Resilience

Looking like the most saddest pony outside of the 
Vet clinic, as one does.
(*This was post-treatment, so she is still slightly 
sedated, hence the "sad" ears).

The long and the short of it is that 2020 has been a really fucking trying year - which isn't something new or particularly shocking given the circumstances of the world we are currently living in. And part of me hates being the person who drones endlessly on about my own challenges. Because, somewhere out there, someone else has it worse - tenfold.

The reality is tho, things have been particularly difficult and while I am still navigating the waters of everything (in a small boat with a giant leak), I'm doing my best to stay afloat.

I know several readers have been waiting to hear an update on Annie - given the vague mention I gave in my last post. I appreciate the few who did reach out, even if just to offer support and a shoulder to help carry the weight of my frustrations and sadness. Life really is better with all of you, and although I am still hiding deep within my hobbit hole, I truly appreciate the love and support.

A more recent photo from a day when 
it wasn't raining for once.
It has been such a terrible summer - it has rained so much that
I actually found mushrooms growing in the middle of the 
SAND arena. HOW?!

Now, buckle up for a very long-winded story time, because in order to do this any justice, we have to go back several months in time and articulate some things for clarity's sake. 

Back in Summer of 2019 (yes an entire year ago), long-time readers may (or may not?) remember the little blip I mentioned in my blog about Annie coming down with a moderate horse cold following a weekend-long clinic at a local barn. Which, is something that can and does happen, especially if you are hauling from place to place a lot. Something we did quite a bit of the last few years.

During that Summer, several horses I know of had symptoms of a cold, ranging from mild to moderate - and it appeared as though it was some kind of low grade flu. It happens - and often times, is not anything to be particularly overly concerned with.

However, a month or two following the initial sickness, Annie still continued to have a very sporadic cough (if I had to put a number on it, I'd say she would randomly cough once or twice 2-3x a week). While it wasn't anything to get into a tizzy over, it was certainly not "normal", especially not for her. But at the same time, it did not appear to be restricting her performance or otherwise. I continued with light riding, as eventually brought her back into full work under the guidelines of a Veterinarian who I had reached out to when she initially got sick. 

During her explosive eye episode, I had the attending Vet give Annie a once over (in October), as I was still hearing some sporadic coughing which was not a "normal" thing for her since she hadn't ever coughed the first two years I had owned her. Upon palpation of the larynx, the Vet was able to induce coughing and told me to give her some time, as her trachea was irritated and needed more time to heal. I continued with sensible exercise, but pulled back from almost all schooling or meaningful work for the remainder of the season.

Photo from October 2019, back when her eye blew up.

Fast forwarding through October to April, the coughing was less, but still at random intervals. Some days I would hear her cough maybe once, and then I wouldn't hear it again for a week or two. One day in February, while picking poo (as much as one can do in the middle of winter, anyway), I found a rather large and concerning glob of goo on one of the stable mats in the horse's run in shelter. The consistency was very mucus-like and I immediately contacted the Veterinarian who saw Annie in October to ask for advice. I was reminded that her system had probably been weakened by whatever flu wreaked havoc in July of the previous year and to continue light exercise, but that expelling mucus is a good sign her systems were working and trying to clear the excess crud, no big thing.

I took the advice, shrugged it off and continued to monitor as time went on. As we moved into riding season, things were relatively normal. We had a few coughs here and there, but nothing that suggested a pattern and because of the nonchalant bed manner, I assumed everything was alright and after a period of time, Annie would be just fine.

May came, and the horses were moved to their new digs in the middle of the month. As the pollen from the alder trees poured down and we rolled out a new round bale for the horses, Annie went from coughing sporadically and randomly to having an all-out coughing episode. Several times over the next two weeks as I organized a Vet visit and attempted to alleviate the issue, she went into awful fits where she'd cough 10-15 times in a row. She'd cough simply standing in the paddock, she'd cough being led out to be groomed, she'd cough regardless of what was going on and I could tell it was very uncomfortable and frustrating for her. While waiting for her appointment, I tried cough syrups and powders to no avail, and was thankful as our Vet visit drew ever nearer. 

