Hold the Horse Down

D. E. Larsen, DVM 

Mike was sitting behind the desk in the large animal hospital, his standard position during every one of our weeks of night duty at Colorado State University.

“Mike, you seem to like the desk job,” I said.

“Naw, not so much. I just need the experience of talking to people on the phone,” Mike said.

This was Thursday evening, nearing the end of our week of night duty. Seniors were assigned night duty every couple of months. Ten of us ran the hospital from closing at five until ten o’clock. We were managed by two interns, one on the small animal side and one on the large animal side of the hospital. We got to go home at night. The interns slept over at the hospital. But they had our telephone numbers if the need arose.

“Larsen, you need to get the whole group together for a quick conference here,” Doctor Reese, the intern on duty, said. “We are going to have an issue tonight.”

I headed out to the small animal side of the hospital and started gathering everyone for this conference.

“Conference?” Rod asked. “What is going on?”

“I have no idea what’s up,” I said. “Doctor Reese needs us all together to discuss the night.”

“Is he going to keep us here all night?” Rod asked.

“I say again, Rod,” I said. “I have no idea what’s going on. I’m just the go-for out getting everyone over to the large animal office.”

“It looks like we are missing a couple of guys,” Doctor Reese said.

“Chuck and Rod are finishing up doing the evening treatments over on the small animal side. They should be here shortly,” I said.

“I’ll wait till they get here. I don’t want to have to repeat everything twice,” Doctor Reese said.

The two latecomers came through the door just as Doctor Reese made that statement.

Chuck sat on the corner of the desk. “What’s up, Doc,” Chuck said.

“Okay, for those of you who don’t know it,” Doctor Reese started. “Doctor Adams had an emergency surgery today. He had the American champion endurance horse come in with a fractured humerus.”

“That is almost an automatic euthanasia, isn’t it?” Jim asked.

“In most cases, yes. But this horse has an exceptional value. So it was decided to give the repair a try,” Doctor Reese said. “It was a complicated surgery, even for Doctor Adams. Repairing a fractured humerus in the horse is almost an unheard of surgery.”

“So, how does that affect us?” Chuck asked. 

“It was a seven-hour surgery,” Doctor Reese said. “Seven hours lying on its left leg, and on recovery, there is radial nerve paralysis in the left leg.”

The radial nerve controls all the muscles that extend the front leg. Without radial nerve function, the animal cannot stand on that leg. I had never heard of it in a horse. In the dog, the leg drags along, wearing the skin off the top of the paw in short order.

“That’s another automatic euthanasia in the horse,” Jim said.

“So the surgery team has been holding the horse down in the recovery stall all evening,” Doctor Reese said. “The plan is to let them go home at ten tonight. We will be responsible for holding the horse down tonight. We will pull two-hour shifts with two of you on each shift.”

“I’m not sure I understand the plan,” I said. “I mean, if we had radial nerve paralysis with the horse on its side during surgery for seven hours, can we expect anything different if we hold the horse down on the other side for ten or twelve hours?”

“It is the only option we have,” Doctor Reese said. “They gave the horse a big dose of dexamethasone. The hope is to see some return to function by morning so they can get the horse in a sling. I will agree, the odds are not good for the horse. But, Larsen, if you want to discuss the plan with Doctor Adams, you can just march right down there and talk with him.”

Doctor Adams was almost a god in the world of lameness and orthopedics in the horse, and he had a massive influence in the veterinary school. He could kick a person out of school in a heartbeat, and there were rumors of him doing just that in the past. True or not, the potential threat made students conduct themselves with an extra measure of decorum. 

“I think Jim and I will volunteer for the first shift,” I said.

“Okay,” Doctor Reese said. “We need to get everyone signed up for a shift. You guys take a phone into the recovery stall with you. There is a phone plug-in there. You give the next shift a phone call a half hour before they are due to be here. Everybody needs to take the responsibility to make it here for your shift. That way, all of us can get some sleep tonight.”

“I need to call Sandy and let her know I am going to be late tonight,” I said.

“You other guys go ahead and head home now,” Doctor Reese said. “Jim and Dave, gather the clipboard with the list and bring a phone. We can go down to the recovery stall and get instructions for the night.”

The recovery stall was a large room, maybe twenty feet square. It was padded with thick rubber mats, like a wrestling mat, on the floor and all sides. Once you were in the room and the door was closed, it was just you and the horse, and do place to duck for cover if the horse was flopping around.

