Lily's Leg, A Novel: Chapter 4, In Which Lily's Leg Blows Up

Lily says, "Stall rest is BORING, yo!"

Blargh.

Trying really hard to get the blog caught up, but it's been hard with everything that's been happening!


Monday July 13, 2015

Dr. E came out to the barn to take out Lily's first set of sutures (pink sutures). There was a little bit of generalized swelling but she said the leg looked good. I wasn't particularly concerned; Lily was only slightly sore on it. Dr. E however, had a hard time getting the sutures out: Lily protested about their removal. One suture looked like it was just a piece of pink string hanging out of the wound but it seemed to be stuck: Dr. E was unable to remove it. She decided to leave it for Friday 7/17, when the rest of the sutures would be removed.

I was given the go-ahead to re-start Lily on bute so she would go back to being 100% comfortable on the leg. Just 1 gram once a day; Dr. E didn't think that would upset her stomach.

So we restarted the bute. And I don't remember anything else about Monday.

Eating every last bit of grain.

Tuesday July 14, 2015

I went to the barn before work and had one sore mare come out of the stall. I felt like I'd just swallowed a rock and it had dropped into my stomach. This was despite being medicated with bute. She was eating well and somehow didn't look quite as pointy as 2 days before. I removed the bandage and was concerned to discover that the swelling was worse than the day before, despite the bute and diligent antibiotic administration every 12 hours as ordered. I was in the process of flipping Lily's schedule to something like 1:00 pm and 2:30 am for the antibiotics on my work days because the barn feeding schedule wasn't ideal for a twice-a-day antibiotic regime: 8:00 am and 4:00 pm. But I still didn't think that switching the schedule should cause this amount of swelling. Her pastern was puffy whereas once it had been tight, and she had some swelling above the wound, which she had not had before. She was not stocked up on any of her other legs (something that she does tend to do when she is stalled and it is hot and humid outside); the wounded leg was the only swollen one.

I might have freaked a little.

Being a good girl. I know horses that require sedation just to be pulled out of the stall while on stall rest. Not this one.

I scrubbed the wounds, dried, and re-bandaged, mucked both stalls, gave Lily her bute and antibiotic, and brought Gracie in for the afternoon and evening. I tried calling my vet but for whatever reason they had closed early for the day. I did not leave a message.

I then went to work and worried for 12 hours while trying to save other people's animals. Let me tell you: compassion fatigue is real, and when you are already suffering from it, trying to work through it while also worried about your own animal is enough to push you to the the last limit of any emotional and psychological strength you might have left. Especially when an employee walks in the door with her dying dog and has hysterics when we could do nothing to save her pet. I had to leave the room to bawl myself. For our employee, for her dog, for the fact that she would always live thinking that she had caused her death when in fact there was nothing she could have done to prevent it. She just wouldn't believe us when we tried to explain.

When you have compassion fatigue AND one of your animals is not doing well, you are left exposed and subsequently ripped open in the face of anyone else's tragedy.

By the time 1:30 am rolled around, things had died down so I was able to leave early so I could stop by the barn to give Lily her antibiotic and check on her.

I love the way BO set the lights between the stalls and the aisle: you get clear illumination in both, especially in the stall because the horse doesn't cast a huge shadow.

She had cleaned up all of her food so I tossed her more hay and gave her another half scoop of grain (I was splitting her grain meals into several small ones, since I had absolute control over what and how much she was eating.) She took her antibiotic dose well and I checked her temperature: 100.2, which is normal for a horse. Good! There was no swelling above the bandage (on her hock) and I was not going to change the bandage again at 2:00 am, so I let it be and went home, where I slept more or less well.

For 5 hours before I had to wake up again to repeat everything all over again. As of this writing, I have not slept more than 6 hours since this whole ordeal started.


Wednesday July 15, 2015

My birthday. There were tons of well-wishes on Facebook, which was one of the few good things of the entire day. Charles was scheduled to work an overnight for the first time in forever, which meant I would not see him AT ALL for 24 hours. I was pretty upset about that.

I was even more upset when I got to the barn and Lily would not come out of the stall. She was hobbling lame. Crippled. It took a while to get her to the wash stall at the end of the short aisle, where I could see even before removing the bandage that the swelling had extended to her hock.

#$%%^^&*@#!!!!!

I removed the bandage to discover a leg swollen with cellulitis.

Fat leg. Doesn't look as bad in photos. But she had lost all of the definition of her pastern, fetlock and tendons. The leg was also hot and had pitting edema (you left an indentation if you squished her skin with a finger.) And you know, she was also crippled lame.

