June 28, 2015

Positive Thoughts Needed for Gem

WARNING: Graphic pictures in this post

Saturday started like so many others before and ended in a way I have both never experienced and hope to not repeat.

Around 2:30 pm we took both the truck and van to the barn. The plan was to trim Pete, say a quick hello to Gem and attach the new tie rings to the trailer. I wanted to hook the truck up Saturday and take the van home with my boys to add any minute of sleep I could to Sunday morning. I was going to be up at 4:30 am to get 20 miles in before the heat showed up.

It all fell apart pretty quickly.

Dusty pulled Pete from his pasture and he was 3 legged lame on the left front. Pete has never been lame and is not in any work right now. We probed and picked and poked, but didn't find any abscess, heat, or areas that would shed light on the issue. We put him back out to check on him Sunday and hoped that it either went away or declared itself.

Wyatt and I picked blackberries along the mare fence line while Dusty attended to Pete. Gem was watching me from the far side of her pasture and I yelled out a hello, but didn't go in to see her.

Next we went to the trailer and we were both kinda sour by now with worry over Pete. Dusty quickly realized that he didn't have the correct drill bit and his mood went even farther down the drain. It was getting late and Wyatt was tired, hot and hungry. We all needed a break so we left to head to Lowes and get the correct drill bit. I figured I would see Gem in the morning, so no big deal.

Well, it was a big deal.

We went to Lowes and got the stuff and when we got back to the van I had a missed call from the BO. I went to check my voicemail figuring it had something to do with Pete and then he called Dusty. All he said was that Gem was cut, bleeding and needed stitches.

We went back to the barn.

Fortunately for Gem's sake, another boarder had gone out to get her mare and noticed Gem was bleeding. She did the right thing and caught her to bring her in to the barn. It was bad. The BO put her in a stall and wrapped it as tight as he could then called us.

This is all we saw when we got back to the barn and pulled her out of the stall and into the cross ties. Lots of blood. At this point we figured it was bad.

We added more wrap to her hoof and called the vet. She used the hoof just fine and was acting normal other than the blood squirting out of her leg every time she moved. Our regular vet was 1 hour out at best, so we called the vet the barn uses. We don't use them for two reasons - 1) they charge double what everyone else does in town and 2) they aren't friendly. They were 40 minutes out, so we said to come out and we waited.  The on call vet told Dusty that no horse has ever bled to death from a hoof laceration. I want to call him back and tell him a thing or two.

We settled in and waited. My parents showed up to help with Wyatt and kept him busy so Dusty and I could both attend to Gem. I also texted my friend Sheree in a panic and she did her best to calm me down.

The blood just came squirting out with her every move and it was bright red - not venus blood. We knew she cut an artery of some sort. We kept adding gauze and more layers of wrap and just felt helpless while we waited. 
The vet showed up and had an attitude a mile wide. He came to the wash stall and said to walk her out of the barn and all the way up front to his truck so he wouldn't have to carry his stuff over. The walk left bloody footprints the entire way.

Once out front, he gave her a sedative and took the wrap off. It wasn't good.

At the barn in the driveway. We saw lots of blood and exposed bone. 

She had cut through the medial heel bulb, but he couldn't see if the flexor tendon was cut or if she got into the coffin bone. 

We talked options. He recommended we go to Tryon Equestrian Hospital where they have board certified equine surgeons and even a vascular surgeon on staff. He said that he couldn't suture it himself with any confidence that it wouldn't get infected or die off. I looked over at Dusty and with tears streaming down my face, I said ok. Make the call and refer us.

He did tell us that we did a great job wrapping her which saved her losing even more blood. I was actually beginning to like him a bit at that point with his direct, but kind way of letting me know what was going on and what the best choice was. Until he confirmed the referral and then just started admonishing us for not using them for our regular vet. Seriously, as he re wrapped her up and then got the paperwork sorted all he did was grill us on why we don't use them and then go off on how it would be better if we did and all the benefits of using them. Yeah, this is why we don't. If I had any inclination to switch vets, he had killed it off right there.

I called my brother to see if he could take Wyatt for the night knowing it was going to be a long night. He had spent the morning moving into his first self owned house and I felt bad having to ask, but my parents had said they couldn't watch him. My brother agreed, but after the vet left I told Dusty to take Wyatt home and I would go alone. We didn't need to drop off a tired, hungry and cranky Wyatt.

