Challenges of the home hospitalized horse
| November 15, 2014 | Posted by Melinda under Equine Endurance, Most Popular |
I thought I was well prepared to take care of a critically ill horse at home. After all, I am a decent horse person combined with three-quarters a vet in the midst of year dedicated to managing complicated referral-hospital hospitalized patients.
Easy right?
Ummm..no. I’m going to share with you some of the most surprising and difficult aspects of providing care at home for a horse that ideally would be hospitalized.
(Usual disclaimers apply – discuss with your veterinarian what is right in *your* case, but this is a list of things I did not consider when offered home care as an option and some things that your vet might not think to tell you).Â
Catheters and Fluids
Let’s assume you have some sort of medical training and running fluids in a catheter is straight forward and really no big deal for you. Armed with the knowledge and technical know-how, I thought it would easily translate to home.
Here’s why it’s different.
- If the catheter clots, kinks, gets rubbed out or otherwise damaged, YOU ARE SCREWED. Unlike the at the hospital where you sigh, perhaps curse, and then get another one off the shelf and put in a second one on the other side. At home, that catheter is your life line. It’s likely the only one you have and you better take care of what you’ve got.
- You don’t have a fancy machine that will beep when air gets in the line, or if it kinks and stops flowing, or if the horse puts its head in a funny position and it stops flowing. Â (air in the line could = death, flow stopping could = catheter clotting, getting tangled or destroyed = see previous comment of having no replacements for anything). As a result, even if you have a near ideal set-up (like I did) that very closely mimics a hospital stall, you don’t dare take your eye off the horse for even a moment when bolusing fluids. As a result, giving fluids becomes very time intensive. 5L takes about one hour to bolus, which meant that is one hour I sat by the pen making sure everything was running as it should.
- As for the q4 hour flushing (the catheter type I was using could not be hep-locked and had to be flushed every 4 hours instead of every 6 hours), I was constantly worried I was going to run out of flush – at the hospital I just grab another bottle of hep and a bag of fluids and voila! unlimited flush. At home I had a finite number of very precious syringes.
If you aren’t accustomed to running fluids at a hospital, than you will be under no illusions that it’s going to be easy and probably won’t be surprised by how hard/stressful it is.
Spending the money where it counts
Let’s assume your motives are very similar to mine when it comes to giving your horses at-home care. Namely to make those dollars go further….
When you are putting yourself through the sleepless night and round-the-clock care to save money, it can be hard to not continue that trend when it comes to supplies. Here’s the reality. Because you are doing this at home, you can’t get away with less than optimal supplies and equipment – you need to do BETTER than if you were in a hospital because not only do you likely not have the ability to replace stuff (like catheters), the environment is also much dirtier and harder on the equipment (not to mention you are likely more tired or less experienced than paid staff at a hospital and more likely to make mistakes). This means that when the vet says “use elasticon to wrap the catheter site”, you spend the $16 or $20 bucks on elasticon to do the job, and not the much much MUCH cheaper vet wrap. Elasticon will do a better job protecting the site, even though in most cases in a hospital setting perhaps you can get away with vet wrap. Maybe most of the time you can get away with reusing needles or syringes for injections, but if the vet says “change needles out after drawing up drugs” or “use a new syringe every time”, then do it regardless of cost. Even if you get away with the practice *all the time* in a hospital. Don’t try and save money in a way that will sabatoge your efforts to manage your case cheap(er) in the field.
Your impact on the clinic
Realize that *you* are a lot of work for the clinic. I tried to be mindful of this. Since the doctor would usually check in every 24 hours or so, I tried to save questions and concerns that were not immediate for those phone calls. Yes, the vet is there to help, but there is a balance between calling them every hour with concerns and being a little bit self sufficient. When you took up the task of doing home-care and against the recommendation to hospitalize and deciding to do it at home, you also took on more responsibility for your horse’s care.
Fatigue
You are going to be really really tired. Like, getting-up-every-3-hours type tired if you have to do frequent catheter flushes. Combine sheer not-enough-hours-of-sleep with worry and decision-making fatigue, and you have a recipe for *not* being able to emotionally process information or make good decisions. Not to mention living each and every up and down as it happens (which you won’t necessarily do if they are in the hospital). And as both the primary caregiving AND the person ultimately responsible for treatment decisions (together with your vet) this becomes a very delicate balance. I cried a LOT. I would barely hold it together for mature phone calls with the vet and then dissolve into sheer sobbing as I had to process yet another piece of bad news, or decide yet again whether I was going to spend another thousand dollars to do XYZ, or just wait it out.