The original wound itself didn't look bad. She had a tiny bid of drainage from the top of the wound and she let me poke and prod it (while wearing a glove!) She was more bothered by all of the other small abrasions on the leg, including that one at the coronet band.

No definition. Note the puffy pastern too.

I took these photos and sent them to my vet, then called. Katie the receptionist answered the phone and I told her what was going on. Dr. L was taking care of an emergency, Dr. E was seeing afternoon appointments and was booked solid. I had to get into work by 2:00 pm and it was 11:30 am. There was no way either of them could make it in time for me to get to work at my scheduled hour. Dr. L might be able to make it by 2:30 pm, so I called work, explained the situation, and told them I was going to be a few hours late.

I called Charles and told him what was happening. He drove out to the barn to keep me company because he is awesome.

Silver lining: I actually DID get to spend a couple of hours with him on my bday!

She was grooming him. Just cuz.

"Can I take a selfie?"

Seriously, all animals adore him.
But she also happens to be the sweetest mare in the known universe, so there's that too.

Once I was done cleaning stalls, we put her away again (I had put a quick bandage of just cast padding and Vetrap over the wounds) and ran over to the nearby gas station to get coffee so I could stay awake while waiting for the vet.

Dr. L messaged me at 2:00 to let me know she was going to be arriving about an hour later than expected but that's okay: you can't control how long an emergency is going to take. Charles waited with me until she arrived; he had to leave to go to work himself. Dr. L took a look at the leg upon arriving at the barn and agreed that Lily had cellulitis. We talked about switching her to an injectable antibiotic (Naxcel) because it's stronger than most of the other readily available orals. She put in a call to Dr. S, the surgeon at New Bolton, to pick her brain about the situation and was told she would be called back. So we hung around and chatted.

We both had to leave; we waited for about 15 minutes but Dr. S had not yet called back. Dr. L decided to go ahead and give Lily her first Naxcel dose and we made an appointment for her to come back out the next day to reassess. She told me she would call me when she heard back from Dr. S.

I had had questions about bandaging, as I didn't feel the sheet cotton was necessary. Could I just do the Telfa, cast padding and a no-now with a standing wrap over it? Dr. L said that since the wound was not draining excessively anymore, yes. She instructed me as I re-did the wrap, with the main difference being that the no-bow was placed lower on Lily's leg so that the bottom edge was lined up with her coronet band and the standing wrap used to cinch the no-bow snugly to her pastern and fetlock. The bottom of the bandage was sealed to her hoof with Elastikon. I then placed a separate small bandage over the wound at her hock, using just a Telfa pad with SSD and Elastikon to keep it in place.

After that we were done. Lily went back into her stall, Dr. L returned to her office, and I changed clothes to go to work.

Dr. L called me about an hour later to let me know that she had spoken to Dr. S, who agreed with the use of Naxcel IM for the next 5 days. She had also recommended Dr. L do two distal limb perfusions, one on Thursday and one on Friday. We made appointments for both days.


Thursday July 16, 2015

Dr. L, Dr. E and an extern arrived at 11:00 am sharp to do Lily's local antibiotic treatment.

Distal Limb Perfusion 101

1. Lily was heavily sedated with butorphanol and Dormosedan.

2. A surgical scrub was done on her medial saphenous vein (large vein that runs up through the middle of the inside portion of the hind legs), alternating Betadine scrub with alcohol. This part can be iffy for some horses, as the dripping scrub and alcohol will tickle their leg. Lily swished her tail angrily in response but did not move.

Scrubbing the leg with Betadine scrub (red in color; that's what those reddish splatters are)
Lily did not have hives; her hair was standing on end. It's a normal side effect of Dormosedan.

3. A tourniquet is applied. Not all horses tolerate tourniquets well. If I were a horse, I would be one of those individuals. Lily, however, is not. She didn't care. You can really appreciate that medial saphenous vein both above and below the green tourniquet in this photo:

4. Vetrap is wrapped tightly over the tourniquet. Dr. L explained to her extern and Dr. E that this is the only time you will ever see her apply Vetrap tightly:

 5. A local block with lidocaine is performed, to numb the area around the vein. Another surgical scrub is done, alternating Betadine scrub and alcohol x 3. Then a strong antibiotic like amikacin is injected into the vein below the tourniquet. An artery would naturally take the antibiotic straight to the wound site but you don't want to inject an artery in a horse because they have a tendency to form huge hematomas. So instead you inject into a vein and because of the tourniquet preventing venous flow to move away from the leg, the injected antibiotic still be pulled down towards the lower leg with gravity.

