"And, when you want something, the entire Universe conspires in helping you to achieve it." -The Alchemist, by Paulo Coehlo



Tuesday, September 6, 2016

Adventures in Treating Lily Wounds, Part 1 Million

This is the wound on Lily's butt that I have been treating for the past...three? weeks. First off: it is NOT a stab wound. How do I know? Because this photo was taken after it was debrided: the original wound was a necrotic, infected slice (maybe 1/2" deep) into her right glute on top of her croup, right above her tail, with a 1" deep pocket  off towards the left corner of this wound going right into the muscle (not just a skin flap). It was gnarly and ragged, as if she had maybe done it on wood. As usual, there was absolutely nothing in the field with which to injure herself. Maybe this...

But she is usually so good about staying away from fences, especially electrified ones. I have no idea.
I missed the barn two days in a row due to afternoon thunderstorms so severe, I couldn't see to drive. The barn is a longer drive from the new barn than home, so both afternoons I just went home. On the third day I went out and discovered the hole in Lily's butt...which was at least 24 hours old. It was swollen but not smelly nor super painful and she let me scrub it, flush it, and rinse it all out without issue. I poked and prodded it and thought, like I did when she tried to rip her face off last year, "Is this something that I can manage on my own?" The answer this time was, "Maybe...?" Here is my full thought process:

1. Does it need stitches? 
No. It was an old wound and the skin was a dull pink and gray. In many cases you can't close an old wound if there is a possibility of existing infection. If it had been a fresh wound with blood and bright pink skin, I would have called the vet out immediately so she could close it STAT.
2. How infected is it?
Gray skin = yuck, necrotic. However, there was no pus and no smell and it wasn't painful. There was some swelling but it wasn't dramatic. You would never have known that hole was there if you hadn't walked up to Lily and walked around behind her, which is what I normally do with both horses when I do my "life checks" at the barn after work. It was so not painful that I literally stuck a sterile syringe up in the pocket and flushed it with diluted iodine and she gave a tiny flinch but totally let me. Those are all good signs that the infection isn't awful. If there had been pus and/or a nasty smell, if she had had a fever, or if it had been so painful she wouldn't let me touch it, I would have called my vet out STAT. It DID need debridement though, so the vet was getting called regardless. More on that below.
3. How do I treat a giant hole in my horse's butt in the middle of the hottest days of summer, when flies are rampant?
You clean it out really well, preferably using coarse gauze and iodine or chlorhexidine (Nolvasan) scrub. Then you flush it out, preferably with diluted chlorhexidine or iodine solution (not scrub) diluted in saline. Flushing wounds is controversial in vet med (if it's a really deep wound, you might actually end up pushing dirt and bacteria further into the hole, increasing the likelihood of an abscess), but I was going to have that looked at by a doctor anyway and, well...I just had a good feeling about what I was doing. Does that count? And then you cover it up with a Telfa (nonstick) pad and put a shit ton of Elastikon over it to keep the flies out of the hole because maggots: you want to prevent them. Elastikon is your friend and you should always have at least 3 rolls on hand in your horse trailer AND your barn emergency kit. Ask me how I know...And if you have a tack room with AC where you store your emergency kit, make sure you leave a roll of Elastikon out in the heat, either in the trunk of your car or in the barn feed room: heat makes the adhesive melt somewhat, which makes the tape EXTRA sticky. This is what I used for Lily's first bandage: my heat-exposed Elastikon, and it stuck like glue to her coat. My vet asked me the next day how on earth did I get the Elastikon to stick like that. Answer: heat. #vettechlifehacks
4. Do I call the vet anyway?
Yes. Yes you do! I left a message with my vet that evening, explaining the situation, the appearance of the wound, its size and depth (in centimeters, because we use international units in vet med) and asking that they call me in the morning. Necrotic and/or old infected wounds need to be debrided (have all of that nasty old skin removed, which needs to happen at least with a local block if not sedation) in order for them to heal. Wounds on the top of the rump are especially nasty because if they turn into an abscess, there is nowhere for it to drain but into the muscle tissues, which in a worse case scenario can actually cripple your horse. That's what I was afraid of. 

