FROM THE DESK OF LISA SWERDLOW

MAY 28,2011

DEAR DR. HIGGINS AND FIELDING:

I’m writing to thank you for the amazing care you gave my mare, Sullivan’s Travels.

Sullivan, a 14 year old maiden mare was in her 10^th month of gestation,  315 days to be exact.  I came out one morning and found her teats had waxed heavily and her vulva was elongated and swollen.  I’ve never bred a mare before but I was sure this was way too soon to be exhibiting signs of labor.

I called my ranch vet, Dr. Jennifer Mathers, who came out immediately to check on ‘Sulli’s’ condition.  She was alarmed by how close to labor she appeared and was on the phone to Dr. Higgins right away.  I was instructed to take Sullivan down the mountain to Loomis Basin Equine Medical Hospital, a place I had heard of but had never been before.

My heart was pounding the whole 30 minute trip down the hill.  When I arrived, Dr. Higgins was waiting for us, with a calmness and focus that let me know that she would ‘take it from here’.  Dr. Higgins immediately performed an ultrasound on Sulli to determine whether the fetus was in distress, which it appeared to be borderline, but not critical.  She administered medication to Sulli (Regimate, TMS and Banamine) to try and keep her from going into labor.  It was apparent that Sulli had placentitis and the foal was trying to come out.  At 315 days, Dr. Higgins told me that survival was not in the foals favor.

I left Sullivan in the caring and competent hands of Dr. Higgins and her very excellent staff of technicians and went back to the ranch to pack up special feed that Sulli was used to eating.

When I returned, Dr. Higgins was there to answer all of my questions, which she did clearly and concisely.  Jill made me feel like she got how very special Sulli is to me and that she gave me as much time as I needed to ask whatever questions I had.

Dr. Higgins then called me every morning and evening to give me updates on Sulli’s and the fetus’s health.  I was astounded at what a great communicator she is without my having to prompt her to make the calls. She assured me that Sulli was being monitored on camera 24 hours a day.

When the weekend ended I was nervous about meeting the weekday doctor, Dr. Fielding, as I had grown attached to Jill’s calm and professional nature.  I was so relieved to meet Langdon and find that he was uber-smart and just as professional as Jill.  Langdon even gave me his direct phone number and I could text him my questions anytime of the day or night.

Our goal was to keep Sulli from giving birth until at least 330 days and we succeeded one day more.  On day 331 Sulli gave birth to Gullivers Travels at 7am Easter morning after 16 days in the hospital.  Jill called us at the ranch at 6am to tell us that Sulli was lying down.

We were at Loomis Basin at 6:45 just as the amniotic sack was emerging from Sulli’s vulva.  Jill, Ryan and Dr. de la Cruz were all present and assisting Sullivan with the birth.

Then came our “miracle” baby, Gulliver!  His being born alive and healthy is owed entirely to the excellent care that he received by Drs. Higgins, Fielding, de la Cruz and Ryan, Lindsay, and all the other techies that took care of Sulli for the 18 days she spent with them.

Gulliver owes his life to these wonderful horse loving people who worked around the clock to make sure he was born alive.

Lucie and I can’t thank you enough!

Sincerely,
Lisa Swerdlow
Bit O’Bliss Ranch

Grass Valley, CA

“I don’t know why she swallowed the fly!”

By Diana Rhodes, DVM

Impression in the ICU unit

This is the story of Impression, a 20-year-old Arabian mare, belonging to our very own Dr. Jill Higgins.  Impression is retired and spends most of her time in Northern California in a small town close to Lake Almanor.  She lives on a large green pasture that includes a few small streams, a fact that will become important later on in her story.

A day before she presented to us, she appeared to be mildly colicky, slightly depressed, inappetant and had low-grade fevers.  She was administered a dose of phenylbutazone (Bute) to help bring down her fever, and she was transported to LBEMC.

On presentation she was alert and her temperature was in the normal range.  Her mucous membranes were dark red, and she had no gut sounds.  We immediately started working her up for her colic signs.  Initial blood work showed an abnormally low white blood cell count, low protein, and markers consistent with dehydration. A rectal exam was performed which only revealed small fecal balls in her rectum and doughy feeling feed material in her large intestine.  We performed an ultrasound of her abdomen in order to see how her intestines were moving and to rule out an increased amount of free fluid. Impression’s ultrasound exam showed us that she had a lot of fluid in her stomach and that her small intestines were not moving very well.

