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The Perils of a Puncture Wound… A Day at CSU Veterinary Teaching Hospital

Once again, I am going to preempt what I had scheduled in order to tell you about what I didn’t have scheduled. I have alluded this past few weeks to the fact that Kadeen sustained a puncture wound to his leg while we were on the road. Sadly, it required a daylong experience at the CSU Veterinary Teaching Hospital this past week. Happily, it is an incredible facility and we are so fortunate to have it in our “backyard.”

I first reached out to Dr. Tom O’Brien when we canceled our last camp and headed directly home. Kadeen’s leg was slightly swollen, with palpable heat, and he was somewhat lame. I called the CSU Veterinary Teaching Hospital and was put through to Dr. O’Brien. We discussed the location of the wound and what I had been doing to treat it thus far. The wound is on the outside of his left front leg, about an inch or inch-and-a-half below the carpal joint.

As soon as I discovered the injury, I flushed it out and started him on antibiotics and Bute. I continued to flush it as long as it remained open. During our road trip home, I did hydrotherapy, running cold water over his carpus for 20 minutes twice a day.

For the first few days after we returned home, I bandaged his leg to provide some pressure against swelling. Between the antibiotics, the Bute, the bandage, and the hydrotherapy, it appeared that we had “turned the corner.” We hadn’t…

Within a couple of days of scaling back on my treatment, his condition deteriorated and he was much more uncomfortable. I reached out again to Dr. O’Brien and he immediately made arrangements for us to come to the clinic the following day. Clearly, I had only masked the problem, not resolved it.

The amazing staff at CSU Veterinary Teaching Hospital

From the moment we arrived at the clinic, we were greeted by caring and compassionate staff. During the initial physical exam, Kadeen exhibited a pronounced lameness. There was some question as to whether or not his pastern joint was sound, as well as the obvious injury to his carpal region. Since it was a traumatic injury, no one really knew what he had done to injure himself.

The decision was made to do a nerve block on his pastern joint. If there was an injury to that joint, removing the pain would theoretically make him sound. However, Kadeen did not react as expected!

After the nerve block took effect, Dr. O’Brien asked Kadeen to walk. My highly intelligent, mountain goat horse initially refused to move. He couldn’t feel his left front foot, so why would he walk off on three legs? Dr. O’Brien had never seen a horse respond that way!

Eventually, Kadeen did walk off, but he was still lame. He had been protecting his carpal joint by making changes in the way he moved his pastern joint. When he could no longer make those accommodations, he was very reluctant to move. The focus shifted back to his carpal region and the assumption was that all of the lameness stemmed from the wound.

While we were waiting for him to get films taken, the techs brought us some horse cookies. I have taught Kadeen to kiss me for a treat. He continued to kiss Alan in the hopes of getting more cookies! At this point, he was not sedated.

Got any more cookies, Dad?
Survey films and a very long ultrasound session

Survey films didn’t show any obvious cause of the lameness, but did rule out a fracture of the splint bone. The ultrasound exam was much more helpful. A wound tract was clearly evident all the way to the splint bone. To my great relief, it did not appear that the carpal sheath or the splint bone were involved. The carpal sheath is the protective covering over the superficial and deep digital flexor tendons. Although there was fluid, most likely infection, present next to the splint bone, it did not appear that infection was present in the bone.

An image captured during the ultrasound

The treatment plan was to reopen the wound, remove any infected tissue and pus, and flush it thoroughly. A second, higher nerve block was performed and the wound was reopened. It was less than an inch from the wound entry to the bone. Very scary, indeed. Dr. O’Brien expanded the access to the wound tract and carefully scraped the bone itself, as well as the surrounding soft tissue. A swab was taken for bacterial culture and sensitivity.

After thorough flushing, the wound was bandaged. The antibiotic was changed from the one I had been using to one more likely to prevent bone involvement. My instructions were to replace the bandage in 24 hours, and then again every two days until the wound was significantly healed.

I cannot say enough good things about Dr. O’Brien and the staff at CSU. Dr. O’Brien’s prompt response to my second SOS and his ability to get me in the next morning were amazing. The students and ancillary staff were equally amazing. I learned that the CSU vet class size is 150 students, and only sixteen of them in the senior class are men! Wow!

One day later

The night of the procedure, Kadeen was given 2 grams of Bute. He received an additional gram the next morning. When I changed the bandage the first time, he did not seem extremely sore. The wound looked terrific. He definitely appeared more comfortable than he had been before the wound was reopened.

Two days later

Forty-eight hours after the procedure, my poor guy was clearly very sore. He was still on a gram of Bute twice a day. There was little I could do but feel bad for him, and try to stay on top of the situation.

