On Thursday morning, March 29th, our mare Allisia finally gave birth. I had been sleeping out there with her for a few weeks already, I was so worried about her pregnancy. When we originally inseminated her last year we had a slight suspicion that she had double ovulated. Knowing that the stallion Contango's semen is one of the longest lived I have ever experienced, we were looking carefully for twins during the preg check 2 weeks later. It was very hard to tell because her uterus is full of cysts that look just like embryos on the ultrasound. We scanned and scanned and scanned, always thinking: wait, wasn't that a shadow of a second spine?, isn't that another cranium?
For those of you who are looking at this website and are not horse people, twins are a bad thing in horses. They usually get aborted or resorbed early on. If they are carried to term they are usually very small and malformed and seldom survive.
In any case, the mare was now confirmed pregnant, the baby was kicking and all seemed well. In December she started dripping milk. That was 4 months before her actual due date. We did a hormone test and discovered that it was low. So we put her back on estrogen to help her maintain the pregnancy. She did. March 29th was her due date and, like the good mare she is, she foaled out.
When I heard her pacing around the stall I woke up and sat up in my cot in the truck parked by the foaling stall. She paced around for a while until the water broke, my cue to call Jeannine, who was sleeping in my guest bedroom ready to help. Mom had an easy birth and the baby slipped out quickly. We let mom and baby bond and talk. When I went to tie up the placenta that was still coming out of mom I noticed a hard red pouch dangling. It was a twin!
The "evil twin" (how we came to call him) had died early on during the pregnancy, probably at 3 or 4 months gestation. When we disssected that horn of the placenta to extract the dead fetus, we saw that he was fully formed. Michelle has him in her freezer until enough quantities of formaldehyde can be procured ( those crazy vet students).
The foal looked good for the first hour of her life but her energy waned quickly and by her second hour we knew we had a problem. That is to be expected with twins. They have to share the placenta, thereby losing out on nutrition. I called my veterinarian, Dr. Lisa Wallace, and she shot to the farm to help the newborn. By then we knew she would not stand and suckle. So Lisa tubed her and we milked out mom and administered her precious colostrum via the nasogastric tube. She got some antibiotics and constant care. We were trying to get her glucose levels up with a dextrose IV and Karo syrup on her gums. She seemed better and we could even hoist her up and hold her up. But by the end of the second day she seemed to be slipping away from us. She started being uncomfortable, distant, not reactive to the world.
The next morning I thought she was colicking, she seemed uncomfortable and kicked frantically, and had not passed any more meconium (baby poop) in a while. I called Lisa again, in a panic, and when she showed up she immediately said that no, that was not a colic, it was a seizure. What was really happening with her is that she was "septic", full of bacteria, from stewing in the womb with a dead brother.
Valium was the first drug Lisa gave her and she reacted very well to it by calming down. Seizures can be caused by swelling in the brain so Lisa immediately put her on IV DMSO. It made her stink like garlic and everyone that touched her got a metal taste in their mouth. She said that she needed a substance named mannitol, a complex sugar that draws fluids to itself that then get peed out. Lisa did not have this Mannitol but called in a favor and had a resident at the VMTH get her some for the filly.
By then I was getting ready to give up on this foal, looking so bad, and I kept thinking that I needed to have a one on one with Lisa about her chances, without all the people around. But there was not stopping Lisa, she was on a mission to procure the medications. She called me a few hours later and told me that she had a better perspective on this foal than I did because she could actually walk away from her and think, whereas we were there with her 24/7, sleep deprived and exhausted. She told me that this foal deserved a chance, and she was going to come back with medication and plasma. All I could say to her was "OK, whatever you say, Lisa".
She came back and we got to work. We alternated saline fluids with Mannitol, gave her the plasma transfusion, put her on some heavy duty antibiotics (amicacyn) in addition to the nexel, and continued to milk out the mare hourly and feed the babe via tube. Not as straight forward as it sounds: IV fluids are good but they tend to collect in the lungs. Also, too many fluids will dilute her blood too much. Antibiotics are great to fight off the bad bugs but will cause diarrhea, which in turn dehydrates the body and are hard on the kidneys. Mannitol diminished the swelling in ther brain but also gives diarrhea and is hard on the kidneys. The plasma is great, insta atibodies, but it can cause an anaphylactic reaction (which she did not have, thank god!). Lisa used her portable I-stat machine to track her blood sugars, CO2, and other functions which allowed us to tweak our path according to her needs. Also, I have not mentioned before that the little girl was flipped over hourly from one side to the other to avoid putting too much pressure on one lung and having sores. We also tried to keep her in an upright position as much as possible for the same reasons, which required using your body to hold her up in that position because she was too weak to even hold her head up.
