Saturday, March 24, 2012

Being prepared for the unimaginable, or about not making assumptions (Principle no. 2)

 «Horsemanship is made up of the habits and skills humans and horses must learn to become partners.»

How many times have I reminded a student about tying up their hackamore reins when tying or playing with their horse?  Or moving their horse around after tightening up the girth?  Maybe this has never been a problem with their horse, but making assumptions can be a dangerous thing. I learned a hard lesson on that very principle this week, case in point:

A few days ago, on one of my rest stops on my way back to Canada, a routine act that I have done hundreds of times quickly escalated into a major crisis that nearly killed my sweet mare Menina.  How does that happen?  It happens when a tired human gets complacent about something they do out of habit and makes a series of assumptions. 

«There is no such thing as accident.  What happens before what happens happens leads to the accident.» To quote Jim Kiser who heads up the Parelli ranch management and has had a career in logging, an industry known for having high rates of work related injuries.  Jim gave the aspiring 2* instructors an excellent lecture on safety and preparation for clinics last January and this is one of the points he made very clear.

This is what happened to me.  Just before dinner, after a long tiring day, I gave Menina a routine IM injection of Pentosan, a natural based product that is used to manage arthritis in horses, is very effective and has no known side effects. Assumption number 1 and 2:  this is a routine procedure that I have done many times and she has never had a reaction, it is harmless.

I pride myself on having horses that are well prepared and confident for shots, and for that reason, I often do their shots at liberty.  Assumption number 3: my horse is calm and confident, and stands still for shots.  Just as I was setting up to inject Menina, she shifted to grab a bite of hay and the needle landed just a bit farther up the neck than I was aiming at - still within the OK area, but right on the edge...

As I came out after dinner, I noticed she was not interested in her hay.  When Menina is not interested in food, alarm bells go off in my head.  As I watched her, she started walking backwards around the pen, then backwards to the corner, and backwards back to the gate.  That was odd enough that I went to look her over, and noticed some swelling and heat around the injection site.  Then I touched it - her whole neck all the way to the shoulder was throbbing really fast, as if her heart was beating 1000 times a minute, and I knew we were in trouble.  I immediately called my vet in Florida and thankfully, despite the late hour, she answered her phone!  We ran through the symptoms and vitals, she confirmed she had never seen a reaction to this product, recommended Bute and calling a vet nearby.  Thankfully, my friend Michelle, where I was staying, had her vet on speed dial and she answered the phone too!  The SC vet was not able to come out, and asked if could we trailer the horse over.  Yikes.  Michelle's trailer was in the shop and mine was all set up for camping, it was going to take a while to get it hooked up - by then, Menina is laying down as if to die; I was not sure I could even get her on the trailer or that she would be able to travel.

As we related this to the vet, she started going over the required procedure on the phone, and Michelle took charge.  Assumption no. 3:  if an emergency occurs, I can handle it alone.  NOT necessarily when dealing with your own horse, and your emotions up!  Michelle is an experienced vet tech AND she is experienced at giving the IV injections, which I am not; I would have really struggled with it, at great risk of making things even worse for my horse (if such a thing was possible, as things were going South fast).

Assumption no. 4:  I have a first aid kit.  Of course I do, but there I am struggling to find the right size needle;  I had thrown away the expired meds and not replaced them, I don't carry sedatives, and I had to search through 3 totes to find my syringes.  By that time, I have no choice but to trust my friend, my horse is dying....  Michelle did everything perfectly without hesitation. She actually stocked all the required meds and syringes and got everything prepared in record time, remembering the dosage prescribed by the vet, and proceeded to do the IV shots with a steady hand.  I then spent the night with a catatonic horse who stood completely immobile for hours, sweating profusely; by 4 am, I was literally praying to the universe to help her (I don't usually pray, I was pretty desperate).  And finally, she started coming back from where she had been; I saw an ear move, life came back into her eyes, and slowly, very slowly, she shifted around and aimed for the hay.  She very slowly and painfully lowered her neck and grabbed a small bite.  That's when I knew she had turned the corner.  In the following hours, I continued treating her with photonic therapy, ice on her neck and lots of TLC, and she improved.  The next day, she had started eating, drinking, moving around and pooping and I went to sleep for 12 hours.

The reason I wanted to blog about this is to share what I learned and maybe prevent someone else from going through the same thing.  I was lucky, I was at a place where I had access to knowledgeable support and help from someone who was level headed and could get everything we needed.  I did not purposely set myself up for success, but somehow, by sheer luck, I did.