Dr. L used a small gauge butterfly catheter (23 G) to inject the antibiotic while creating as little trauma as possible. The dark reddish spots on Lily's bandage are Betadine scrub.
Amikacin is injected over 2 minutes; I was in charge of timing it.

6. A pressure bandage is applied to the venipuncture site, below the tourniquet, to prevent a hematoma from forming.

7. The tourniquet is left on for 30 minutes total to allow the antibiotic to do its thing, then it is removed. The pressure bandage over the vein is left on for 24 hours. 

What is the purpose of a distal limb perfusion, aka DLP? 

There is a very limited number of antibiotics that can be safely used with horses. The stronger an antibiotic, the more expensive it is, especially at equine doses. Also, because said usable antibiotics are so limited, we are starting to see resistance to those antibiotics. DLP allows a stronger antibiotic to be used at a safer smaller and less expensive dose to aggressively attack an infection. We do not use this in small animal (cats and dogs) because there are so many more antibiotics that can be used with them. 

Cool, huh? 

Lily's leg was re-bandaged for the day, and we all returned on Friday for the next treatment. 

Friday July 17, 2015

The DLP was repeated. It was only Dr. E and Dr. L this time. Dr. L again used the smallest gauge needle possible (again, 23 G. For comparison, this is what we use in small animal for drawing blood from a cat's medial saphenous! It is a tiny gauge!) The problem this time was that they would hit the vein but a clot would form in the needle, which resulted in them having to stick multiple times, eventually with a larger 21G before they could get the amikacin into the vein. Of course Lily ended up with a huge hematoma on the inside of the leg. Nothing to be frightened of; it was just unsightly. The doctors applied a larger pressure bandage and I was left with Naxcel to get me through the weekend. They also removed all of the sutures and Lily was cleared to start hand-walking the next day Saturday. On Saturday I was also to e-mail photos to Dr. E (she was on call) and call her to decide if a third DLP should be done. 

Saturday July 18, 2015

Lily's leg looked really swollen to me, both above and below the vein pressure bandage and also around her hock. I freaked out, especially when again she was so gimpy she didn't want to leave the stall, but I was a mean person and forced her to come out for her first official hand walk. Both vets had agreed that Lily's soreness was most likely worsened from her being in the stall. 3 minutes into our walk, I had to agree: Lily was already remarkably sounder. 5 minutes into the walk, her slight head bob had disappeared entirely! We turned around and walked back to the barn for a total of 10 minutes of hand walking.

I removed the lower leg bandage and felt better once I saw that the leg beneath it looked exactly the same as the day before: still puffy, but not as bad as it had been on Wednesday. I took pictures which I e-mailed to Dr. E via phone (where would we be without smartphones, seriously?) and then called the emergency service to have them ask her to call me back.

These are the photos I sent her:

Generalized puffiness from fetlock to hock, but swelling on pastern had disappeared!

Pressure bandage over vein.

Note hock swelling when compared to the other hock.

You can really appreciate how fat this leg was. And this was an improvement from Wednesday!

Hematoma above pressure bandage

The wound itself. Goopy SSD but otherwise looking good.

Dr. E called me back within 15 minutes. She thought the leg looked good and either way, we couldn't do another DLP even if we had wanted to. She told me to apply an ice pack and some Surpass to the hematoma above the pressure bandage; she said it was excellent that Lily had walked out of her soreness. I was told to continue everything and we scheduled an appointment for Monday 7/20 for Dr. E to take another look at Lily and see if she could go on an oral antibiotic like SMZ or continue the Naxcel.

The saintliest mare of all, sporting one of Archie's bandages.

I want to make this clear, based on some posts and comments I saw on other blogs a few weeks ago because I don't want people assuming and judging me for having Lily insured: Lily is insured precisely to cover this type of event. This, what happened this month. I insured her when we moved from Florida to Maryland and had to have her hauled by a third party, as it was recommended by the hauler. It was a 1200 mile haul; she had never been trailered for such long of a distance before in her life; she was Florida bred and born, and I had no idea how she would react to it. I insured her in case something happened to her in transit and during that first year of her being insured, the insurance paid for itself tenfold (literally!) when she sustained her annular ligament injury. Since she proved to me that the insurance was worth having, she has been kept insured ever since. 

Colic surgery is not the only reason for insuring a horse. I wouldn't put any of my horses through that. A horse that has colic surgery has a 50% chance of needing it again. This is a personal decision, but that is a huge risk to me: to me, colic surgery is not worth it. That said, colic surgery is not the most catastrophic thing that can happen to your horse. If we had not had insurance for Lily, I'm not sure what we would have done given everything that has happened with her left hind during the 3 years she has been insured out of the 4 years I have owned her. Especially this time around. I pay $350 a year for her $7500 major medical & surgical coverage. It has proven yet again to be worth having. As it is, she has accrued close to $2,000 so far in emergency exams and farm calls that are not covered by her insurance. Not because we have exceeded the limit, but because farm calls and exams are not covered, period.

