One Tough Cookie- an equine surgery survival mystery.

This past summer, I took on a new equine partner. Chanel, or "Nelle" as we call her, has been Middlest's horse for the past few years, but with Middlest's departure to University, I decided to give a partnership with Nelle a try. My horse, Chaser, went on to another human partner, and Nelle and I started to get to know one another.
The start was a bit rocky. We had to work through her tendency to rush fences and then buck several times on landing. This we accomplished by just allowing her to do so, and riding through it and not getting defensive. Our instructor, Bev Newton, helped me get it right. Over and over, until Nelle trusted that she could jump and I was going to ride it through without repercussion. Slowly, she forgot to be defensive, and we could get through a jump round competently.
In dressage, we had to work on that trust, and stretching into my contact, allowing flex and flow. It came in fits and starts but by the end of the season, we were able to do a competent Training level test.
On cross country, we had to work on control. Really, that is what it is about. Speed can only come after control over fences, and between them too. And we had some, well, less controlled rides, so we stepped back until we had a lovely, slow, but controlled ride at the end of the season.
Our winter looked bright, with dressage to work on, adding lateral movement and team building.

This is Nelle's "tolerant of crazy people" face.

Then, on the Wednesday after Christmas, Youngest and I returned home after a two day Pony Club Dressage lesson/ Christmas party. We unloaded his "wonderpony"- Zac, and drove into town for some errands.
We returned home in the late afternoon, and went to the barn to start evening barn chores.
I started with Samantha's stall (always the dirtiest! How does she do it?) and was busily filling up manure baskets, when Youngest went to take out the first load of manure. This is done by pushing the barrow through Nelle's stall and paddock to the pile out on the north end of the property.
He started yelling for me.
So, I ran out and to see Nelle, on her side, and what we would call "cast". Which is when a horse gets stuck when rolling and can't get their legs back underneath them to get back up. She was between a large water trough and a fence post. Part of my mind was thinking "this is very  odd" while my other part was processing how to get her up. I threw over the water trough and drug it out of the way then told her to get up, which she did. But even in the dark shadow of the barn, I could tell something was very wrong. I brought her into her stall. She was cut up on her legs, and had sliced open her lip, but worse were her eyes. Nelle wasn't home. Then she started to stumble and fall. I made a call to the house, for all hands on deck (love cell phones).  Huz and the girls came on the double and started to help. By this time, Nelle was throwing herself against walls violently, and when she was on her feet, she was circling, and had a head tilt. An odd squeak and crunching noise came from her shoulders and chest when she paced. Neurologic and painful. She passed two decent piles of feces- is this really a colic? Middlest started calling our wonderful equine vets, as Huz and I had our hands full trying to keep an 1100 lb horse from great destruction of self- and the barn too.
Dr. Chrissie Schneider arrived as fast as she could, and into the scene of an unbelievably painful horse. Lots of drugs, and the assessment that we needed to ship her quick to the OSU Vet School if we wanted her to have a chance. With kids following orders barked by me, we got her out into the snowfall and onto the now heavily bedded trailer for the fastest ride in a trailer ever crafted by this driver. Dr. Schneider had loaded her up again with meds before we loaded her on the trailer, but the meds had about 20 minutes of useful levels, and the vet school is a 43 minute drive. I had images of my trailer being tossed about on I-71/I-70 through downtown Columbus by a horse out of her mind. Would the doors hold? Would the walls even hold?  Huz was asked to just give directions for fastest way to get there. As I drove, the truck got very quiet. Middlest had elected to come with us. It is her horse after all, but I'm sure she questioned that wisdom as it became apparent that we were not going to take a full 43 minutes for the drive.
31 minutes after leaving Cowfeathers Farm, we pulled into the large animal hospital, amazingly, to a still-standing horse, that walked off the trailer fairly normally. There is a philosophy that a trailer ride can be therapeutic for a colic. A lot of bouncing around can change gas patterns and such. I suddenly had hope that Nelle was going to be okay.
The triage team quickly assessed her with a naso-gastric tubing to look for reflux, a rectal palpation that felt different than that on the farm by Dr. Schnieder (I'm giving you horse people clues all along here, but you still probably won't get the answer without being told!) Dr. Schneider had thought perhaps a torsion, the critical care doc thought maybe impaction? They did an ultrasound and a belly tap, placed an IV catheter. They tried to wash all the wood shavings and splinters out of her eyes, as she had neglected to close them in her thrashing on the ground.
She was moved to a stall with a pile of pain meds and fluids. If it is an impaction, maybe it will pass with fluids and time. If the pain meds don't keep her under control, then it is surgery.

