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Chokes, Nosebleeds and Birthday Parties

The Call

Charlotte didn’t sound particularly worried in her voicemail as she recounted the events of the evening. Calmly, she explained how this evening’s feedings went as usual. She disclosed that all three geldings were overdue for dentals, and were otherwise a picture of perfect health. Until right before she made this call.

Around 6 pm, Charlotte’s daughter alerted her that Nike was coughing, drooling and running frantically around the paddock. He refused to be caught, and uncharacteristically showed no interest in the treats that were offered to him. “Nike never says no to a treat, so something is wrong.”

Thinking of choke and colic, I emphasized the importance of not feeding him anything. No treats, hay, water or anything else in the mouth until I could examine him. Charlotte reiterated this sternly to her daughters before lowering her voice in the phone, “Just a heads up, my daughter is having her birthday today so there’s a dozen 9 year olds running around the place.”


A Few Words on Choke

Most owners can list the classic signs of choke such as food coming out the nostrils, drooling, coughing and acting stressed. There is also a common misconception that “choke” is the same in horses and people.

In horses, choke refers to obstruction of the esophagus. Usually, feed becomes lodged right after it is swallowed, or right before the esophagus enters into the stomach. In people, choking occurs when something obstructs the trachea or “wind-pipe.” In other words, inhaling one’s food or drink. Horses choke because food became stuck on the way down, never reaching the stomach. Their signs of distress are not because they can’t breath, but because of the pain from the esophagus spasming around the obstruction. Most chokes resolve before I can get there. Those that haven’t, usually resolve after passing a tube down the esophagus and pushing the bolus into the stomach. In some rare cases (especially when the choke has been going on for days before being seen by a vet), there is too much damage to the esophagus for the horse to recover…and in those cases, owners usually elect for euthanasia.


Nike

On my way down the driveway, I passed the backyard teaming with children hyped-up on sugar. I pulled into pasture surrounding the tidy little barn. A forelorn girl stood patiently with a grey pony at the end of the leadrope. Except for the drool, he appeared relatively normal. It appeared that Nike’s choke episode had likely resolved in the 30 minutes it took for me to arrive. However, unlike the usual feed-pasted nostrils, Nike’s nostrils were clean and dry.

“Do you mind if they watch? Some of them want to be vets.” Charlotte asked. A classroom-sized gathering of nine-year-olds stared intently from outside the stall. I didn’t mind, but paused for a second to provide a disclaimer for what I was about to do.

To rule out choke, a nasogastric tube is passed up the horse’s nostril. With finess and timing, the horse swallows the tube. The tube is then advanced down the esophagus until it either collids with the obstruction or enters the stomach. This is the same technique used to administer fluids and electrolytes in cases of colic. While a relatively safe procedure, there is one complication in particular that can lead the unsuspecting spectors traumatized. A nosebleed.


Nosebleed Criteria

There is a small area in the nasal cavity that contains the most sensitive and fragile blood vessels in the horse. In the event that the tube touches, scrapes or bumps this area, all hemorrhagic hell can break lose. We are talking substantial bleeding from the nose. The nosebleed isn’t life threatening, but it can be difficult to convince people of this when they see the blood cascading out like a waterfall. If the blood pouring out their horse’s nostril doesn’t freak them out, the snorting of golf ball-sized blood clots across the stall and splatter across everyone within a 6 foot radius will.

I’ve tubed over 300 horses since graduating vet school. I have come to believe in the Nosebleed Criteria. Although nosebleeds are rare, you can guarantee one if the following criteria are met:

  1. Grey or white colored horse
  2. 3 or more people watching
  3. Someone insists the horse won’t get a nosebleed

It just so happened that all three criteria had been met in the middle of this birthday party. So when I felt the tube nudge up against the ethymoids, I wasn’t the least bit surprised when blood came rushing out of the nostril. The steady stream of blood pooled in the shavings below Nike’s face. I dodged golf-ball sized clots with every snort Nike made.

No one could dodge the blood splatter.

I felt pressure on the tube give as I advanced the final 6 inches into the stomach. If Nike had choked, it had cerrtainly resolved by now. Unfortunatrely, his nosebleed had not resolved yet. When I gave the good news to Charlotte, she didn’t seem to hear me. Her eyes were fixated. Her expression was purely mortified. Not a single attendee of her daughter’s birthday party was spared. Evidence of the emergency and the nosebleed was all across the girls’ faces and outfits.


