Saving Orla "What You Don't Know About Joint Sepsis Can Hurt You"
by Bethany Videto
As it is with most horse lovers, I loved horses as a small child but my family was not affluent enough to afford me riding lessons. Every summer we would go on a family vacation and for as long as I can remember I would bug my parents to take us trail riding the entire time, until we hunted down a barn that offered it. All five of us would be helped onto a horse’s back, taken for a ride for an hour or so, before packing ourselves back into that wood panel station wagon of my childhood, smelling of horse, manure. and hay. I looked forward to that hour all year long. Once I turned twelve, I was bound and determined to get myself riding lessons. So I worked cleaning dog pens for a local dog breeder for just enough money every week for one lesson. I did that until I was able to start helping out in the barn to work off a second lesson per week. Eventually, the barn hired me and I rode 3 days a week and half leased an on-site Halflinger. He was stubborn and threw people all the time, but at that age we bounce and I bounced right back into my saddle.
I got older and moved from part-time barn hand jobs to more substantial ranch jobs. If I could not afford to own a horse, I would work and be paid to ride horses that other people owned. Years went by this way and I added on training horses for others at a small fee. I loved riding each and every horse, even the ones that injured me. When I was 26 I picked up riding lessons again with the goal of adding barrel racing to my docket. I became very close friends with my instructor, Caitlin, who introduced me to her beautiful, Buckskin, Appendix, Orla; who, at 2 years old, was already over 15 hands! I fell in love! I had to have her. Luckily for me, my friend Caitlin agreed to sell her to me, holding her for 2 months while I was able to buy her. She sold her to me for a fair price and helped me find a rough board barn where I paid minimal fees and was responsible for 100% of the care for my horse, which was just fine with me. My whole life had been leading to this! I was ready!
Orla has been the light of my life ever since. She is smart, beautiful, full of energy and can be a bit more than a bit of a diva. To watch her move was a joy. I can honestly say that she is one of the more challenging animals I have ever ridden. She loves to work and has so much energy that keeping her, in literally takes constant attention. You could work her on the flat, put her on a barrel pattern, stick her behind a cow, or just go on a trail ride, and she would treat it all with the focus and devotion we all hope to have for our jobs. Flash forward 4 years, literally a few weeks after her 6th birthday- I showed up to the barn to find her lame. She was toe touching her left hind rather than stepping down on her whole foot.
I immediately recognized the signs of an abscess, or I believed I did. I began a regiment of soaking her foot in Epsom salt and warm water daily, packing her foot with drawing slaves and wrapping it. She hates being inside, but she was forced into stall rest. After three days the abscess popped! I was happy, but she still seemed tender so I decided leave her in for another day to keep it clean. I show up the day after it popped and she still seemed off. I was confused, so I turned to my Farrier. He comes the day after that with hoof testers. She didn’t react to any specific spot, but she did have a big pocket under her frog. We talked it over and decided that the most likely cause of her tenderness is that the pocket is so big; it was the size of the frog itself! He gave me a powder to mix with warm water and soak her foot in for 45 minutes for the next two days. If there were any debris of puss left up there, we were determined to get it out!
Two days go by, I soak, pack and wrap her foot, again, but this time using the powder that my farrier gave me. She still does not get better, in fact, she got worse. She won’t even put weight on her left hind now. I called my farrier who was stumped. So I take the next logical step, I call my vet. He can’t come out that day, but has time in the evening the following day. My vet shows up with a sonogram machine and an x-ray machine. I feel there is no way that this mystery could go unsolved. Overnight Orla had developed inflammation around her coronary band, which we felt was another clue. He x-rays her and uses the sonogram. Her x-ray looks good (huzzah!) and the sonogram reflects fluid sitting on the top of her foot in her coronary band. They most likely cause of the problem is now that the abscess pushed upward into her coronary area, rather than flushed downward with gravity. It is a little uncommon, but not unheard of. So he sets me to soaking her foot in hot water with Epsom salt for half an hour twice a day, applying icthamol and wrapping her foot with plastic wrap. We’re going to get this thing to pop even if it takes up every free, waking moment of my life! Two days pass with no improvement. The vet returns on the third day.
