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This is the difficult part. I may go back and tell more about Sarah's previous life, but right now, in July of 2002, she has reached a new stage. We've been together for 12 years, and last fall I got an inkling that something was up. Not something good. She had a cracked molar and needed dental work. The dentist came with the vet so the vet could sedate her for the possible extraction. Being a good vet, he listened to her heart before doing anything. He discovered that the murmur that she'd had for a long time had worsened a bit. It was no longer something not to worry about, but something to keep an eye on. He sedated her with a very light dose, and used a correspondingly larger dose of pain killer, and the procedure went fine. Well, I wasn't doing much riding last winter, though the weather was good. My job had moved 35 miles south, and Sarah was boarded 35 miles north.... So, in April, I moved her to a barn only 15 minutes from work, and one right on miles and miles of trails along a river park. Nice place, well run with a resident manager, and the board cost was about the same -- and it was so easy to go out to the barn straight from work in the evenings. I had the barn's vet come out to give her a rabies shot. I met her there at noon, on my lunch hour. When I arrived, the vet was quite upset, and in short order so was I. She, also being a good vet, had listened to Sarah's heart before doing anything. The heart sounds were almost absent, no "lub-dub", only a terrible swishing sound like that of the ocean. She advised me never to ride Sarah, not to give her any vaccinations, not to worm her, and not to stress her in any way. She said she could drop dead at any time, and recommended I take her to the U. of Pennsylvania's New Bolton Equine Center for a cardiological exam. I was very upset, though Sarah didn't seem any different. Maybe a little less energetic, but not in pain and not unhappy. She is 17 years old, only middle age for a horse. I immediately called New Bolton for an appointment, then called around and emailed looking for a ride (I don't own a trailer). Meanwhile, I also called her old vet who had noticed the changes last fall. He was very nice and we talked for a long time. I commented that Sarah was in heat, and he told me that a mare in heat has a lot of estrogen in her blood, and it has the effect of thinning the blood, which would make any murmur worse. I sighed a little sigh of relief. Maybe things weren't so bad after all. I did notice two days after the initial diagnosis that her heart no longer sounded so terrible... she wasn't in heat anymore. Now, it sounded like this: "lub-shhhhh dub". To this day, that is the way it always sounds. I managed to coordinate an appointment and a trailer ride two weeks later, and some very good friends hauled us up to New Bolton in a nice, roomy trailer that Sarah could stand in loose, her preferred way of travelling. She also dislikes bumper helmets, and removed hers with the halter sometime during the trip, then shat on it. Never shy to express her feelings, that one. The Good Doctor Olga Seco performed the exam, which included a great many grad students and interns with stethoscopes all over Sarah (she didn't mind), as well as her own thorough stethoscope exam to listen to the heart sound qualities from different areas. The murmur was coming from the left side, but was clearly heard on the right side as well. That is a loud murmur. (The students were listening to her gut sounds, her heart sounds, her lung sounds, and even her butt sounds, if butts make sounds. Evidently all but the heart was normal.) She then attached the EKG clips (they pinch the skin, but Sarah didn't mind that either), and began the ultrasound exam. It was fascinating. Holding Sarah, I was in the right spot to watch the screen while Dr. Seco explained what I was seeing and what it meant. She examined both sides, in all sorts of places, so we could see all the valves working and all the chambers of the heart. The conclusion, which was obvious on the screen, was that Sarah's aortal valve was not functioning properly; it has thickened and stiffened, and vibrates when it closes (the shhhhh sound, which if it worsens is known as a "thrill" and can actually be felt with the hands as a tremulous vibration as far down as the legs). Because the aortal valve takes too long to close, some of the blood that the left ventricle is pumping out to the body washes back into the ventricle, and has caused that chamber to enlarge by 50%. Not good. She also has a minor murmur with the mitral valve, but nothing to worry about. The EKG was normal the entire time, thank God. The prognosis, which I received in print about 2 weeks later, is that Sarah should be good for another four to five years, but at some point will die of congestive heart failure, or simply drop of a heart attack, possibly dying in her sleep. The prescription is to exercise her regularly at moderate paces (no hill climbing, no galloping) to get and keep her relatively fit, and administer 440 mg. of enalapril maleate divided into two doses daily. That medication dilates the blood vessels, thus making it