It is nice to be known for being good at something. In my particular case I had recently moved to an area where the previous veterinarian was not a horse person. When word spread around the equine community that I had a bit of horse sense, I quickly gained a following of devoted horse owners. Normally I would be flattered by this but as you might guess at times it can lead to some interesting situations. Just like everyone I know I enjoy a little time off. I had gone on a trip to visit some family for a long weekend. On my leisurely drive back home I received a concerned phone call from one of my devoted clients. She was concerned that her horse was choking and assured me that she wasn't going to have the other doctor look at it, but instead wanted my opinion.
Perhaps I should explain a little more about choke. In most choke cases that I deal with we are not talking about half-swallowing a peanut, not being able to breath, and needing someone to do some quick fist-to-gut action to save your life. Instead we are talking about an obstruction of the esophagus (the tube that takes food and water from your mouth down to your stomach). Lets continue with the story. Of course, the first thing that I told her was that I was not yet back home and would not be able to come right out. I recommended that another vet really should look at it to make sure she got the care she needed right away. Instead, upon finding that I was unavailable, she said that she thought the horse was going to be fine and just wanted to know for sure what things to watch for to make sure. Well the two big keys are if a choked horse can eat and drink they are no longer a choking horse. The owner called me back later to tell me that the horse was eating grain and drinking water and I thought it was the end of the story.
I thought wrong. She called me the next day, concerned about her horse again. Unfortunately finances were a major restriction in what the client was able to do for her horse so she was trying to manage as best she could simply getting advice over the phone. Again she assured me that the horse was drinking water and in my mind sound like it was still doing okay.
The next day rolls around and she finally decides that the horse is too valuable a performance horse and really needs to be looked at. When horse and owner arrived I knew we were in trouble. The mare was very gaunt, dehydrated, and weak. Bad, bad news. First we tried passing a tube. No luck. Next we tried an injection of a smooth muscle relaxant. No luck. Tube again: no luck. As I said before finances were a big constraint and the owner said she really was at her limit for spending and couldn't afford anything else.
Having heard of this but never tried it because of the risk for complications I offered another option. I said we could try to break the choke up (by this time we had figured out that our most likely cause of the choke was a pelleted dry beet pulp that the mare had attempted to eat three days prior) working from the top down. The idea was to flush small amount of water in and the siphon it back out with chunks of the beet pulp coming along for the ride. It would cost very little and would just be time and energy put into it. Unfortunately there was a good deal of risk of too much water being flushed and having it then breathed in to the lungs to start a bad case of aspiration pneumonia. With these concerns in mind the owner opted to go for it as it was pretty much her last and only chance to save this good horse.
After 45 minutes of flushing and siphoning I felt that little progress was being made. Of course I had other cases and appointments to take care of and couldn't stand their flushing all day. The owner, on the other hand said she was willing to sit and keep working at it for as long as I would let her stay. Seeing no more harm in that than just euthanizing the horse directly I showed her what to do and set about some of my other tasks. Checking in every few minutes and doing more flushing it seemed that very little progress was being made.
After what seemed like all afternoon we finally started to see some progress. There were actually some flushes that seemed to be working. The owner wanted me to take over again and I agreed to try one more time. A couple good flushes of water in were successful at siphoning a good long stream of beat pulp back out. On my next push down the esophagus I was amazed to find that nothing was stopping my tube. I continued pushing until I reached the stomach and I was relieved to say that we had just saved this horses' life. The owner and her friend started dancing around and hugging me and almost crying. No, I am pretty sure they were crying...but these were definitely tears of joy.
Sometimes it pays to never give up.
Monday, February 21, 2011
Sunday, January 30, 2011
Stay in Bed
Being on call is always interesting. Some times you will go days at a time without a call and then for some reason a night like this happens. I was fast asleep in my bed, as most people should be around midnight on a weekday, when my phone rang. Miss horse owner was very distressed. Her horse kept going down and didn't seem to want to get up. I was just starting to get into the details of what was going on when another call beeped in on me. I quickly asked permission to switch lines and tell the person I would call back. Cow owner on the other line said he had a cow calving and I could call him back in a minute. Now back to the distressed horse owner. I sat listening quietly for about ten minutes while the owner went over what had happened multiple times and then asked if I could come out. I mentioned that I also had a cow calving that would be coming into the clinic and it would be best if she could come in with the horse. She said that the storm was already picking up at her house and she thought the trailer was drifted in but she would go back and check.
In the meantime I phoned cow owner back and tried to determine just how much of an emergency he had. He assured me that the calf was already dead and he was in no rush. I soon understood why. He said he had noticed that she had started calving yesterday morning...yes a day and a half before. But then later on in the day she kind of quite and then started into it again today and so he decided to check on her. As much as I would have liked to berate him for lack of timely care I listened until he was done. I asked him how the cow was doing now and if she was acting sick at all. He said she was doing great and was showing no signs of being sick. I layed out the options for him for the middle of the night. First, we could have him bring her in after I was done with the colicky horse which would probably be in a couple of hours. Second, since he said she was doing great we could actually get some sleep tonight and bring her in first thing in the morning as it would really only be a few hours difference and the calf was already dead. We also talked about the poor chances that a cow had with a calf that had been dead inside for a couple of days. To make my middle of the night he decided that he wanted it down as soon as I was done with the colicky horse. Great.