I asked the vet to reverse the sedative and he said he has seen horses hauled sedated all the time. I was annoyed that he wouldn't reverse her or give her anything for the pain. Have you ever tried loading a drugged up horse with massive wrapping on a cut and bleeding hoof while you are crying your eyes out? It isn't easy and it took a long time.

Eventually I was on the road. The hospital was only 45 minutes north in NC and the route was pretty much all highway. It was nearly 7:00pm by this time.

When I pulled into the drive they met me outside the hospital. They asked how lame she was and I told them she wasn't at all, so we unloaded her outside. I went in the trailer to clip her lead rope on her and they undid the back doors. When I came around back to unload her I saw their expressions at the pool of blood on the trailer floor. Even with he vet's wrapping, she continued to bleed everywhere.

We got her inside the beautiful facility quickly. The head surgeon was there as well as an intern and a skilled tech. We led her into the x ray room to take a closer look and she unwrapped her hoof. Blood squirted across the room. The vessel was shooting blood everywhere. She had cut a pretty big artery to the hoof.

She quickly accessed the situation and asked for a hemostat to clamp off the artery only she couldn't get it so Gem went into yet another wrap. I loved this vet from the get go. Tears would intermittently stream down my face, but I kept it together enough to listen to what she was saying.

Gem needed full out surgery ASAP. Yes, she could bleed to death from this. No, they didn't have a donor horse on property, but they did have plasma. She took blood work and she saw signs of acute blood loss, but not enough to be scary. The brief run down was this:

Surgery to stop the bleeding, rinse out the tissue and inspect the flexor tendon and the coffin bone. She suspected both were involved but didn't know for sure. Either way she would need to stay in the hospital for 2 weeks in a cast to prevent motion of the heel bulbs and give her the best shot at healing.  Was I game?

I was tired, stressed and my heart was full blown breaking at this point. I was also very much alone. I couldn't think straight. She asked if she was insured. I said no. I had a question that I needed to have answered, but I couldn't articulate it right and just kept watching Gem bleed through the dressing. I know the vet was annoyed, but I needed to ask it and needed to ask it correctly.

I didn't care about her endurance future. I didn't care about if she could ever be ridden again. I needed to know prognosis for a pasture sound horse. She is only 16. I don't mind a pasture pet for the next 10+ years, but I do mind a painful barely able to move pasture pet. I needed to know her prognosis as a pasture sound horse. I did manage to get it out in a somewhat clear manner and the vet finally understood my question.

Good prognosis for pasture sound
Guarded for riding
Probably not for endurance.

Ok. Take her away.

We moved her to a nice stall to get her ready. I can't recall the last selfie I took. I don't have any on this phone which is now 2 years old. I took a very bad one with Gem in fear I wouldn't get another chance at pictures with her.

Blurry, crappy selfie

The intern was extremely nice and friendly. She placed the catheter in her neck and gave her both Gentamycin and Maxcell (a 3rd generation Cephalosporin). She then rinsed her mouth out to prepare for intubation. Gem bled through the wrap while she was being prepped. The head vet then came to take her off to the operating room.

I signed my life away and they showed me to the waiting area. I told them I would stay through recovery and might be pacing outside.

I headed outside and saw a beautiful sunset as I broke into sobs.



Then I waited. I paced, I talked to Dusty, I texted with Sheree. I paced some more. Eventually I became too tired to pace or cry and headed inside.

Another local friend, Theresa, texted to say that they were at a horse show 10 minutes away and would be over as soon as they could. I thanked her profusely.

The time slowly dragged on.

About an hour later the intern came out to tell me the good news:

Her flexor tendon and coffin bone were fine. They saw no foreign material outside of normal debris. She was stable. They were going to start closing her up and would be out when they finished and she was awake.

I sighed in relief of that. I knew a cut tendon would be very bad. At least this was in our favor.

Theresa, her husband and sister all showed up around this time. It was 11:00pm. She brought my favorite snacks, something to drink and the best thing in the world right then: a huge hug. I needed it.

We sat around and talked about Gem, her horses, the horse show. Anything to pass the time. It was a great distraction.

The head vet came out around 11:30 or 11:45pm. It had been a long surgery.

