Prepare for [almost] Anything

That-which-shall-not-be-said Rule

We learn through social cues that there are certain things you just don’t say and questions you just don’t ask. Like “taboo” topics at dinner, there is a list of phrases that never have a place at the table. This code of conduct was born out of superstition and irony, particularly in emergency situations. Breaking this unspoken rule is a punishable offense, earning the perpertrator anything from a glare to absolute discontempt.

The most grevious offenses are those commited on a Friday with an hour left on the clock, or at any emergency. Any mention of it being a quiet day on call willl surely be met with a hefty dose of animosity from co-workers. Point out that the work-day was slow, and 5 minutes later there will inevitably be an emergency flying through the front doors.

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The Law of Impecable Timing

Along the same lines as the “jinxed” list, emergencies follow the law of impecable timing. If you want to guarantee you receive an emergency call, make any sort of plans. Schedule a haircut. See a movie. Tell a friend you’ll call them at 6. Schedule an oil change for the car. Set a 10pm bedtime. You can even think to yourself, ‘I’ll finish that load of laundry when I get home.’ That load of laundry will be mocking you six hours and two ERs later.

The law of impecable timing – it’s a thing.

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The Art of Preparedness

I was on call last weekend, but made plans to meet friends for coffee at 9AM. And like clockwork, mid-order, I received an ER call at 9:04. The barista mouthed the words, “your usual?” She knew the deal.

The hysterical voice was difficult to understand, cutting in and out with fragments of sentences. I caught snipits as she recounted events: police siren, car honking, horse reared again, fence broke, bolting around, fence attached, cut up, blood, painful, shock, trembling, wounds, won’t put weight on the leg.

Monroe, a 7 year old paint gelding, had been tied to a fence. Spooked by the police sirens racing by, he reared back and broke off the part of the fence he was secured to. He bolted, the section of the fence chasing him through the paddock. I left the coffee shop, triaging with the owner over the phone. We were coming up with a plan she could put into action while I made the 30 minute drive to her house.

He was bleeding. No bandaging material.

He was pacing, unwilling to bear weight on one leg. No extra lead rope.

He was trembling. No banamine. No bute.

Only one laceration required stitches, and the remainder of the wounds were small, superficial cuts and abrasions. By the time I arrived, he was also willing to walk on the injured leg. After the initial assessment and treatment, there didn’t appear to be any life-threatening injuries and he was already looking more comfortable. As we were getting ready to depart, the owner approached my window. “Do you guys have an emergency kit or something that I can buy? I’ve never needed one up until now and I want to be prepared next time.”

The list I gave her sparked the idea for this post.

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Equine Emergency First Aid Kits

You can spend a pretty penny buying ready-to-go kits. A quick google search will show you that kits range anywhere from $75 to $1,000. I put together a list of supplies that I would recommend for a fairly comprehensive emergency kit.

Most of the medications are prescritption and would require a vet to sign off on dispensing them. These are medications that I would be okay with clients having on hand, so long as they were routinely seen for annual exams (established doctor-patient relationship regulations).

ESSENTIAL SUPPLIES OF AN EQUINE FIRST AID KIT

KEY ITEMS

• Thermometer
• Stethoscope
• Headlamp
• Spare Halter & Lead Rope
• Gloves
• Clippers
• Hoof pick
• 60ml dosing syringe

BANDAGING

• Bandage
• Scissors
• Non-Sterile Gauze – 4″x4″ Squares (1 package)
• Elastic Adhesive Bandage (Elasticon®) 3″ (2 rolls)
• Cohesive Bandage (Vetrap®) 4″ (2 rolls)
• Non-Adhesive Wound Dressing (Telfa® pads)
• Non-Sterile Gauze – 4″x4″ Squares (1 package)
• Elastic Adhesive Bandage (Elasticon®) 3″ (2 rolls)
• Cohesive Bandage (Vetrap®) 4″ (2 rolls)Non-Adhesive Wound
• Dressing (Telfa® pads)
• Rolled cotton
• Brown gauze (2 rolls)
• Baby diapers
• Duct tape

SOLUTIONS AND SCRUBS

• Betadine® Solution (4 oz)
• Chlorhexidine solution
• Bottle of isopropyl alcohol (1/2 gallon)
• Paper Towels (1 roll)
• Chlorhexidine solution
• Bottle of isopropyl alcohol (1/2 gallon)
• Paper Towels (1 roll)
• Sterile saline (1 liter)