As was expected the horse trailer was well drifted in and so I had to go out. When I arrived I found a bad situation. The horse was down and thrashing in a cramped box stall. One side was a fence instead of a wall and the gelding was showing how adept he was at sticking his legs through the fence and then trying to roll with his legs stuck in the wall. Great. The owner's adult son was sitting on the horse's head in an attempt to minimize the thrashing from side to side. A quick vitals check showed that his heart rate was elevated over 100 beats per minute (normal fit horses are usually 20-30) and breathing rate was at about 60 breaths per minute (normal being less than 20). His intestines were not moving anywhere on his right side. His color was poor and he was obviously in extreme pain. He attempted to thrash multiple times in the first couple of minutes so I quickly gave him an IV of a heavy sedative. After he was sedated I finished my exam and things weren't looking good.
After about ten minutes the horse began thrashing around again. This was a really bad sign as the dose should have lasted him for closer to an hour. I discussed with the owners the need to make a decision on further treatment or euthanasia. Unfortunately, though I can strongly encourage people to make a decision quickly, especially with the drugs already wearing off, I cannot make decisions for people. Over the next half an hour we sat and watched the horse becoming worse while they continued to ask questions, watch the horse, discuss with each other, ask some more questions, watch the horse some more, discussed with each other some more and told me the horse's life story and on and on. Finally I said that a decision had to be made, the horse was suffering, and I had a cow waiting for me to help it calve. I told them I had to step outside and call the cow owner to tell him to bring the cow in and in the meantime they needed to make a decision. When I finally got back in from the wind they had decided to euthanize the horse. Sad ending to story number one.
I headed back into the clinic and the cow and owner met me there shortly after I arrived. When I told him to bring the cow into the chute I found that things weren't quite as the owner had said. The cow was sick. Really sick. She was down in the trailer and didn't want to get up. When the owner said that wasn't a good sign I had to agree. He said maybe I should just take her home and shoot her and again I had to agree that his option was probably the best as she probably would not make it through the stress of pulling the calf. Unfortunately, after a few seconds thought he decided that he was stubborn and he wanted to try. Great.
After 20 minutes of heaving and pushing and cursing the owner finally got the cow into the chute. Believe me, if it had been anyone else they would have given up long before but this owner was a really big man and he got her in by shear weight and will power. Now the cow was showing just how sick she was. Breathing hard, barely able to move, and eyes sunk in were all a good indication that the toxins from the dead calf had spread to the rest of her body and she wasn't far from following her calf.
After reaching in I found that her cervix was only about half dilated and the calf was a true breach; backwards with the legs forward, not to mention bloated and full of gas. The smell was almost over-powering. I had a frank discussion with the owner of how bad things were looking. But once again, after some time for consideration he repeated that he was probably too stubborn but wanted to try to get the calf out. To the cow's credit she did much better than I thought she would, and I was more successful than I thought I would be. I was able to get the cervix to relax some and also was able to get both feet back. We started to pull the calf but made very slow progress as all natural lubrication was long gone and I spent most of my time working synthetic lubricant into the uterus and around the calf. As is always the case with these type of deliveries things went excruciatingly slow.
After what seemed like an eternity we finally had the hips clearing the pelvis and I thought for a second that we might win. Mind you it was a very short thought because right at the moment is when the cow decided that she had had enough. She started to go down on the front and and I scrambled and got her back up. Then she went down on the back end and wouldn't try to rise. I released the sides to try and roll her onto her side as she started to go down on the front as well. I could tell that she was going and grabbed a stimulant to give as an IV but it was a wasted effort. All told it had been about 90 seconds since she started to go down and within a minute she was dead. Super great.
Now I had a 1400 pound cow dead in my chute, with a dead calf halfway out, and no tractor to pull it out. Fortunately the owner had some long chains so he unhooked his trailer and backed up as close as he could. He pulled with the truck while I used a bar to pry her feet up through each of the obstacles along the chute and finally we had her out. Luckily he had a bale lifter on his flatbed and he loaded her directly onto there.
Forty five minutes later the clinic was clean. Forty five minutes after that I was getting out of a very long shower. No matter how many times you shampoo and soap, the smell of the dead rotten calf just does not go away. Right around five am I was climbing back into bed. All I could think was I had been up all night and all I had to show for it was sore and aching muscles from working so hard to deliver the calf, a stench that wouldn't leave, and three for three dead patients. I should have just stayed in bed.
