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09/13/2002: "A VERY Long Update"
It’s been such a long time between entries because, frankly, I haven’t been up to making any - considering the circumstances. As I check back, I’m amazed that it all started just a few weeks ago. It seems like years…
In my earlier posts, I recounted that Indy had developed an infection after his castration in April - a serous cord it’s called - and my vet, Dr. Conley, had to re-castrate him on the right side. That seemed to heal just fine, but something still wasn’t right. One thing was Indy’s increasingly frequent and strained urination. At first I thought it was just irritation from the incision, then I thought he was “marking” his territory - which he DOES do - but finally I just felt something must be wrong. Then too, he started acting, well… just not QUITE as bright as I thought he should. One of those indescribable things, but you KNOW it’s real. I called Dr. Conley back out.
Poor Dr. Conley was buried under West Nile cases in the Amish community he serves, plus, he was feeling quite ill himself. But, when his office staff suggested he should put this off, he said he didn’t think so. He came the same morning that I called. He found Indy to be spiking a temp of 101, and when he palpated, he found what he thought was a fairly large, hard impaction at the pelvic flexure. He said this mass was pressing on Indy’s bladder, making him feel as if he needed to “go” all the time. He tubed mineral oil and told us to keep an eye on his manure and his urination. Dr. C was really feeling bad. In fact, he had a doctor’s appointment for that afternoon himself, because he was afraid HE might have West Nile! Fortunately, that didn’t turn out to be the case.
Indy passed the oil just fine. His temp stayed normal, and he seemed to feel like himself again, but the urination problem seemed to get even worse. Dr. C came back out and palpated him again. The mass was still there, just as big and hard as ever. As Dr. C continued to palpate, he decided that this was not a fecal impaction at all but bladder stones. He said they were the size of baseballs and as hard as rock. He immediately got on his cell phone to Purdue to discuss the situation. The vets at Purdue agreed that they probably were bladder stones, and that they were too big to use ultrasound to break them up. Indy would have to have them surgically removed. This was on Thursday, and Dr. C set up a referral to take Indy to Purdue the following Monday morning.
I felt like I was in shock since, on top of this, I’d had to have my precious, darling little dog, Nicky, put to his final rest the same day Dr. C had been out the first time. He was 17 years old, and he’d had either a heart attack or a stroke the day before. We’d tried treating it medically, but it wasn’t working, and we did what we had to do. He slipped away peacefully with me, Mike and the entire vet staff petting him and telling him what a wonderful doggie he was. He was indeed. Mike laid him to rest next to DJ that afternoon.
In spite of our grief for Nicky and our fears for Indy, we had to check out our trailer that hadn’t been used for almost three years. THEN, I had to teach Indy to load in it. He’d never even been IN a two-horse step-up type trailer. Thank God - and INDY! - the loading training was a breeze, and Indy was going in and out of that trailer like he’d been doing it his whole life. That Monday when we loaded up to go to Purdue, he hopped right in.
He was snorty and excited when we got there, but never gave me a second’s problem. He was always extremely easy to control, even when faced with all these strange and scary things.
Even with all their equipment, the vets at Purdue were hard pressed to figure out just what these masses were. They palpated, ultrasounded, and finally examined his bladder with an endoscope. No stones. The “stones” were in fact abscesses on his left spermatic cord, along side his bladder. This was NOT a good change in diagnosis. Removing bladder stones would have been relatively straightforward, normally with a good to excellent prognosis. This deep abscess was another kettle of fish entirely. Prognosis: guarded to fair. This WAS potentially life-threatening.
Deja Vu: 2000, DJ, Purdue, shocking diagnosis out of nowhere. I felt like I was in some kind of nightmare where you keep doing the same horrible things over and over and can’t wake up. Thank God I had Mike to drive, because I would not have been able to - no way.
Indy’s doctor, Dr. Lescun, felt the best thing to do first was do a laparoscopy, since that is minimally invasive and would give them a much better view of just what they were dealing with. He said that, since he would need to put Indy under general anesthesia for the laparoscopy, he wanted our permission to go ahead and surgically remove the mass if it seemed feasible. Of course, we agreed. It was a VERY long wait. Finally, the nurse came out and said that they had only done the laparoscopy and that Dr. Lescun would be out to talk to us in a few minutes. I knew this wasn’t good news - and I was right.
Dr. Lescun showed us a video of the procedure while he explained the problems. The mass was positioned so that part of it was behind Indy’s pelvis - and virtually impossible to access. Dr. Lescun said surgery to remove it would be “heroic” in nature, and of course, dangerous. Not only that, the thing was SO hard they were not able to even get a sample to culture to determine just which “bugs” they were fighting.
Dr. Lescun suggested putting him on Baytril IV for two weeks, then test again to see where things stood. He said we COULD take Indy home for this, but I was too afraid something would go wrong. As hard as it was for me to leave him for TWO WEEKS, I felt it was in his best interests to have him in their hands as long as he needed a catheter. It was a VERY long 100-mile drive home.
Two weeks of waiting - with no guarantees that the Baytril would be able to penetrate that mass and kill the active inflammation. We went back to visit Indy every Tuesday and talk with Dr. Lescun, but there was nothing he could really tell us until the Baytril had time to do what it could do, and he ran more tests. He was very up-front that he could make no promises, because deep abscesses are very serious problems. He said he would consider Indy’s prognosis “fair” rather than “guarded” because the abscess wasn’t interfering with any internal organs except for the slight pressure on the bladder - which was more of an irritant that a life-threatening situation. Also, there were no adhesions to the body cavity or the intestines. He said he REALLY hated those. Fair prognosis. Well, it was better than guarded…
It was a long, long two weeks. What with dealing with this WAITING, my grief for my beloved little Nicky - not to mention being no where NEAR being finished trying to get a handle on losing DJ - I was a basket case. Dr. Lescun was going to run ultrasound and blood work on Thursday - giving the Baytril two full weeks - and call us as soon as he got the lab work back.
By Thursday morning, waiting for that call, I was having full-blown anxiety attacks. In fact, we were a little late getting out to give Ami her breakfast because my heart started racing, and my throat and chest constricted so much I could hardly breathe. I had to put my head down and wait for it to ease or I would have fainted. God! I was SICK.
I’m sure Dr. Lescun must have asked for the blood work STAT, because he called before noon - with the GREAT news that the Baytril had worked. The mass was about HALF the size that it had been, and the blood work was almost normal as well. Dr. Lescun said he was VERY pleased. He said that the blood values that were still not back to normal - the hematocrit and the globulin - WERE improved and he would have expected them to be slower coming back into line anyway. He said the fact that all blood work was improved indicated to him that this abscess was the only thing going on and that Indy didn’t have any other hidden sources of inflammation. He was VERY upbeat. In fact, he sounded surprised that things had come along so rapidly. Well, Indy IS a Morgan after all, and Morgans are tough as nails. As Dr. Lescun himself told us last Tuesday - the doctors can “assist nature” with all their antibiotics, but in the end it’s the horse’s own immune system that has to win the battle. Indy won.
The plan is to leave him there, still on the Baytril, until Wednesday, when they will switch him to an oral antibiotic - known as TMP/SMZ. If he doesn’t spike a fever within 48 hours, that will be a good indicator that the TMP/SMZ is taking over the job. Since this is the same drug that Dr. Conley gave him before when he had the temp - and it worked - the odds are that it will work again. If all goes as we expect, we will then bring Indy HOME next Saturday afternoon. HOME!
Whew! I guess that’s enough for this time. More later…
