When we cannot save them all, but we can save some

Like many rescues in the area,”Starfish Rescue” used to rotate through all the local vets. Almost as if going through phases. Before I eve stepped foot on the property, I was warned ahead of time. One, their bill is outstanding at over $5,000 owed. Two, overcrowding. Three, don’t be surprised if compliance is low. Four, don’t get sucked in.

My first time arriving at the rescue was in response to a horse that was down and seizing. We never determined the cause, and he never seized again. My second visit, months later, was to recheck a laminitis case that my colleague had seen a couple of weeks prior. The mare had recently had her feet trimmed, and Maureen (owner of the rescue)reported the mare was still having difficulties walking. It was difficult to focus on the laminitis over the glaring neurological deficits. After a full neurological work-up, EPM was at the top of our differential list. With titers returning at >3500 with two subspecies, we felt comfortable with the confirmed diagnosis and began treatment.

Over the next couple months, I attended several more emergencies at the rescue. Sick foals, colicking mares, face wounds, terrible leg wounds, even a sweet gelding hit by a car…cases I will never forget for both good and sorrowful reasons. And trying to make a difference, while balancing financial constraints with high quality diagnostics/treatments means a lot of advanced diagnostics went under the radar. With a limited budget composed of donations, it is a different challenge all of its own trying to negotiate and prioritize which horses to treat and which horses could not be saved…especially when the rescue’s conviction stands behind saving them all.

Early on, my recommendations based on poor prognosis (septic joints, fractured joints) was unheeded. It would take weeks for the rescue to come to the same conclusion, with the euthanasia being performed by the same person who picks up the horses afterwards. A bullet to the skull can be an effective form of euthanasia, but when it goes terribly wrong, it can be one of the most inhumane ways.

6 months in, and I have earned their trust. Early on, I would have to defend every diagnostic, medication, treatment protocol and justify quality of life concern. Now, not only am I greeted with open arms, but their compliance with my instructions and view of my professional opinion, does not waver. It is amazing what time (on and off the clock), patience and a whole lot of energy can do for a relationship, especially a professional veterinary one.

There have been cases that tugged my heartstrings, and cases that I spent night after night attending. We have lost some horses and saved some horses, but with every horse, we have always tried our best. It was some of these strange cases that I further expanded on my skill set, performing joint lavages and regional limb perfusions. With money a constant wall we are up against, I’ve put in many calls to specialists and board certified surgeons/internists. I am thankful for both their time and energy, and the helpful advice that has led me to treating cases in unconventional, yet successful manners.

So, although I didn’t know it when I showed up at Starfish Rescue the first time, it would come to be one of those places with some of the most sincerely compassionate people I have ever met…and something I have wholeheartedly become thankful for this year. And it reminds me of medicine in general, that we cannot save them all, but we can certainly save some.

Case of the Mondays

Like most things in life, do something long enough and often enough, and it gets easier. Drawing blood, placing catheters, passing a nasogastric tube, suturing…do it often, with a goal of doing it well. Then, there comes the added benefit of confidence. And there’s no better way to appreciate a skill, than to have acquired it and then lost it. About halfway through a “typical” day, I was made aware of those skills I take for granted.


BAL Gone [every kind of] Wrong

It started with performing a bronchoalveolar lavage on a gelding with intermittent coughing over the past year which fluctuated with weather, exercise and environment. With non-specific findings on ultrasound, we proceeded in our diagnostic plan to determine the nature of the cough. We elected to retrieve a non sterile sample from the lower airways to evaluate for RAO and IAD. I’ve passed an endoscope countless times, and performed it successfully and easily enough that I consider it at acquired, reliable skill.

By the conclusion of the BAL, I felt like I had rehearsed for a performance demonstrating everything that could not go right. The highlights of this performance included:

  1. BAL tubing hit the ethymoids, causing a profound nosebleed
  2. Projectile, unrelenting spraying of clots across self, assistant, owner, trainer and three innocent onlookers
  3. BAL tube entered the esophagus, rather than the trachea
  4. BAL tube retroflexed and came out the oral cavity
  5. BAL tube severed by teeth when traveling through the oral cavity
  6. BAL tube #1 ruined, retrieved BAL tube #2
  7. BAL tube positioned correctly in trachea, cuff would not inflate
  8. BAL tube #2 leaky cuff confirmed
  9. Continuation of #2 problem (Projectile, unrelenting spraying of clots across self, assistant, owner, trainer and onlookers)
  10. BAL tube in position, cuff inflated, saline injected in…unable to collect any saline
  11. Added more saline through tubing, retrieved <40 ml

I was relieved when the whole thing was done. After all the above complications, at least the sample was collected and submitted. What else could go wrong? Then, I got the lab report stating:

Sample has insufficient cells, inconclusive. Recommend collect second sample for analysis.

This was just the first appointment of the day.


Miscommunications, mistakes, mishaps and misfortune

When not a soul could be found at our second appointment, I called the owner. Turns out, the appointment had been rescheduled to the following week…news of which, didn’t happen to make it to today’s day schedule.
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Our third appointment canceled.

Our fourth and fifth appointments had the wrong addresses (showed up at a neighbor developement and then mistakenly went to the owner’s house instead of the boarding facility).

Collected the wrong blood tubes, forgot to dispense a medication refill, double-charged on an invoice, made at least 12 U-turns…

And the cherry on top? At 6pm, as we’re wrapping up at the last appointment and about to begin our 90 minute drive home through late rush hour traffic…my assistant hesitantly asks,

“Hey, have you been having problems with the gas gauge?”

I hadn’t. No one had. About 4 minutes later, the thing we were dreading came to fruition. We ran out of gas.


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