The ML saga: The end of stage 1
| October 10, 2014 | Posted by Melinda under Uncategorized |
Last night was the last day of IV antibiotics for ML. She will be switched to orals today.
Thank goodness. I’m not sure I could continue to amuse the improving 2 year old for the hour it takes for the antibiotics to run IV.
If I wasn’t sure she was feeling better, I could look at the difference between the first, second, and third nights that we did 1 hour IV antibiotics for evidence.
She alternates between napping and swaying – and subsequently freaking me out since running these antibiotics too fast will cause her to sway and collapse – and being, well, a 2 year old that’s starting to feel better and is a bit bored. Last night the balance between the two was clearly shifting towards bored 2 year old.
Somehow she knows that during that hour she can’t move her feet. Not when I climb up on lawn chairs to readjust fluid bags. Not when I drop my book in a flutter of pages. She’s not fidgeting or being impatient. She’s interacting. She’s interested in me.
She’s incredibly sweet and cuddly. Somehow I ended up holding her head in my arms and scratching behind her ears for a full 10 min last night, and at various points had my shoulder used as a prop for her head as we both chilled out. She’s also a great expert at nuzzling. She’s the best nuzzler I’ve ever met. Like the kind you see in the movies where the horse gently nuzzles the face and hair of the sad person and it makes your heart break. Sometimes she gets this gleam in her eye and she very gently attempts to use her teeth on *me* in a very baby-horse-michevious-way (that is absolutely not allowed, which she is reminded of each and every time). Just to let me know she has some spunk. Occasionally she asks me whether the fluid bag is edible (no), or the fluid lines are edible (no), or my shoes (no) or my phone (no). If I read a book, she rests her nose in the pages and doesn’t mind the turning of the pages hits her in the face.
So why did a spend a good portion of the hour last night crying?
Because this is the hard part.
The part where the nursing care involves spending a LOT of time with the horse doing time-intensive things like running fluids or cold hosing. In those long stretches of boredom you get to know each other in a way that only happens when you can’t do anything but stare at each other for an hour.
The part where she continues to be a perfect patient, even as she feels better, and how she remains so trusting, and willing.
The part where she is interacting with me in a way that makes me think she genuinely likes (and trusts) me, even as the illness drags on.
The hours spent together right now are bonding us as close together as logging that time out on the endurance trail. After 2 nights spent sleeping next to her stall, and 4 days of round the clock care, I’m bonded to this horse in a way I wasn’t on Tuesday.
Why is this hard? Because as good as she looks, she not out of the woods. The vet and I remain “cautiously optimistic”. There’s probably a very good a chance of some complication down the road, and her survival will probably depend not on whether she can beat the pigeon fever (the antibiotics will likely take care of that) but which complication she ends up getting and to what degree.
A fighter?
I don’t get the sense that ML is a fighter. When I thinking of “fighting” I think of inflexibility, and sheer stubbornness. ML isn’t like that. I think she’s survived so far because she’s more like silly putty.
As a kid did you ever play with silly putty? It could be broken, but it took a lot of force applied very suddenly to cause it to fracture apart. But unlike playdough it stretched forever.
She’s has an incredibly amount of flexibility and resilience. She’s not wasting energy fighting against this, she’s allowing herself to be stretched without breaking. I think it’s an important distinction. She’s putting one foot in front of the other and doing the bare minimum necessary to survive without a lot of drama.
I don’t know whether she’s a particularly “tough horse”. The vets spent the first week telling me that she was so sick because baby horses are wimpy. And yet, now that she pulled through what was probably an endotoxemia “shower” on Tuesday, I’m being told that she’s quite a tough and stoic horse.
My opinion so far is that she’s neither and is probably a lot like Farley – an honest horse. One that can be trusted to tell you how bad it is without either minimizing it or being a drama queen.
Looking ahead
Last night was the first night she was stable enough I felt comfortable to sleep in my own bed and drive to the stable every 4 hours during the night for the catheter flushes.
If she pulls through this, even with the probable abscess in her lung, the vets don’t see an issue with her as an endurance prospect.