It took about three minutes in her stall for her to go down hard and painful. I went in to hold her head and say goodbye. I told her, "You made it through a broken foreleg. You were barely lame when you sliced your hindleg to the bone. You are the toughest cookie I know. If you can, I know you'll make it. If you can't, I'm sorry."

And they took her to the anesthesia stall.

I hate seeing my horses under anesthesia, and chained upside down by their legs to move them. I don't mind how it happens, or that is does happen, I just didn't want to remember her that way. It is also how they move them to the necropsy room when they die.
So, I hid. Anxiously fluttering around the edges of the halls with Huz trying to alternately comfort me and distract me. Middlest hid too, by going to sleep in the truck.
After a few lifetimes, and not hearing that they recommended euthanasia on the table, I worked up the courage to stand outside the surgery suite, which has a big window in it. We were told it wasn't a torsion or an impaction.
They thought maybe a slip through the epiploic foramen? Nope.
How about a hold up on the gastrosplenic ligament? Nope.
By this time, taller stools had arrived for the surgeons. The surgeons are tall women, but not tall enough for going deep!
By "running the gut", or painstakingly, hand over hand moving the gut through your touch, and sight where possible, they found the issue.
The small intestine disappeared under the liver.


Anyone medical types figure it out?

Nelle had a diaphragmatic hernia with 20 feet of small intestine in her chest cavity.

Okay, extra points for whoever guessed it when I mentioned the odd squeak and crunch noises noted way back in the barn!

So, for everyone else, a diaphragmatic hernia is a weird, weird diagnosis.
If you have ever had the hiccups, you have felt your diaphragm. It is a sheet of strong muscle that separates the chest cavity, with the heart and lungs, from the abdominal cavity, with the liver, stomach, intestines and other organs. The diaphragm is NOT meant to have a hole. This is bad.
It seems as if our Nelle had been born with a hole in the diaphragm, at the top, near her spine. It was only a few inches long and wide, about the size of a fist. She had raced for years, then ridden for more, jumping, running, playing, bucking, rolling.... all horsey stuff, without an issue. How do you win races with a hole in your diaphragm?
Then, on the Wednesday after Christmas, the intestines found that hole, and went on a lookie-loo into the chest cavity.  They should've stayed home.

So, our brave, and strong surgeons managed to repatriate the intestines that were stuck in the wrong room, hold up all those organs (horse is upside down when having surgery!) and blindly staple a strong mesh over the hole in the diaphragm, preventing recurrence. All whilst trying to suction all the fluid they had been dumping into the abdomen, thinking it was a colic, out of the abdomen and the chest- into which the hole had kindly allowed free fluid flow. And fluid in your chest is also a very bad thing. There are no speakers outside the surgery suite to hear what is being said inside. Just as well. I can imagine the colorful words I would've chosen had I been lead explorer on that adventure.

 The next day, she looked like a prize fighter who had gone many, many rounds.
Her eyes were practically swollen shut, and she was bashed up most everywhere. But, she was standing, and almost alert.

She spent a week in the equine ICU with great care. A few setbacks here and there, and some worries, but she is tough. Really, really tough.

 And it wasn't long until she was off her IV line, and eating some hay. Then eating a little grain, and being allowed out on short walks. The big shaved patch on her side is so they could do ultrasounds.  Huz brought her down to his neck o'the woods to take x-rays of her diaphragm to see if the mesh was still in place post surgery.

Dear Pony Clubbers, yes, this is a chain shank, and we know it isn't correct use, but it was hospital issue, and we are not about to split hairs at this point. Horse is alive and walking!

And then came the day when we could take her home!

Alert, and happy and ready to return to Cowfeathers!
She has an incision from the base of her sternum practically to her udder, and that's freaking me out, but one foot in front of the other!

That was nearly 6 weeks ago. She has done well. I'm glad her stall is so huge, as stall rest is trying for a thoroughbred. This week she was given access to a small paddock, and in a few weeks, she can have access to the whole paddock and allowed to trot and canter, and kick up her heels! This last bit has been achieved far too many times on her hand walks. She's a bit stir crazy. So, I will be chuffed to stop expecting her intestines to fall out when she gets wild.

Great team work by our family, Dr. Schneider and the able -and I'm sure eloquent under-pressure team at the OSU Galbreath Equine Center; Drs Schroeder, Mudge, Dern and (soon-to-be) Dr. Weaver. They were a God-send and truly life savers. And, so very thankful for support by my lifetime partner, Huz.
With continued good fortune, I will be back to working on my partnership with one tough cookie by late spring, early summer. She may have earned a new show name:
"Next out on cross country is Cate Drost riding 'One Tough Cookie'!"