MEDICATIONS

• Electrolytes (paste or powder)
• SSD ointment
• Bute
• Banamine
• Trimethoprim-Sulfa Tablets (SMZs)
• Acepromazine tablets
• Dormosedan gel
• Mag60 paste

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KITS AND CARTS FOR AN EQUINE FIRST AID KIT

The other part of the emergency kit is the actual kit itself. I prefer to use hard-sided containers or carts, because bags and cloth can easily become wet/mold. Replacing everything in the kit because of a water leak, spills, manure etc.. would be quite costly. I don’t recommend cutting corners on whatever carrier you use. I’ve seen some barns buy surplus medical crash carts, stackable tool organizer kits from Home Depot etc…the nice thing is all the supplies can easily be moved by one person, vs. grabbing individual bags/boxes.

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Other considerations …

On the subject of preparedness, I would recommend having “cheat sheets” or info-posters reviewing what constitutes an emergency and very brief info on what common horse emergencies are. A diagram of basic horse anatomy and vitals would also be helpful. Below are some examples of these materials.

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On-Call Days

Down-time and Silent Days

Making the most of it

There are on-call days when the phone is silent. This silence comes with its own secret recipe for stress…4 parts foreboding for 1 part paranioa. It can feel like the longer the silence, the more intense the impending ER storm is going to be. It took me awhile to figure out what to do, or not do, during down-time while “on-call.” After trial and error, I have developed strong on-call-but-not-on-a-call habits. When I first started taking on-call, it felt normal to be poised by the cell phone just waiting for it to ring. When an ER did ring, I could spring into action and be out the door in less than 5 minutes. But when the phone didn’t ring, a faint feeling of regret would creep in. Not only did I feel that the day was (personally) wasted, but I also felt (professionally) unfulfilled.

For me, utilizing down-time while still on-call is essential for avoiding burn-out, promoting work-life balance and reinforcing the truth that work has not become my life. When I say utilizaing, I mean being productive enough that time doesn’t feel wasted in wait for an ER than never comes. On the other hand, any project that is started has to be one that can be dropped at a moment’s notice. But on silent days…I still check my phone a minimum 5 times/hr, confirm max volume 2 times/hr and check that airplane mode is not activated once/hour.

My most recent day on call was anything but silent. Between 7:30am and 11:30pm, we had attended 7 emergencies and saw 2 add-on appointments. That’s a full day, especially during the slow season. As I drove home at 1am, I found myself running through the day’s events and eventually mulling over two emergencies in particular. It wasn’t that these two emergencies were clinically distinct, fascinating or dangerous…in fact, they are both circumstances that I would normally shrug off as inconveniences of the job. However, I think the nature of the two circumstanaces is important when gaining perspective into a day-in-the-life of a veterinarian.

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The “Nevermind” Emergency

The ER call rang 15 minutes before the start of our doctors’ meeting. Susan, who was not a current client of our practice, was frantic over the phone. While in the midst of explaining what was happening with her mare, she repeatedly interrupted herself to say

“My vet’s not answering. I can’t get ahold of my vet. I don’t understand why she’s not answering.”

I can imagine how confusion, fear and panic in the moment, is exacerbated when a client’s trusted lifetime vet of 15-20 years is MIA. Tone of voice, pitch, inflection and word-choice can paint a vivid emotional picture, especially of the client feeling pain and confusion brought on by a sense of abandonment. On rare occasions, bitterness and resentment are aimed at whichever vet does respond to the call. From firsthand experience, this type of treatment from clients is hard to swallow.

“Shelving” Client Mistreatment

When it comes to professional advocacy, I think simply swallowing mistreatment from clients does the profession a disservice. In my opinion, having the issue temporarily “shelved” vs. simply swallowed, establishes a line between acceptable and unacceptable behavior. While I don’t think disrespect is something to just “put up with,” having an open discussion requires a particular environment and mindset that emergencies cannot always afford. Bottomline: In order for me to do my job, I have to focus on the reason I am there. This means “shelving” issues that are not imminent or critical.

On the otherhand, I know some vets get upset when they are called only as a “last resort.” Sometimes, clients say that.

“I am only calling you because my vet is out of town.”

“I just need a vet, any vet.”

“I wouldn’t be calling you if I had other options.”

I take these comments in context of the extremely difficult circumstance the client is in, the difficult spot this puts their vet in and the fact that I’m here to help. This thought process keeps the negative thoughts at bay. It also helps that I am an empath by nature.