She’s starting to get really soft stools. Not diarrhea….yet. The antibiotic we are using (IV up to this point, will go to oral today) is one that is the least likely to cause colitis in these situations, so the fact that we are seeing evidence of intolerance means we will not be adding in another antibiotic that was being considered. I’m thrilled since I was uncomfortable with the idea of a “just in case” antibiotic that was not only very expensive, but also once a day IM for a couple of weeks. Soft stools now meant I didn’t have to have that conversation with the vet.
I’m picking up gastrogard and probiotics today.
The PCR panel was negative, which doesn’t completely rule out “tick fever” – however the negative test combined with an improvement on the current antibiotic we are using makes internal pigeon fever a good choice. If she was a less sick horse I might be tempted to treat her for tick fever anyways. But, reality is she’s simply not stable enough to throw another drug at her “just to see”. Depending on her progress I might revisit the possibility of tick fever.
The next milestone will be taking out the catheter. The catheter is the reason she can’t have access to the pipe stall area of the stall unsupervised. She rubs her neck on the pipe corral fencing and risks damaging the catheter. I’ve back off her IV banamine significantly to see what the fevers will do.
I’m considering writing this up as a case report for publication (not scientific publication – more like those stories you read in Equus). I think it was/is an interesting case with some twists and turns (and maybe even more of those to come) and because I did diagnostics along the way I have a lot of specific information – not just speculation and guesses.
How am I doing?
I’ve tried to make a point of leaving the barn whenever I can. It’s usually for just one or two hours but I think it helps.
Yesterday I went for a run (yeah!). Not the best run, but a run. I’m still tentatively planning on running the fifty tomorrow depending on where the fevers/banamine/catheter end up today.
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This wasn’t funny at the time but someday it will be: Yesterday afternoon I had just enough time to run to the grocery store to buy dinner for my incredibly supportive husband. I picked out lovely food, got to the register and couldn’t remember the PIN numbers on my debit cards.
The PIN numbers I’ve had for 10 years.
I didn’t have cash or my check book on me and credit was not accepted so that whole fiasco ended with me walking out of the grocery store in tears with no food. And no time to go back because of catheter flushes etc that needed to be done.
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Matt and I have agreed this is a special horse and so we are spending more money than we normally would in a situation like this. We are taking it day by day and discussing things as they come up while still keeping an eye on the total bill.
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Let me know if you have any questions. I’m more than happy to go into specifics of any aspect you might be interested in.
As before, I’ll leave any minor updates and milestones in the comments, and when I have time/energy/something-to-say I’ll write up a bigger post.
Fingers crossed tight that she’s out of the woods soon and that she doesn’t get complications and that I read about you two in EN in a few years when she completes her first 50 <3
Here’s a copy paste from the AAEP pigeon fever fact document that I shared a couple posts ago. This is the blurb on internal PF:
Internal infection occurs in approximately 8% of affected horses, which is associated
with a high case fatality rate (30 to 40%).
Diagnosis can be challenging, and long-term
antimicrobial therapy is imperative for successful outcome. In a retrospective study, the
organs most commonly involved were liver, kidney, spleen and lungs.
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I’ve been asked whether giving antibiotics will delay internal PF abscess healing. The answer is probably? But if you don’t the horse is goin’ to die so it’s a mute point. That 30-40% number is WITH THERAPY (and ML is showing more severe signs than most). Pus filled abscesses bursting into the blood stream is bad bad bad. Pus filled abscesses bursting through the skin is “eh”. So, you pick the lesser of the 2 evils and perhaps avoid the systemic endotoxemic shock that I saw on Tuesday….
Hi Mel- I totally understand what you speak of when you mention the bonding that has occurred between you and ML through this ordeal. I went through the same experience with JB when he had his pastern Arthrodesis surgery. We were already pretty bonded but when I spent months and months of care and keeping him as comfortable as possible in a 6 month confinement situatino, something changes in a person/horse relationship. Some horses , I believe, understand at some level , the concept of being helped. JB showed a level of patience and ability to cope far greater than I ever expected. I think alot of it has to do with self preservation. So, I know things are tough right now, but at the risk of sounding ” woo woo” don’t underestimate the strength you are providing to her through your care , concern and staying positive. She is probably scared but obviously has found comfort and trust in your presence to keep hanging on. I also understand the financial burden you are facing. You will be ok. I am glad you have a supportive husband. that is sometimes half the battle.. having a good support system. Hang in there.
