This is when the vet arrived. There was not much to explain other than the progression I had witnessed. and so they went to work trying to assess what was going on. She confirmed for herself that the mare was indeed blind and deaf (no reaction to clapping and her pupil were dilated and fixed). Her temperature had now plummeted to 97 F (36C).
Standard questions:
"Is she vaccinated? "
"Yes?"
"How long ago?"
"In the spring."
"What for?"
"All the normal things EEE, WEE, Tetanus, Rhino, Influenza, West Nile. (We don’t vaccinate for rabies here)".
But, I confessed because it was on my mind, I did not boost for West Nile. I never have. This fall had been unnaturally warm. While we usually had a killing frost by now, the bugs were still in full force.
The vet hummed and hawed with this information.
A different idea.
"Any sign of trauma?"
"No. None."
She is a very pale horse; any blood or scratch would be visible. Beside I reminded her that she had a very high temperature at first-trauma was not likely the cause of this. She agreed but was trying to look at all possibilities.
She calls in on an internal medicine expert and after a quick conversation on the phone she comes back to us and looks closely at her eyes and her gums. She was looking for jaundice. You see, when the horse’s liver fails it can send them into a neurological state.
There was no sign of jaundice.
We reviewed the progression of the symptoms one more time as the mare circled around us, me hauling her head around to prevent her from drifting into the fence over and over again. Finally, the vet made a decision that probably saved her life.
“We can’t tell what is causing it” she said; “it could be viral, it could be bacterial but clearly her brain is inflamed we need to reduce that inflammation.”
She gave her a large dose of Dexamethasone and another dose of Banamine.
She took a couple of vials of blood, one to get a full panel done once back at the clinic to see how the mare’s metabolism was doing and get a blood count to look for sign of infection. The rest was for potential specialized test to detect diseases that could cause all this.
She checked for swallowing reflex and thankfully it was still there. So, she gave her a large dose of oral antibiotic and left me a bottle.
“Twice a day- keep her mouth closed until you see her swallowing. If this is bacterial it will help.”
She also handed me two other bottles with instructions to repeat the dose every 12 hours for the Banamine and every 24 hours for the Dexamethasone.
She asked if I could trailer the horse to the clinic: “A spinal tap would be very telling.”
I looked at her for a beat, then we both looked at the mare stumbling around, blind and scared.
“No. I don’t think so.” I said.
She agreed.
It took some work but we managed to guide this barely conscious stumbling horse into the box stall-the safest spot for her. Solid, safe, bedded down with thick straw. She was walking in circle now, her tongue hanging out. She had stopped sweating. The evening was warm and quiet.
“If she goes down,” the vet said as she got into her car, “don’t go in there, it’s dangerous, just call me. When they go down, they usually don’t get back up.”
She held my eyes and I nodded.
I got it.
The next day
I did not want to go to the barn.
My first thoughts as I woke up were of course about my mare as I stared at the ceiling, summoning the courage to get out of bed. I had left her the night before, quiet in her stall, no longer walking in circle but nose resting on the wall, drooling and grinding her teeth. Her temperature normal, still blind but seemingly able to hear again.
She needed her Banamine and her oral antibiotics.
I got up.
I played multiple scenarios in my head as I put on my boots. It’s my way of preparing for the worse. If she wasn’t down, things were going to be looking up I told myself.
It was encephalitis- an inflammation of her brain. My internet search yesterday had convinced me of that. She had all the signs. But those were the symptoms, as to what caused it the most likely culprit was West Nile Virus, I thought. The long warm weather, the abondance of mosquitos this late in the year, the fact that I had vaccinated a bit early in the spring but had not boosted in mid-summer…Most of the articles were pretty unhelpful ( I need to change that with my contribution..) but one thing they agreed on is that neurological horses that went down had a very low prognostic.
I braced myself as I opened the door of the barn.
I could see her head and her ears! The relief almost made me weep. She was resting, one leg cocked, no longer splayed leg like the night before. No longer shivering and twitching and her head turned as I walked toward her.
She could see me!!!
I went into the box stall, I noticed the blood on the wall where she had clearly banged and cut her nose but I hugged her head and petted her dried sweat on her neck and chest.