8 minutes away

Returning to the ER at hand…I kept Susan focused, making sure she was in a safe situation, the mare was contained, and gave her a few minutes to call me back with their physical address. Caught up in overwhelming situations, sometimes you can’t remember how to spell your own name. In this instance, she had to find a piece of mail so she could read off her home address. According to GPS, we would arrive at Susan’s in 45 minutes. During the first half of the drive, the office relayed two other ERs to respond to. When my phone rang again, I recognized the number as Susan’s.

In my experience, when a client calls while you’re still in route, it is for one of three reasons:
– The situation has become dire, they are panicking and have lost all sense of time
– To find out where you are because it’s past your original ETA
– They are canceling the farm call for one reason or another

I answered the phone as google maps’ estimated ETA read 8 minutes.

“I actually don’t need you to come out. My vet just got here.”

This isn’t too uncommon that another vet beats you to a call, either because the client called other vets to see which would arrive fastest or because their regular vet returned their call. I will be honest, this is frustrating. I wished Susan and her horse the best.

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Order of Operations

Determining Which Emergency to See First

When faced with multiple ERs, I prioritize based on severity, urgency and the potential risk to human safety. Numerous times, I’ve been less than 5 minutes from the ER when the client calls to let me know that another vet showed up. This ultimately ends up in re-routing, lost time and money, but most importantly, an unnecessary delay in rendering aid to other patients and clients. Our policy is to bill an in-route cancelation fee, but I have yet to follow through with this. With new clients that don’t have established payment methods with us, pursuing payment is nearly impossible.

I understand the panic and desperation owners feel when their horse is injured or sick. In a situation of overwhelming helplessness, the only help they can provide is getting a vet on the premises. For this reason and out of empathy for clients in these scenarios, I have not had it in me to bill them a cancelation fee. And then there are those rare occasions when the driving force behind a client’s actions are not driven by shear concern, fear and panic. There are times when a client’s motives and intentions are not upfront or even honest…

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ER Disguises

Critical, urgent and not-so-urgent cases

The second emergency was located 45 minutes south, within a mile of our office. It was a choke, which resolved mostly on its own by the time we arrived. As we were finishing up this second ER, the office alerted us to another emergency. Now, the ER waiting list included a mildly painful colic, a moderately painful colic that did not improve with banamine, and a laceration that had significant, uncontrolled hemorrhage. Despite pressure wraps, the owner could not get the bleeding to stop and she feared the horse would bleed out soon. We headed straight to the laceration emergency, ready to face a chaotic, blood-soaked scene upon arrival. As we pulled up to the barn, I could hear laughter and followed the voices to a small group of people standing around a bay polo pony in the wash rack. There wasn’t a drop of blood in sight, and pony appeared healthy enough.

“I’m here for an emergency, do you know where the horse with the laceration is?”

A middle-aged woman and what I presumed was her daughter, nodded.

“This is him. This is Emo.”

For a moment, I thought I had made a grave mistake and navigated to the wrong emergency (the mild colic). I reached out for something to say, still confused and mortified that I had made this profound error. The woman turned to look at Emo, walked over to his right front cannonbone and pointed at a scrape…a two inch long superficial abrasion with only the hair missing.

“I don’t know how he did it, but he managed to lacerate his leg here.”

I thought I had gone crazy, but was much more horrified upon realizing that this scrape was the previously described uncontrollable hemorrhage. She must have read my face.

“I didn’t want to be waiting around the barn all afternoon, so I might have exaggerated a little over the phone.”

She chuckled sheepishly. The other people started to dissipate once the uncomfortable silence kicked in. On an untimely cue, my assistant came huffing down the barn aisle with arms full of wraps, suture and scrub kits, fluids, clippers and even a tourniquet tucked into the v-neck of her scrub top.

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You never know what you’ll find

Prefacing this post with a disclaimer: Graphic wound images are contained in this post.

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After working with particular clients enough, you get a feel for what kind of emergencies they do and do not call about. Depending on experience, knowledge and comfort level, some may call for a tiny cut or they may only call when it appears their horse may bleed-out. And with others, you never know what you’re going to find.

One of our clients left a message on the office phone the night before. Her mare had sustained a wound to her haunches that she thought might heal well on it’s own. She described the wound as superficial, probably a kick from a pasture mate. She said the wound was not bleeding and you couldn’t see any real obvious wound. She didn’t want to pay an emergency fee because finances had been tight, so the office asked if I was willing to work her into the busy day. Fortunately, we were running early and finished up with the day’s appointments a couple hours sooner than we thought.