We passed a stomach tube to remove some of the excess fluid because horses cannot vomit.  X-rays of her abdomen were taken to rule out the possibility of sand or a stone.  Based on her clinical signs, housing situation, and history, samples of manure and blood were collected to test for Salmonella and Potomac Horse Fever.

While awaiting test results, Impression was admitted to the hospital and started on intravenous fluids, anti-inflammatories, and pain medication.  Precautions were taken to help prevent laminitis.  Initially we also left her stomach tube in place to prevent excess accumulation of fluid in her stomach which results from the decreased intestinal motility.   The following day the blood test confirmed that she was positive for Potomac Horse Fever (PHF).  Eventually, she also became positive to a test of her manure.

Potomac horse fever, also known as Equine Monocytic Ehrlichiosis or Shasta River Crud, is caused by an organism called Neorickettsia risttici.  The disease was first described in horses living around the Potomac River.  The organism can be found in various life stages of flukes, a type of worm that is found parasitizing aquatic snails and aquatic insects, including caddis flies and mayflies.  Natural transmission to horses is thought to occur primarily through ingestion of the aquatic insects that are found around water sources including rivers, streams, and/or irrigated pastures.  The same insects may also be attracted to light sources, such as would be found around a barn, and potentially fall into horse feeders.

Clinical signs of the disease include mild colic, fevers, inappetance, edema, diarrhea (in approximately 60% of cases), abortion and laminitis.  Despite resolution of many of the clinical signs, laminitis is often severe and progressive and contributes to the mortality associated with the disease. While PHF is not a considered a common cause of mild colic and diarrhea in this particular area, we have seen 4 cases of the disease in the past few years here at LBEMC.

The treatment for the disease is an antibiotic called oxytetracycline, which needs to be administered intravenously.  Once the diagnosis of PHF was made we started Impression on oxytetracycline and her condition improved daily.  Impression stayed in the hospital for a total of 6 days.  Impression was lucky because she did not develop laminitis.  She is currently back at home with her pasture-buddy and doing very well!

The successful outcome in this case can be attributed to the early recognition of clinical signs, aggressive supportive care, rapid testing, and prompt institution of targeted antimicrobial therapy.  The absence of complications such as the development of laminitis plays a significant roll in long-term outcome of PHF.

Impression at Home

“Noble Design” is a six-year-old Haflinger gelding owned by Linda and Eric Bickel. He was referred by his regular veterinarian Dr. Scott McIntosh to Loomis Basin Equine Medical Center for further evaluation and treatment of fevers he had for over two weeks. His owners noticed he had also lost a significant amount of weight over the previous month. Because these clinical signs can be caused by many disease processes involving several organ systems, a progression of diagnostic tests were necessary to solve this mystery.

Blood work revealed increased Globulins (antibodies) indicating some form of chronic inflammation. Additional blood samples were submitted to check for internal pigeon fever or strangles which both can cause internal abscesses. His abdomen and chest were clipped and ultrasounded revealing lung changes consistent with inflammation of the lung; no visible abnormalities were found in his abdomen. Also, a belly tap was performed and the sample of fluid was obtained from his abdomen but was found to be normal peritoneal fluid. A transtracheal wash was performed which sampled secretions in his lower trachea looking for signs of inflammation or infection. Thoracic radiographs were taken and they finally revealed the source of Noble’s illness — a pulmonary abscess was found within or next to the lungs.

Pulmonary abscesses are rare and can be formed when a foreign pathogen (bacteria or fungus) invades and the body’s defense system walls off the affected region. The chronic inflammatory response generated causes fever and weight loss to occur. Each diagnostic test performed allowed us to narrow the source of the inflammation and eventually find the pulmonary abscess.

