Case Study: Pirate
With Pirate, we knew we had our work cut out for us
When Pirate, a young Quarter Horse gelding, walked through the hospital doors, we knew we had our work cut out for us. He had been treated for pleuropneumonia with antibiotics off and on with little success, and had recently taken a turn for the worse. An ultrasound of his chest showed a large pleural abscess (between his lungs and his ribs) that involved a large portion of his right chest, fluid between his lungs and his chest wall and a significant amount of collapsed/consolidated lung on both sides of his chest. Even with his extensive illness, Pirate still seemed to have a smile on his face, and we knew he was going to be a special patient.
A trans-tracheal wash and thoracocentesis were performed to identify the specific bacteria responsible for his infection. For the trans-tracheal wash, a needle is passed through the trachea, and fluid is flushed into the lungs. The fluid (and accompanying bacteria) are then removed and submitted for analysis. For a thoracocentesis, a needle is passed through the chest wall and fluid is removed from the pleural space. This fluid is also submitted for analysis. Pirate was started on broad spectrum antibiotics until his results returned—those results would tell us what antibiotics would work best for Pirate’s specific infection.
Soon after his arrival, a chest tube was placed through the left chest wall to allow drainage of the fluid that was restricting his lungs from expanding. This was maintained in place for several days to promote continuous drainage. During that time, Pirate was a very sick horse—he was running high fevers and his appetite was almost non-existent. However, when you looked at him it was like he was saying, “Don’t worry, I can get through this!” So, we pushed forward, and let this little horse show us what he could do!.
With the results of his tests back, we changed his antibiotics to ones that were more specific to combat his infection. On the new antibiotics, Pirate’s condition slowly began to improve—his appetite was increasing and fevers resolved. However, the abscess in the right pleural cavity was becoming larger and better encapsulated; we feared that antibiotics would take months to penetrate and reduce the size of the abscess. After very careful consideration, a thoracotomy was opted for treatment of the abscess. With this procedure, a large incision is made between the ribs through the chest wall, and then the abscessed material can be removed by reaching (small) hands into the chest cavity and scoping out the pus. The procedure was very successful for Pirate, and after a month of being hospitalized, Pirate was finally discharged to go home.
Although he was finally home, the work was not done. It was very important to keep the abscess pocket as clean as possible, and allow it to heal from the inside out. So, over the next 2 months, Pirate’s owner and caretakers judiciously flushed and cleaned the hole in his chest. They did a wonderful job, as the pocket became smaller and smaller, until it was finally non-existent! Pirate was placed on a several month rest and reconditioning program while his lungs continued to heal. When he started acting like a 2 year old in turnout (running away from his trainers, squealing and bucking like a bronc horse), we knew he was ready to go back to work. He’s got a battle scar on his side that will never go away, but he’s on his way back to the show pen, ready to prove to the world that he is really something special.
Pirate stole has stolen a piece of the hearts of everyone at Southwest Equine. Pirate faced each challenge head-on, and maintained his sweet demeanor through it all (including some very painful but necessary procedures). His recovery is also largely attributable to the amazing people working to get him healthy at home. He had an extensive list of treatments, and they were performed perfectly by his owner and caretakers. We can’t wait to see what successes lay ahead of this special horse!
A little bit more about pleuropneumonia…
Pleuropneumonia is frequently referred to as “shipping fever”, because it most often occurs after long-distance travel. Long-distance shipping can cause stress that compromises a horse’s immune system, making them more susceptible to viral and bacterial infections. Conditions in the trailer such as high amounts of aerosolized particulates (hay, dust) and difficulty lowering the head to cough can increase the risk of pleuropneumonia. Fortunately for the thousands of horses that travel long distances in the United States each year, pleuropneumonia is a relatively uncommon condition; however, when it does occur pleuropneumonia can be devastating.Soon after his arrival, a chest tube was placed through the left chest wall to allow drainage of the fluid that was restricting his lungs from expanding. This was maintained in place for several days to promote continuous drainage. During that time, Pirate was a very sick horse—he was running high fevers and his appetite was almost non-existent. However, when you looked at him it was like he was saying, “Don’t worry, I can get through this!” So, we pushed forward, and let this little horse show us what he could do!.
Initially, horses with pleuropneumonia often have vague clinical signs including: fever, decreased appetite, dull attitude, and cough. This can quickly develop into nasal discharge, short / rapid breaths, and reluctance to move (this is a very painful condition). Some horses will respond to strong antibiotics alone, but if large amount of fluid or abscesses develop surgical intervention may be necessary. It is also important to note that these horses can be very ill, and secondary (life-threatening) complications such as laminitis are common. As in the case of Pirate, the road to recovery is a long and treacherous one. This includes weeks to months of antibiotic therapy and stall rest. Fortunately, with diligent care, most of these horses can return to a high level of performance and live long, happy lives.