On arrival, the small palomino mare was in a pen. I had seen her a couple months ago for a face laceration, and before that, an episode of choke. The mare was always suspicious as we approached her with a tote of supplies. Almost an entire roll’s worth of tape had been used to secure a bandage over the right gluteal muscles. As I pulled the sheet of tape off, I saw the soaked maxi-pad that the owner immediately commented on. “I figured, what’s more absorbant than a maxi pad, right?” I removed the maxi-pad and was surprised at the severity of the wound. It was definitely a wound requiring attention, and not superficial in the least.

The wound at first glance.

An L-shaped laceration resulted in a large flap of skin. Beneath the flap of skin, was a deep gaping wound extending several inches into the underlying musculature. The owner must have read my expression because she soon asked “It’s bad, isn’t it?”

“It is big, and it is deep. But luckily, this is fairly fresh.”

After clipping some hair, the large triangular skin flap became apparent

We set about clipped the area, scrubbing the wound and exploring the extent of the damage. Meanwhile, the owner wracked her brain about what could’ve caused the wound. Most of the time we never find out what happened. It is unnerving, knowing that what sharp object inflicted the damage, still lurks in the field with the possibility of a second offense.

Determining the extent of the injury

The front half of the laceration was sutured together easily enough. Dead space was minimized with a deep layer of sutures, and the skin was re-opposed with simple interrupted. Since some dead space existed, and considering the extent of the wound, a Penrose drain was placed. The mare was started on Excede, with the plan to add SMZs due to expense. Bute and SSD were also dispensed. The owner would continue on-farm care involving flushing the wound and readjusted the drain daily. Vaseline was applied to prevent scalding of the back leg from constant drainage that was sure to ensue.

Based on the location, a simple bandage was not possible. We put in 8 stay sutures that would allow us to feed a shoelace through just like you would a tennis shoe. This shoelace method, a tie-over bandage, would secure a clean towel or pad to the wound. Unfortunately, I did not remember to take pictures of the finished work.
In 4 days, the drain will be removed. If the skin flap survives, the owner will continue to flush the wound daily and may also end up packing some of the wound with gauze. However, profound swelling and reduction of dead space, did not allow for room to pack the wound.

It has been a couple days now, and due to financial concerns, the owner could not afford for a recheck. We will be back to remove the external sutures in 10-14 days, and next time I’ll be sure to take more pictures.

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The Doctors’ Meetings

Every other Friday, before each doctor sets out for the day’s appointments, the four of us meet at the only diner in town. Our practice sits on the edge of a quaint town with no need for a single stoplight or stop sign. One of only two restaurants, the diner is nestled in a row of buildings that look straight out of a stagecoach western. State patrol frequently choses this humble eatery as the location for their change-of-shift. On those particular mornings, the diner’s small gravel parking is overrun by patrol cars. This is also the only time when the town experiences traffic as a result of overly-cautious commuters going 10 below the 25 mph speed limit.

Our doctor meetings are held over breakfast, with discussion prompted by 2 or 3 items on the “doctors meeting list” or DML. Items that make it onto the DML come from a wide range of topics, vary in importance and certainly are not guaranteed to stimulate rivoting conversation. Over the past couple months, items on the DML have include updated pricing, barn packages, changes to inventory, on-call schedules, charging tax on products, assistant performance issues, standard protocols for packing equipment, damaged or missing equipment, new drugs we’d like to have on hand…etc.

Once the items on the DML have been checked off, there is an end to the meeting formalities. This is when the meetings get interesting. This is my favorite part of the doctors meetings, when I get to revel in the hard-earned wisdom of seasoned vets.

Case discussions.

It starts off with one of us seeking input on a particularly challenging case. Without fail, it leads to the opening of the case discussion floodgates. In discussing one case, someone inevitably remembers a case they would like insight on…which triggers another doctor to bring up their recent patients and so on.

I call it the case dominos effect.

These dominos turn half-hour meetings into 1.5 hour meetings, subsequently making us all late to our first appointments and causing a chaotic post-meeting scramble in the office. While fascinating and rich with info, there is another reason I look forward to these talks. Its the environment that has been created for the conversations. The table is a safe place to talk openly and without fear. There is no room for judgment, shaming or belittling. These moments are key to nurturing a honest, sincere comradery between colleagues and fosters a strong sense of moral and unity…things I have rarely seen in multi-doctor practices. In an effort to net suggestions or help from our combined 48 years of experience, we also create a robust support system and receive encouragement.

And there have rare occasions when our conversation divulges to less professionally astute topics in veterinary medicine, like the newest gossip about neighboring vets and practices. That’s a subject for another time, and a deserves it’s own blogpost.

