Refuge Farms (www.refugefarms.org)

Last evening, at the end of the day, I stood in the driveway to the barn and just looked. I looked out at the pasture and saw them. And yes, I cried. I looked at them. And then I carefully looked. Not just glanced. I soaked in each and every one of them as deeply as I could. The mental pictures are burned in my mind. It is good sometimes to take the time to make those pictures. To take the time to soak them in. To look at them. Not just glance, but really look.

One week ago today, our lives were shaken to their cores as Jeri-Ann became ill. With no warning and purely as a hunch, she was taken to the University of Minnesota Equine Center. During her time there, I was faced with the ungodly decision: Do we treat her? Or do we euthanize her?

What was the decision? Why, even, the question? What on earth was wrong with her? And what was the outcome?

Below are the discharge orders for our baby, Jeri-Ann. I'll let those words from her attending veterinarians tell you how dangerously close we came to not having "The Baby" in our barns .

And then the next time you are here, you, too, will look. You will pause. Take the time. And look. Really look. You will soak them in, too. And you will create your own mental pictures. And yes, maybe you will cry a bit, too.

Client: Refuge Farms (Rescue)
Patient: Jeri-Ann, Equine, Belgian, Female Intact, 2550 lb, DOB 05/01/2005
Admit Date: 05/29/11
Discharge Date: 06/03/11

History: Jeri-Ann, a 6-year-old Belgian mare, presented to the University of Minnesota Equine Center on May 29, 2011 for evaluation of lethargy and changes in behavior. She had been observed lying down more often than normal during the day. no changes in food consumption were apparent. On April 15th, Jeri-Ann was vaccinated with a a 4-way, rabies, West Nile Virus, and tetanus and dewormed with ivermectin. She has direct contact with six other horses. The latest new horses on THE FARM were between February and April of 2011, but she had no contact with the temporary horses. Her manure production during the trailer ride to the hospital was decreased.

Physical Examination: On physical exam, Jeri-Ann was quiet and dull compared to her normal personality. She weighed 2,550 lbs. She had an increased heart rate of 96bpm and an increased respiratory rate at 36 breaths per minute. Her temperature was high normal at 101.3F. Her mucous membranes were pink and moist, with a normal capillary refill time of less than 2 seconds. Her gut sounds were normal in all four quadrants. intermittent muscle fasciculation (muscle quivering ) was observed, primarily over her neck.

Diagnostic Testing:

Neurologic Examination: Jeri-Ann exhibited mild hind limb ataxia at the walk. In addition, she was observed to pivot on her inside right hind leg when turning in tight circles and demonstrated bilateral weakness while performing a tail-pull at the walk. No other abnormalities were identified.

Rectal Palpation: This was performed on the nigh of admission and daily for the next two days. Due to the mare's large size, only a limited portion of the eposterior abdomen could be palpated. Within this area, no abnormalities were noted.

Manure Sediment: No sand was present in the feces, although a small rock was found.

Urine Specific Gravity & Dipstick: The results were within normal limits, consistent with normal kidney function.

Complete Blood Count: This test is sued to identify inflammation or infection, anemia, and possible visualization of Anaplasma within the blood. Anaplasma was not identified and all values for ed blood cells, white blood cells, and platelets were withing normal limits.

Serum Chemistry Panel: Jeri-Ann had a mild increase in liver enzymes, including SDH, GGT, and AST. She had an elevated CK at 880u/l, indicating mild muscle damage, consistent with her history of spending more time than usual down. Jeri=Ann had a slight decrease in potassium, attributable to her decreased feed intake.

Abdominal Ultrasound: No dilated loops of small intestines were noted in the ventral abdomen; however, intestinal thickness, motility, and abdominal free fluid were difficult to assess due to her large size.

EHV-1/EHV-4 Test: A nasal swab was submitted for virus isolation of Equine herpes Virus-1, a viral disease that can cause neurologic symptoms including ataxia. This test was negative, indicating that her clinical signs are unlikely to be caused by Equine Herpes Virus.

PSSM Test: A blood sample was submitted for genetic testing for Equine Polysaccharide Storage Myopathy, a genetic mutation causing an inability to properly store and utilize glucose. This disorder can cause weakness, trembling muscles, and increased amounts of time lying down and is common in draft horses such as Belgians. We will contact you when the test is complete.

