Baker - traumatic injury, abdominal surgery, recovery

Whew!  I am so exhausted, but I wanted to take some time to sit and write about what has been going on - for anyone who hasn't been following all the drama on Facebook.  And to catch everyone up on the whole story.  So, Wednesday morning started out like any other morning, until about 6:45am, when I got a text from Lois, who feeds the horses in the morning.  She said "I think something is up with Baker.  Rolling a lot. And Fiona gave him a little kick to the side a few minutes ago.  He's not acting right."  I immediately went out the back door, in my pajamas (I was already awake, but just doing morning paperwork, so I hadn't gotten dressed yet), to assess the situation.  I watched him for just a minute before I decided that it was definitely something serious.  She told me that Fiona had kicked him (she had a video of it, but it was too dark to see exactly where he got kicked), and that within 2 minutes of being kicked, he walked over to where she was at the gate, urinated a little bit, and then laid down and started rolling.  His symptoms were very similar to what you would see if a horse is colicking - laying down, rolling, looking at his sides.  Basically, they are very uncomfortable and are trying to get the pain to go away.  Being that we knew he had been perfectly fine until he was kicked, we assumed that he was just in pain from being kicked.  I told Lois to keep him either up or down, but not to let him roll (if she could).  Then I ran in to get dressed and call the vet.  Dr Swift was about 30 minutes away, so while we waited for her to arrive, Lois and I did our best to keep Baker from rolling.  Sometimes we were successful, but sometimes we were not.  It's pretty hard to keep a 500lb baby from doing what he wants when he is in so much pain.  It was heartwrenching to watch him have to go through all this and not be able to do anything about it.  The longer it went on, the worse he seemed to get, and then terrible thoughts started going through my mind.  I'm not really a person who cries that much, but I did shed a few tears as I waited for the vet to arrive and worried about what might be wrong, and what we might be facing as a result.  I had no idea what Fiona's kick could have done that could have caused him so much pain.

Finally, Dr Swift arrived and immediately gave him something for the pain.  Within minutes he started to relax and feel a lot less painful, and she was able to fully examine him.  She could not find anything obviously wrong with him, but before she could finish examining him, he started to become painful again, and started thrashing about and trying to roll.  This was, obviously, very concerning to her, and she decided that we would need to take him in to the NCSU Vet School, where he could be examined more fully.  There, they could give him more drugs for pain and sedation to make him comfortable, and they have all the best diagnostics to help us figure out what was wrong.  But, before we could get there, we would have to get him and Fiona on the trailer.  We decided that it would be better to put them on the larger, six horse trailer, instead of the smaller, two horse trailer.  We were very worried that Baker would try to lay down while in the trailer, and if he did, that Fiona would step on him.  The six horse trailer has a stud divider for the front stall.  That means that the partition goes all the way to the floor, as opposed to all the other partitions, that only go about half way down.  This would be the ideal partition to use for Baker, so that if he did lay down, he would not be able to slide under the partition to where Fiona would be standing.  However, we wanted to give him enough room that he could lay down and not get stuck.  So, we had to figure out how to remove one divider to make a larger area for Baker, and then move the stud divider down one section so that he was protected from Fiona. Around this time, Megan showed up at the barn to help out as usual.  As soon as she saw what was going on, she jumped in to help.  And also around the same time, a lady I had never met before, Dawn, showed up as well.  I had scheduled an appointment with Dawn to give one of the ponies a massage that morning.  As soon as she got there, I apologized that I hadn't had a chance to call her, and that I was going to have to cancel the appointment.  Without batting an eye, she said it was no problem at all, and asked what she could do to help!  So, we had a couple of folks working on Baker, trying to keep him calm and quiet so he wouldn't hurt himself any further, and a couple of folks working on getting the trailer ready to take Fiona and Baker to the hospital.  As soon as we had it ready, we attempted to load the horses.  Things got really hectic at this point, so I honestly don't remember the exact order of events.  I do remember that it took several tries to get both Fiona and Baker on the trailer.  We tried one first, then the other, but both were too agitated to focus on getting in a large, scary box.  The vet had to sedate Fiona a couple of times as well because she was so upset about how her baby was doing.  At one point, we were trying to get Baker on the trailer, when he started to get painful again, and started trying to lay down and roll on the gravel.  That added another concern - that his eyes would get injured by the gravel as he was thrashing about.  Finally, after almost an hour and a half, we managed to get both horses on the trailer.  Baker was up front in the larger stall we had made with the stud divider, and Fiona was right beside him in a regular stall.  We were all very concerned about how things would go while I was driving down the road.  I would have loved to have been able to ride in the back of the trailer with them, but I was the only person who was capable of driving the big rig.  So, Megan volunteered to ride in the back.  She was safely in the open section away from the horses, but where she could keep an eye on things and call me if I needed to stop.  Luckily, by this time, most of the morning traffic had died away, and we made it to the vet school with only having to stop at one light along the way.  Fiona and Baker had remained calm for the majority of the ride, and Baker seemed a little less painful when we arrived.