And if the DML is blank? We still meet for breakfast because that’s just a pleasant way to start the day.

Treating more than the horse

We treat more than pets. Legally, of course. The person attached to our patient is just as important as the patient itself. Whether it is an annual exam or late night emergency, attending to the client is, in essence, attending to the patient. Help the client to help the horse. I think there are floating misconceptions among some vets, and about vets, that our profession only serves the patient part of the equation. By ignoring, negating or dismissing the client half of the equation, I believe vets are neglecting the very reason we even have a patient…that someone reached out to us.

Why did you become a veterinarian?

I’m always curious to hear other veterinary professionals discuss their reasons for choosing this profession. By far, the overwhelming majority of answers are centered around a core feeling of compassion/love for animals, coupled with a desire to maintain, improve and advocate for animal health. On a rare occasion, I hear a starkly different answer along the lines of “because I don’t like people.”

People and Medicine

The “because I don’t like people” reason strikes a contrast with the more common reason. Firstly, it comes off as void of sentiment and does not even mention a regard, concern or care of animals. In fact, there is no mention at all of the locus- animals. Second, the veterinary profession is comprised of and dependent on people. People infiltrate the entirety of veterinary medicine, filling diverse roles such as colleagues, professors, CE conventions, receptionists, assistants, lab technicians, owners, trainers, buyers, caretakers, transporters, state and federal government personnel, pharmacists, sellers, externs, drug reps, students…

There’s comical memes out there about this very reason for becoming a vet. Or similar ideology such as “the only thing I like about you is your pets.” I appreciate the humor. Truth is, this is a sincere reason for pursuing a DVM according to some. I’ve never heard a practicing veterinarian cite this reason. The only subset of people I’ve heard use the “Because I don’t like people” are vetmed hopefuls.

Ideal vs. Real

Veterinary hopefuls seeking a career free of people, are bound for personal and professional disappointment. Travel the road to DVM long enough, and it becomes unmistakably clear that the there can be no veterinary field without people.

Over the last year and half in private practice, especially as an equine practitioner, I have become increasingly aware of the importance of people skills. Not just refined communication skills and strong bedside manner, but the ability to perceive, listen, collaborate and recognize client needs. Especially as an equine practitioner, we are on the forefront of this interface and often times dealing with all interactions one-on-one. Back to the basics, there would be no patient if there was no owner caring to have their pet seen.

Don’t like people? Doesn’t mean you aren’t capable of being a veterinarian. There is already a tremendous, seemingly infinite list of inherent challenges that come with the job. Adding another parameter obstacle, not only increases this weight of challenges…but I imagine it becomes a thief of what would otherwise be some of the richest, most rewarding experiences in veterinary medicine. Even more detrimental and profound, is what this limitation means for the care of the patient, quality of medicine and overall health of the profession.

I’ll say this. You don’t have to be a social butterfly or extrovert. Plenty of “I”s in the vet field. But if you don’t like people, maybe one of the most rewarding outcomes of joining this profession will be a change in heart.

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Thomas

There are certain patients and clients you know you’ll never forget. Some cases that almost haunt you, arising from the subconcious on a whim. Little reminders seem to be hidden in tiny corners and crevaces of every day life. Whether its meeting a person or horse with the same name, diagnosing another patient with the same disease, or even sitting at AAEP lectures with the topic being similar in nature…a horse with a similar disposition, or sometimes just a single word on a billboard. It seems just as time has gone by, there is a reminder somewhere that brings the memories trickling (sometimes flooding) back.

This is the story of Thomas, one of the cases that for many reasons, I will not forget.

I first met Thomas in January for a routine dental and vaccines. His owner, Emma, had been referred to me by the practice that performed his pre-purchase exam only a month prior. His PPE had gone smoothly with no significant abnormalities found during the extensive work-up. The owner wasn’t able to attend this first appointment, but the trainer was present. She lead the handsome young gelding into the washrack. Just watching him walk into the washrack, I could see incoordination and exagerated gate in the hind end. His hind feet were parked oddly out from under his body, with his front feet almost ontop of one another. He stumbled and stepped on himself multiple times in the 5 minutes I spent observing. He had a slight head tilt to the left and the left side of his lower lip drooped. The nature of the appointment instantly changed, with the focus turning to neurological examination instead of a routine dental.