- The coffin bone and flexor tendon were fine

- The entire medial heel bulb was almost sliced off, but was healthy and had good blood supply

- She was able to tie off the artery and her hoof would do fine without it

- The exposed bone was an ossified side bone - I had to look that up. The collateral cartilages that run in the heel bulbs can calcify/ossify in some horses for numerous reasons. It is usually an incidental finding and causes no issues - This one was now fractured so she removed the fragment and rasped the remainder smooth

- She was able to suture it all together again, but there was a bit of tension. She used wire through the hoof wall itself and placed stents which she wasn't happy to do under a cast, but better than having loads of tension on the wound

I think that was everything from surgery. Next we discussed her recovery.

- 2 weeks in the hospital in a weight bearing cast. This is vital. That soft tissue has to heal and it has to heal without it opening back up, becoming infected or becoming dead. The cast will keep all the tissues immobile to give it the best shot. She does not want to have to take it off before 2 weeks.

- She would continue to get IM Ceph and Gentamycin for 3-4 days then switch to oral Ceph and Amikaycin (Spelling?) ( a less toxic aminoglycoside)

- She also will be doing something I find very interesting called local perfusion. She will place a tourniquet on the leg daily then infuse both lidocaine to help with the tourniquet pain and additional antibiotics to the small vessels that feed the injured tissues. This will force the antibiotic to leak into the tissues. This will be done as long as the vessels remain open which is typically 3-4 days. Infection is a very real and dangerous risk.

- Bute for at least a week

- Gastroguard daily

- 4-6 more weeks of stall rest at home to follow

- Once out of the cast she will need bar shoes to prevent any motion of the heel bulbs while it continues to heal. Probably 6-8 weeks in front bar shoes.

I thanked her profusely, asked if I could see her and then she took me to the ICU to say hello. Theresa came with me and we were both surprised at how good Gem looked. She was using the hoof with full weight and looked bright eyed. I gave her a kiss and said goodnight.

I went home with an empty trailer around midnight.

Sunday:

Visiting hours are only 9-10 am and 4-5 pm every day. Which sucks because I work those hours, so visiting is going to be difficult.

Dusty, Wyatt and I went up Sunday morning to see her.

She was still in ICU mainly because they wanted to limit her motion and wanted to avoid the walk to the other stall area if possible.

Gem is not an affectionate or vocal horse. She may nicker quietly if I have food that I am withholding, but that is all I ever get. When she saw me down the hallway she let out the loudest, happiest whinny I have every heard from her. It put an instant smile on my face and I ran over to her. The staff, including the head vet from the night before, all looked around at her and broke into big smiles.

Gem did well overnight, but was pacing way too much. She had a window outside in her ICU stall, but the neighbor's sheep had wandered up in sight and it was making her very nervous. Plus, she has never liked being in a stall if she can't see another horse. ICU was completely walled off from stall to stall. Head vet was worried she would blow through her cast, so she was going to move her after her local perfusion that morning. She already had ACE on board, but would be getting a higher dose.

Gem has to stay calm.

Other than that there wasn't much to report beyond what I knew from the previous night. Hurry up and wait. AND PLEASE GEM STAY CALM.

Once the cast is removed in 2 weeks we will know more. The hope is that the soft tissues have healed. If there is infection, dehiscence or dead tissue the game will change. We are playing it day by day.

I took some pics of the facility to share.

The front

Gem's ICU stall. She is looking outside at the sheep. Doesn't she look so pretty and super fit??

Pacing. Pacing way too much

Her casted right hoof. 

Her new stall. She will have neighbors on both sides she can see through the slats plus some across the aisle. The sheep won't be visible out her new window

I thanked everyone again and we left. I won't be able to visit until Wednesday morning due to their crappy hours and my work schedule. I really need her to be good.

After we left I needed a mental break from it all. There is a supposedly gorgeous new show facility about 10 minutes away where Theresa had been the night before. Tryon International Equestrian Center. You can google it if you wish. We decided to take Wyatt over and see it.

It didn't disappoint. The place is massive and not even completed yet. Tons of rings all holding hunter or jumper classes. The Grand Prix the previous night had a prize of $120,000.

We walked around the facility for a while (did I mention that it was free to get in?) and then headed home. I was exhausted, but we still needed to check on Pete and walk the pasture plus talk to the BO.