As soon as we checked them in, we got them off the trailer and filed into one of the exam rooms.  There must have been a dozen people - veterinarians, vet techs, interns, students - all there to help Baker.  They started by taking his history from me, and the story of what actually happened that morning that led him to be brought in.  Meanwhile, someone was taking his vitals and assessing his current situation.  They administered more pain medications, since he was starting to become uncomfortable again.  They performed an ultrasound to see if they could see what was causing him so much pain, and they tapped his belly to see if the fluids in and around his abdomen were as they should be.  On the ultrasound, they saw that his small intestine had become swollen and distended.  At the time, they weren't sure exactly why, or what caused it, but just that it was not correct.  The belly tap yielded more unsettling news - his fluids were definitely not as they should be either.  In their efforts to try to avoid a surgical solution, they fed a tube down his nose, into his stomach.  Through this tube, they pumped fluids.  If his digestive system had been acting properly, then the fluid would have continued down the stomach and through the intestines.  However, the fluid kept coming back up, called "reflux", which is another indication that things were not as they should be.  As all of this was going on, so many thoughts flooded my mind, especially that I might lose him.  Again, I'm not much of a crier, but I found myself sobbing as I watched Baker go through all this, and worried what the outcome might be.  With all of this information, the vets decided that the only way to treat Baker's issue was to put him under general anesthesia and open up his belly.  They still didn't know exactly what was wrong, just that things were not behaving they way they should, and in cases like this, time is a critical factor.  The longer that a horse's digestive system is not working properly, the more things can go wrong.  And all of this was complicated by the fact that Baker was only 3 months old.  Surgery like this on a full grown adult horse is bad enough, but surgery on a baby is even worse.  So, I was suddenly (but not too unexpectedly) faced with a very difficult decision.  If I elected not to do surgery, Baker most likely would not survive.  It wasn't certain, but being that they didn't really know what was wrong, it was a pretty good assumption.  To do the surgery, and all the recovery afterwards, they quoted me a cost of $8,000-$10,000, and that was provided they only had to do one surgery.  Since they didn't know what they were getting into, they said it could very well be more complicated, it was possible he would need more than one surgery, and it could end up costing a lot more.  And, of course, there was no guarantee that he would survive the recovery period, much less, the surgery itself.  All of this was based on what they thought might be wrong with him, but since no one really knew, this cost was only an estimate.  However, the cost just to open him up and look around, would only be around $2500, and that included what they had already done with him thus far.  It was a very difficult decision, but in the end, I had to know exactly what was wrong, and I had to at least try to give him a fighting chance at survival.  They promised that once they opened him up and saw the entire situation, they would talk to me before making any further decisions.  If it was all going to be too much at that point, then we might not go any further, but if it looked like something they could fix, then they would continue.

So, I watched as they ushered him in to the surgery prep room.  They moved Fiona to a stall in the back, and further sedated her.  They said it would be better if we went ahead and weaned them, since, if he made it through surgery, they wouldn't want him nursing from her for several days anyway, and it would be practically impossible to keep him from doing that if they were together.  So, once his surgery was over, I would be taking her home with me.  I watched as they fully anesthetized Baker, and rolled him on to his back, and hobbled all four legs, and lifted him into the air.  Once they did that, they moved him into the next room, and he was out of sight.  And so we waited.  The surgery was only supposed to take about 20 minutes to prep for and 20 minutes to actually get in there so they could what was wrong.  I should have heard from them in about 40 minutes, but it was more like a nerve wracking hour and a half before anyone came out.  The report was actually better than we expected, but also quite unusual.  Once they had opened him up, they immediately saw that the small intestine was twisted upon itself.  This had been caused by all the rolling around that Baker had done after he was kicked.  It wasn't the cause of the initial pain, but rather, the result of his thrashing about because of the pain inflicted on him by the kick he received.  As soon as they untwisted the section of small intestine, it started to return to normal.  There were still some concerns about it, but it was definitely looking better.  Next they started to look around for what caused the initial pain.  We knew that he had been kicked, and roughly where he had been kicked, but what was it about the kick that made it hurt so much?  Did a rib break?  Was there a tear in his diaphragm?  All the extra time that we waited for him to come out of surgery, was because they spent a lot of extra time looking for what was wrong.  They even had several additional vets to come take a look to see if they could find the problem.  But, no problem was ever found.  There was nothing torn, or ripped or broken, or in need of any kind of repair.  There wasn't even any outward indication that he was injured - no broken skin, not even any hair loss.  We are all still very baffled as to why this kick, that apparently didn't cause any damage, seemed to hurt Baker so much that he felt the need to writhe around on the ground in pain.  Regardless, the small intestine was returned to its normal position, he was sewn up, and he was allowed to start waking up from surgery.