The findings of the neurological exam revealed cranial nerve deficits, especially noteable on the left side. Facial nerve paralysis, the head tild and decreased pupillary reflex times were the most significant CN abnormalities. On dynamic assessment, he had a grade III hindend ataxia and grade II bilateral forelimb ataxia. He had assymetrical muscling of his gluteal muscles, with the right being much more extreme than the left. He had marked weakness during the tail-pull to the right, at one point he almost fell over. Given the cranial nerve deficits and generalized ataxia, we decided to rule out a top differential of EPM. He had neck radiographs taken at the PPE, which after second review, were normal. No traumatic events were in his history.

His EPM titer results came a week later. The titer levels were high, indicating a 95% likelihood that his signs were attributed to EPM. We moved forward with a standard treatment protocol of daily Ponazuril and Vitamin E. In a month, we would return for a recheck neurological exam.

We continued the Ponazuril another month, during which his imrovement plateaued. Emma, opting to give him every fighting chance, elected to try another EPM medication called Protazil. After a month on the protazil, his recheck exam found significant improvement. His neurological signs had improved enough that now a right hind limb lameness became apparent.

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5 months later

Now 5 months after diagnosing the EPM, with most of his facial nerve and ataxia signs resolved, we moved forward with his routine care. His vaccines and dental went without complications and he continued to receive his bodywork and acupuncture. I’ve held some skepticism in thepast, but the bodywork and acupuncture had a profound effect on his physical and mental state. He looked brighter, moved easier and the right hindlimb lameness was resolved.

A month later, I received a text that he had relapsed. The same day, I went out to exam him,. He was dull, quiet and his neurologic abnormalities at returned worse than before. After heavy consideration, Emma made the difficult decision to let him go. Unfortunately, for insurance to cover the costly treatments and reimberse for all the money spent, a necropsy at a certified facility had to be performed. I won’t name the insurance company, but I will say that how all the details were handled was grotesque. The insurance company required that Thomas’ necropsy be performed with 8 hours of his euthanasia. Since the only lab near by was 6 hours away, and since Thomas was not safe to transport, it took detailed coordination between all of us to meet the time constraints. In the veterinary field, you develop a way of talking about these things in a tactful, professional manner. I have never had a client involved in the details of this process, and honestly, I had never been involved in planning such intricate, time senstive logistics. The whole process was heartbreaking and gruesome for Emma, a nightmare for anyone whose beloved companion becomes an object, entity or commodity to company policies. I admire her and all of the strength she clearly showed through this painful process.

To meet the time constraints and laboratory hours, we had to euthanize Thomas in the middle of the night. After working that day, I set my alarm for 12am so that I could make it to the barn by 1 am. His transportation (provided by my assistant) would deliver him to the lab between 7 and 8 am. I set the alarm, just in case…but I definitely did not sleep. I had discussed his case with multiple internists, researched novel treatments so extensively that anytime I went onto google, it asked if I wanted to search new research in EPM. Although I was confident in my diagnosis and that the treatments we had done were the present gold standard, there was still that little voice whispering “but maybe…”

We arrived at the barn just before 1am. We placed the catheter, sedated Thomas and lead him out of the barn. Fog had crept in and it was starting to rain. Then, it started to pour. I remember the syringes being slippery, and all of us squinting through the beams of the headlamps as we laid him down under using anesthetics. He went down gently onto his side, deep in a sleep state, before Emma gave the gesture to give the final injection. Within minutes, Thomas was gone.

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Answers

It was 2 weeks before the necropsy results came back. The trouble with EPM, is a definitive diagnosis is not always possible even with necropsy and microscopes. The chances of identifying the organism, especially after months of treatment, becomes slim. My fear was that the necropsy would not identify the organism anywhere, and determine the cause of his neurological disease indeterminant. When I read the results, my heart sank. No EPM organisms had been identified on necropsy and histopathology. But down, at the very bottom of the extensive report, a note said that the abnormalities found in the spinal cord were consistent with those seen in EPM.

We had all reached a point where we wanted answered. We wouldn’t get the answers as to why he suddenly relapsed, or why he didn’t respond to treatments like some horses. EPM, the heartbreaking disease that it is, can do anything at any time…making it a challenge and yet another disease warranting further research.

We did not get the answers we wanted, but we did get the answer we needed.

At a horse show a couple weeks ago, I ran into Emma. We small-talked a little, and she hugged me before we parted ways. She expresed sincere gratitude for my efforts. She said one day she might look at bringing another horse into her life, but that she isn’t ready. I returned the hug. Sometimes, at the end of it all, that’s all you can do.

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Click here for information on Equine protozoal myeloencephalitis (EPM)

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