Cardiology Consult: An ECG was performed the day following Jeri-Ann's admission; no abnormalities were noted aside from an increased heart rate. Although her heart rate declined somewhat over the course of the following week, it remained above 60 beats per minute throughout her stay. Dr. Tobais' examination on 06-03-11 revealed no murmurs or other abnormal heart sounds; aside from the elevation in heart rate no specific evidence of cardiac insufficiency or failure was noted. Peripheral pulse quality was normal. Dr. Tobias attempted to perform an echocardiographic examination, but due to Jeri-Ann's size it was not possible to obtain a satisfactory image of the heart. Dr. Tobias reviewed the mare's ECG strips, and concurred without assessment that the trace was consistent with sinus tachycardia, with no evidence of a pathological rhythm disturbance.

In-Hospital Therapy:

Fluid Therapy: An over-the-wire catheter was placed in Jeri-Ann's right jugular vein and she received intravenous fluids to maintain hydration and provide additional fluids in case her symptoms at admission were due to a colonic impaction. Her packed cell volume and total protein were monitored throughout her stay to asses her hydration status and remained normal for the entirety of her time in the hospital.

DMSO: In view of Jeri-Ann's neurological deficits at presentation, she received three doses of DMSO through a naso-gastric tube. This is an anti-inflammatory and antioxidant agent.

Electrolytes and Mineral Oil: 8L of electrolyte water was administered by nasogastric tube twice to help with hydration as well as maintain electrolyte balance. Jeri-Ann also received one dose of mineral oil to assist with gastronintestinal motility and act as a marker for GI transit.

Flunixin (Banamine): Jeri-Ann was given Banamine the night of presentation to help reduce pain and provide anti-inflammatory support.

Phenylbutazone (Bute): Jeri-Ann received two doses of phenylbutazone to address the possibility that her elevated heart rate was due to pain. When little effect on her heart rate was noted, this medication was discontinued.

Oxytetracycline: This is a broad-spectrum antibiotic, used to address the possibility of Anaplasmosis. Jeri-Ann received two doses daily by intravenous injection for a total of five days.

Vitamin E: As vitamin E deficiency can play a role in muscular weakness, Jeri-Ann received treatment with this vitamin during her period of hospitalization.

Assessment: At the time of discharge, Jeri-Ann was bright and alert; her attitude has improved dramatically since the time of her admission. Her appetite has improved and she has been eating hay and Nutrena Senior feed in small rations throughout the day and night. In addition, her hind lib weakness and ataxia has resolved. The precise cause of her illness remains undetermined. It is possible that she had a mild colic episode (e.g. colon impaction) that resolve with oral in intravenous fluids. Her heart rate remained elevated during her stay but gradually came dot to 60-66 bpm by Friday. There was no change in her heart rate while she received treatment with anti-inflammatories such as bute or Banamine, and her heart rate did not increase after stopping these medications. We have not identified any evidence of musculoskeletal pain. It is possible that she has a higher than normal resting heart rate, or that she has some abnormality in her heart itself that causes her increased rate. However, she is not showing any other signs of cardiac dysfunction at this time.

Recommendations: As the precise cause of Jeri-Ann's illness remains uncertain, please watch her closely over the next 2 weeks. We recommend that you monitor her heart rate daily for the next week, followed by once a week to every other week. Please give us or Dr. Kersten a call if you notice any recurrence of symptoms following her discharge.

Please monitor her water intake. She should be drinking approximately 2.5 five-gallon buckets of water per day, and even more under hot conditions.

Signs of heart failure to watch for include lethargy, coughing, difficulty breathing, development of fluid (edema) along her belly, and stocking up. Please give us a call immediately if Jeri-Ann develops any of these problems.

Thank you for bringing Jeri-Ann to the University of Minnesota Large Animal Hospital. She is a lovely mare and was a pleasure to work with. Please do not hesitate to contact us if you have any additional questions regarding her care.

Sincerely,

What a grand gift we have been given! Our baby, Jeri-Ann, has returned to us - elevated heart rate and all. We are watching her very, very closely and will not hestiate to re-admit her should the symptoms reappear. But today, whenever the thought crosses my mind, I look up. And I look. Not just a glance, but a look. And I treasure all of them. Every last body of them. And I rejoice for the gift of more time with them all.

Enjoy the journey of each and every day,
Sandy and The Herd - especially Jeri-Ann