The waking up would take several more hours, and there wasn't much left for me to do at the hospital, and I needed to get Fiona home and in a more comfortable area.  So, we loaded her up (after more sedation), and headed home.  The vets promised to call me as soon as he was awake and they could see how he was doing.  Once home, I put Fiona out in her familiar paddock, but with a new face - Sandi joined her to keep her company.  She whinnied for Baker a couple of times, but seemed to quiet down pretty quickly.  I had barn chores and lessons to keep me busy, but I couldn't help but think about Baker and how he was doing.  The vet called that evening, as promised, to let me know how he had come through waking up from surgery.  She said that he had done really well.  He was on IV fluids, but he hadn't panicked when he was coming out of anesthesia, which is really good.

Photo by Lauren Buslinger when she visited him that first night for me

 One complication of a big surgery with a horse, is that they panic as they are waking up, and end up breaking a leg or something like that.  They did say that he really seemed to miss his mom though.  And that the next 48 hours would be very critical to his success.

The next morning, the vet called me with an update of how things went through the night.  Unfortunately, things did not go very well.  Baker ended up spiking a pretty big fever.  A normal temperature for a horse is typically about 100-101 degrees.  Baker had a fever up to about 103 or higher.  They were very concerned that he had developed sepsis from the surgery, so they had added a lot more medications to try to control his temperature and his pain.  Only time would tell.  My plan that day was to run a few errands that I had to do, take Dylan to his doctor's appointment that had been previously planned for that day, and then head over to see Baker.  I was very worried that things would take a turn for the worse, and that I wouldn't get there in time, but it was the best I could do.  I had been treating another horse on the farm for a small cut on her leg (it was actually Baker's half sister Gia).  So, right before we went out to run our errands that morning, I went out to treat her leg.  Unfortunately, when I found her, all four legs were completely swollen more than half way up to her body.  I took her temperature, which was 102.3, and I checked her for soundness.  Remarkably, she was sound, despite all the swelling.  But all the signs pointed to a full body infection called cellulitis.  It can develop from bacteria entering an open wound, despite all efforts to keep the wound clean and protected.  So, I put a call in to the vet, and she agreed that it was probably cellulitis, but she would have to come out to see Gia and check her over to confirm it before she began treatment.  It's not a terribly serious infection, as long as it's treated, but it does require a vet to inspect it, and several medications including an antibiotic.  And that meant that I would have to put off seeing Baker longer than I had hoped to.  And that added another bill on top of the already mounting costs that Baker was incurring.  As they say, when it rains, it pours.  So, I found myself crying again!  All of this was just too overwhelming and too much for me to take in.  However, Dr Swift came out shortly to see Gia.  She confirmed that it was probably cellulitis and started treatment immediately.  The good news is that, in less than a day, Gia was looking back to normal.  She still had to receive medications for about a week, but at least she was going to be fine.  Finally, I was able to get to the hospital to see Baker for the first time since his surgery!

Our first view of Baker since surgery

Because his morning update had been so alarming, I was very concerned about how he would look and feel when I visited with him that first afternoon.  I found him alert and awake, and the vet said that he was doing a little bit better than when they had called me that morning.  Thank goodness!  He had his own private stall, and due to how susceptible he was to infection, we were required to wear plastic boots and gloves when we entered his stall.  He was hooked up to an IV that was on a long tube that hung from the ceiling.  That allowed him to be able to move around freely, but still receive fluids.  He also had a large bandage on his belly to protect the incision from the surgery.  And finally, he had a tube still in his nose so that they could regularly check for reflux.  The tube was protected by a muzzle he had to wear, which he hated immensely, and kept trying to rub it off on the wall the whole time we were there.  However, despite all that, he was improving slightly.  During regular ultrasounds, the vets had not noticed any thickening of the walls of the small intestine, which would have indicated that it was not working properly.  He had had a little reflux throughout the day, but that was not abnormal after a surgery like this, and he was able to keep some of the fluids down.  Best of all, his fever was down, and they weren't too worried about the sepsis anymore.  Dylan and I spent at least an hour with him - lots of rubbing and scratching wherever he seemed to like it best!  He definitely seemed to enjoy the attention, and he seemed grateful to see familiar faces. I left feeling a lot better about how things were going, but still reserved that we were out of the woods.