Lily's Leg, A Novel: Chapter 3, In Which Lily Stops Eating

Because she wants to be a supermodel.

(No, not really.)

She was thin on arrival from the hospital, but I swear she dropped another 100 lbs in a 48 hour period. Insane.

I woke up early and called HC Summers, the store in Jefferson MD that I mentioned in my previous post, to see if they had Elastikon. As it turns, out they did.

So I drove all of 15 minutes to get there and realized upon entering that not only did they have Elastikon, they also had ALL OF THE OTHER BANDAGE MATERIALS I HAD NEEDED THE PREVIOUS DAY! *face-palm* UGH. Now I know I can really, truly get them all in one place! Hindsight is 20/20.

I bought a couple of rolls of the 4" Elastikon (Amazon only had the 2" by the case with Prime shipping) and moseyed my way back down to the barn.

I went home to pick up Charles so I could at least see him while doing stuff at the barn. We drove out to the barn, where I picked Lily's stall, changed her bandage, noted that there was more swelling than the previous day but not a lot, and realized also that she had finished her morning grain but hadn't really eaten much else. She looked so freaking skinny on this day. I love the boarders at this barn and they all mean well, but they all stopped by one by one to tell me what had worked for their horses with weight gain. They have no way of knowing that I have tried everything, that this was because the mare was stressed out about being alone, that she has such an insanely fast metabolism she will drop weight within hours if she is not eating constantly. I explained this to them and still appreciated all of the advice anyway, especially because everyone was so kind in their way of giving it. I have said it before and I will say it again: I love Marylanders.

Still, I freaked over the reluctance to eat. I freaked out epically. I called my BO and left her a voicemail, asking if there was any way I could start bringing Gracie in at night to keep Lily company when the other horses were turned out. The stall on her other side was unoccupied, so it would be perfect for G-mare.

I gave Lily another dose of UlcerGard and decided I was discontinuing her bute, since not eating her grain well is her #1 sign of ulcers and bute can exacerbate them. This, of course, would lead to other issues.

Charles took Lily out to hand graze while I picked her stall and noted that she peed twice while touching noses over the fence with the geldings in the neighboring field. Oh great. Let's compound the issues: Mareface gets extra attached to other horses when in heat, and her appetite also decreases when she's in season. Great. Just great.

Silver lining: At least we now know the prostaglandin shots worked after the whole stallion saga?

After I was done freaking out, we put Lily back in her stall and went out to Southern States so I could buy her something to help with ulcers. My options: Legends Gastrotech and Triple Crown Alfa-Lox forage. Both were around the same price: $30. I chose the forage because forage is always better for horses.

And of course Lily would end up turning her nose up at it. -_-

Yay, let's continue wasting money!

Upon our return, BO was at the barn and had just finished setting up the other stall next to Lily for Gracie. She is giving me a reduced price on stall board by allowing me to do a sort of self-care: I'm doing the stall mucking and Lily's afternoon meal + her meds, while also providing my own grain; the barn provides hay and shavings in unlimited quantities and feeds Lily in the mornings for me.

BO was going to let me do the same with Gracie. The single thing the barn staff had to do was turn her out in the morning; I would clean her stall, feed her, and bring her in in the afternoons. Basically, at the moment the barn is my second job.

Charles took Gracie for a spin, since he hadn't ridden in almost 2 weeks, while I set up haynets for her in the stall and her grain meal. She got a bath upon their return and was brought into her suite, but even with the food she wasn't exactly thrilled about it.

Lily, however, turned around and started eating. And eating. And eating.

She didn't take her head out of the hay feeder during our remaining time in the barn.

Gracie was a little agitated initially so I ended up putting on her halter and tying her up inside the stall. Miss Manners knows now that when she is tied she is to be a model citizen (only took a year...) and she instantly relaxed. I brought out the brushes and gave her a thorough grooming. It was like pressing a "Reset" button. She was completely calm after that.

Now that both mares were happy, we felt comfortable going home.

Lily's Leg, A Novel: Chapter 2, The Bandage Materials Hunt

Friday, July 10

I want to note that while I could have stocked up on bandage materials at work before Lily's discharge, I chose not to because I wasn't sure what I would need and I didn't want to spend unnecessarily. 

HA. Hahahaha...*sob*

Well, on Friday I got up first thing and figured I would go to Southern States in Mt. Airy (about 20 min away on the south side of Frederick but also about 20 min from the barn) to get my bandage supplies.