He attempts to lance the abscess. Orla, under tranquilizer, does not approve of needles being poked into her foot. She runs forward, kicks at the needles and shows the vet what almost 1200 lbs of disgruntled mare looks like. I give my vet a lot of credit. He never lost his temper and never gave up. He eventually is able to drain the abscess and informs me he will be by daily to administer antibiotics via shots. The next morning she is planting her foot on the ground! I was over joyed! Finally the problem is solved! I let my vet know, that although she is definitely still uncomfortable, things are getting better! It was a short lived celebration, as two days later, although she had not gotten worse, she had not gotten better. That night we x-ray her foot again; it has been a week. This time the x-ray does not look as good. There is some haziness at the edge of her coffin joint. The infection has done some damage. For the first time I am told my 6 year old mare will not be the same ever again. It was a slap in the face. Now it is a matter of keeping the infection from getting worse. My vet informs me that he will send the x-rays to a surgeon to see if she would benefit from surgery.
The next day I receive a call from my barn that she is laying down and will not get up. We had put her out in a small med-paddock to get some sun and fresh air and she would thrash at anyone who came near her. My fiancé and I rush to the barn at almost unsafe speeds. We arrived to find my horse lying down with one leg dangerously stuck under a panel. I have my fiancé and the other two women at the barn help me pull down the panels and Orla sat up immediately. I ask her once to stand and she does, but she is sweaty and unstable. Not only that, but she has gone back to not placing weight on her hind left again. I knew my vet was coming to give her more antibiotics later, but I didn’t want to wait. I call and inform him what happened. He was at my barn within 90 minutes. The vet lets me know that we should not wait for the surgeon to respond, she needs to go to a large animal hospital. I asked if she should go immediately and he tells me that I can wait until the morning. It’s Sunday and the staff won’t be there.
Why do I tell you this long, drawn-out, seemingly boring back story? Because if I knew in those first few days, what I know now, I would not have waited two weeks for her to not get better. I would have cut straight to the chase. I cannot emphasis this enough: If your horse develops lameness, even if it appears to be an abscess, even if the vet tells you he’ll keep monitoring your animal, if it gets pass a week and your horse is still not improving, call a specialist. If something feels wrong, don’t wait. Go to the large animal hospital. Follow your gut, your instincts are probably correct. Otherwise you may end up where Orla and myself are, because at this point in the story things get a lot worse for my baby. It has been so emotional that I am tearing up as I write about it.
As soon as Orla got to Tufts they began diagnostics. Fluid samples, sonograms, x-rays. My fiancé and I spent the entire day walking Orla from procedure room to procedure room. They had given her tranquilizers and applied a block to her foot to make her more comfortable. A block is when they pump fluid into a portion of the leg or foot to anesthetize the lower limb. This gave her some much needed relief when standing, but she would still hobble behind us as we led her around the hospital corridors. By the end of the day it is determined that Orla has what is known as a Septic Joint. No amount of antibiotics or soaking would ever have helped her. In fact, if we had waited much longer the infection would have ultimately taken her life.
The next morning Orla is in for Joint Lavage surgery. This is where they go into the joint and remove some material in hopes that they are removing the infected tissues and fluids. Now, the second thing I want to stress at this point is that you should always make sure the material pulled during surgery, especially one that is due to infection, is sent to a lab to be cultured. This becomes an important point in the story shortly. Once the surgery is over the surgeon sits me down and states that the joint had more damage than the he was hoping for. I am advised, once again, that although she is 6 years old, she will never move the way a horse her age should move again. This time I am additionally informed that she may never be ride-able again; my poor, beautiful mare, who lives to work, may never work again. My heart aches when I hear this news. I was struck by the realization that, that aspect of our relationship is gone forever. I had poured almost twenty years-worth of pent up love, anticipation and accrued skills into building our bond under-saddle and in less than a month, it had been consumed by tiny bacteria, never to return. Just like that.