Oh, and I also shaved her entire mane off in May bc 
what good is an emotional breakdown if you don't shave off 
SOMEONE'S hair? All jokes aside, I think she looks 
like a Trojan war horse now, and I love it <3

Finally, Vet Day came, and I loaded up and headed out to Barn C to meet up with the Veterinarian. We went over a few things, and I was thankful when Annie began coughing (because it is often the way of things that you take a sick animal in to be seen and miraculously they stop doing the very thing you were so worried about) and produced a very small amount of mucus on the ground for him. He performed a rebreathe, which she passed, as well as advised her lung sounds were good. However, we were given a light diagnosis of "heaves", but the Vet advised that without further diagnostics, it is really a process of elimination if the prescription he gave did not work. (Readers will note how often I stress that Equine Veterinary Medicine is not prevalent in this area. Basic care is available approximately 3 hours away (in this case, those Vets traveled to us which is helpful) but any extended care which includes radiographs, ultrasounds, and more complicated blood panels are 7 hours away). 

With all of this in mind, we were prescribed antibiotics and steroids as a "catch all" prescription to see if any of the following was a magic bullet. Things thankfully began to improve exponentially once Annie was on the medications and as we finished off the last remaining amount of steroids, I noted that although the terrible coughing fits were 100% gone, the randomized coughing was still lingering around. I vocalized that I didn't feel as though the steroids were working, even after being sent several more packets of them. Feeling wary, I struggled my way to getting a referral bounced to a clinic 7 hours away for more diagnostics after I joined several Equine COPD groups and started to become more educated.

Now, I'll be frank. I had a few people look at me sideways and call me crazy for booking the appointment (including the Vet). I also had to push a little bit to convince them that yes, the diagnostics I listed were the ones I wanted and yes, it is for a mare that coughs infrequently. 

As we hooked up the trailer and headed out, admittedly I felt a little foolish. My mare was not presenting like a heaves case - she has never had issues recovering her breathing, nary a heave line to be seen, does not have exercise-induced mucus streaming out of her nostrils (or any mucus), she never avoided food, hadn't lost weight, and she has never struggled to breathe regardless of the activity. 

The 7hr drive was pretty nice - save for the 
fact we left kind of late, which meant we didn't
get into our hotel room until nearly midnight.

Still, there was this feeling that something was wrong.

We saw the Vet on a warm but rainy Monday morning near the end of June and I won't lie - I saw the skepticism in the Vet's eyes as she started her examination. (Fun fact, this is the same Vet who treated Maizey when we hauled out, so she is getting real familiar with my crew).

Blood was drawn and sent off to their in-house lab and a rebreathe was performed which Annie did not pass and ended in a complete coughing fit very reminiscent of the ones she endured mid-May. If I might interject one thing here, though, is that I felt as though the rebreathe was only failed because Annie actually started to panic because they had held the bag over her nose for far longer than the first Vet team did. Which, is probably standard practice, but I could see the fear in her eyes as the air was pulled from the bag. Still, the end result was coughing vs "spooked" breathing, so the "fail" still stands in a way. The Vet noted that during the rebreathe her lungs sounded decent and she didn't hear anything too alarming.

Pictured: A Very Cheap Date
Hahaha, just kidding. The sedation
may have been cheap, but that's about the 
only thing cheap about it.

The blood panel came back and all was in order, which actually made me raise a brow. Part of me was so sure that there was an infection somewhere (hence my thoughts that the steroids were not doing anything with the previous vet), but the blood test showed a perfectly balanced system. Puzzled, and slightly worried, we carried on with the examination and tests. The Resident Vet (who was overseeing the procedure) looked at me a little weirdly when I said I had stopped giving the steroids from the first vet because I did not feel they were working.