Long term Jugular catheter

Body clip for thoracic and abdominal ultrasound

A long term IV catheter was placed, and Nobel was started on injectable antibiotics and anti-inflammatories. After the two weeks on injectable antibiotics his bloodwork was reevaluated. His globulin levels had not dramatically improved since the previous visit, so he was switched to an oral antibiotic for antother two weeks.

During his next recheck, radiographs of his thorax were repeated. We could no longer see any evidence of the previous abscess, and his bloodwork had returned to normal.

Noble was slowly re-introduced to his regular exercise program and regained the weight he had lost. In these pictures, Nobel and Eric are working cattle just 4 months after his ordeal had started.

This is the story of Kendra, a yearling Gypsy Cob filly. Her owner, Gail DeMarco, had recently imported her from the U.K, and she was sent to Arizona for her quarantine period. When she arrived at the ranch in Shingle Springs, she was dull, lethargic and inappetant. Close monitoring by her owners revealed that she had a fever of 104 degrees. Dr. Matt Judd from Slate Creek Veterinary was called to examine her. He determined that she had a serious pneumonia.

Her owner, Gail, gives her account of the news that she received that day: “When Dr. Matt examined Kendra, he told me that I had to get her to Loomis Basin Equine Hospital because they were prepared and equipped to treat a case of this severity. He told me that she had very bad pneumonia and it was likely that she would not make it. My husband and I immediately took Kendra to Loomis; we were frantic.”

Dr. Fielding and Dr. Higgins confirmed by ultrasound that she had a severe fluid accumulation on one side of her chest and a large pleural abscess on the other. Several liters of fluid were drained from her chest, and this significantly improved her clinical status by allowing her to breathe more easily and effectively. The prognosis given to the DeMarco’s was very poor, but the doctors were encouraged by her positive response to fluid removal. Fortunately, Kendra’s owners had a major medical insurance policy for her, which was extremely helpful in covering her extensive medical care. Kendra’s owners would have given her all the best treatment anyway, but it was a blessing not to have to bear the entire financial burden in addition to the emotional distress.

Kendra spent weeks in the intensive care unit. She received oxygen therapy, intravenous antibiotics, and multiple chest taps to drain recurrent fluid accumulation. She also received intrathoracic injections of TPA (Tissue Plasminogen Activator), which is an enzyme that encourages the degradation of fibrin in her pleural cavity. This is an advanced treatment that is thought to improve long term lung function by allowing more fluid to be removed with each tap and limiting the amount of scar tissue formation. It was a long road for Kendra with months of antibiotics and many recheck examinations. As you can see from the recent photos, Kendra is a BEAUTIFUL, happy, healthy horse and shows no residual effects of her life-threatening illness. Thank you, Gail, for the gorgeous recovery photos and best of luck to Kendra for a long and happy life!

By Andi Foster, DVM

Boy George is an adorable 1-year-old miniature donkey who presented to Loomis Basin Equine Medical Center after being in the wrong place at the wrong time and getting stepped on by a full-sized adult horse. Boy George was seen in the field on emergency and was splinted (despite his disapproval of the plan) and brought to the clinic for further assessment. At the clinic, x-rays were taken of his right hind leg which confirmed a significant fracture of his cannon bone.

Surgery was considered the way to provide him with the best chance at recovery, and he was taken to surgery for fracture repair. During surgery, Dr. Jason Errico applied a transfixation cast which involved drilling sterile pins through his cannon bone combined with the application of a cast around these pins. X-rays were taken during surgery to ensure that the fracture was aligned properly.

Boy George under anesthesia:

Drilling of the pins:

Realignment of limb:

Application of the cast:

Boy George recovered very well from anesthesia and became accustomed to his new cast quite quickly. He went home to recover from his surgery and a few weeks later returned to have the pins removed in a second procedure. This second step also went smoothly and the fracture was determined to be healing very well. Another cast was applied and Boy George had a few more weeks with his new cast. He became more and more adept at moving around in the cast and maintained a very good attitude about his recuperation and stall rest. His third recheck in December showed that he was continuing to heal well and a final cast was applied which remained in place for several more weeks.

Recheck x-rays with cast on — note the bony callous formation:

Boy George still has some time to go before he is completely back to normal but he continues to do well and we all wish him the best on his road to a full recovery!