In the meantime I phoned cow owner back and tried to determine just how much of an emergency he had. He assured me that the calf was already dead and he was in no rush. I soon understood why. He said he had noticed that she had started calving yesterday morning...yes a day and a half before. But then later on in the day she kind of quite and then started into it again today and so he decided to check on her. As much as I would have liked to berate him for lack of timely care I listened until he was done. I asked him how the cow was doing now and if she was acting sick at all. He said she was doing great and was showing no signs of being sick. I layed out the options for him for the middle of the night. First, we could have him bring her in after I was done with the colicky horse which would probably be in a couple of hours. Second, since he said she was doing great we could actually get some sleep tonight and bring her in first thing in the morning as it would really only be a few hours difference and the calf was already dead. We also talked about the poor chances that a cow had with a calf that had been dead inside for a couple of days. To make my middle of the night he decided that he wanted it down as soon as I was done with the colicky horse. Great.
As was expected the horse trailer was well drifted in and so I had to go out. When I arrived I found a bad situation. The horse was down and thrashing in a cramped box stall. One side was a fence instead of a wall and the gelding was showing how adept he was at sticking his legs through the fence and then trying to roll with his legs stuck in the wall. Great. The owner's adult son was sitting on the horse's head in an attempt to minimize the thrashing from side to side. A quick vitals check showed that his heart rate was elevated over 100 beats per minute (normal fit horses are usually 20-30) and breathing rate was at about 60 breaths per minute (normal being less than 20). His intestines were not moving anywhere on his right side. His color was poor and he was obviously in extreme pain. He attempted to thrash multiple times in the first couple of minutes so I quickly gave him an IV of a heavy sedative. After he was sedated I finished my exam and things weren't looking good.
After about ten minutes the horse began thrashing around again. This was a really bad sign as the dose should have lasted him for closer to an hour. I discussed with the owners the need to make a decision on further treatment or euthanasia. Unfortunately, though I can strongly encourage people to make a decision quickly, especially with the drugs already wearing off, I cannot make decisions for people. Over the next half an hour we sat and watched the horse becoming worse while they continued to ask questions, watch the horse, discuss with each other, ask some more questions, watch the horse some more, discussed with each other some more and told me the horse's life story and on and on. Finally I said that a decision had to be made, the horse was suffering, and I had a cow waiting for me to help it calve. I told them I had to step outside and call the cow owner to tell him to bring the cow in and in the meantime they needed to make a decision. When I finally got back in from the wind they had decided to euthanize the horse. Sad ending to story number one.
I headed back into the clinic and the cow and owner met me there shortly after I arrived. When I told him to bring the cow into the chute I found that things weren't quite as the owner had said. The cow was sick. Really sick. She was down in the trailer and didn't want to get up. When the owner said that wasn't a good sign I had to agree. He said maybe I should just take her home and shoot her and again I had to agree that his option was probably the best as she probably would not make it through the stress of pulling the calf. Unfortunately, after a few seconds thought he decided that he was stubborn and he wanted to try. Great.
After 20 minutes of heaving and pushing and cursing the owner finally got the cow into the chute. Believe me, if it had been anyone else they would have given up long before but this owner was a really big man and he got her in by shear weight and will power. Now the cow was showing just how sick she was. Breathing hard, barely able to move, and eyes sunk in were all a good indication that the toxins from the dead calf had spread to the rest of her body and she wasn't far from following her calf.
After reaching in I found that her cervix was only about half dilated and the calf was a true breach; backwards with the legs forward, not to mention bloated and full of gas. The smell was almost over-powering. I had a frank discussion with the owner of how bad things were looking. But once again, after some time for consideration he repeated that he was probably too stubborn but wanted to try to get the calf out. To the cow's credit she did much better than I thought she would, and I was more successful than I thought I would be. I was able to get the cervix to relax some and also was able to get both feet back. We started to pull the calf but made very slow progress as all natural lubrication was long gone and I spent most of my time working synthetic lubricant into the uterus and around the calf. As is always the case with these type of deliveries things went excruciatingly slow.
After what seemed like an eternity we finally had the hips clearing the pelvis and I thought for a second that we might win. Mind you it was a very short thought because right at the moment is when the cow decided that she had had enough. She started to go down on the front and and I scrambled and got her back up. Then she went down on the back end and wouldn't try to rise. I released the sides to try and roll her onto her side as she started to go down on the front as well. I could tell that she was going and grabbed a stimulant to give as an IV but it was a wasted effort. All told it had been about 90 seconds since she started to go down and within a minute she was dead. Super great.
Now I had a 1400 pound cow dead in my chute, with a dead calf halfway out, and no tractor to pull it out. Fortunately the owner had some long chains so he unhooked his trailer and backed up as close as he could. He pulled with the truck while I used a bar to pry her feet up through each of the obstacles along the chute and finally we had her out. Luckily he had a bale lifter on his flatbed and he loaded her directly onto there.
Forty five minutes later the clinic was clean. Forty five minutes after that I was getting out of a very long shower. No matter how many times you shampoo and soap, the smell of the dead rotten calf just does not go away. Right around five am I was climbing back into bed. All I could think was I had been up all night and all I had to show for it was sore and aching muscles from working so hard to deliver the calf, a stench that wouldn't leave, and three for three dead patients. I should have just stayed in bed.
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