What the heck happened to MerryLegs?
| October 9, 2014 | Posted by Melinda under Uncategorized |
If you are my facebook friend and saw this status update Tuesday afternoon, you probably have some questions:
“Whelp spoke too soon. After 24 hours of looking really good, Merrylegs has relapsed to a fever of 107F. Why she isn’t on the ground seizuring and dead I have no idea. I’m suitably freaked out, as it the vet, who said they’ve never seen pigeon fever with a temp this high . They will be here in an hour to place a catheter and they are going to let me run the IV fluids etc here at home to save some money. She’s not insured and I don’t have all the money in the world. Please say a prayer for us.”
In fact, if you aren’t my facebook friend, after reading that, you probably have some questions.
What the heck happened?
A quick recap
- Last week Tuesday (9/30) I noticed a draining tract and suspected pigeon fever
- Wednesday a local vet who was treating the other horse with pigeon fever on the premises treated ML as well. Confirmed it was pigeon fever, noted she had a temperature (102+) and gave IV Bute and instructions to continue to give oral bute.
- Thursday/Friday she appeared better.
- Saturday night I called well-known and trusted clinic in the area with concerns about ML’s progress. I was told to call them in the morning if she wasn’t better.
- Sunday late morning they came out. ML had a fever of 105+. Abscesses were ultrasounded, lanced. She was given IV Banamine, with instructions to continue a larger dose of oral bute, and started her on an oral really common antibiotic.
- Monday she was much improved. So much so I actually posted on facebook that I thought we were turning a corner!
- Tuesday 8am she was a bit “off” but temp was still down and she ate her morning meds
Which brings us to Tuesday at noon.
Where I went out to visit and do my noon treatments (cold hosing, abscess care, temp check) and found that her temperature was 107F
WTF
In case you didn’t know, temps that high absolutely justify swear words.
I checked my thermometer. It’s one I “borrowed” from school (accidentally actually) so it’s not a 99 cent unreliable piece of crap. It was working. I verified her temp several times and then called the clinic again.
The vet was in disbelief. He asked me if I was sure it was pigeon fever (I’ll believe what ever you tell me doc and as of 48 hours ago they were telling me pigeon fever…) We talked about my budget and options. Being a fourth year vet student they were willing to do a lot of the treatment myself at the ranch so my dollars would go further. (Tangent: I’ll do an entire post on the challenges of caring for a “hospitalized horse” at home at a later point).
What was going on? She was way way way sicker than she should be with just pigeon fever (“PF” from now on). You don’t see temps this high. It could be viral….but usually those spike fevers over 48 hours or so – and we were going on day 8 of fevers. Even without a specific cause, the game plan was to do 48 hours of supportive care and then reevaluate.
My hopes were not high. Between the time the vet was called, a catheter was placed and we started the first 10L bolus of fluids she had decompensated to the point where her (I’m going to use some doctor terms here – sorry) mucus membranes were injected, her CRT was slow, she was even more depressed, her heart rate was 80, and she was making grunting sounds as she breathed (we believed from pain). She also had muscle fasciculations.
Then the final piece of news that broke my heart. Harsh lung sounds and crackles on one side. Ultrasound confirmed the findings. Pneumonia.
This was not the picture of a horse headed in the right direction.
The vet went over her triage plan with me for the night. We were only looking ahead 48 hours, and knowing that if there wasn’t significant improvement by the ‘morrow, quality of life and prognosis was going to have to be seriously considered. Especially if sequela such as founder or colic occurred, which they often due secondary to serious illnesses in horses.
When I started this post on Wednesday, I had a bunch of details of exactly what we did, along with time frames so you could appreciate why I got to sleep in 1 1/2 hour chunks of time sporadically over the next 24 hours.
However, that was when I thought this was the final crisis. Now that I have so much to talk about we are going to gloss over that 24 hour period and hit the highlights (George R.R. Martin are you listening?)
Lots and lots of “goodies”
In short, we started her on IV heavy-duty antibiotics that had to be run in slowly over an hour when given, planned another 10L bolus of fluids in the middle of the night, along with IV banamine, did temp checks and a multitude of other little tasks that had to be staggered from other little tasks so that *something* had to be done every 120 min or so.