Things I needed:

• Telfa pads (nonstick gauze pads with the shiny covering, like what's inside a band-aid. There are generic ones available, but the popular brand is Telfa. They are also used in human medicine.)
• Kling gauze aka rolled stretchy gauze, or brown gauze
• Vetrap
• Elastikon (there should be a black market for this...seriously)
• Sheet cotton
• Betadine Scrub
• Large square gauze - 1 pack

Well. I found the Vetrap, the cotton, gauze squares, generic iodine surgical scrub and...nothing else. I bought a giant bag of Stud Muffins and I don't remember what else. There is a tack shop called Stablemates less 5 minutes away. So I stopped by there. The MOST important 2 things I needed were the Elastikon and the Telfa pads.

Stablemates had Elastikon!

Except they only had 1 roll of it left IN THE ENTIRE STORE. 1 ROLL! And ONE SINGLE ROLL is $9. Yup, it is THE MOST EXPENSIVE of the bandage material stuff (I knew that going in though). Because the stuff is magikal and lined in gold. 

As luck would have it, they had a sale going on that day and I got 20% off on it. Yay!

I needed more though. I was estimating one roll of Elastikon per bandage change. So I needed 2-3 more rolls. 

There is a little store in Jefferson MD, right by the stallion farm, where I've been buying the girls' grain. I wondered if they would have what I was needing...But it is on the OTHER side of Frederick (north), it was a weekday (traffic) and I was trying to get to the barn by 2:30 before stall board turnout because I wanted to ace Lily before the other horses went out. It was already 1:00 pm. 

So I stopped by Tractor Supply, which is maybe another 10 minutes down the road. Nothing. They had NOTHING. I looked and looked and paced the aisles thinking maybe I was missing something. Nope: didn't have Elastikon. 

By this point I was starting to get quite agitated. This was supposed to be a simple mission and it was turning out to be so much more complicated than originally thought and started beating myself up over not just getting the materials from New Bolton so I could have them and not have to go through this freaking mission.

I stopped by a Weiss supermarket next to Tractor Supply looking for the goddamn Telfas. Nope, no Telfas. I was leaving the shopping plaza, when I realized on the way out that there is a CVS in that plaza, turned around, looked for parking again (I was in the Beast, which means parking in a small country shopping mall can be a mission all by itself) and ran into CVS...YES they had the Telfa pads! Generic and ON SALE! 2 boxes of 10 for $8. I bought 4 boxes. 

You also want some of these in your equine and human first aid kits. They are da bomb and are great for improvised band-aids on animals and people.

By this point I was almost running late to get back to the barn and my levels of agitation were skyrocketing: I was livid at myself by this point. I figured fuck it with the Elastikon; I had enough for today. I ordered a case of 6 on Amazon for $26 that would arrive on Sunday (because Prime shipping rocks!)

I ultimately was able to make it to the barn right on time and as luck would have it, the young man that does afternoon turnout was late on this day so I had enough time to take Lily into the wash stall and change her bandage. The leg looked AWESOME. Just a small amount of localized swelling and she was very comfortable on it: no lameness at all. I figured this would all just be a breeze from now on. 

Nice, tight leg. The wound at the back of the leg looks goopy because of the SSD.

Close up.

Not actually touching the leg because no gloves: I've been washing my hands and wearing gloves to do everything with this leg, with glove changes any time I touch something dirty. But just pointing at the drain hole: this is where the drain was inserted into her leg to allow any fluid build up from inside the leg to exit and thus prevent an abscess from forming.
Healing nicely.

Swelling very localized to the wound itself. I was thrilled.

ALL THE BANDAGE MATERIALS.
And my bag full of minocycline.

SSD applied to wounds, which conveniently makes them temporarily sticky for the Telfa pads.

Rolled cotton layer.
I asked her to weight the leg while applying; she kept wanting to rest the leg. She has since come to understand that anytime I'm messing with the leg, she is to weight it. She's really good like that.
No kling/brown gauze because I never could find it. But that's okay.

Finished bandage with blue Vetrap and Elastikon top and bottom to seal it.

And maybe I should just expect the worst from now on like I normally do because my mental exercises in positivity just mean that I fall that much harder when things go wrong anyway. 

I then picked her stall and aced her right as the other horses were being turned out. She screamed and paced a while and then it kicked in...but she was really lackadaisical about her food and most of her hay from the evening before was still untouched. I swore she had dropped more weight overnight. I was told she had taken forever to eat her grain that morning too. I gave her a dose of UlcerGard and almost forgot to give her her minocycline. I syringed it to her and she managed to spit at least half of it all over me. Fun. And worry about her not getting enough antibiotic. This was before I started adding molasses to the mix: the molasses made her far more receptive to these dosings.