I started her on SMZ that evening and gave her a dose of Banamine. My vet's office called right at 8:00 am sharp when they opened the next morning, a Friday, and as luck would have it, Dr. H had an opening in the afternoon and she could make it out to the barn to check on Lily. I wasn't sure I would be able to make it to meet her, but it looked like it was going to be a slow day at work, so there was a chance...As it would turn out, I made it out early but the one-lane road back to MD was closed for an hour, so I basically sat in my car at a standstill while Dr. H treated Lily. -_- She called me to let me know what she had found, how everything had gone, and what the plan was. In a nutshell: the wound was infected, she had had to sedate Lily in order to do the local block so she could debride the wound and scoop out all the dead tissue (that's why it looked like a stab wound afterwards: she took a lot of stuff out), rebandaged with a wet-to-dry bandage, and told me we were on abscess watch: we were looking for pain, fever, lethargy, inappetance. If any of those happened, she would need to go to the hospital to be put under general anesthesia to have major surgery to remove the infected muscle tissue. The bandage absolutely needed to stay on: if it came off over the weekend, I would need to call them on emergency to have the wound cleaned out again and re-bandaged. We would be doing injectable antibiotics for at least 7 days. If all was good in 7 days, we would D/C the antibiotics and declare her safe from the possibility of abscessing.

I went "La-la-la" mentally over the hospitalization part, saying in my head, "Not hearing not hearing not hearing" (obviously I heard because I could repeat to you guys what the vet said) and when I got to the barn afterwards, I took Lily aside and had a serious talk with her. I was very calm and very quiet and I took her head in my hands and said out loud to her,

"You need to get better with treatment at home, okay? I have to draw the line somewhere and we are drawing it at general anesthesia." 

And then it hit me and every hair on my body stood on end, and I added, "Also: you didn't have to do this, you know? This was completely unnecessary. I was going to heal on my own." 

Because Lily's wound was in exactly the same spot as my torn gluteal muscles that had been giving me so much grief. Exactly the same spot. So here is where we walk into the magic realism that is my daily life, in case regular readers haven't noticed yet... 

Animal familiars were believed to be a witch's aide, and one of their purposes was to help the witch with her endeavors...but also to protect the witch. They would take on the witch's pain in order to heal her. They would die for her if necessary. You can go google all sorts of information on that, but in all reality, my relationships with my animals are no more supernatural than anyone else's that pays close attention to their pets. Which means: these are normally supernatural relationships, if you want to call them that. I can't even begin to count how many out-of-this world stories I've heard from clients describing the bonds with their pets that go beyond all rational, scientific explanation. We call this "the human-animal bond" in veterinary medicine, and it is actually backed up by research. More on that here and here. It is HUGE and I think you guys should go read up about it if you've never heard of it before! Seriously: there are scientists around the world studying how our pets help heal us.   

When you go looking at the scientific facts, it shows that basically, our pets are our familiars, if you go by the ancient meaning of the term. We don't have to be involved in anything supernatural or out of the ordinary to have unique bonds with our animals. If you have pets, you know they will try to comfort you in times of stress, sickness, and sadness. And there are theories that one way animals will try to heal us is by taking on our pain themselves. Just like the mythical familiars used to. Some of the stories I heard while working in veterinary Oncology were the stuff of fairytales.

And so I looked at Lily with new eyes, the part of me that believes in magic and anthropomorphization, thinking, "Is this really happening? Did she really feel so awful about dumping me that day after the quicksand that she went and hurt herself to help me heal?"

Because if ever there was a horse that dwells on things, it is this one. It has been two years since I came off of her when she dodged to keep us both from falling into a hole in the ground. She was so startled by the hole that she dropped her withers, causing me to end up on her neck before falling off. Ever since then, she has been extra-extra careful about double-checking dark spots on the ground and not dropping her withers when she does so. She'll do just about anything to stay underneath me. Compare the story of her reaction to me coming off during the quicksand incident to the first time she dumped me on trail four years ago

"It wasn't your fault," I said to her now. "You got us out. You saved us! You didn't have to do this. Really. I don't forgive you because there was nothing that needed to be forgiven...you did your job! But if you need to hear it: I forgive you. You never did anything wrong." Probably didn't really need to let my thoughts roam that way, but just in case...

She looked back at me quietly. 

And so Lily and I had an agreement. 

It is the first time where I've treated her for an injury where she has cooperated every single step of the way and the first time that I've remained calm and cheerful towards her while treating an injury, even in the beginning when we were on abscess watch and I was stressing, waiting until the first bandage change when we would know the verdict about where the current would turn. Her temperature stayed at a very normal 99.5, the swelling around the bandage vanished, and every day she happily came up to me in the field so I could take her out and stab her with needles for her antibiotic doses while stuffing her face with cookies. 