Sweet little hospital stall I got set up at the ranch. Has a fan and is the perfect size to hang fluids from the center. She doesn’t get to go outside unsupervised into the pipe stall area because she tries to rub her catheter out.
It was a long night spent in a sleeping bag on a haybale next to her stall.
But it was worth it because she looked OK in the morning. Not great…but systemically doing OK. No fever, and she was nibbling, peeing, and passing normal manure. Â Her CRT was back to normal and that weird grunting thing she was doing was gone.
And then more good news – blood work came back and yes, there was evidence that major infection of some sort was going on, but her organ values look good – which meant she’s handling the NSAIDs and other medications well.
She also was slightly-to-not dehydrated. This doesn’t mean we shouldn’t have given fluids – she was shocky and there’s more reasons to give fluids than just dehydration, but it did make me feel relieved I had delayed our planned second 10L bolus of fluids a couple hours because I was worried about fluid overload from the amount of urinating she was doing.
This brings us to Wednesday morning. I’m was cautiously optimistic that were on the other side of things. We were on serious antibiotics that would completely eliminate PF as a concern – whether external or internal. She wasn’t dehydrated, didn’t have a fever, wasn’t foundering, and looked pretty darn BAR (bright, alert, responsive).
Funder came out and bought me lunch, helped me with my noon treatments and then distracted me for a glorious couple of hours.
And then, at the 4p treatments I temped her at 106.5.
WHAT. THE. EFFFFFF!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
Systemically she looked better than the day before. Not shocky, still pooping and nibbling although she wasn’t drinking as much as I would like (do horses EVER drink as much as we would like?). So I was more frustrated than freaked out, but also really worried. .
I felt like I was running out of time to get a handle on this. NINE DAYS history of fever. And while she was stable that particular afternoon, she was wobbling on a tipping point every day.
On Tuesday I had joked with the barn owner that my horse had malaria. But it was that thought that made me think of other little parasites in our area….
There’s only one thing in my geographic area that I know of that can cause really really high fevers over weeks, that wouldn’t be touched by any medications we had given her so far, that often occurs concurrently with other diseases (like PF).
Equine Ehrlichiosis. “Tick Fever”. My suspicion was only confirmed with several friends on facebook mentioned other cases in the area.
Merrylegs is not totally classic for the disease. Signs such as leg edema and some characteristic bloodwork changes are not present. “Stumbling” is a common sign and she’s not stumbling. Â However, there is something odd and abnormal about how she’s using her feet. She hesitant over thresholds and inclines and is commonly misjudging the approach. I was so worried about founder on Tuesday that I couldn’t really look past any oddity beyond signs that might indicate founder, but Wednesday I realized there was something else.
It took most of yesterday to convince the vets to test for Ehrlichiosis. I was a good client. I did not scream, shout, or demand or call a million times. I was reasonable. I waited longer than I wanted to get a callback with the answer.
I resisted the urge to say all the things clients say to vets that is really irritating.
- It’s just a blood test!
- I talked to my friends and all their horses have it….
- I read on the internet and the signs match….
I am a fourth year vet student. They have shown me an enormous amount of respect and professionalism. The least I can do is return the favor.
I won’t lie. By the end of the day, I was almost ready to treat empirically for tick fever on my own regardless if they agreed. But in the end, the test was decreed a good idea. The point I made was that if it *is* tick fever, then everything we are doing are useless and the fevers will continue to break until we treat for it. And if it isn’t tick fever? Then that is information too, we can continue to do exactly what we are doing with confidence that likely we are providing her what she needs to pull through.
They can do the PCR test in-house, are collecting blood this morning and I should have results this afternoon.
I really really really hope that test comes back positive. Treatment is cheap, relatively simple and carries a pretty good prognosis. If it isn’t “tick fever” and she continues to spike a fever I guess it’s a game of wait and see
And that is where I am now, 9am on Thursday morning. Whether or not I get to do the 50 miler on Saturday will entirely depend on whether or not she still has a catheter in (requires q4 hour flushes), which is really disappointing. I’ve been looking forward to that race for almost 6 months. Sounds silly in the midst of such a crisis. I haven’t lost all hope, but I know it’s unlikely.