We went into the large animal examination room and I led Annie around the stocks several times, as she has never been in anything like that in her life (although I imagine a straight load is good practice for this). Once she was comfortable, she was sedated and the Vet performed a tracheal wash. This procedure is pretty neat, and it actually is not something they typically do at this clinic. In fact, the Vet who performed it had never done one since school, so she was pretty excited for the opportunity (happy to help Vet's live out their dreams, I am). The Vet who owns the clinic oversaw the procedure, and they began explaining to me how it would work.

It was difficult to get any photos of the procedure because there 
was a big window that was streaming in sunlight which created a glare
if I stood directly in line with the Vet. Thankfully you can see it pretty
good here.

Essentially, a needle is inserted into the horse's trachea mid-way down the underside of the neck. From there, a sterile catheter is pushed through the end of the needle point and extends down into the horse's trachea into the lungs. Once this is completed, saline is pushed into the lungs (which I know, sounds totally weird) and then immediately aspirated back into the syringe. The sample that is collected is able to be looked at under a microscope and/or sent for cytology if required. Typically, when you pull back on the plunger, the sample should look slightly cloudy and a bit tinged with color (yellow/brown/white).

The Vet pulled back on the plunger and uttered what every horse owner dreads, "Er... that's not what I've seen in videos/labs." Aka: "That's not what it should look like."

Oh, great.

I'm SO sad it is blurry, but you get the gist. 
This is what they pulled back and drew during the first
flush. You can kind of see the one tech prepping
more syringes in the background, as they flushed her 
probably 4-5 more times.

I knew in that exact moment I had made the right decision in hauling her the 7 hours to run more tests.

At this time, the practice owner wandered over and the two of them exchanged a few words - since we were all wearing masks and maintaining social distancing I could only eavesdrop snippets of their murmurings. I heard the practice owner say, "...impossible to have pneumonia this long..." and "...would be septic by now...."

My heart continued to race until I could stand it no longer and asked what they had found. Of course, they weren't entirely sure themselves but assured me they would be smearing a sample and the treating Vet continued the procedure by flushing saline into Annie's lungs four more times to clear all of the disgusting eggnog looking mucus-y liquid. Once the syringe came out clearer, the catheter was pulled and the techs excitedly hurried off with a sample to stain. At this point, the Resident Vet looked over at me and said, "Now I'm not so surprised the steroids weren't working."

Let me tell you, when a first year Vet student and several techs are called to the back to "check out the cool thing we just pulled from this horse", it isn't such a great feeling when it is your own animal. 

Two more samples - the Vet is holding another syringe in
her opposite hand. Slowly getting less chunky/ egg-nogg-like. 
Still not great.

While we waited for the stain, the Vet moved on to the endoscope. In a rather unfortunate (but kind of hilarious) set of circumstances, the Vet was in the very wrong place at the very wrong time as Annie coughed when the endoscope tickled down her throat. The Vet was showered with a watery, grassy, mucus bath, which I am sure she was ever so pleased to be wearing for the remainder of her day, considering we were her very first patients. 

The endoscope revealed a lot of mucus build up on the lower portion of the respiratory tract, which seemed consistent with the crud that was still yet to be named. The Vet theorized that the sample from her lungs was potentially mucus and infection, but we would know more after a specialized lab viewed it (approximately a one week wait for results). 

Endoscope in progress - with a towel over the nose and mouth
to prevent additional mucus showers on the poor Vet.

Despite the techs staining the slides, it was difficult to determine what was present. I am not sure why this is, but I guess it had something to do with the stains they had available and the capabilities of their machine. However, they noted that they were quite confident it was mucus-chains and some kind of infection. Still, we sent a sample off for a complete review and while this was being done, Annie was prepped for her next test - a ultrasound of the lungs.

The ultrasound revealed some moderate scarring to the lungs, which is par for the course given the absolute shit-kicking her respiratory system has gone through the last year. I tried my best not to cry as the Vet pointed out the areas where you could see the scarring and the resident Vet leaned over and said, "Your mare should be a lot sicker than she is." It wasn't said with backlash, but more with amazement that this mare who looked picturesque of outwardly health was actually struggling internally. 