easier on her heart, and may help extend her lifespan. As a matter of fact, in cases like this, sometimes the horse will live a normal life span. She is not to be ridden when the temperature is over 90 or even near it, especially with the high humidity we have here. I am to watch for certain signs, one being swollen legs. Anything unusual should be reported. I bought a good stethoscope and listen to her heart every time I'm with her, as soon as I get there and before I leave, as well as during and after exercise. I bought an on-board heart monitor so I can keep track of her pulse when riding the trails, and slow down or dismount if it goes unusually high. Riding in the ring I don't worry about, as I don't do any sustained work, using short walk breaks to keep her cool. It's been really hot for weeks now, so I haven't been riding at all. Instead, I bring her in from the pasture and hose her down, scrape the excess water, and take her to the arena, where I free lunge her at a working trot and occasional canter (now and then she adds a buck or two, and sometimes her lovely extended trot). At the end of 20 to 30 minutes, I bring her in and feel her skin -- cool! The initial hosing down with cold water really helps, as her skin starts off very cool, and the whole time she's exercising, the water is evaporating to cool her as she works. Her heart rate hasn't gone much above 65 after exercise (resting rate for her is around 32, or 40 if carrots are involved), and drops quickly. Since we started her on the enalapril (happily, she eats it with her grain, not noticing it at all - I licked one pill for quality control purposes, and it is not bitter, just a bit sour), she has more energy and in general seems to be doing quite well. The murmur sound never changes. I will take her back to New Bolton in October for another exam. The doctor will be able to determine if there are any changes in the murmur, which will predict how fast the degeneration is progressing and give us a better idea of her working lifespan. I have my fingers crossed. Note: When the vet who discovered the much worsened murmur was at the barn, I had also asked her to examine Sarah's eyes, as she has always had an occasional odd reaction to shadows, sometimes jumping them, other times just pausing a moment when coming into shade from bright sunlight. Plus, she used to spook, but that has subsided as she's learned to trust my judgement (except for large satellite dishes in the middle of fields and similar alien objects). The vet checked out both eyes, and said that the focal distance was different for each eye. This would account for spooks as well as difficulty in handling shadows, and maybe the odd way she has of looking at cross ties and suddenly deciding they are snakes The enalapril is a story in itself. It is a human medication used for hypertension and congestive heart failure, usually prescribed at no more than 40 mg a day, which is less than 10% of Sarah's prescription. In the dose Sarah requires, the prices I researched ranged from $1,000 to $300 a month. I was in despair until I came across a little internet firm in Maine called horsepharm.com. Somehow, the CEO read my somewhat desperate email, and he called me. He is a fine gentleman, and had a TB mare himself that he lost to congestive heart failure. He went to work finding a cheaper version of this drug, which is a generic. He outdid himself, and I pay only $60 a month for the enalapril. And I don't mind at all that printed in small letters on the big bottle is "Made in Slovenia". The stuff works, and I celebrate the breaking up of the Soviet empire. (I must admit that as a Dilbert fan, I occasionally imagine little men in fur hats, up to their waists in mud, cranking out the enalapril.) Below are some pictures of Sarah taken about a month ago, before the weather got so bad. I am riding her to warm her up in the first picture on the left, and in the others, she is giving rides to two wonderful kids, Nicole and Cam Kalp, whose mother Lisa can be seen leading Sarah. You can see that when I rode her, she was quite energetic, but when the kids were on her, she was very quiet and careful. Such a good mare. Her true heart isn't damaged at all. |
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Lisa leads Sarah for Nicole, who looks pretty relaxed. She loves the purple helmet! |
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I'm leading Nicole... who seems to be disappearing into her helmet! Them kids have little heads.... And I appear to be hauling a river boat, like a hard working mule. Hot day. |
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Cam had been very impressed by the Belmont race the day before... he rode Sarah like he was a jockey, leaning forward and pumping away, yelling "GO!" now and then. Heh. Heh. Sarah tends to ignore such commands from wee little children.
Here Cam is preparing to give Sarah a kiss on the nose as thanks for his ride. This happened to be the last picture in the camera, so I missed the shot when she lowered her head and Lisa lifted him up a bit. He did plant one on her nostril. Sarah likes kisses.
On to Lessons Learned
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