Three days later

The second bandage change was three days after the procedure, which happens to be the day I am writing this. The wound is healing beautifully. Kadeen is less lame, and he voraciously attacked his breakfast. I am starting to think that I might be able to relax a little…

I have heard from a couple of friends who had horses who experienced a similar wound. One had involvement of the splint bone which required surgery and six months of rehab. The other one had a septic joint. That friend had her horse at Kansas University and spent twice what we did… but thankfully, with good results. I consider us very, very fortunate that we appear, as of this writing, to be heading in the right direction.

CSU Veterinary teaching hospital
Clockwise from lower left: Lameness exam, surgical debridement, the incredible new equine facility at CSU
Sleeping off his sedation. The vet techs busied themselves braiding his mane.

And now for the processing…

I received my veterinary degree forty years ago! I practiced small animal medicine, and not for nearly as long as I had planned to do so. My life and my career took an unexpected detour when I adopted children. Those children arrived with serious attachment and trauma issues. Parenting these children was very, very difficult. I started a local support group that ultimately became a national nonprofit, The Attachment & Trauma Network. I didn’t return to veterinary practice for decades, and then only small animals and very part-time.

My understanding of physiology and biology is still there after four decades. I can read a medical article and understand it. One of my strengths, when I was practicing, was my ability to translate medicalese into something my clients could understand. When I write medical blogs for this website, I refresh my own understanding of the topic by doing extensive research. I make certain that my information is correct, and I am quick to point you in the direction of the experts on that topic.

However, when it comes to actually doing a hands-on treatment, I am very, very rusty. If you add in the variable that it is my own animal, I am probably worse than worthless. As this puncture wound scenario with Kadeen has unfolded, I have lost many hours of sleep processing how I handled this situation.

Why didn’t I catch it immediately? Did I do everything I could have initially? Should I have sought out a local (unknown to me) veterinarian at our next stop on the road? Did I have everything I should have had in my medical bag? (NO!) Did I correctly assess the degree of infection and inflammation and his discomfort, or did I lull myself into thinking my treatment approach was doing the trick?

I cannot give myself a very good grade with respect to how I handled this. It is up to me to figure out where I went wrong and what I should have done differently. Otherwise, how will I do better the next time? It is for that reason that I wrote last week’s blog, No Decision IS a Decision.

My thoughts about how things unfolded in Florida were not meant to sound like a Monday morning quarterback. My goal was to make people realize that they needed to have a plan. While I fully expected to hear some pushback on my viewpoint, I was very pleasantly surprised that 97% of the comments were positive and in agreement with me. Additionally, that post experienced ten times the coverage of any of my previous posts. Apparently, my thoughts were not my thoughts alone.

Of the 3% of people that did push back, a portion of those folks did so in the spirit of educating me about the peculiarities of evacuating from a hurricane on a peninsula. I personally believe that there are more similarities than differences when comparing wildfire evacuation to hurricane evacuation. Nevertheless, I appreciated the information provided by people who recognized that I was not bashing, but who perhaps felt that I didn’t have all of the facts.

To the readers who were extremely defensive about what I wrote, I ask you this: What grade would you give yourself when evaluating your plan to do the best that you could for your animals? I have had a very rough week evaluating my handling of Kadeen’s lameness. I am sick to think that I could have or should have done some things differently. He’s my boy, and he depends on me to get it right. Did I?

If I don’t process this and evaluate my errors, how will I do better the next time? I have been extremely fortunate that my horses have had very few medical issues. Sadie’s hole in her head was our most traumatic event in years, and there was no question that I wasn’t going to handle that one myself! What would be the point in getting defensive if I am faced with the realization that maybe I messed up?

I have already described all of the excuses I could offer as to why I wasn’t a fully functioning equine veterinarian. Does that matter? Is Kadeen any less lame because I had “legitimate” excuses? Was his risk of serious joint or bone disease any less just because I had excuses? The excuses offered by Floridians who chose not to evacuate related to no trailer, more horses than trailer space, the weatherman got it wrong, too much traffic, and a few other explanations. Were their horses in any less danger just because their owners had excuses?

Maybe my plan the next time is to recognize my limitations immediately and just get to someone who is currently practicing. I don’t know… but what I do know is that I will hold myself to an even higher expectation of getting it right.

What about you folks with no plan for a natural disaster? Are you going to continue to play the odds and hope you won’t need a plan? If you have already been caught inadequately prepared, have you formulated a new plan? Should you get caught yet again, will you have the same excuses? I hope not, for the sake of your animals. Again, at the very least, make a plan for identification. That is inexpensive, easy to do, and demonstrates at least some willingness to reduce your risk of permanent separation.

As a postscript… While we were at CSU Veterinary Teaching Hospital, there were two other horses being evaluated. Neither horse would readily load into the trailer when they were ready to leave the clinic. I asked Dr. O’Brien what percentage of horses would not load after their appointment. His response was, “One in five!”

Part of any crisis emergency plan is to make sure that your horse can be moved off of your property. Are you prepared for an emergency?

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