When I called Jeannine she encouraged me to "call in my Life Line" (aquired a few months before while doing a favor to none other than Dr. Magdesian, who is the god of emergency neonatal care.) I called him and told him what the situation was and wanted to know from him what he thought were the filly's chances. Over the phone he said that they were probably around 70% but that he would come and look at her. That was a great gift from him to do that for us, I did not expect him to, but I accepted. He showed up and sat next to the foal and very gently and unobtrusively assesed the situation. He asked Lisa what we were giving her, saw what we were doing and concluded that they could not do any better at the Noenatal ICU at the Vet School. He said that the seizures did not concern him, that she had normal
brain funtion, that seizures in septic babies are normal, and that she
could have a few more seizures and that he would still not be concerned
about them. He told me, though, that he was very concered about her kidney function after hearing her blood values. He now gave her a slightly lower chance of making it, 60% he said. He made a few suggestions as to dosages for the antibiotics.
If you were told that you had a 50/50 chance to win the lottery, you would certainly play. Those are pretty darn good odds, I think. That is all I wanted to hear. Her chances were better than 50%, even. That seemed very promising to me. But that night was not fun. Baby was mostly looking catatonic, had light seizures all night, was runnnig a fever, hooked up to IV drip and getting fed by tube (a tube that was now in her for longer than it should have been, another concern of ours).
But the next morning (this is now Sunday) when Lisa showed up again she found baby much better. Her mucous membranes looked better, she had stopped having seizures, she was peeing lots and her kidneys were holding up. In addition her blood sugar had stabilized and she was starting to look a bit more present.
So we continued with the 24 hour care. By now people were showing up to relieve me to go to the bathroom or take a shower; they kept me company, brought food, extra blankets, towels, and took late night or early morning shifts. Penny brought a tempurpedic mattress for the girl to lay on as well as lots of blankets and some Depends to sop up her urine. Anton ran the washer and dryer 24 hours per day to keep up. Rhi, Michelle, Holly and Jeannine releived me a few hours at night when the adrenaline was starting to wear off and it became impossible to stay awake. Carrie and Marcia helped in the mornings. I slept an average of 3 hours per night, which is better than no sleep at all.
By Sunday night the babe seemed better, her ears were moving a bit, and her eye followed the movements in the stall. She slept a lot and peed a lot, which was a good sign. By monday morning she wanted to get up but was still attached to the IV so to give her exercise it took 3 people: one to support the front end, one to support the hind legs, and one to hold the fluids. Her legs were still very floppy and uncoordinated. By then she was well enough that we were trying to offer her the bottle because we wanted to be able to remove the nasogastric tube. Kirsten was successful in getting a few good draws off the nipple that afternoon. We continued to offer it to her. We discovered that we had to wait for it to be her idea. If we offered her the bottle she would not take it, but if we waited for her to root around and make sucking noises like she was hungry, she was more likely to take a few sips. Rhi releived me for a few hours that night and when I got back on duty, at about 1:00 am, I was determined to make her take that bottle. I waited for her to root and she took the bottle and drank 6 oz, quite a bit for her first true suckle. I continued with the same system for the rest of the night and by morning I had her strongly on the bottle. We removed the NG tube, and at some point in the night she had removed the catheter herself. Now finally we could see her face without all that tape on her, and she was free to move around more.
I was still hard for her to get up on her own so Jeannine and Shelly rigged up Shelly's dog's tracking harness for the girl so we could support her easily while walking around the stall. She wanted to get up every few hours and we helped her, then she would sleep off her activity. I sarted bottle feeding her only standing up next to her momma,so she would not get lazy or forget that she was a horse.
Tuesday evening, while we were chatting with Lisa about the day, we look over in the stall and notice that she has gotten up by herself! All was good except that the girlie was not too interested in mom, since it was I who controlled her resources (milk) and not momma, I realized she needed to be put back on the teat as soon as possible. I started placing the filly in the right position and letting her suck my finger till I had drawn her mouth right by the teat, then I would shove the teat in ther mouth and let her suck. I did that all night, my longest and hardest night. Every 20 minutes the little munchkin wanted to get up and eat. So every 20 minutes I got up from my cot in the stall and worked on getting her to take the teat. By the next morning she was on.
We called her Catrina. It's a C year in the dutch studbook, so all foals born this year need to be named starting with a C. But I wanted to call her Catrina bacause she was at first such a disaster, strong like a hurricane, and maneged to bring all these people together from all over the valley and further, rooting for her, and helping out.
Today for the first time momma and Catrina got turned out on grass. Allisia was very happy to get some fresh grass and some space, after being locked up in a stall for a week. Baby frolicked around and took a snooze in the grass. We have a video of course but I don't know how to post it to this website. The pictures will have to do.
Anton was great to help with the babe, especially towards the end when I was delirious and my volunteers started getting tired and I had less and less help. He also did more laundry this last week than in his entire life, and kept me fed and nourished. Momma was a star for letting us swarm all over her baby, milk her out, keep the lights on in the stall, make her baby stink on DMSO, etc etc. She stood quietly right over the baby and us, never stepping on any of us, never getting agitated, always stoic after her numerous sleepless nights.
All my helpers were fantastic to be there, let their maternal instincts take over and fuss over the baby and me.
Lisa... well Lisa is Catrina's guardian angel.
