a pregnancy where she hemorrhaged and almost died … and another year when she was unable to conceive. (When I later told a friend outside the Bluegrass about this mare, she wanted to know why the farm would put her through another pregnancy. The answer is that for this Bluegrass Thoroughbred farm and any farm that makes its living from breeding horses, broodmare wombs are “miniature economies.”) The mare was Barr’s patient, and the vet was worried about what might happen.

Next: Did the Foal Watch mare have an easy delivery?

24 hours during foaling season continues

2010-07-26T13:15:00Z

A severely colicking mare struggled for life in the emergency room in our last installment from the Eclipse Press book Equine ER by Leslie Guttman. Today, we find out whether her owner decided to send her to surgery.

The owner was having trouble comprehending that she had to make a decision fairly quickly that she could not undo. It was hard to take it all in.

“Sometimes the least expensive thing is to go to surgery,” Dr. Rolf Embertson said. “If we wait, then put her through all that pain, and then decide, the bill is even higher.”

At the end of another hour, Embertson needed to know how to proceed. The horse wasn’t improving, her pain increasing. Surgery now looked like the best option to save her.

Large colon displacements have been occurring in horses for centuries. In this 17th century anatomical illustration, the large colon is located in the intestinal loop shaped like a backward question mark in the upper left. (Courtesy National Institutes of Health)

The owner said she was still worried about hurting the mare by putting her on the table.

“The biggest question is: Is it something we can fix?” Embertson replied. “If it’s something we can fix (like a large colon displacement), we should go to surgery. If it’s a pain issue, it’s not inhumane to go to surgery; it’s inhumane for your pocketbook. That’s just the truth. … If it’s pain you’re worried about, the way to get rid of the pain is surgery.”

In the background, you could hear the interns slapping the horse’s side, trying to get her to stand up.

The owner looked down. “If we decide to do surgery, how soon can you do it?”

“Now,” Embertson said.

The owner still couldn’t give him an answer. Embertson checked on the mare again; she was breaking through the pain medication every ten minutes. The interns thought the pain was now unbearable. The veterinarian returned. The owner told him the horse had had a good life. Embertson said he empathized; he had a dog at home he was also facing putting down. Silence followed.

“How do you do it?” she asked.

“We sedate her heavily and then give her an injection,” said Embertson. More silence. Then the owner said she wanted to euthanize. She didn’t give a reason. Likely it was a combination of knowing the mare had had a long life plus the cost of the surgery.

The owner wept on the horse’s mane saying good-bye. Then the mare started to shift and moan. The drugs were wearing off again.

The owner left the room. One of the interns injected the mare. Her chest rose and fell, and then stopped. Life left the room; you could feel it.

Embertson watched. He hadn’t wanted to put her down. He started to second-guess his conversations with the owner. “I could have pushed harder to go to surgery,” he said to me. “We could have saved her.” Then he told tech Brent Comer to make sure to listen to her heart before they took the body away.

“I will,” Comer said, as he braided a section of the horse’s mane and cut it off for the owner while intern Dr. Alexandra Tracey did the same with the tail. I asked Comer if they always did that.

“Yes,” he said, “or sometimes people want a forelock. Of course, I would have my horse mounted and stuffed in my living room.”

Next: Brave foals in the intensive care unit.

Hello Weekend: A mare in trouble

2010-07-19T13:02:00Z

Our chronicle of 24 hours during foaling season at one of the country's top equine hospitals continues in this excerpt from the Eclipse Press book Equine ER by Leslie Guttman. Last week, a mare with severe colic came in. Today, medical staff continue to try and assess what her problem is, and time appears to be running out.

Dr. Embertson was calm as he discussed the situation with the owner, telling her that they were going through standard diagnostic procedures to try and figure out the origin of the mare’s colic. Embertson is always even, stoic, contained. Californians would say he has good boundaries. He is in his early fifties, tall, trim, one of those men who although he has lost all his hair, wears his dome well, like a professional athlete.

Embertson explained the mare might need surgery.

Would the colicking mare end up in the operating room?

“I don’t want to put her through that torture,” she replied.

“Let’s see if we can figure out a little more what’s wrong with her,” Embertson said, adding that he wanted to do a rectal palpation.

But first intern Dr. Alexandra Tracey needed to finish an ultrasound. As she scanned the beige probe across the mare’s abdomen, she saw the large colon had quite a bit of gas in it. But that was all the intern could see.

The owner was now becoming distraught. She was embarrassed by her emotions and explained to Embertson how much she loved the horse. He told her he understood. He and his wife were having a birthday party on Sunday for one of their ten horses; the mare was turning thirty.

Embertson began palpating the mare. He could feel the large colon was displaced (out of its normal position), but it was impossible to tell how severely and whether part of it was twisted, shutting off blood flow to tissue and other organs. While he palpated, Dr. Albert Solé Guitart quickly collected peritoneal fluid – liquid from the abdominal cavity. If there had been a gastrointestinal rupture, the fluid would show elevated protein and white blood cell levels, and, usually, bacteria and plant material.

Then the vets refluxed the mare (obtaining stomach contents via a tube, threaded down through the nasal passage). They found the amount of drained liquid wasn’t excessive, signifying the mare’s problem likely wasn’t originating in her small intestine. Because the small intestine is closer to the stomach, more fluid would have probably come out if it were. The problem was farther downstream in the gastrointestinal tract. After a short while, the results came back from the mare’s bloodwork and peritoneal fluid. The values were normal, meaning, at least for now, she didn’t have a rupture.

Embertson told the owner about the displacement. From the amount of pain, it was also likely the mare had a twist in the large colon. The options at that moment were: surgery; waiting to see if the colic would resolve on its own with the clinic’s help (providing fluids, pain meds, and laxatives); or euthanization. But those options were more complicated than they sounded. Surgery entailed cost, perhaps more than she might want to spend. The average cost for a colic surgery is between $4,500 and $6,000.

Even though the hospital does successful surgeries for large colon displacements all the time, the cost could go up if they ran into unexpected problems on the table, or if the mare didn’t recover well. If they waited to see if the situation would resolve, then the issues were 1) how long could they manage her pain, and 2) if they eventually did decide to do surgery, then they would have likely put the mare through significant pain for nothing. Also, waiting too long to operate could create more, possibly fatal, problems such as a rupture. Euthanization, of course, meant no turning back.

Embertson said he thought it was unlikely the mare’s colic would resolve on its own, saying, “She’s got 300 milligrams of Rompun (the brand name for xylazine) in her,” but was still struggling.

In the stall, the mare collapsed again.

Next: Did the mare survive?