A special thanks to all the doctors who worked with Boy George:
Dr. Jason Errico, Dr. Molly Dinucci, Dr. Anne Hitchcock, Dr. Jill Higgins, Dr. Langdon Fielding, and Dr. Andi Foster.

DJanna is the mom, Ferradae is the filly, and patience is the virtue that the owners of these two horses possessed in great quantities. In fact, tenacity, faith, and patience are the three important virtues for anyone who chooses to breed mares. LBEMC clients, Sherry and Thomas Musgrove personify these virtues as they demonstrated the utmost faith in their Hanoverian mare, DJanna, and the staff of LBEMC.

On March 21, 2008, DJanna gave birth to a long-awaited foal which, as a bonus, was a filly. She was quickly given the name, Ferradae.

The saga began in 1997 when the Musgroves imported DJanna from Germany. Dr. Greg Fellers endorsed their selection by finding her sound in all respects. Between 1997 and 2003, DJanna was the ideal broodmare. She conceived on the first cycle, produced outstanding foals, and was an excellent mother.

Starting in 2003, the situation deteriorated for DJanna and the Musgroves. During all of 2003 and early 2004, DJanna not only failed to conceive, but she also developed multiple uterine infections which required veterinary intervention in the form of repeated uterine flushes and antibiotic infusions.

DJanna finally conceived in mid-2004, but in late December, she suffered the greatest indignity in the four year ordeal. She began to abort her pregnancy and retained a macerated fetus (essentially the entire fetal skeleton) which required the combined skills of Drs. Fielding, Jacobs, and Morgan to remove. Sherry Musgrove could have delivered a lecture on fetal skeletal structure to the College of Veterinary Anatomy as she captured and cataloged every one of the fetal bones to insure that none were left in the uterus.

Remarkably, after this ordeal, a biopsy of DJanna’s uterus was classified as a 1B (1A is best, 3C is worst) and breeding attempts were resumed. Despite unsuccessful attempts at embryo transfer and a successfully treated uterine yeast infection, she conceived on her first breeding of 2007 and foaled on schedule in 2008. The final icing on the cake was her conception on the first breeding attempt of 2008, putting her in a position to deliver a sibling of Ferradae’s next year.

Ferradae:

The success of this venture comes not only from the patience and faith of the Musgroves, but also from the exceptional cooperation and communication between them and the staff of the clinic. The doctor, staff, and Sherry were constantly investigating and sharing newly published information about advances in equine breeding. Sherry’s careful observation and intuition about DJanna’s estrus cycles led to very precise timing of her insemination. Based on preliminary data about mares, DJanna was on daily aspirin before and throughout her pregnancy and was also on Regumate for all but the last few days of pregnancy.

(Molly Misakian, DVM)

Jacob

Oleander

Jacob in ICU

Jacob at home

Jacob Biles, a 7-year-old male alpaca, presented to Loomis Basin Equine Medical Center on emergency for inappetance, lethargy, and excessive water consumption. Jacob shares a pasture with another alpaca, a llama, goats, and chickens, but he was the only one acting sick. Normally, Jacob avoids being handled and prefers to be with “the herd.” He lives for feeding time and never skips a meal. On this particular morning, however, Jacob allowed his owner to touch him and was not interested in his breakfast. The owner noticed that he was particularly interested in his water.

When Jacob arrived he was lethargic and depressed. On physical examination, his heart rate was decreased, but the rest of the examination was fairly unremarkable. Jacob’s bloodwork, however, revealed some significant abnormalities. His BUN and creatinine were both very elevated, which indicated that he was in renal failure. He also had an elevated blood glucose level and electrolyte abnormalities. Because Jacob had always been very healthy and because his clinical signs developed so suddenly, the doctors at Loomis Basin Equine were suspicious that Jacob may have ingested a toxin, possibly Oleander. Oleander, even when consumed in very small amounts, can cause kidney failure, cardiac abnormalities, and electrolyte disturbances, similar to those seen with Jacob. Oleander poisoning is life threatening, so it is always important to treat patients immediately and aggressively. Jacob was admitted to the hospital and placed on IV fluids to increase blood flow to his kidneys and to promote diuresis. He was also given IV lidocaine, to treat his heart abnormalities. Jacob’s owners went home to explore the pasture for oleander or any other toxic plants he may have ingested.

