Tuesday, 5. February 2008, 12:23:18
Saving a Paraplegic Foal
What do you do when a healthy foal suddenly becomes paraplegic? For many, the answer would be simple--euthanasia, especially if he had an uncertain prognosis. But this attractive bay Quarter Horse colt, incongruously named Lucky, continues to survive and improve in the care of his devoted owners and veterinarians at North Carolina State University (NCSU). His story offers hope for similarly affected foals and valuable insight into caring for handicapped horses. "From birth, he was just special," says owner Anita Powell of the Impressive-bred colt, who was named Lucky for his St. Patrick's Day birth date. "He just grabbed our hearts right from the start." Lucky started life the hard way--nearly strangling at birth from a vaginal-rectal delivery (where the mare's reproductive tract was torn and his head protruded from her rectum while the rest of his body was being delivered normally from her vagina). Once that was resolved and the mare tended, everything seemed fine until one afternoon about two weeks later, when Anita noticed he was dragging his hind toes a little. "Even then I didn't worry much," she recalls. "They can be so awkward at that age." But when she checked on him about 11 pm that night, she was shocked to see him down in the stall with a circle thrashed in the bedding from him pivoting around his suddenly immobile hindquarters. He also was not urinating. The Powells immediately rushed him from their Clayton, N.C., home to their veterinarian in Apex, who referred Lucky to NCSU with a tentative diagnosis of spinal damage from the mare stepping on him. However, radiographs showed no apparent damage to Lucky's spine. Based on his age, presentation, and a high fibrinogen level in his blood, veterinarians suspected spinal cord infection and opted for an MRI scan of his spine. Such infections are not common, but even within that population Lucky was unique. "The MRI images are dramatic," says Betta Breuhaus, DVM, PhD, associate professor of equine medicine at NCSU and the lead veterinarian treating Lucky. "They showed exactly where the abscess was, that there was a lobe of it pushing on the spinal cord and another lobe pushing down into the chest, and the majority of it was under the scapula (shoulder blade). We see this sometimes with Rhodococcus (bacteria) or Streptococcus equi (equi variant) secondary to navel ill, septic joints, or systemic infection (I can remember maybe 10 in the last 30 years). But it is unusual for it to be caused by S. equi zooepidemicus, as well as with no other clinical signs or problems. It was just bad luck for him." Euthanasia was an option. But the Powells opted to treat him, and armed with knowledge of the abscess's location, Breuhaus was able to pinpoint it with ultrasound and insert a catheter to drain and lavage it (wash it out), removing a few hundred ccs of thick pus.
"In 30 years of exclusive equine specialty practice, I have never seen anyone try to treat one like this," she states. "In my experience, they either have an infection in the vertebrae, but there is no impingement on the spinal cord and the infection is treated and the horse gets over it, or there is infection in the cord and the foal is put to sleep." Not all of the abscess was able to be drained via catheter and surgery was considered, but the deep location of the abscess and future mobility concerns stayed the surgeons' hands. A second MRI performed 10 days after the first one showed the abscess had shrunk significantly, and the spinal cord was no longer being compressed. Over the next few weeks, Lucky regained the ability to urinate and began showing small signs of mobility in his back end such as twitching and withdrawal from pinch tests, which gave everyone hope. Lucky spent about three weeks in intensive care at NCSU, receiving intravenous fluids, antibiotics to further treat the infection (azithromycin and rifampin), monitoring of the shrinking abscess with ultrasound, and physical therapy in the form of getting him up to stand as well as he could every hour and massaging his legs. By the time he went home, he was able to "sling his hind legs around" if he had some supportive help. Due to his size, the option of sending him to a canine rehabilitation facility for aquatic treadmill exercise was strongly considered. However, the mare couldn't be housed at such a facility, and the Powells wanted the mare to stay with him for social reasons. But even this wasn't to be. Throughout Lucky's treatment, his mother's milk kept drying up despite treatment with domperidone, and her attitude towards him became hostile. "She just became a witch and wouldn't let him nurse," recalls Breuhaus. "She kept drying up and we couldn't trust her with him." "I didn’t want to wean him on top of everything else," says Anita. "But it had gotten to the point that she didn't care anything about him and he couldn't really care much about her. They (the NCSU veterinarians) prepared us as best they could for what we were getting into, and we talked about it and agreed on it as a family because we knew it was going to be a family commitment." Thus Lucky became an orphaned foal as well as a paraplegic one, but he still had a loving human family to care for him.