After this I tried taking her out to hand graze but she wanted to gawk at the other horses and walk in circles around me, so back she went into the stall. I gave her alfalfa as a last resort (because it tends to get her jacked up when she is confined) and she munched on that. Whatever. At least she was eating SOMETHING.

I took Gracie up to the round pen and we had a really wonderful session at liberty. The first time she has offered up to do the things we had been practicing in spring, but without any lead rope as an aid. It was so so so awesome. I didn't ride; I didn't feel like it. The groundwork was very relaxing though.

Good mare

One week later, I have started having dreams of doing bandage changes on Lily and not having the right/enough materials...

Lily's Leg, A Novel: Chapter 1, The Return Home

This is long overdue and I'm sorry, guys. Life has been absolutely freaking insane since Lily arrived home, including an extra emergency farm call and two additional vet visits to manage some complications.

But first things first.

-----------------------------------------------------------

On Thursday July 9th, Charles and I drove up to New Bolton at the University of Pennsylvania to pick up Lily. I had called that morning to let them know we would be there around 3:00 pm, but we ultimately arrived 30 minutes ahead of schedule. I called them at 2:00 pm to let them know we would be arriving early; they were scheduling that day's bandage change for Lily to coincide with our arrival so that they could show me how they were doing it.

The receptionist from the weekend prior was there and she remembered us, though it was another receptionist that took care of us. We were checked out and the bill was within the estimate range we had originally been given ($3-5k including the deposit of $1500). "This is amazing!" I told the receptionist, meaning it in the best way possible, and she looked at me like I had sprouted another head. I'm sure they don't hear that one a lot...The Marion DuPont equestrian hospital in Leesburg had wanted as an initial deposit what ultimately ended up being our entire bill for 7 days of hospitalization at New Bolton.

Guys, if you are in this region and your horse can be hauled the distance safely, I really recommend this hospital. Not just for the price, but for everything: the care my horse received, and the daily updates on how she was doing. I had this incredible (and annoying!) knack for calling every time Dr. S was doing Lily's bandage change. Her secretary would leave her a message and I would often get a callback within 15-30 minutes. I tried to keep phone calls short because I know how busy it is on the other end, but there was one day when I called back a second time so we could discuss treatment once Lily went home and Dr. S returned my phone call a few minutes later. I was stuttering on the phone in my attempt to make it as brief as possible and Dr. S gently said, "You have time to think; don't worry." So I stopped and was able to formulate all the questions I had, and she answered all of them.

Loved her. Really did.

I was given a paper bag with an obscene amount of antibiotics in it, as well as a printed copy of my discharge instructions for Lily's aftercare. I skimmed over them quickly to see if I woud have any questions, but it was all pretty straightforward.

A tech met us in the lobby and took us to Lily's stall, where she called Dr. S to find out about Lily's bandage change: it looked like she had a brand-new bandage already. They had indeed already changed it, but would be changing it again so I could see the process.

I realized that Lily had a little routine going on here. I initially thought she just wanted out of the stall, as she was eagerly standing next to the tech while she contacted Dr. S, but as we followed the tech and Lily to the treatment area, I noticed that Lily knew exactly where they were going.

It's hard to explain clearly, but it was strange to me to see my horse so familiar with a routine that I was not part of. Is that weird? I see her every.single.day. If two days in a row go by where I don't see her, it feels so strange. Like I'm forgetting something vital. Like how to breathe or where home is. The longest I had been without seeing her prior to this was the 5 days between her being shipped north to MD and us driving up a few days later.

She was walked into the treatment area and I was introduced to more doctors. I realized then that my horse kind of had a fan club too! I grinned because this is a common happening: Lily is a cute, dainty mare with a pretty dished face, but not particularly striking to look at like, say, Gracie with her flowing sun bleached blonde tresses and dapples. Lily's magic is when you get to know her: she is so polite, so reserved, yet so incredibly sweet that people who get to know her fall in total and absolute love with her. It takes a couple of interactions with her to see this side of her; it's not something she shows you at first sight unless she really, really likes you...like the tech that was holding her for the bandage change. :) Lily liked her a lot, and the tech rewarded her by reaching over into a bin full of small baggies and producing one. She tore it open and I saw that they were treats! Lily was familiar with what they were and was happy to eat them out of her hand.