Pulling for you, ML!! She is so lucky she has such a knowledgeable and dedicated owner, I know that sounds cliche but seriously.
As ever, let me know what I can do..I’m not the type to insert myself in people’s lives especially in times of crisis, but you know I’m nearby if you need something. Which I hope you know includes riding any of my horses for some stress relief, btw!
Honestly, a ride sounds WONDERFUL. If you are free sometime next week and assuming ML is figured out by then can we plan on it? Put me on something fun and non stressful LOL.
And thanks for the reassurance, even if it does sound cliche. Intellectually I *know* I did the reasonable thing at each step of the journey so far, and even looking back I can’t see where I should have done things differently. Tuesday night I was second guessing how she looked on Tuesday morning (was this all due to massive dehydration? Did I just miss how dehdyrated she was that morning?) but then the blood work came back and said no, it wasn’t *just* dehydration + colic signs that were causing it. So I felt better.
the hard thing is the plan is literally changing every 6-8 hours. It’s been a full time job plus some for the last 48 hours to keep on top of everything.
I was actually watching her legs when you led her out to cold-hose her, and she didn’t look neuro, and I don’t regularly watch her walk, but she did look… tentative. Like she wasn’t 100% sure where her feet were. They were tracking right, but if she was a human I’d say she was thinking about how to walk properly.
YES! That’s EXACTLY how I described it to the vet. I think if I pushed her by forcing her to go at a faster pace over unfamiliar ground she *would* stumble. I think I first wrote it off as pain from PF. And then I was worried about founder. And then I chalked it up to her feeling like sh*t from the fever – but it’s totally neuro and very consistent with tick fever. Crossing fingers crossing fingers crossing fingers….
I’m using “neuro” to refer to not musculoskeletal or pain or mechanical lameness. Neuro is just a way to lump a bunch of stuff into this “other” category. But I knew what you meant by “not neuro”.
Update, I’m going to see if my brother, who takes directions really well and is comfortable with horses will flush the catheter for me Saturday as long as no other treatments need to be done.
Oh, Mel, what an ordeal for both you and ML! I’ll keep praying for you guys, since there’s not much I can do from a distance…but I hope diagnosis and prognosis is good, she improves, and that you get to go to your ride. 🙂
Err…race, that is. 😉 So used to “50” being in the context of a ride that my brain forgot it’s *your* 50!
I knew exactly what you meant! It will be funny if you go through the same thing on your blog – I have to double check ALL my posts before publishing because I use “runner” and “rider” interchangeably and for the wrong events. At the ride and tie me and Funder kept calling the aid stations vet checks.
Keep us posted, Mel. I’m stuck in meetings all day, so I’ll be surreptitiously monitoring y’all via my phone under the meeting room table.
Isn’t it amazing she hasn’t foundered with the high fever for so long – sounds like she’s got a good, strong constitution.
Sending jingles – hope the test clarifies things for you!
After the vet saw her today she said that she’s “tough” and is impressed in 48 hours she has bounced back as well as she has even with the continued fevers. So I’m hoping that’s a point in our favor!
For those of you not following me on facebook, here’s a copy paste up date that I just posted:
ML update: Vet was just out and collected blood. Did a recheck. Lung sounds are the same – neither worse nor improved. However the rest of her looks much improved and both of us remain “cautiously optimistic”. She agreed there is something “NQR”/hypermetric about all 4 limbs so that’s a wait and see thing. If the tick comes back positive then we have our answer, otherwise….well….we will get to that if we have to. Vet LOVED my hospital stall set up. A big thank you to Matthew Newton and Bonnie McIntosh Magill for helping make it happen. One very positive thing I saw was shavings in her coat and mane. I haven’t seen evidence of her laying down since this whole thing started. So sometime this morning between me leaving and the vet arriving she managed to lay down and get back up again. Excellent!
WOW. I’m so sorry this has proven to be such an ordeal. What a lucky filly Merrylegs is.