I gave her the antibiotics, the Banamine and took her temperature (normal). I brushed her dried sweat and returned her coat to its normal soft and lustrous state, I washed her nose and face from the blood, found the few scratches and cuts where it came from-all of them minor.
She was far from normal but she was 100 X better. She could see me, hear me and controlled her legs and her balance.
Late last night the vet had called back to let me know what the blood work had told her. Everything looked really good, surprisingly, her CBC was within normal, her liver enzymes also. She was not dehydrated and everything else looked absolutely as it should.
She was holding off on sending the blood for disease screening because as grim as the thought was, if we faced euthanasia a sample of the brain tissue would be the way to go and much quicker.
Our way forward was based on the following: no tests results were not going to change our treatment.
There is actually no treatment for any of the viral diseases that she could have (we have no EPM up here) only supportive care. Potential bad actors at this point were Eastern or Western Equine Encephalitis, EHV or West Nile Virus. But the vet thought it highly unlikely to be any of those since she had been vaccinated yearly.
Bacterial meningitis is extremely rare in horses and with no invasive treatment in her recent past (no dental work, or surgery) it was even more unlikely. On the extreme low chance that it was, she was on an antibiotic that was going to hit peak efficacy in a day or two. (I was skeptical that a simple antibiotic could pass through the blood brain barrier but the vet told me that what I was giving her was able to do so.) Also, it was prophylactic because if her immune system was fighting something major, we did not want any secondary infections to sneak in.
She was on supportive care and the rest was up to her.
The lessons I learned is why I share this story.
- Vaccinate your horses.
- All viral diseases causing: meningitis, encephalitis, brain swelling-whatever you want to call- it have the SAME outward symptoms. (fever, lack of appetite, lethargy, ataxia, teeth grinding, blindness, deafness, head pressing, loss of control of facial nerves: inability to close lips, chew, swallow, twisted nose, drooping eyelids, circling, agitation at first then stupor, muscle tremors or twitching, paralysis.)
- Very high fever can lead to brain inflammation and vice versa because swelling of the brain will mess with the horse’s ability to regulate its temperature.
- A fully neurological horse is terrifying and dangerous.
- Horses have five level of consciousness or Mentation: Normal and alert, obtund (decreased level of consciousness with listlessness and drowsiness) also called lethargy, stupor (responds only to vigorous or painful stimuli), semi-comatose and finally comatose (recumbent). As a horse recovers it will go back and forth between those- as long as there is OVERALL improvement there is hope.
- Dexamethasone is a powerful anti-inflammatory that can help with brain inflammation. (So can DMSO but it’s a lot harder to administer- it needs to be dripped in, and it needs to be pharmaceutical grade as it goes straight into the vein.)
- All the nerves that come out of a horse skull go through a very small opening- any swelling there will pinch and compress nerves that go to the front and face of the horse. The hind end is more affected if the swelling reaches the spinal canal.
- Neurological horses do better with reduced stimuli (dark and quiet is best).
- Horses that remain standing at the worse of the symptoms have better prognosis then those that go down.
- Horses produce a LOT of saliva, it’s very thick and viscous, do not be alarmed.
- Horses that don’t eat and move very little can go days without drinking and not be dehydrated.
- Some vet will refuse to come and do a saline IV support or hydration support on farm, but a vet CAN pump water into the horse’s stomach directly if the horse cannot drink.
- Mucus coated stool is a sign that the intestines haven’t worked in a while but it’s not necessarily a bad thing, especially when you see it on new stool that finally moved out.
- Vets hate not knowing- we all prefer answers and certitude- cut them some slack when they try to explain things to you (and to themselves) but remain critical when things don’t make sense or dont fit the hard data..
- Sometime supportive care is ALL you can do.
- Facial paralysis usually goes away on its own when it’s not trauma related.
- Neurological horses can make a full recovery.
My mare made a steady recovery over the course of two weeks. She regained her sight and awareness within 12 hours of receiving Dex, she ate water-soaked hay (a few handful) and drank 5 liters 72 hours after the start of this ordeal. It took her about a week to regain control of her lips well enough to graze and another few days to stop drooling. The mental fog and overall exhaustion kept her quiet for about two weeks but throughout she showed consistent improvement.
She is absolutely normal now.
