Posted by: yogavet | October 21, 2009

getting too old for this… already?

This week has been hard on my body, and it’s only Wednesday.  I love medicine, but wish sometimes that my patients were not so flippin’ LARGE… such as when they cannot get up on their own.  1,100lbs of floppy horse = not safe or fun for anyone.

Thankfully, the filly that came in Monday morning unable to stand on her own is only about 500lbs.  But still, too heavy for me to be trying to pick her up!  (I keep trying to remind myself of this).   She was found in her stall down on Monday morning, and her owner had last seen her in that position the night before – he thought nothing of it that night, since it is common for young horses to lay flat out, sleeping.  But in the morning it was clear that she had been struggling to rise – she had facial rubs and a cut over her eye.  And try as they might, they could not help her get up; she seemed so weak, she wouldn’t even try.  Their regular veterinarian came out, gave her some pain medication and checked her for colic (severe colic could cause a horse to be down and struggling), but couldn’t find anything significantly wrong except for a high heart rate, and dark mucous membranes, which can indicate a certain level of vascular compromise or shock.  So they brought her into our clinic for further evaluation. 

I, of course, did not have all this information when she arrived  šŸ™‚  The message was passed on to me as a "possible colitis" and/or "suspected gastric ulcers"…  So I opened the trailer to find a filly, flat on her side, looking very pathetic, and somewhat wrapped in a very large blue tarp.  I took some initial parameters (heart rate, mucous membranes, gut sounds), and then proceeded to encourage her to get up (I need to get her off the trailer, after all).  The transporters looked at me like I was crazy.  "We couldn’t get her up, even with 5 men."  Ah.  Suddenly the tarp makes sense.  "So you rolled her on to the tarp and slid her on to the trailer?"  Yup.  Excellent.  Now what?

We continued to triage her on the trailer.  Blood was drawn for evaluation, an intravenous catheter was placed in her jugular vein.  The bloodwork revealed significant muscle enzyme elevations (unreadable), and wacked out electrolytes (that’s a scientific term).   Her muscles were hard and trembling, and she had minimal skin sensation but she did have deep pain perception, and was able to move all her limbs – nothing was broken, and there were no obvious neurologic deficits.  It was becoming clear that she was likely suffering from a primary muscle disease… but we needed to get her up on her feet in order to minimize ongoing trauma to her muscles.  And she had mostly pushed the tarp out from underneath her in her continual struggle to rise, so sliding her off the trailer would be very difficult.  She had to stand and walk out of the trailer (mostly) on her own power. 

It took 3 strong men plus me (hehe), but we got her up, after much yelling and screaming and lots of sweating.  She stood, shakily, and over the next few minutes became stronger.  It was even more obvious that there was no bony or neurologic cause of her weakness… it was the muscles.  We hooked her up to IV fluids, started supplementing her with calcium (one of the electrolytes that she was fairly deficient in, which was also compounding her muscle weakness).  She began eating hay ravenously, passing normal manure (bonus!  Only horse vets get this excited about poop), and urinating… dark brown urine (coffee colored, you might say… an indication that myoglobin, a muscle enzyme, was being filtered through her kidneys… not so good).  She stood for another 90 minutes, then we found her down again, and we were unable to get her up despite much encouragement.  I got her rolled on to a cushy mat for the night, we gave her some more pain medication, and the technicians kept her warm and comfortable overnight. 

The next morning we got her up again… with much man- (and Ashley-) power.  Her electrolytes were normalizing, and she seemed stronger.  She stood for 6 hours (yay!)… but continued to pass dark urine.  Her muscles remained firm, and she was weak.  She laid back down that afternoon, and I was unable to get her back up.  BUT I was also unable to get her to quietly lie on a mat… she was getting fiestier, and stronger.  Bonus. 

This morning, it was (slightly) easier to get her up.  And she’s stayed up all day!  Her urine is now normal.  She looked exhausted when I left the clinic at 6pm, but she’s definitely stronger, and improving. 

So what’s causing all this?  It’s probably Polysaccharide Storage Myopathy, which is a genetic condition which causes horses to store way too much glycogen in their muscles.  Glycogen is supposed to be stored, but when properly stored, it is available for use as energy when needed.  When it is crammed into every nook and cranny of the muscle cell, they can’t function properly, and the glycogen just sits there, useless.  Badness ensues, especially when the horse tries to exert itself. 

Now I need to call the technician to ask if the filly is still up… and get some sleep so I can be prepared to wrestle with her tomorrow.  So far, my right knee and my right shoulder ache…  ::sigh::   It’s all worth it if she walks out of the hospital without assistance. 

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