I am curious how you determine whether or not she has the abcesses in her lungs? Is that just a given with the Pneumonia? Or is that part of the Pigeon Fever? Is Pneumonia typically developed as a result of Pigeon Fever? I would be curious to understand this part better if you get time and feel like talking about it.
First, thank you for the kind words. They mean a lot.
the lung thing. So internal pigeon fever is most often found on the liver, kidney, spleen, and lungs. I think mostly in that order. Her other blood work values are normal so we are assuming that either there are not abscesses on the liver/kidney, or they are inconsequential. She has a focal region in the caudal left lung lobe that is abnormal. So we suspect a PF abscess(es) in the lungs. Which would fit the clinical picture and it’s somewhere PF is known to go. There’s a chance that it is secondary pneumonia that occurred because of the “endotoxin shower” or crash she had on Tuesday afternoon and is because she was septic and there isn’t an abscess there. HOWEVER. Because she is not showing any clinical signs related to the lung pathology, and it’s remained virtually unchanged we suspect that it’s PF there.
I hope this makes sense? In summary there’s many different places PF can go internally, the lung is one of those spots but not the most common. We hear (stethscope) and see (ultrasound) abnormalities that could be consistent with pneumonia/PF in that area.
In some ways if it is primarily lung I’m really lucky. Kidney and liver are more common and when those abscesses burst and they are peeing blood or undergoing massive liver damage, you just hope you have enough organ function left over for life and metabolizing the drugs you have to give. So perhaps in this scenario that was constantly worse case scenario over and over that is the silver lining.
There are many different types of pneumonia and some cause abscesses and some cause pathology in other ways. I think now that I know/think it’s PF abscesses I would probably describe it as “PF in the lung” instead of “pneumonia” but the concept is the same. And we call other abscess forming types of pneumonia “pneumonia” so I don’t think it’s technically wrong.
It makes sense.. and basically it sounds like PF is a complicated disease that cause a multitude of problems. I did not know that, so thanks for the education.
One vet told me “PF can do whatever it wants”. I think that’s a good wrap up description. Most of the time it’s a minor infection, but it can truly do whatever it wants whenever it wants. Fortunately it’s an extremely wimpy bug that’s easy to kill – which is why it’s frusterating/confusing why we keep having ups and downs with ML. Usually once you decide to go to IV baytril it’s all over in a good way. But ML’s case has struck the vets as “bizarre” from the beginning adn it’s certainly continuing to be that way. *sigh*
Sigh.
On the one hand, this is a well written post (very interesting description of ML as a silly putty survivor rather than fighter) and yes you should write it up for a publication, and thanks for keeping us posted so well.
On the other hand, totally crying reading this, and sending up horsey prayers that ML pulls through it all.
Let’s make a day to ride next week, all you have to do is show up with a helmet and get on and enjoy yourself. 🙂
Hoping and praying for a good outcome.
Sending happy healing vibes! Next time tell the grocery store to run it as a credit card – then you don’t need pin.
This particular grocery store only runs debits (winco) so wasn’t an option. Which sucked big time. But their prices are really low and they are by our house which is why we shop there. Because right now, 24 hours later I *still* can’t remember my pin that’s actually my plan – go to a grocery store that takes credit!
Chin up! I’m so glad to hear that ML seems to be *cautiously* on the mend… I’m sending you both all my best wishes that you’ll come through this stronger than ever.
bonita of A Riding Habit
I’ve been thinking of you both. I’m so sorry it didn’t turn out to be something straightforward like ehrlicia.
I know exactly what you mean by the bonding time. I spent probably hundreds of hours soaking Tristan’s foot from 2012-2013, and it’s not that I didn’t love him before – but it’s a whole ‘nother level when you spend all that downtime together and work so hard to keep them happy and comfortable.