“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.

Tercio

The wire can be seen above a thin layer of sand

Repeat radiographs one week later

Dr. Errico & Dr. Inoue locate the inflamed bowel

Radiograph of the removed section of small intestine to confirm the wire's location

Tercio is a 19 year old Peruvian Paso owned by Kathy Keenan of Loomis. He presented to LBEMC for inappetance and weight loss. He was initially examined in the field by Dr. Anne Hitchcock and had a fever, increased heart rate and respiratory rate with labored breathing.

He came into the clinic for further diagnostics. His blood work revealed changes consistent with an ongoing inflammatory response. Abdominal radiographs were taken and to our surprise a small radioopaque foreign body (suspected wire) was seen in his ventral abdomen. A belly tap was performed where we take a sample of the fluid surrounding his intestines. Normal abdominal fluid is straw colored and clear. Tercio’s abdominal fluid was essentially pus which indicated that an advanced peritonitis was the cause of his fever, weight loss and inappetance. This peritonitis was most likely a result of the wire perforating his intestine as it moved along his intestinal tract.

Tercio was started on injectable antibiotics and anti-inflammatories. He was offered anything he would eat which consisted of everything from fresh grass to equine senior. A long term catheter was placed in his jugular vein since he would be on antibiotics and anti-inflammatories for severalweeks. His abdomen was clipped and a thorough abdominal ultrasound was performed. On ultrasound we could see thickened sections of the wall of his small intestine as well as his large colon. Radiographs were taken again after he had been in the hospital for 5 days. The wire appeared to be in the same location.

Wire removal surgery can be very risky due to the fact that the intestinal tract is approximately 100 feet long and, because of attachments inside the abdomen, not all of the intestine can be exteriorized outside the abdomen for safe access to the foreign object. Also, it is not ideal to perform abdominal surgery on a horse that has infectious peritonitis because this could compromise the integrity of the closure of the abdomen and increases the risk of an incisional infection. The concern was that if we took him to surgery and were not able to find the wire we would not have gained any ground in improving his condition. However, the wire needed to be removed in order for Tercio to heal.

OnceTercio was stabilized, he was taken to surgery for an exploratory celiotomy. In all of the radiographs, ultrasounds and even with the use of a metal detector, we felt fairly certain that the wire was staying put just to the left of midline on his ventral abdomen. He was anesthetized and laid on his back on the surgery table. A mass of small intestine was found that was adhered to itself, the apex of his cecum and his left body wall. These three structures should not be attached to one another. The adhered cecum and small intestine were freed from the body wall. The cecum was freed from the small intestine. The wire could not be palpated but the discreet section of inflamed and hemorrhagic bowel seemed to be the only place where the wire could be located. To remove this portion of small intestine, a resection was performed which removed approximately six feet of small intestine in his proximal jejunum. Radiographs of the piece of bowel removed confirmed the inclusion of the wire. Tercio had an excellent recovery from anesthesia and did well in the hospital postoperatively.

Tercio is currently being rehabilitated in order to give the abdominal incision time to heal properly. All horses with ventral midline incisions require approximately 90-120 days of rehabilitation before they are back to full work or full turnout. Tercio is no longer being ridden due to his Degenerative Suspensory Ligament Desmitis which affects many Paso’s. But he is eager to be turned out in the field where he is the leader of two sheep.

Horses are usually very selective eaters, but we do see wires and nails occasionally causing problems for horses. This can be a life threatening condition and Tercio was lucky to have a dedicated owner that supported him through this.

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