I won’t lie. This isn’t ideal. It’s best if you can give some of the responsibility to someone else. Or at least have someone you trust tell you when it’s not the right time to make big decisions.
You can say “I won’t sleep a wink if my horse is in the hospital” but that’s different from actually not sleeping a wink because you were the primary caretaker during the illness.
Reasons I chose home care
Yes, money was a concern. But there were 2 other reasons I made my decision.
1. Mentally for the horse
I felt like ML was unstable enough, that the additional stress of hauling her (she’s only been a trailer once) and being in a new place wasn’t offset enough by the higher quality of care and monitoring she might have had at the clinic. Stress kills or at least doesn’t help and I felt like I had a better shot at turning her around if I kept stress as low as possible.
This won’t apply to every horse. If it had been Farley, I wouldn’t have cited this as a concern, since I know hauling and being in new places isn’t a big deal.
2. Handling
I didn’t want my young horse, who was likely going to be uncooperative for some procedures, roughed up.
I didn’t want my sweet 2 year old to come out of the hospital head shy, needle shy, and less trustful of humans. Her mental well-being was equally as important to me as her physical well-being.
As it turns out, this wouldn’t have been an issue with the clinic I was using. After watching the multitude of vets who came out and handled ML during this crisis I can safely say that this clinic hires excellent horseman who have exceptional handling skills and ML’s mental well being was as high a priority for them as it was me.
What a relief.
Unfortunately this IS a problem at some clinics. I’ve personally seen especially young horses handled in ways by medical personnel that make me sick to my stomach to think of any of my horses being treated like that. It’s hard in a hospital setting. You need to do something, the horse is resisting to the point of being dangerous, you are frustrated, and worried about your safety, and you are faced with 5 other critically ill horses *also* needing care. You know you can do something to make sure that horse doesn’t do that *this time* and damn the future behavior consequences.
I’m fine with my horses being twitched, restrained, and handled in ways that I wouldn’t do as a *horse owner* in order to get a necessary procedure done, but I do not want my horses hit, struck, popped on the head or handled in other ways out of frustration or anger.
Thus, as a horse owner, seeing what I’ve seen over the last couple years I’ve lost my faith that my young, scared horse is going to be treated in a such a way that is fair and safe in a clinic and I won’t leave my horse at a clinic I don’t personally know and trust.
Again, not an issue with the clinic that I used for this episode – their excellent reputation in the community was completely validated and in the end, I would have been comfortable dropping ML off with them, knowing she was in capable and fair hands.
Tips
Here’s my top tips if you find yourself managing a rather complicated case at home.
- Organize. Have a container for each procedure that needs to be done. I had a separate container for abscess flushing, catheter care, medications, icing, TPR checks etc.
- Get away from the barn. Especially with catheter care you won’t have many opportunities. Find a half hour to run an errand, or go for a walk or run, or visit with a friend. It will help.
- Let go. It’s easy to fall into the trap that you have control and if you just do it *better* you will have a better outcome. In reality, setbacks aren’t necessarily your fault. If you’ve followed your vet’s instructions, did what you were capable of at the time, and not tried to cut corners – then be at peace.
I Couldn’t help but think that this is all excellent avice for someone being a medical caregiver for animal or people.
It was not something I was thinking about at all when writing this, but I think you are right!
Excellent post. (And excellent new comments section – this one remembers who I am!)