The vet called me the next morning with another update on how Baker was doing.  He had improved even more during the night.  He had not had any more reflux since 4am, despite them feeding him fluids in his nasal tube several more times.  That was really great news!  That meant that his digestive system was allowing everything to proceed through as it should.  He was even starting to pass small amounts of poop!  When I went to visit with him that afternoon, he was doing even better than that.  He seemed much brighter and happier.  He was definitely happy to see us!  They had removed his nasal tube and the muzzle.  They had also started to offer him small amounts of grain that was moistened with water to make it easier to digest.  And, they wanted to offer him grass as well, but since they didn't want to risk taking him out of his stall yet, they picked the grass and brought it to him.  How spoiled!  He was still hooked up to the IV fluids, and he was still receiving pain medication, but this was all definitely a step in the right direction.  By the time we left, he even felt comfortable enough to lay down for a nap.

He was exhausted after our visit!

I was definitely starting to feel a lot better about his progress, and started to have more thoughts about his recovery and less thoughts about losing him.

By Saturday, he had continued to improve.  They were able to take him off the pain medication completely.  He was still eating small amounts of food, and still pooping small amounts as well.  They had started to offer him several different "flavors" of water in the hopes that they would entice him to start drinking on his own.  If he could start drinking on his own, then they could take away the IV fluids, and then we would be one step closer to him being able to come home.  They also took his belly bandage off that day, because he kept urinating into it, and that had caused a little swelling.  They were hopeful that they could keep the incision site clean and protected without the bandage, and it seemed to be going well so far.  They were still offering him small amounts of grass, but they said that was definitely his favorite thing to eat!  He gobbled that up whenever they brought it in, but he mostly just picked at everything else.  This was also the first time that they mentioned a day that he might be able to go home.  They were hoping that if everything went well, that he might be able to come home on Wednesday.  I felt a lot of relief with this news.  Things were definitely looking more positive!

On Sunday, most of the improvements continued.  He was drinking water on his own, so they took him off IV fluids.  They started him on hay, which he loved.  He would eat his grain, but it wasn't his favorite thing.  He was still bright and alert, but very bored.  He really enjoyed any visitors he would get.  They did have to put his belly bandage back on.  He was laying down alot, and they wanted to make sure to keep his incision as clean as possible.  The only piece of negative information, is that he had only pooped once during the day.  Typically, horses poop about 5-6 times per day.  This definitely had me concerned that his digestive system was starting to get backed up again.  And if so, that we would have to endure another surgery.  By Monday morning, the news was good again though!  Baker had pooped 5 times overnight.  I was so relieved!  The update I received Tuesday morning, however, left me worried again.  He had become "mildly uncomfortable" during the night.  He was laying down, swishing his tail, looking at his belly, and feeling generally uncomfortable.  These are all signs of a mild colic.  The vets took away his hay, but allowed him to continue eating grass.  He was still drinking and pooping, so at least he had that going for him.  They also rechecked his bloodwork, and performed another ultrasound to see if they could see any problems that would explain how he was feeling.  Neither of those tests revealed anything alarming.  Luckily, by about mid day, he was back to "normal".  It turned out to be just a little scare, but it did mean that it would be a few more days before he could come home.

Over the next few days, they watched him carefully, but he didn't show any further signs of discomfort, or any further problems.  They gradually increase the amount of hay and grain he could have, and he tolerated all that very well.  He was able to come off the antibiotics and pain medications that he was on, and handled that just fine as well.  Finally, on Friday morning, they called to say that he still looked really good.  They had taken his blood to do one final check to make sure everything was ok.  If they didn't find anything, then he would be released to go home!  I was waiting on pins and needles for about 2 hours before they called back with the results.  Everything looked good and he was free to go!  I went to the vet school on my lunch break that day.  I was so grateful for everything that the folks at the vet school had done, but I was excited to be taking Baker home, finally! He walked out of his stall, and outside the hospital, and saw daylight for the first time in over a week.  He was a little hesitant to get on the trailer, but after just a few pauses, his hopped on.  The ride home was quite uneventful, and once home, I put him in a stall. He has to be on strict stall rest for a month.  Then he can go in the round pen for a month, and then he can go back out in a large paddock for a month.  After all that, he can go back to "work".  I have a chart for the folks that feed and care for him to fill out whenever they handle him.  It will help us to monitor how much he is eating, drinking, pooping, and what his general behavior is like.  If he does have any setbacks, hopefully, this will help us catch

them quickly.  A dear friend has loaned me a few round pen panels so that I can build him an "outside stall".  This will allow him to get outside and eat some grass and see some sunshine, but it won't allow him to be too rambunctious.  So far, he is taking it all in stride.  I have handgrazed him a few times, and he has been very quiet and easily manageable.  He is quite calm in his stall, but he does talk to any person or animal that he can see.  I have him in a stall where he can see the action in the arena, in the hopes that it will relieve some boredom.  Time will surely tell, but I think things will get better from here on out.