The first time I had to give Lily injectable antibiotics four years ago to treat a horrific and unexplainable case of cellulitis in her left hind, she was so bad about needles that I needed two people to hold her so I could give her the injections because she would rear and spin to get away from me. She would actually bang her head on the stall ceiling in the process. It was a fucking nightmare. She got worse as treatment went on! 

And here I was giving her injections by myself, IV, while she stood quietly next to the hitching post, untied. 

Elastikon is sticky, but even heat-exposed Elastikon won't stay on for more than 48 hours, especially when the patient gets itchy because the hole in her butt is healing and she starts rubbing it on everything. Solution? Skin glue.

Dermabond applied to the edges of the Elastikon by Carlos.
And then we ran out of skin glue. 

Plan B?

Krazy Glue.

I kid you not. Krazy Glue is a known substitute for skin glue.


"Does this bandage make my butt look big?" - Lily


No Lily, it makes your butt look like a patched inner tube. *snicker snicker*
"That's not nice, Mom!" - Lily.
Don't go doing these things without talking to your vet first, okay? 
All of this was discussed with my vet prior and she thought it was genius! But wounds, especially large, deep wounds like this one, can turn into life-or-death situations if mismanaged and you should always consult with a doctor before you go attempting unconventional treatments, be it applying manuka honey to your dog's degloving injury or Krazy-glueing the bandage onto your horse's butt.

We only applied glue to the outer edges of the bandage, which would allow my vet to cut out a window in the central portion of the Elastikon square so she could change out the iodine-soaked gauze she had stuffed into the hole.

Like so. See how she cut a window in it? She changed out the gauze you see here, cleaned the wound, and then we covered the window back up with Elastikon, that we Krazy-Glued to the Elastikon "frame" so it would stay on come hell or high water. 
My vet was thrilled with her progress at the first bandage change, and from there on out it was left in my hands, with me sending her pics at every bandage change to keep her posted on how Lily was continuing to heal. 

A week later I was given the clear to ride. I was surprised about that, because if I hadn't been out of comission myself, I would have been riding! She was never sore nor lame while moving, and I saw her galloping and playing around the field like nothing had happened. 

Because hole on her ass...get it? Get it?
After the first bandage change, when we were declared in the "safe zone" by my vet, I let the ER humor fly.
I've joked about this thing way more than I've stressed about it, this time around...
I had not ridden Lily since my fall. I never got on again that day, and because riding Gracie was uncomfortable despite her being so much smoother, I assumed that riding Lily would be worse. So I had not gotten on, though it wasn't for lack of wanting. 

I had dragged myself back to the gym the second my ribs and abs stopped hurting, which was a lot sooner than Carlos had expected (he'd given me three months...I think I was back in the gym that initial time 2 weeks post-accident.) Why? Because immobility was making me stiffer as each day went by and my muscles were tying themselves in knots. I needed to move to straighten everything out again. So I went to the gym, did a full-body workout with maybe a third of what I normally would have lifted...and realized that it didn't take much to get those muscles sore in a bad way all over again. So I took another week off of the strength training and just did a couple of lighter sessions on the elliptical. Just getting on the elliptical made a huge difference. I then tried strength training again. And discovered that I could lift as long as I was careful. I've been really cautious about lower body work especially, doing individual leg training so I could focus on correct movement of each leg, but also working on strengthening the injured muscles without re-injuring them. Normal soreness is okay, but if the muscles start to burn, I know I'm overdoing it. I laughed over the wimpiness of the weight I'd been moving with my legs compared to before, but it really helped to do SOMETHING. I promise you guys that I am NOT doing a William Fox Pitt here; I have been 100% listening to my body and backing off when it tells me to. I wouldn't have progressed the way I have if I had not done so!

As of this last week, I was finally able to make it into the gym a more normal 5-days a week and do my regular routines. Squatting is the one exercise that I'm still being careful with, and I'm having to time workouts differently: no leg workouts on days that I'm doing heavy cardio (like Spinning) or riding. Lunges are still off the table entirely. 

Improvements have seemed very, very gradual but have actually been by leaps and bounds, with the occasional day where I wake up with the burning in my glutes again for no explainable reason. 

Anyway. This is all to explain: last weekend I went to Stephen Birchall's dressage clinic at Austen's barn, where Liz, Emma and Austen would be riding. I originally wanted to ride (duh) but even if I had been able to, I had not been able to practice the way I would have liked to prior to the clinic. So I went as an auditor. I returned home itching to put to work everything I had learned...