Lily used to be a nervous wreck around vets but after her whole annular ligament ordeal + cellulitis two years ago, she became very much used to both injections and veterinarians. The mare used to spin and rear in the stall if approached with a needle in syringe...even if I was the one doing the injecting! The first time she was on injectable antibiotics, I was having to drive out to the barn in the middle of the night after work to give her her second daily dose because my BM at the time, who was a very experienced horsewoman, was unable to do it herself because Lily would flip her shit to such an extreme. Mareface has come a long, long, looooong way in more ways than one, and I was hoping that all of her previous experiences would have led to a positive outcome for her during her stay at the hospital.

It was wonderful to see that this had indeed been the case.

Dr. S showed up around then, as the other doctor was getting all of the bandage materials ready. The bandage was removed (there was one bandage up to her hock and a separate pressure bandage on her gaskin from the previous day's limb perfusion) and I won't lie: it looked a little worse than I had originally expected. The leg was still pretty swollen around the wound site. Dr. S must have seen my expression because she said, "This looks REALLY good!" And took her time explaining everything that she was seeing from her point of view compared to how the leg looked before. I felt much better then. She said Lily should be in the clear to make a full, fairly prompt recovery, as there had been absolutely no tendon involvement, no joint involvement at the fetlock, and we were a week out from the splint bone fragment removal, so she wasn't really concerned anymore about the bone becoming infected. Lily would be 2 weeks on stall rest with only hand grazing (no hand walking), with hand walking starting after her sutures were removed. The first set of sutures (pink in color) should be removed on Monday 7/13, the second set (blue in color) on Friday 7/17 or Monday 7/20; she said my vet was aware already. The worst that could happen was that Lily would get some sort of skin infection and even that would not be a major setback. She said she had spoken to Dr. L, my regular vet (Dr. E, her newer associate, was the one that referred us) and she was comfortable doing the antibiotic limb perfusion at the barn if necessary.

Correction of my previous incorrect use of terms: it's called a DLP or distal limb perfusion, not an "antibiotic infusion" as I kept erroneously calling it. There where will be a LOT more on that in the following posts, so I'm not going to go into huge detail about it now. It basically involves injecting antibiotic into a vein that communicates with the wound on a horse's lower leg so a stronger antibiotic can be administered directly to the area from the inside. I still think it's one of the coolest things I've ever heard of, and I had no idea this was a treatment for horses. It's not used in small animals...yet, at least.

Dr. S said as long as Lily stayed comfortable, she could go back to full turnout and riding after the two weeks of increasing hand walking. Best news ever, seriously, and after her much more minor ligament injury two years ago that was so much more complicated to rehab her from, this seemed easy peasy. I had high hopes that for once Lily would have an easy, smooth recovery from an injury.

I was talked through the process of re-applying the leg bandage, and I did not get pictures because I was intent on listening:

1. Scrub wound + drain site below it + scrape at coronet band and at hock with Betadine scrub
2. Apply SSD ointment to all wounds on leg
3. Apply Surpass to the swollen areas around the wounds
4. Apply nonstick Telfa pads to wounds
5. Apply thin layer of cast padding to keep all the pads in place
6. Apply a layer of sheet cotton
7. Follow with a snug layer of brown gauze
8. Finish with a layer of Vetrap
9. Place Elastikon at top and bottom of bandage to keep shavings from getting under the bandage. Elastikon is a stretchy beige tape with magikal properties: it is, I think, the only medical material that will stick securely to fur, even when wet. I think it is marketed specifically towards the veterinary field because of this. I could be wrong, but the truth is I've never been able to find it at a pharmacy. You can, however, usually find it at tack shops and farm supply stores. Note: have a roll of 4" Elastikon in your equine first aid kit! It is far superior to duct tape for securing a bandage to weird/high motion parts of your horse's anatomy.

Dr. S asked if I was comfortable with the bandage and I told her yes. It was basically a modified Robert Jones bandage, similar to what we do in small animal with cat and dogs legs. (The "regular" Robert Jones bandage uses several pounds of material to create a much bulkier bandage to stabilize more serious fractures on lower limbs.) The modified Robert Jones is used for applying light to moderate compression to a limb to both protect wounds and/or surgical sites and also to provide stability to minor fractures. (Here is a great article with photos on how it's done and how convenient that it's also by the University of Pennsylvania. ;) ) She gave me the option of buying more materials from the hospital or a farm supply store. I chose the farm supply store. I had the following day off and had the time to go hunting for everything I would need for the weekend (hint: "hunting" is the most accurate term for what would happen), as I could buy most of the materials by the case from work with my employee discount.