20 minutes later, Nike’s nosebleed had slowed to a trickle. And I pulled out of the driveway leaving Charlotte to wonder how on earth she was going to explain this to the parents that would be arriving any minute.


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First Foal of the Season

In the beginning…

Reproductive work makes up less than 5% of our cases. Foals have always been a special area of interest to me, largely because my first veterinary-related job was with a university and USDA breeding herd. For 3 years during my undergraduate studies, I spent the summers orchestrating and managing a breeding program consisting of 30 mares and 3 stallions. It was during these summers that I thought to myself for the first time

‘I can’t believe I’m getting paid to do something I thoroughly love and enjoy.’

I felt like this every day. Although the actual cycling and breeding  (AI and livecover) was interesting, without-a-doubt my favorite part was the foals.  Foals were the heart and soul of the job. From their first day to their last  day, they were both the most challenging and rewarding aspects of my job.


In the present…

Since there is definitely a professional void that foals used to fill, I jump at any opportunity to work with them. Last year, I inherited a big client with a small breeding program. We delivered 6 foals last year, and with the exception of one FPT, they were all healthy. This client also became one of my favorites, and I was filled with mixed feelings when she shared the news she was moving out of state. Part of me was sad at the thought of never working with her and her horses again, while the other part was excited for her new opportunity. The odds of working with mares and foals drastically dropped.

However, another client happened to have a pregnant mare that was rescued off a reservation last summer, She was pregnant, feral and has been a ticking time-bomb for the last 4 months. Since it was impossible to ultrasound or examine her, her due date was a complete mystery. As a 2 year old, she was facing a heightened risk of foaling complications (specifically, dystocia),

The client placed cameras in the stall for constant monitoring, and we all spent many evenings obsessively glued to these cameras. I even found myself checking the cameras while driving between appointments, grocery shopping and every night before bed. Over the past 2 weeks, curiosity turned to obsession as the rescue thought labor was underway any time she laid down, swished her tail, took a break from her feeder or circled her stall.


After the long wait…

It was on a Wednesday, which happens to be one of the weekdays I am not on call for emergencies. When my work phone rang, I didn’t have to look at the caller ID to know that it was the owner of the rescue.

“We’ve got wax!” 

I actually squeel-yelled into the phone with excitement and then apologized for blasting her eardrum. Waxing, in 95% of cases, means impending parturition (birthing process) in the next 6-48 hours. From my previous experience a breeding program, I guessed she would deliver her foal in the middle of the night, between 12am and 3am.

At 11:30pm, I was already out the door before I knew who was calling. This time there was a panicked tone on the other end of the line.

The foal is coming and there’s something wrong! Come quick!”

I live 8 minutes away from the rescue. I was there in exactly 7 minutes. During that handful of time, the foal was born. He lay sprawled on the ground, soaking wet. His dam, while curious about the new arrival, was equally suspcious and reluctant to approach. After passing a physical exam without a single abnormality, I spent a little time soaking up the moments. The adrenaline rush was replaced with heavy exhaustion. My colleague, the official doctor on call, was due to arrive any moment (she lived 30 minutes away). The foal was now in her care until 6 the next morning.


A note on exhaustion, fatigue and sleep deprivation

While I treasure foals, and welcome the surge of emotions that come with the entrance of a new horse life, I was also entering zombie mode. I had spent the previous two nights handling emergencies and then worked two full days with no sleep.

During vet school and the internship, mental/emotional/physical exhaustion is a very real problem. Going without sleep for 36+ hours takes sleep deprivation to a dangerous level. It wasn’t uncommon to wake-up in the driver’s seat, engine still idling and suddenly realizing you don’t remember the drive home.

In the middle of my fourth year of vet school, I remember jolting awake to the sound of someone knocking on my window. My neighbor’s worried expression was followed by

“I wanted to make sure you were okay. My husband said you’ve been idling here for 4 hours. Are you okay?”

It was 4:30 am. I assured her I was okay, just tired.

And during the internship, I even fell asleep standing up. After 42 hours without sleep, I was watching our clinician perform an abdominal ultrasound on a very sick patient. Before I knew what was happening, I felt myself suddenly fall forward…stumbling into the ultrasound and doctor trying to perform it!

Nothing will make you treasure and value sleep like an internship, vet school or any other inordinately demanding job. Looking back now, I shake my head in disbelief that any employer, program or profession would even consider asking or expecting someone to reach this extreme level of fatigue. It’s not only dangerous to the individual, but the patients as well!    


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