Jacob did not do very well in the first 48 hours of his stay at the hospital. Overnight, he developed bloody diarrhea (another clinical sign often seen with Oleander poisoning.) He remained very depressed, would not eat, and his BUN and creatinine increased. Because his glucose level continued to climb, he was started on insulin. At this time Jacob’s prognosis appeared grave with the only positive sign being a normal ECG. We continued to treat Jacob supportively with IV fluids and tried very hard to get him to eat. Jacob’s owners did find Oleander on the property, so a blood sample was submitted to UC Davis for Oleander toxin screening to confirm the diagnosis.

In the days following, Jacob continued to be inappetant and to have bloody diarrhea. We decided to transfaunate him by taking the contents from the rumen of a cow and passing it through a tube into Jacob’s stomach. This procedure was performed to replace “normal” bacteria that had been washed from his GI tract by diarrhea. Although Jacob was not eating and the diarrhea continued, his bloodwork began to show improvements. His BUN and creatinine, although still elevated, had come down.

Over the course of the next week, Jacob made a huge “turnaround.” His kidney values continued to decrease towards normal, he became much brighter, and the diarrhea was resolving. We were able to wean Jacob off his fluids once his kidney values returned to normal. Jacob was released from the hospital and returned home to “the herd”. His kidney values were rechecked a few days after he went home, and they were normal! Jacob is currently doing very well. His owners report that he is “back to his old self again.”

Jacob’s blood test came back positive for Oleander toxin, so his owners have removed all Oleander from the property!

Late on a Sunday evening, a very pregnant mare presented to Loomis Basin for emergency evaluation and treatment of a severe colic episode. Infinite, a former Standardbred racehorse turned broodmare, was 355 days in foal (which in the average mare is considered “overdue” though gestation length can vary considerably). She was treated medically with IV fluids and pain medication for her colic symptoms but her pain and systemic stability continued to deteriorate. Based on ultrasound, the fetus began showing signs of distress as well. Colic surgery was determined to be the only way to attempt saving the mare; however, surgery on a very pregnant mare has greatly increased risks as well as increased costs. For these reasons, her owners decided that surgical treatment was not an option for her. Unfortunately, the humane choice was to euthanize the mare.

Trinity with Dr. Fielding:

Trinity on oxygen:

Much deliberation went into what to do with the fetus. In horses, it is very difficult to save a foal that is taken early from the mare, either by C-section or induction. These babies undergo crucial development in the final days before birth and usually do not fare well even a few days “premature”. Because this mare was so far along and was starting to “bag up” (indicating that delivery was not too far off), we decided to try rescuing the foal. The baby was taken by C-section before the mare was put to sleep. Preparations were made to resuscitate the foal once it was surgically delivered. The strong little filly began breathing on her own immediately, but still required immediate oxygen therapy and cardiovascular support. Over the next week, all of her body systems required support to get them functioning on their own: she was fed through a feeding tube, received medications to ensure proper kidney function, and remained on oxygen therapy, received antibiotics and plasma to protect from infection that can occur with an immature immune system.

The autopsy of her mother showed that she had a large enterolith (intestinal stone) that was completely obstructing her colon with the possibility of causing it to rupture; immediate surgical removal would have been the only way to save the mare but that would have greatly increased the risk to the foal.

Enterolith from Infinite:

We are proud to report that this sweet little filly has learned to drink milk from a pan and is now maintaining all of her own needs with properly functioning organ systems! She will be raised as an orphan, but she has such a strong will to live that she will do her mother’s legacy proud! We are excited to watch and see the exciting things that she will do in her lifetime, knowing that we all had an integral part in giving her that life!

Cassandra and Grace with Trinity:

Perpetually Pretty’s 06 colt was very healthy and normal at birth, but, at 10 days of age, his owner, John and Bonnie Ball, found him down and non-responsive in the pasture. Dr. Katzman paid an emergency visit right away, recognized the severity of his illness and quickly referred him to the hospital. Upon arrival, he had a very low heart rate, severe hypoglycemia (extremely low blood sugar), acidemia (acid build up in his blood), and hypovolemic shock (decreased blood volume). He also had seriously elevated liver enzymes, indicating active destruction/damage to his liver tissues. An ultrasound of his liver showed marked enlargement with an abnormal pattern to his liver indicating swelling/edema of his liver.