Lesson no. 1:  there is no such thing as a routine injection!  Be prepared and know what to do and who to call in case something goes wrong.  Even the most benign needle shot has the potential to cause serious problems.  I have seen many horses react to vaccines, some quite severely.  Vaccination must be done with care and consideration, and never underestimate the possibility of side effects.  In fact, any product you inject can cause an allergic reaction.  You could also hit a nerve, ligament or blood vessel, or infection can set in - I have learned that some horses can contract a flesh eating bacteria from a very simple shot, which can kill them very quickly.  Understand the possible risk, have a local vet's number at hand in case you need it, and try to do it at a time and place where you can get help if something happens.  It also imperative to be very clear about the proper way to do an IM injection, and the pros and cons of injecting in the neck vs the chest or the hind quarters.  To that effect, I found this well documented article with good pictures of the three recommended IM injection sites.  If you have never done one, you might want to ask your vet to show you how and where, it is a very useful skill for any horse owner.  All the steps are important, including drawing back on the syringe before injecting to ensure you have not hit a blood vessel.  This is one thing I don't do as a habit, but will from now on (even though that is not what caused Menina's reaction, but it could have been a possibility).
http://www.aces.edu/pubs/docs/A/ANR-1018/


Lesson no. 2:  always halter your horse before doing an injection and make sure it is well prepared, confident, and standing still with its head level to the withers.  Do not inject a moving horse, you could land in the wrong spot, break the needle, and it could react strongly if it is scared or defensive.  Some products can kill you horse if injected in a blood vessel.  My horse takes shots very well, but I got complacent and did not halter her.  She brought her head down to eat, and I injected the wrong spot, which may have been part of the problem (although no one knows for sure at this point, she could also be allergic).

Lesson no. 3:  always observe your horse after an injection and act immediately if you notice anything out of the ordinary.  I made the mistake of leaving right away to go to dinner.  After all, my horse had never had a problem with this product and it was not a vaccine.  Had I watched her for half an hour right after the shot, I might have noticed something earlier and prevented such a traumatic episode.  On the positive side, I immediately detected her odd behavior when I returned and went to check her vital signs.  Every horse owner should know the vital signs and how to check them.
Here is a handy chart to take with you http://special.equisearch.com/pdfs/VitalSignsChart.pdf

Lesson no. 4:  always use a sterile needle and syringe.  I stock a box of sterile needles, but have been known to reuse syringes when I routinely inject the same product to the same horse (after washing them, but they are not necessarily sterile at this point).  This can be a cause of infection or bacteria.  Again, probably not the case here, but we don't really know for sure...

Lesson no. 5:  it's probably not a good idea to give shots to a horse that has been traveling for long hours or is about too, as their immune system may have compromised and they may not be able to fight off infection as easily.  Wait until you are at home in a familiar environment and you and your horse are not unduly stressed.

Lesson no. 6:  regularly review the contents of your first aid kit and make sure you have everything you might need.  This is especially important before undertaking a major trip.  Organize it and keep it in a location where you can easily find everything you need quickly.  And keep a working flashlight with it, small syringes are hard to find in the dark!

Lesson no. 7:  if in doubt about the conditions in which a medication has been kept, throw it away, no matter how expensive.  Refrigeration is required for many meds, and open vials can get contaminated or spoil if they are not kept in the recommended environments.  My vial of Pentosan had been opened for a couple of months, and travels with me in the trailer.  It may not always have been kept in optimal conditions.  My vet did not think there was any risk in using it (I did ask first), but after what happened, who wants to risk it?  I threw it out, just in case that might be what caused the reaction.

Lesson no. 8:  make sure you have easy access to a trailer in case of emergency, and that it is ready to go.  I am not sure how I might have been able to plan better for this one, I did have a trailer handy but it was not quite ready to go.  I was not really planning on going anywhere for a few days!  Michelle normally has a trailer in the yard, she just happened to take it in for repairs.  As a general rule, having quick access to a trailer is always a good idea for medical emergencies, as well as making sure your horse is well prepared to load confidently and quickly.

One more thing:  in such an acute crisis, I relied entirely on my vet's advice, although I am not generally a proponent of medicating horses and tend towards trying natural alternative therapies first.  This was not a situation to start experimenting, and there was no time to find out if this or that might work!  We needed to turn it around fast.  The alternative therapies did help Menina recover very quickly and eased her pain and swelling once she got over the worst of part of the episode. There are definitely times where a vet is your best resource.  Even when I use alternative therapies, I make sure my vet is aware and we discuss the pros and cons of every protocol, as well as the results.  I want her on my side and they do have a lot to offer.

I welcome your comments on the subject!  Keep it natural.
My friend Michelle here at Avalo Farm





4 comments:

  1. I am so glad Menina is alright. I have seen a number of reactions to medications and vaccines. A mare I used to own died from a reaction to penicillin. The year before I had given her penicillin for an injury with no problem at all. My vet has said that reactions may develop for products that were previously tolerated well. Be careful if you want to continue using the same product that caused this reaction as the next one could be worse.
    Judy

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  2. Judith, that thought crossed my mind and I won't be using it until I review the situation with my vet at home and she is on site.

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  3. Great blog and excellently written with many good points to remember!

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  4. Just an update on this event: I consulted with my vet at home and we are filing a report with the manufacturer. The most likely causes are either contamination of the product or an allergic reaction. Every other possibility has been ruled out. The original version of the product did not indicate refrigeration or carry an expiry date. The latest packaging does. I have discontinued using this product until further notice.

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