This was wonderful to read. I’ve been there when it comes to needing/wanting something that you take for granted in the clinic but you don’t normally have on hand at home. Like lidocaine. Or ultrasound. Or Dormosedan. Your entire “Handling” section also applies to cats. And skittish dogs. I’m really picky about who I let handle my cats at the hospital for the same reasons you’re picky about who handles ML at this stage. I had a kitty that passed away 2 years ago. She used to be really good at the vet’s office: very easy to handle, no problems whatsoever, not even for blood draws. Until the day I dropped her off at a veterinarian’s for a dental while I was in tech school. I have no idea what they did to her, but that cat became SO TERRIFIED of vet offices in general that not even I could touch her if I took her into work or school afterwards. She would go ballistic. For the last 5 years of her life, I had to take her to pet store vaccination clinics and I diagnosed her cancer myself. I didn’t take her into an animal hospital again until the day she died. It still enrages me to think how badly she must have been treated that one time to make her so very terrified for the rest of her life. Seriously: if an animal is being so fractious that it needs to be manhandled to the point of abuse, chemical restraint should have been considered before letting the situation escalate to that point. So I totally hear you on your concerns over ML’s handling at a veterinary hospital. After that one experience, no veterinary professional touches my animals, equine or otherwise, without me being present.
From an LVT’s point of view, I did wince when I got to the part about reusing needles and syringes in a clinical setting. I know in large animal things are often different, but I personally will not use a vet that I know recycles needles and/or syringes, not even for my horses. Even if it’s on the same patient or using the same drug. I expect to see my equine vet open new needles and syringes each time: it is something that I watch out for, and I would be horrified if I paid the big bucks to hospitalize my horse and discovered that syringes and needles were being re-used. I won’t do this when giving injections at home, even when I’m paying full price for my needles and syringes. This has been a big no-no at every small animal specialty hospital I have worked at, at least in FL and MD (I don’t know about other states). It still happens at some old school general practices in this area but at my hospital we get to fix the resulting problems from this, like the one dog that came into our ER with a gargantuan abscess over his shoulders from SQ fluids that had been administered with a reused needle. It was not pretty. :/
Best practice is to change out needles/syringes. However, because of different species tolerances for infection this may or may not happen depending on circumstance. (it’s why we can do clean but not sterile open abdominal surgeries on a lot of large animal species).
I suppose it horrifies you to learn to we reuse the same needles vaccinating cows until it breaks? 😉
Lol! I know things get reused with cows, so not horrified there and totally NOT surprised about needles breaking! OMG their hide is so tough! We did get introduced to cow vaccination in tech school. I have photos on my FB. 🙂
…photos on my FB of my grimace while trying to stick a 16G needle through that living leather! For a vaccine!! And we had the opportunity of dehorning a calf…which was a totally not sterile procedure. So yup: very much aware that large animal is very different from small animal! 🙂 I’d just be concerned about a veterinarian re-using a needle or syringe with horses or small animals. The owners are all equally crazy. 😉
So I think it’s all about context when it comes to horses. You are coming from the perspective of the horse as a pet/individual animal that is closer to a dog or a cat than livestock like a horse. Not everyone feels the same way about horses and IMO it’s why matters of horse care and welfare is so controversial. It is far from black and white. You and I might feel a particular way about our own horses (I dislike even using needles for IM vaccine that were also used to draw the vaccine out of the bottle but I don’t always have extra needles on hand. so it’s what I do sometimes) – but the reality is that in some context the horses are going to be treated more like the cow. I think that is part of what is hard about being a vet – seperating out me as a *horse owner* (or dog owner etc) and me as a *vet* for the client and patient in front of me. I do things as a vet that I fundementally disagree with personally, but do professionally because that is the best way to serve that patient/client. For example, euthnizing a young, friendly, beautiful german shepherd bitch because she had hip dysplasia evident on radiographs, for a breeder that was unwilling to put her on NSAIDs, do surgery, or rehome her. This was hard because I have 2 dogs with similar issues that have been on NSAIDs for 5+ years without any complications or side effects. It can be done. To euthanize a dog because she *might* have complications from treatment in the future? That’s a grey area. In the end the vet and I euthanized the dog. Because when it came down to it it was in the best interest of the dog, even though it was something I deeply, personally disagreed with. And I did it without judgement.
Everything we do in the wider veterinary profession that isn’t “best” falls into these grey areas (and I would argue that “best” does too because of issues of money and priorities). Obviously reusing needles isn’t the same as euthanizing (although the last cases of EIA in CA were because of needle/medical equipment sharing among the underground quarter horse racing sector so……) but I feel the principles are the same. I’m not horrified that people re-use needles, even on horses. I know it happens and is going to happen regardless of my approval, so I’ll just try to make sure that it doesn’t happen when someone is managing a really sick horse at home where it really is the difference between life and death and not necessarily a sliding scale of complications.