All of these findings made Dr. Fielding suspicious for Tyzzer’s disease, a liver infection that affects foals in their first month of life. These foals are often found dead before any signs are noticed with the diagnosis made on autopsy. There are only a few reports of successful treatment for this disease. Based on his suspicions and clinical findings, the colt was started immediately on fluid resuscitation, intravenous glucose, and a continuous infusion of a potent antibiotic. He had severely traumatized his eyes by thrashing on the ground before he became unconscious; medical treatment was instituted for his eyes (topical antibiotics, pain medication, etc.).

The colt became responsive once his blood parameters were corrected. He began to show interest in nursing and interacting with his mother. He was supported with continuous IV treatment for several days until his liver had time to heal and start to function normally.

He was discharged to his owners with antibiotics to continue fighting the liver infection and with long term treatment for the ulcerations on his eyes. Dr. Morgan performed multiple recheck examinations of the colt over the next few months and has now given him a clean bill of health without any detectable long term effects. Due to the close attention paid by his owners, the quick action of all veterinarians involved, and the long-term diligent care given, he is now a happy, healthy, very lucky weanling colt.

Second day in hospital:

Home and healthy:

Bandit, a 7-month-old Paint colt, presented on emergency for fevers, lethargy, history of diarrhea, colic and weakness. The most striking finding in his laboratory work was an extremely low protein level in his blood, as well as a very low white blood cell count. The initial goal was to determine where and why he was losing so much protein. Because he was recently acquired by his new owners, he had never been dewormed, which is critical for weanling/yearling horses. Severe intestinal parasitism can cause the symptoms he was experiencing, as can a fairly rare intracellular bacteria that can invade the intestinal tract of horses his age (Lawsonia intracellularis). There is a treatment for Lawsonia, but if he is treated without having the disease, then it can make him much sicker. Ultrasound of his abdomen revealed to us that he did have severely inflamed loops of small intestine, and a belly tap showed us that he had signs of moderate inflammation/toxicity in his abdominal cavity. A fecal exam showed many parasite eggs confirming heavy parasitism, and his half-sister at home had begun passing dead worms in her manure following treatment. We began cautiously treating him for parasitism, as we did not want to kill all the worms at once and cause him to become impacted. Because his condition continued to deteriorate, he was treated also with aggressive supportive care including IV fluids with synthetic proteins, plasma transfusions, antibiotics, intravenous Lidocaine, drugs to control endotoxemia, and pain medication while we awaited the test results for Lawsonia intracellularis. Over a period of a few days, he slowly began to respond to the treatment, became more comfortable, and started eating more. Finally, his PCR test result came back confirming that he was shedding Lawsonia intracellularis in his manure. The combination of the two problems was likely the reason that he was so severely debilitated. He was started on the specific drug for Lawsonia and was slowly weaned off of the supportive treatments. After spending over one week in the intensive care unit, Bandit was finally released to go home. His half-sister at home who was the same age, was also tested for the bacteria, but she was luckily negative. Following a three week course of treatment, he is slowly rebuilding his protein levels, and is regaining the energy and vigor that a normal 7-month-old colt should have! Bandit was very lucky to have such dedicated owners who were determined to pull him through this life-threatening illness.

During treatment:

Postscript: Bandit returned to the clinic for reevaluation five weeks after his hospital stay. His energy and appetite had returned and the diarrhea, lethargy, and fevers were gone. Bandit and his owners left with smiles.

Five weeks later:

Snow Star was first presented at the Loomis Basin Veterinary Clinic in February 2004. She was evaluated for lacerations to the left hind leg and foot. Snow Star was sedated and the wounds were cleaned, debrided and sutured where possible. There were no skin edges to close over the foot or the medial aspect of the cannon bone.

This is the story of Snow Star’s treatment.

Read the PDF article by Blake Brown