The visit was completed with a prescription of injectable antibiotics and the promise to reconvene when the results from the cytology came forward. However, both Vets were quite confident that there is some kind of airway issue going on. It is difficult to say how it came about, but the best guess is that Annie's immune system was absolutely shit-kicked last year and never really fully recovered. And once the pollen and round bale dust got into her lungs, her lungs failed to clear out the crud and there it sat, festering and churning into a full blown infection. 

A very drunk Bannie post-endoscope and the Vet performing
an ultrasound of her lungs. 

It makes me wonder just how much of it there was, considering we would now be entering Round 2 of antibiotics.

We started the antibiotics and I also had ordered spirulina and MSM weeks previous to start her on, as several of the COPD groups recommend it for heaves or any airway problems. A week later, the Vet called us with the results and the sticky eggnog was determined to be the following: 70% nondegernate neutrophils, 5% small lymphocytes, and 25% vacuolated macrophages with a variety of Kirschman spirals (mucus), mild amounts of plant material, rod shaped bacteria. And the response of: the cytologic findings reflect mainly a neutrophilic inflammatory response. 

All of that to say, there is infection and the aforementioned white blood cells were there attempting to deal (unsuccessfully) with the problem. 

Since there was a bit of lag time between us ending the antibiotics and getting the results, instead of being able to just continue the antibiotics, we had to start a full round again and I was also prescribed steroids as well. 

The Very Best Bannie, whilst receiving her daily needle poke of antibiotics
(sans halter).

We're still in the midst of treatment, and things have been mostly trending upwards, although there have been a spattering of bad days which have made me question if the medications are actually working effectively. Still, as my mother has taught me, I need to trust the process and give things time to work - it didn't take overnight for this entire mess to happen, so it'll realistically take months to get us back to where we once were, especially as we navigate the waters in finding what maintenance methods work or don't work.

I am trying to stay optimistic though, because Annie has been absolutely on fire these last few rides. Mare has a lot of get up and go within the last two weeks and while part of me is elated to see her feeling better, I am also a bit sad that the calm demeanor I saw for most of the Summer was most likely directly related to the fact she felt like absolute poo. 

I should probably also mention that altho she was clearly not feeling well, she
still managed to ejecto-seato me during our weekend stay at a friend's barn
when we travelled out for our vet appointment which brings my
grand total to three falls off of this mare. All of which are completely
and utterly ridiculous.
I was riding her bareback in the indoor to get her out of her stall
she was staying in all weekend, and although she was spooky, she was mostly level-headed
(I had even lunged her lightly prior to getting on). Unfortunately, the wind shook
the back doors and Annie spooked HARD. I slipped off her right side as she went left, 
but hung onto the reins. As I landed on my feet (which I thought, score!), Annie
started to panic and started to go backwards (didn't Emma just post something about
how dangerous it is for horses to back up when they panic??) and spin and
her front right leg came crashing down on the side of my right knee and left me unable to
walk properly for nearly three weeks.
So uh... thanks, Bannie.

So... we're still edging ever forwards. Horses still fucking suck and I'm still frustrated beyond belief with my terrible luck this year. But, these animals depend on me and I'm trying to do everything I can to ensure rehabilitation of Annie's lungs goes according to plan. And as such, we're not really doing anything particularly... productive at the moment. Lots of long walking hacks, some trot sets and the very occasional mini schooling session to keep things moving, keep her brain engaged, and encourage her to keep some semblance of non-feralcy. 

In all of this, I cannot help but be amazed at Annie's resilience. I had always thought this mare was so... breakable and frail and looking back I cannot help but see how truly stoic and strong she really is. How absolutely blessed am I to have a horse that, even after ten long days of being stabbed with a needle, she wandered up on her own accord, shoved her head into my arms, and let me cry out months worth of frustration and sadness.