Monday, January 17, 2011

The Will to LIve

The Will to Live
     Three years ago, Angel was born dysmature and septic.  Angel could not stand, could not suckle, and had a bacterial infection (neonatal septicemia) affecting her entire body.  Hospitalization in a neonatal intensive care unit was not an option due to financial constraints.  Under the best of circumstances the likliehood of survival in this situation is 20%.  In an at home care setting, it is drastically reduced.  Somebody forgot to tell Angel.
We set up a MASH unit in the outdoor paddock where Angel and her dam lived.  Angel’s human family basically stopped eating or sleeping for the next 10 days.  I provided Angel with an intravenous catheter and a nasogastric feeding tube, and administered initial aggressive treatment to address the immediate issues of failure of passive transfer, sepsis, inadequate caloric intake, toxemia, and possible cerebral anoxia, and gave the owners a crash course on IV medication and fluid administration, feeding tube maintenance, and neonatal foal nursing care.  Remember, Angel couldn’t stand  – she could barely lift her head.
     Angel required around the clock care and she got it.  As day 1 became day 2, then 3…6…10 I watched amazed as Angel’s owners gave life to this gritty little filly.  As the caregivers began to look increasingly weak and exhausted, Angel did just the opposite – by 2 weeks of age she was a bouncing, active, clinically normal foal.  We all danced for joy (well, her owners watched with bleary eyes while I danced – they were just too wooped to jump around) and Angel set off to live a normal life.
     Turn the clock ahead to late summer, 2010.  Angel is now 3, and has been sent off to spend some time with a cowboy trainer.  She went on a slow cattle drive and had some great experience just learning to be out and about with other horses.  Unfortunately, there was an outbreak of Strangles on the ranch while she was there.  Strangles is a strep bacteria: Streptococcus equi sp. equi.  It is highly contagious.  A typical case of Strangle goes like this: the horse is exposed to the bacteria.  Three to five days later the horse is depressed and has a fever.  This may go unnoticed.  By day seven the horse has a thick yellow nasal discharge.  Over the next week to ten days, the horse develops swelling just behind the cheek bones (retropharyngeal) or between the jaw bones (submandibular) caused by lymph node abscessation.  These abscesses break open and drain, the horse recovers and that’s that.  An uncomplicated case of Strangles is not treated with antibiotics, and has no long lasting consequences for the horse.
     Complications occur in about 10% of horses with Strangles.  These include abscesses that compress the airway and interfere with breathing or swallowing, pneumonia, formation of internal abscesses within the abdominal cavity, and an uncommon immune mediated disease called purpura hemorrhagica.  All complicated cases of Strangles require intensive medical treatment and are potentially fatal.
     Angel didn’t handle her Strangles well.  By the time her owner was notified and came to see Angel she had been sick for 3 weeks.  She had multiple abscesses on the left side of her face and neck, she had pneumonia, she was suffering from severe malnutrition, and to top things off, she had multiple foxtail abscesses under her tongue and in her throat.  This picture was taken the day Angel came home.  She was weak, staggered as she unloaded from the trailer, had long strings of saliva falling from her mouth, and stood with her head extended, her eyes half closed.  Her heart rate, respiratory rate and temperature were elevated and she had difficulty breathing.  Her hip bones and back bone were prominent – I estimated her weight loss over the 3 weeks at over 100 pounds.
      Once again, the MASH unit was organized.  However, instead of a 65 pound neonate, the owners were now trying to manage a critically ill adult.  I placed an intravenous catheter and we began intensive antibiotic, anti-inflammatory and fluid treatment, but when Angel’s initial blood work came back from the lab, it was obvious that we were not going to able to provide adequate care at home.  She was suffering not only from a critical bacterial infection, but also from severe cachexia.  Our bodies burn many additional calories when we are ill.  Angel’s ability to prehend, chew and swallow had been compromised for 3 weeks, and to compound this problem, she had been competing for food in a group of horses.  In her increasingly weakened condition she had been left with the poorest quality hay to try and consume.  Her blood protein levels were alarmingly low – her body was consuming itself in an effort to fight the infectious process and it was losing the battle. 
     Angel’s owners and I sat down and had a heart to heart.  None of us were willing to give up on Angel, even though it was clear that she once again was facing an immediately life-threatening situation with a guarded prognosis for recovery.  I called UC Davis and arranged for an emergency referral.  Angel’s owners loaded her up and off she went.  Angel , whose normal body weight is 950-1000 pounds, weighed 760 pounds on arrival at the University hospital .  Diagnostic testing including ultrasound and endoscopy confirmed the presence of pneumonia and multiple upper airway abscesses.  Under the excellent care of Dr. Dawson, a senior medicine clinician and her staff, Angel once again defied the odds.  She was in the hospital for close to 3 weeks, and continued her treatment at home for another month.  By Christmas Angel had recovered completely from her second brush with death.  Here she is, head up, bright eyed, and round barrelled.
     It takes a village.  Angel has a tremendous will to live.  She also has a family who loves her and doesn’t hesitate in the face of adversity.  Grandma, grandpa, grand-daughter, the entire medicine staff at UC Davis, the benefactors who support the UC Davis Emergency fund, the Care Credit organization, myself and my assistants, all played roles in Angel’s survival. 
     These days we see and hear a lot of stories of loss, of animals suffering because the money isn’t there, because people give up.  Angel’s owners are not wealthy, but they were willing to look for help when they needed it, and to roll up their sleeves and work themselves to the point of exhaustion to care for their horse.  Their dedication and Angel’s desire to survive are insipirational.
I believe that education is the key to evolution. I believe that animals are the key to compassion. I believe the learning never stops.


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