I used to board at a barn that had a high tick population and several horses there had ehrlicia – some of them more than once. Terrifyingly high fevers. Luckily by the time I was there they ran bloodwork and started doxy as soon as they saw early signs. Tristan never came down with it, but he used to get these horrific abscesses whenever he got a tick bite. They’d blow up to the size of softballs and drain in disgusting ways.
Will be thinking of you both, I so hope to hear good news soon!
My thoughts are with you guys. What a tough mare to put up with all this and keep being strong. I’m on the other side of the country, but if there is anything I can do just ask. Please keep us updated. I am not on Facebook with you, so I am relying on the blog!!
*HUGS* oh, and more *HUGS*
I have a feeling this is all going to be okay for the sheer fact that so many other ridiculously long and amazing races you’ve run this year seem to have been preceded by a sudden decision to go or it seemed to have snuck up on you one way or another or it was preceded by something ridiculous that in no way (at the time) seems to be the proper way to prepare for such a feat. This race was planned for and now it’s got a chance to go awry and make you think it won’t happen. But because all of the others happened and BOOM you were out there and BOOM they were amazing, that’s simply how this one must go, too? The Universe is gonna get you all hesitant and stuff and then THROW you into it just ’cause.
Or at least that’s what I’m hoping.
That’s my story and I’m stickin’ to it.
*SO MANY HUGS* I hope you feel rather squeezed to pieces now. And if not a physical person, which I swear I remember being mentioned at some point in time, then count these as mental support braces present to bolster you through. No touchy touching occurred. 😉
You totally made me laugh :).
And yeah, it does seem like pre planned races are frowned upon in my life. Just look at the year I actually finished Tevis (what a cluster…). Or the Mt. Diablo fiasco. I HAVE LEARNED MY LESSON. From now on, not waiting until the last minute to sign up in order to gaurantee a t-shirt….now it’s last minute as defined as REALLY LAST MINUTE.
Well, you can’t do Western States on the spur of the moment, so you’re going to have to beat the pre-registering superstition at some point or another. Fingers crossed that this is the last of it!
ML update (2:30p): Temperature is still holding steady so have held off giving the banamine that I *could* give her until I see it rise above 102. I really want to see if she can maintain on 2x a day banamine and not 3x. Got my run in (yeah!) and I’ve come home to do a random house chore (trying to get time away from the stable) and then it’s back out to do a temp check. She was getting a bit sassy during my 1pm treatments (silly baby horse stuff) so she’s definiately feeling better. I’ve actually watched her drink out of the water bucket a couple of times and a little bit is gone every time. She was an angel for her abscess care stuff this afternoon and the lanced abscesses look really good – draining a LOT of pus, and the edges of the wounds look pink with healthy granulation tissue. The desitin+vaseline recipe I switched to on Sunday has completely eliminated the skin scald from the draining abscesses and her skin as actually HEALED. And I’m only hosing the abscesses 1x per day. Put away the icthamol and furozone for abscesses my friends – vaseline and desitin are your best friends.
I hope she gets better soon, poor Merry Legs!
From fb:If I was to post a cursed positive status update here (which I am in no way doing…) it would say the ML continues to look better and better and even though is still having fevers systemically is very stable. Still waitung on ehurlichia pcr reaulta. Lungs sound same as tueaday.
Sending healing thoughts your way-
thanks for keeping us updated and I hope you get an answer soon!!
Here’s the story so far: Test results are back for ehurliosis/anaplasmosis/tickfever: negative. Assumption is that we are dealing with a case of internal pigeon fever and that all the systemic signs are related to that. Definitely not out of the woods but we remain cautiously optimistic that she will pull through. Will depend on whether she can handle the antibiotics, whether we can control the fevers (which is what the neuro signs are probably related to), whether the probable abscesses in her lungs progress. or whether secondary stuff ends up happening like colic, fouder, or purpura hemorhagica or other hypersentivity stuff that she is now at risk for.
Oh my gosh. late to the party here.. but my mouth just dropped when I was catching up on blog posts. I am so sorry Mel. I am pulling for you both. Prayers and hugs.
Because I take great joy is surprising people, the fact you came back to this mess highly amuses me :).