When we got home, Dusty went to the barn and I stayed home with Wyatt to give him a break from all the running around. Dusty said he found a massive chunk of hoof wall shoved under Pete's frog which we hadn't seen the previous day. He removed it and Pete walked off much happier although still a little off on hard ground. We will watch him closely.

Dusty also walked every inch of Gem's 35 acre pasture looking for anything that could have caused this. The only thing he saw was that the far upper left corner of the fence (which is my least favorite fence of all time: hot wire that isn't turned on) had the bottom strand all deformed and loose.

The BO had taken in 3 almost starved horses a week prior just to get them out of their situation. He planned on caring for them until he could find a suitable home for each. This corner of Gem's pasture is the only area where she could have seen the new horses and they are separated by a 12 foot wide lane. My guess is she was curious and stuck her foot through, got caught, and pulled it out causing this.

Ok..well...that is plenty long. I will keep you all updated as I can. Please pray for my Gemmie. I just want to bring her home.

A huge thank you to everyone who commented on the posts on FB. Also to Liz who has become an amazingly warm and friendly person in my life through this blog. She messaged with me Sunday morning about everything and helped calm my fears. Saiph (another fellow blogger) also helped with some questions I had regarding wraps for when Gem comes home to me. I can't thank everyone enough of rat kind words and thoughts. Gem and I have a long road ahead.




12 comments:

  1. Oh, Sara, I am SO sorry to read this. You and Gem are in my prayers, and you've got the backing of the blogger support ring all around you. It sounds like Gem is in excellent hands under knowledgeable and proactive veterinary care.

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    1. Thank you Ashley. I'm so glad I started blogging or else I would feel so very alone right now with this. It is nice to know people are out there thinking of us.

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  2. I'm not sure what possessed me yesterday to check Facebook before pulling out of the barn, as it is not something that I normally do. I check e-mail, texts and phone calls, not FB. But I did and the first post that popped up was that you were en route to Tryon for surgery. And then I saw the pictures. I was as upset as if it had been one of my own horses. I'm not a big praying person, but I prayed for you and Gem all the way home and all last night, and checked FB first thing this morning and was SO RELIEVED to read that the surgery had gone well and there was no tendon involvement. SO relieved. I know you still have a long road ahead of you but I'll be thinking and praying and sending all the healing thoughts for your girl. Gem is a fighter. If any horse can pull through, it is her. It sounds like she is in great hands and the equine hospital is lovely. Please don't hesitate to ask if there is any way I can help. Lily had a puncture wound to her left hind back in 2011 and then a soft tissue injury in 2013. Lots of bandaging, antibiotics, x-rays, and stall rest both times, and then the long road to both rehab and lengthen turnout to 24/7. I'm happy to share any shareable knowledge from those events.

    And she does look gorgeous in that photo of her in the stall.

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    1. Thank you and thank you so much for answering my questions. She will pull through because she has to. There is no other way and positive thinking can be very powerful.

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  3. Oh wow, how terrifying, I'm so sorry, what an ordeal! Major and I send healing (calm) thoughts to you both. Get well soon!

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  4. Pretty, pretty mare. She says, "I'm too fit for this stall rest bullshit!" ;-)

    Not much additional to say outside of our messaging.. Definitely thinking about you...will continue to check in and message as things go on. Don't hesitate to message at any time.

    This is all gonna be in the rear view mirror someday...and I can't wait for that day for you.

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    1. That is exactly what she is thinking! I can't wait to sit in the sunshine alongside the river with a glass of moonshine in my hands in a few weeks.

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  5. She does not look like she attempted to tear her foot off in those pictures. I'm very, very happy she did not bleed out. And the prognosis is so much better than when Saiph first contacted me and asked for help. And I sent all the help I could muster. Some of them are staying to try to keep her calm. Lots of light, love and peace to you and Gemmie.

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    1. Karen - thank you so much! All positive thoughts and help to keep her calm are much appreciated and needed right now. I switch between confidence that things will be fine and nearly breaking down.

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  6. Oh holy shit, I am so sorry. What a thing to have to go through. I'm so glad that the surgery was straightforward, and will be thinking of you both as she heals - c'mon, Gem!

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  7. I continue to send healing thoughts and prayers your way. Gem's a fighter, I'm sure.

    Shauna

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