...and tacked up Lily for the first time for me to ride in over a month and a half. It coincided with my vet clearing her to be ridden. 

She was SO happy to see me bring out her tack. This is the mare that used to have no work ethic...I just needed to figure out what job she wanted! She enjoys being my partner. She had been willing to work with Jess, but each time she had realized I was not the one getting on, she would give me a disappointed look. I swear.

I slipped her mullen mouth snaffle into her mouth for the first time in...two years? (We normally ride in a low port kimberwick. She loves that bit but it's not dressage legal.) And hopped on and we walked on a loose rein down to the arena. 

Remember: the mare hadn't been worked in nearly a month! This is the kind of thing I NEVER would have dared to do prior!

And we proceeded to have a lovely ride. I realized halfway through, as we did our second canter work set, that I had no pain at all. 

The next day I tacked up both horses, took them down to the arena, and tied one to the fence while I rode the other. I had no pain at all. 

We're officially back to this...

Video still from that first session.
...and another!
Gracie's response to dressaging: self-carriage. Slack in the reins, one-handed, while I took the photo with the other hand. This was on a different day that I rode both horses. :)

As for Lily's wound, here is a progression of its healing:

The bottom right photo was taken this past Sunday. It is amazing how quickly that enormous hole closed up.

So maybe it's coincidence, which is likely, or maybe there really was something to Lily's injury helping my own progress. My scientific side goes with the first, while the side of me that still believes in all things magical goes with the second. I'll never know.

As of Labor Day, my maximum time in the saddle has gone up to 2:15 hours and 10 miles! Still can't run, but that's okay now. :)

Yesterday afternoon I went out to check on Lily at the end of the day. She had been drinking water at the trough near the field entrance and had started to turn around to go back to the herd when I opened the gate. She paused and I called to her. She pricked her ears and walked over to me. She sniffed me up and down slowly like she always loves to do, then quietly put her forehead against my chest so I could rub around her ears. 

"I love you," I said to her, as I slipped on her fly mask. 

Apparently both my mare and I are working on this...
;)



23 comments:

  1. Glad the wound is healing up (making a mental note regarding the crazy glue). Love those riding photos, you both look like you're having a blast :)

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    1. We were! It was like we had never stopped riding. :D

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  2. Horses! That is a pretty creative injury!

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  3. What a relief that she's healing!

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  4. She sure is keeping you up to speed on wound healing principles. Ugh. I'm glad it is healing well and that she was never lame during the process.

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    1. Me too. And I didn't even mention on the blog the other slew of relatively minor injuries she's had this year because they've been transient. But this is not the first time in the past 2 months that she's been on injectable antibiotics!

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  5. Kraaaaaazzzzyyyy glue because its craaaaaaaaaaaazzzzyyyy! That's all I can think about.

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  6. The animal-familiar thing: YES. My horse and I do this, back and forth. You reminded me today, which is a good thing. My back has been hurting and I've been ignoring it and not my mare is presenting with odd back soreness.

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    1. There is so much that is unexplainable in our relationships with our animals...and sometimes the simplest explanation really can be the correct one. Hope both you and your girl feel better soon!

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  7. I love the idea of the crazy glue. And I totally get the animal familiar idea. It makes sense to me.

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    1. I should write about some of my veterinary oncology stories...it really is incredible.

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  8. Glad your MareFace is healing...she need to learn to keep herself in one piece.

    Best thing ever for bandages is Livestock Tag Glue. When we were doing bandages for catheters for the cows we used this stuff. Originally we used super glue but we didn't find it to be sticky enough. That tag glue lasts so much longer! But hopefully you never have to try it haha

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    1. I will need to buy Livestock Tag Glue...so I can guarantee that I'll never need it! ;) Thank you for the tip!

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  9. Magic is the stuff science hasn't figured out how to explain yet (imho).

    My guy let me irrigate his infected gums (foxtails in his hay) at liberty with a syringe of listerine for weeks. He walked up when he saw the syringe and opened his mouth. Of course it took me a while to notice him pointing out the problem in the first place.

    Glad you two are healing up. :D

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    1. It's funny how they'll tell us, no? :)

      Thank you! <3

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  10. Wow the progress pictures are impressive- so glad Lily healed up well. These horses sure know how to make us worry sometimes....!

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  11. OMG Lilly :( You did NOT have to do that. I am glad it is healing well. NO MORE!

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