“You guys have had a long day,” Doctor Reese said as we squeezed through the large door that was opened only a crack for our entry. “We are set up with two-man shifts at two-hour intervals. We just need some instructions.”

“All you need to do is have somebody sitting on his neck all the time,” Doctor Adams said. “He is fully recovered and will try to jump up if he gets a chance. His left leg has no radial nerve function, and bone plates on his right humerus will not hold his weight. His only hope is to get enough return to function so we can get him in a sling tomorrow.”

Jim placed his knee on the horse’s neck as Steve stood up, and then Jim swirled around and sat down on his neck. It looked like an easy maneuver, but the horse did try to raise his head during the change of position.

“I’m about beat,” Steve said as he pushed past me. “I don’t think I will be going into Equine Orthopedics after today. We have been working on this horse since ten o’clock this morning. You should have been in on that surgery. I will never complain about the surgical approach of the humerus on a dog again.”

“Retracting the muscles must have been a chore,” I said. 

“I don’t think most people could have done the surgery,” Steve said. “Doctor Adams is so strong, and he made some of it look easy. But, a seven-hour surgery is almost too much for this kid.”

The surgical team filed out of the recovery stall. 

“Call me if you need anything. I will try to get some shut-eye,” Doctor Reese said as he left the stall and shut the door.

I plugged in the phone and laid the clipboard down in the corner, and set the phone on the clipboard.

“I guess if we hold the horse down, the phone will be safe in the corner,” I said.

“I hate being closed in this room with a horse,” Jim said. “There is no way to be safe if the horse is really flopping around.”

“Well, it’s one thing if you are recovering a normal horse,” I said. “This horse has almost zero chance of recovery, and here we are, stuck in this recovery stall with it.”

“The thing that I don’t understand is how are they going to get this horse in a sling anyway?” Jim asked.

“I don’t know. I would guess they will have to sedate him to lift him into it,” I said. “I don’t know why they didn’t do that this evening. By morning, the nerve on the repaired leg will be shot too.”

“I think Adams just wants to be able to write up this repair,” Jim said. “I doubt if it has been done before.”

“I don’t think so,” I said. “If it has, it hasn’t been done very often.”

“Have you heard of a radial nerve paralysis ever returning to function?” Jim asked.

“I haven’t heard of it occurring in the horse before, but in the dog, the leg gets ruined before there is any return to function,” I said. “At least that is the impression that I get from Doctor Creed.”

“It’s probably about time we switch positions,” Jim said. “My butt is getting tired.”

I moved around the horse and knelt with my knee on his neck. Jim stood up and stretched, and I tried to turn on my knee and sit down on the horse’s neck. The horse swung his head up at the same time, knocking me off his neck, and suddenly I am lying on my back beside his front legs. I scrambled away from his legs, and he was immediately was up on his sternum. In an instant, he tried to stand.

His left leg hung uselessly, and he placed his repaired right leg out to stand. It held together for a brief moment, and then the leg collapsed as the repair broke apart.

I looked at Jim and shrugged my shoulders.

“I wonder what Adams is going to say about this?” I said.

“We better call Doctor Reese,” Jim said as he picked up the phone and dialed the intern quarters.

Doctor Reese was there in a flash.

“Oh, boy,” he said. “Not much to do now. I will go call Doctor Adams.”

It didn’t take Doctor Adams long to get to the hospital. I have no idea where he lived, but I would guess he drove fast.

He entered the recovery stall with a frown and knelt down to examine the horse’s leg.

Jim and I stood aside, not saying a word but waiting for Adams to explode.

“I have to go call the owner,” Doctor Adams said. “Then we will put him to sleep.”

That was all that he said. I could hear Jim take a deep breath when Doctor Adams left the room. Doctor Reese looked relieved also.

It was maybe five minutes later when Doctor Adams returned with a bottle of euthanasia solution.

“It was a long shot anyway,” Doctor Adams said as he drew up the solution into a couple of large syringes. “I have never seen radial nerve paralysis in a horse before. Too bad, I really wanted this repair to work.”

With that, he gave the injections and patted the horse on his head.

“We can move him back to necropsy in the morning,” Doctor Adams said as he left the room.

We stood there a couple of minutes, nobody said a word.

“I will call the others,” Doctor Reese finally said. “You guys can go home.”

“I think this was the best outcome for the horse,” Jim said. “But somehow, I feel like we dodged a bullet tonight.”

“Doctor Adams likes to look mean,” Doctor Reese said. “But he is really a nice man, down deep.”

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