The First of Many

As a young veterinarian working in a general practice, I’ve already figured out that about 80% of the time we just cruise along, vaccinating, running Coggins tests, writing health papers, floating teeth, practicing generic, cookbook medicine. The type of stuff that even my husband, the small animal ER vet with no horse experience outside of veterinary school, could probably handle. Sure, there are badly behaved, less-than-handled horses and donkeys and minis that can be challenging to do anything to, but for the most part it’s not all that challenging physically or intellectually.

(Keep in mind that I’m talking about a general practice here, the vast majority of what we do is preventative care and general wellness.)

The other 20% of the time, we are dealing with situations in which there is the possibility of a spectacular success or a spectacular failure. Of course, there is a vast continuum of what could be considered a success and what could be considered a failure. Most are not spectacular, but the possibility was there.

I drive to fall somewhere within the success continuum. I am willing to try some out of the ordinary treatments to get there, but I also do massive amounts of research through journals and colleagues to make sure that my therapies will at the very least do no harm.

This is where you guys get to meet my adorable little patient.

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Say It Again is a 30 year old miniature horse owned by the nicest woman you will ever meet. She lost her husband several years ago and now her horses and her dog are her only companions. She loves them like children, and would do anything for them, but despite working a job 7 days a week that keeps her away from home sunup to sundown, she still has trouble making ends meet.

She called me out to her home a few months ago, with the complaint that Say It Again had a “bubble” on the surface of his eye. Despite my attempts to get a better description, I was unable to envision what she was seeing. When I arrived, I was met with this:

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My best guess (we’ll never know for sure) is that he somehow sustained a puncture wound to his cornea, and the sudden decrease in pressure sucked part of his iris through the puncture. Another possibility is that he had a severe corneal ulcer that finally perforated the cornea, again causing a decrease in pressure and the anterior synechia. Due to the clarity and lack of edema in his cornea at the time, and the lack of purulent exudate that would usually accompany an ulcer of that magnitude, the first case is more likely.

At this point we had a debate. This is a severe lesion, usually very painful, prognosis for vision is poor, and in many cases surgery would be the recommended therapy. My boss’s opinion was to enucleate the eye.

The client could not afford an extensive surgical repair, or really an enucleation, if we’re being completely honest. I was most worried that laying down a mini at his age would be a significant risk, there was a very good chance he would not get up again.

We made the decision to treat the eye medically, against the advice of my boss and the ophthalmologist I discussed the case with. My theory was, we can always take the eye out if it doesn’t work, we didn’t have anything to lose.

We put him on a course of triple antibiotic topically in the eye, which she bought from the feed store because that was all she could afford. We also gave him 1cc of banamine daily for pain management. (I want everyone to understand that this is the most minimal of therapies, we were very much hindered by budget and this was all we could do.)

At his second check-up a week later, the eye looked like this:

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The entire anterior chamber was full of purulent material (hypopyon) and the exposed iris was becoming necrotic. We started him on a course of systemic antibiotics as well, and carried on with the other treatments.

Then I went and got married. When I returned 10 days later for the third checkup, the eye showed HUGE improvement.

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While there was still a small amount of hypopyon (we continued the systemic antibiotics for another week), the exposed iris had sloughed off, and a new corneal scar was forming. I had warned the owner that the eye would probably never look normal, but that we were looking for the globe to regain its normal shape, and the cornea and anterior chamber to clear. She remained optimistic, although my boss still said I should enucleate the eye.

Two weeks later we had Say It Again’s final check up.

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While the inner architecture of the eye is still abnormal, the cornea has cleared, a scar is present and shrinking, and the globe appears nice and round. The owner was ecstatic.

It was a good lesson for me that sometimes waiting and trying a simple therapy can work. Jumping to the conclusion that the eye was a lost cause and laying him down for surgery very well could have resulted in the owner losing her best friend. I was so thrilled that everything worked out, and even though it was a very low budget case it was extremely rewarding.

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