On the walk over I had noticed that Lily was head-bobbing a bit on her right front, like she had the day of the accident. I mentioned it to Dr. S, who palpated the leg, checked the hoof with hoof testers, and then had the technician walk her around the treatment area. "Is it a reflection of the left hind?" I asked. "I think so," Dr. S said, "She is stepping short on the hind leg as well." They had decreased her bute from 1 gram twice a day to 1 gram once a day on this day; she said I could bump her back up to twice a day since she had been perfectly sound before.

I was given all of the leftover materials from this bandage and also any extra meds from Lily's hospital supply, including a couple of bute tablets. "Here, you paid for this already. Take it with you!" And we were sent home. Dr. S said to call her if we had any questions or concerns.

The tech that had been holding Lily walked outside with us and hand-grazed Mareface while Charles and I went to hook up the trailer. It took all of 4 minutes for us to get back with the truck and trailer. The technician handed Lily's lead to me and we loaded her up. Lily seemed thrilled to be returning home.

Repeat photo but whatevs

I can't say enough good things about our experience with UPenn's New Bolton equine hospital. If things had to happen the way they did, I'm glad Lily ended up in their care. I want to note that it is not common to be able to continue to receive updates from the same doctor that admitted your animal into the hospital over the course of an entire week: they have days off during which your pet will be transferred to another doctor who will oversee his/her case while your main doctor enjoys their "weekend" (because it doesn't always fall on an actual weekend.) Lily was in the hospital for 7 days and on each day I spoke with Dr. S herself. Either the doctors have longer rotations at UPenn before a series of days off and we lucked out, or she was coming in to do the bandage changes herself, which sometimes happens but is not the most the most usual thing.

I had been dreading rush hour traffic, as we were leaving the veterinary hospital close to 4:00 pm, but as it would turn out it was not bad at all. It still took us a little over 2 hours (the drive sans traffic was exactly 2 hours) to get back to the barn, where BM had left the stall ready for Lily.

Lily was very confused at being caged instead of turned out and she stressed a bit, screaming occasionally. I stressed over the whopping dose of antibiotics she was getting...4400 mg of minocycline twice a day. 44 capsules at EACH dose!

Pro: they were capsules so I could break them open to get the powder out, mix it with molasses and water in a syringe, and syringe it to her.
Con: the powder is somehow oily (I'm sure there is a scientific explanation for that but my brain has not been working for a while and I don't care enough to go looking for the proper term) so if it falls on your clothes when mixed with water, it does not come out.

For those of you who have picky creatures like mine that won't eat their meds mixed in grain/a mash/hidden in treats (Lily will eat them in Stud Muffins up to a point; she has a limit) you can do this:

44 capsules OH.MY.GOD

Break open capsules into small Glad plastic containers. These are their smallest size. I believe they take 1/2 to 1 cup of food? I can't remember.
Each one of these is one dose.
If you have tablets instead, crush them.
Then add about 1 tbsp molasses or applesauce. (Lily hates applesauce -_- Yes she is a weirdo.)

Then add a *small* amount of water. About a tbsp also.

Put lid on container and...
Shake it like a polaroid picture!

Voila. Disgusting antibiotic mix that your horse might like a little better because it has molasses added.

Pour into a 60 ml catheter tip syringe. Using only a small amount of water and molasses means that you have a creamier liquid that sticks to your horse's tongue better and also a smaller amount of mixture to dose. Less = better! And easier to get into your horse.

For Lily's dose of antibiotics the next morning, I was able to get 5 capsules into one Stud Muffin treat at a time, for a grand total of 9 Stud Muffin minocycline sandwiches. I tossed them in her morning grain for the barn staff to give the next day, and warned BO that Lily would have a ridiculous amount of treats in her breakfast because of this.

I gave her a dose of UlcerGard and ended up giving her a titch of ace IM to keep her relaxed. I was worried about going home and leaving her alone all night, dreading that she would decide to panic in the stall and injure herself somehow. It had been two years since the last time she was confined and I really wasn't comfortable with her being completely alone without another horse in the barn. It was almost harder to leave the barn than it had been to leave the hospital after our one and only visit during Lily's stay there.

I am fortunate to have met some truly wonderful people through this blog.

"Sending an angel to help heal Lily. Hugs, Sara & Gem"
From Sara. This was a surprise that arrived right before Lily returned home.
Yup, I cried.

Guess who this is from! :D

Beka sent me Archie's standing wraps and no-bows from her own months-long saga with his left hind.
(In case you didn't notice, it is the same spot on the same leg! I think Lily wants to be Achie's twinkie.)
These have come so, so handy. Between Beka's collection and mine, Lily can have daily bandage changes for almost an entire week before I have to do horse laundry again! She also sent me a black bag to hold the bandages so that I could access them easily in our tack room or in front of Lily's stall.

Blogger love.
Many, many thanks to both of you! <3