Devastated I decided the only thing to do now was get her healed to the point where she could at least come home and be comfortable. She stayed at Tufts, receiving Limb Profusions (A Limb Profusion is where a Torne Kit is place on the leg and antibiotics are flooded into the area and allowed to sit in order to fight the infection). She is placed on several antibiotics and a decent amount of Bute. The day after surgery she was willing to place her entire foot on the floor. This made me hopeful that we could bring her home soon. But two days later she had not progressed. Now it was Memorial Day weekend and my mare was cared for by weekend technicians, whom let me know during one visit that my mare is “grumpy” and “difficult.” Some advice for any medical students out there who want to be vets, never complain about an animal to it’s owner! I immediately determined that the care she was receiving on the weekend was sub-par because the tech did not “like” her. I was accruing a bill in the thousands and the weekend tech found it appropriate to let me know she did not like being in the stall with my mare. How else could she care for her? Was she cutting corners to spend less time with her? Was she being heavy handed with my already limping mare? I’ll never have the answers to these questions, but I should never have been given cause to think them.
Tuesday after Memorial Day weekend rolls around that the surgeon called to tell me what I already know, Orla is not getting better. He wants to do a standing joint flush and send the fluids and materials to the lab to get a culture. Wait a minute… the material pulled during her invasive surgery was not sent to a lab to be cultured?? And now that she was not getting better they had to go back in and get more material to do so?? I was confused, but I reasoned that maybe it wasn’t common practice to culture the material from surgery. Maybe the fluids used during surgery taint the sample? How could I know? My mother-in-law, bless her for supporting me emotionally through this entire process, also found this suspect and turned to her veterinary contacts to find out. It turns out that the material taken from surgery should always be sent out for a culture. This could have put us days behind!
The next day, Orla still does not look any better and for the first time my surgeon informs me that if Orla does not start responding to a treatment soon, she will not only never return to work, she will never return home! I was in the kitchen when I got off of that phone call. I cried so hard I had to sit on the floor with my back against the cabinets. I was losing my baby. I was doing everything I could for her, I was fighting a battle I knew nothing about, and I was losing. That evening the surgeon and I opted not to wait for the culture to come back from the lab and to move Orla onto another antibiotic that treats a wide scope of bacteria. I was paying for an extra procedure and lab culture that we weren’t waiting for the information to come back on, but I was through wasting time! Chloramphenicol is a fantastic antibiotic with the exception that 1 in around 40,000 humans has a reaction to it; their bodies start to suppress bone marrow production. So with the knowledge that this was a Hail Mary pass, we started Orla on her new the medication. The very next day she was moving much more comfortably! She is also given a boot that provides her heel with a twenty degree lift to take stress off of her tendon, again she responds to this right away and moves even more comfortably! I had been visiting Orla daily for almost two weeks at the hospital and just sitting in her stall with her. Now she was so comfortable that she followed me around the stall and wanted to follow me out the door. My heart lifted!
After three days on the new drug I was told she is definitely pasture sound and would at least be comfortable enough to breed. Again my heart leapt! She may never work again, but she will live and may even have a baby! I could have swooned! After 16 days at Tufts Large Animal Hospital, and the most stressful month of my adult life, I loaded Orla onto a trailer to come home. She has a slight hitch in her step, but she is happy, bright eyed and alert! On the ride back to the barn I cried again, this time because I was so relieved (Don’t worry, my fiancé was driving)! I had been carrying around the weight and stress of watching my mare slowly degrade for a month now and on that ride home in my truck it finally lifted. I was over-joyed! My bills were so high I can’t imagine how I will manage to pay Tufts, pay for ongoing treatments, as well as board, hay, grain, shavings, utilities and buy groceries so we can eat. But my baby is alive and getting better every day! There is no amount of money in the world I wouldn’t give for her. She is a life, money is a concept. She is happier every day, more comfortable every day, moving better every day!
If I could go back in time I would have brought her to a large animal hospital MUCH sooner and I would make sure that cultures were taken during surgery. I would be pushier about things getting done on a timely basis and I would tell that weekend technician where to stick her opinions. However, I regret nothing when it comes to my decision to do whatever it took to bring her home. I will continue to do whatever it takes to give her the happiest and most comfortable life I can provide. I am not wealthy, but I am a horse owner, I am mother. Nothing is more important to me than the health and well-being of my child. We still have a long road ahead of us, but we are walking it together.
Editor's Note: If you would like to 'pay it forward' and help defray the costs of the Saving Orla ordeal, and help a brave young woman just starting out in life cope with the financial crisis caused by doing the right thing for her horse.
From Bethany: " I wrote this article about the things I have gone through so far with Orla. I tried to highlight the things I would want the reader to take away from my experience, to better educate horse owners about what the signs and symptoms of equine joint sepsis are.