Thus began the next phase of Lucky's life--living at home in Anita's heated/air-conditioned small-animal kennel with round-the-clock support from Anita, her husband H.B., their teenage sons Braxton and Cameron, and a niece named Andrea. "He has two people with him 24 hours a day," says Anita, who initially slept back-to-back with him on a full-size mattress and box springs, complete with an open sleeping bag and a pillow, in an expanded area about the size of most foaling stalls. "It was really hard when he first came home," she remembers. "We got him up every two hours to feed him and make sure he didn't urinate on himself, and move him so he wouldn't get sores (from laying down so much). I'd be in tears with the stress of it all, looking down at him, wondering if he'd ever get better. Then I'd look at how much better he'd already gotten, and keep going." Initially Lucky was trailered to a nearby canine rehab facility to use an aquatic treadmill, then when he outgrew that he went to an equine aquatic treadmill in Southern Pines (two hours away) three times a week. The Powells cleverly rigged a sling in their slant-load trailer to keep him from falling during the trip, and someone always rode with him in case he needed help. The trips stopped when the weather turned hot and he seemed more stressed than helped by all the travel. "The treadmill really helped him," says Anita. "If it were closer, we'd still be taking him. We even thought of buying our own, but they just cost too much." H.B. jokes, "We started talking about fundraisers and asking our friends for $1,000 each, and pretty soon we didn’t have any friends." Instead, the family continued to get him up every day, walk him as much as he could handle, and put him in a sling (that can slide along a bar over his stall) for some self-exercise. He's been a model patient, Anita reports. "He's real relaxed about anything we do with him, very easy to work with and trusting," she says. "We used to lay him down to work on his feet, and he'll just about fall asleep in the sling. I think he'd go anywhere I asked." Instead of resenting all the handling, Lucky has thrived on the attention, nuzzling everyone within reach and playing with their clothes but never actually nipping. "If you wear a jacket with a zipper on it, he'll take it in his teeth and zip it up and down all day long," says Anita with a laugh. "We even rigged up a heavy-duty zipper on a board for him to play with, but it didn't have nearly as much appeal for him as one attached to a human. We gave him lots of toys and played with him a lot so he wouldn't get depressed, and he loves it all. If you act like you're going to leave, he'll go over and get crossways in the door so you can't leave. "When he was little, he was so cute. He'd wind the sling up (twist the chains by turning in the same direction over and over), then pick his feet up and just spin out of it like a kid on a swing," Anita says with a laugh. "He's just like my third child. I guess that says it all." A very large part of Lucky's success so far is due to his committed owners, says Breuhaus. "He'd be dead if he had been born to other owners," she says flatly. "Either they wouldn't have tried to treat him or they wouldn't have been able to handle it. These people have been very creative in handling his needs and are knowledgeable enough to make it work. He's in excellent condition and there's not a sore on him."
Today Lucky still doesn't get up on his own, but he can lay down on his own and needs much less help to rise. And he can walk fairly well unassisted, although he is still pretty wobbly behind. Braxton or Cameron walk behind him during exercise, using a hand on each side of his rump as needed to assist his balance. His flexor tendons are a little slack on all four feet, particularly the hinds, so today he came to NCSU for help and got simple diamond-plate extended-heel shoes to support the tendons. He's been off antibiotics for about two months now and out of the sling for about three weeks (although he was put in it for today's shoeing work), and everyone is pulling for him to gain more mobility. "He gets so excited when you come to feed or play with him," says Anita. "He whinnies as loud as he can and tries to buck. He used to fall all the time, but now he can do it without falling. It's definitely not pretty, but it's so funny to watch him play and wring his head around. He thinks he's getting better every day." "I thought that as he grew, his spinal cord would grow, mature, and heal," says Breuhaus. "It's possible that there is some scar tissue in or near the spinal cord that's causing issues. Surgery might be able to help, but as long as he's improving without it, we're not going to mess with him. We're counting on the fact that he's a young foal with time to grow and repair. "We still don't know if he'll ultimately make it," she adds. "He has learned to rely on them (the Powells) and waits to be helped. We are racing against time and his growth to get him more stable before he is too big to be helped. I thought he'd improve really fast once he got going, but his recovery hasn't been as fast as I'd like. We won't know how it will all work out until it does." She does suggest that as people-oriented as Lucky is, a little training might land him a career as a trick horse if he recovers more mobility. Steve Reed, DVM, Dipl. ACVIM, of Rood and Riddle Equine Hospital in Lexington, Ky., has consulted by phone and says it might be a year before they know what kind of horse they'll end up with, reports Anita. "My hopes are that he'll be able to get up and down on his own and lead a happy life," says Anita. "I don't care if he ever makes it to a show. A lot of people get to showing and forget what made it so fun. One day I was playing with him and smelling his muzzle and said to myself, 'That's just the best smell in the world.' He brings back all the passion and love of the horse that we all started with. That's why we are doing this. And as long as he is happy and getting better, we'll keep going."
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