The decision to opt for a terminal procedure is never easy. So when a team of equine veterinarians performed a lifesaving, but terminal Caesarean section to save the life of a foal, residents Dr. Eduardo Arroyo, Dr. Anna Berreta, Dr. Nick Hall, and Dr. Cristian Patino made the decision as a team.
"Our main goal was to preserve the life and fertility of the mare and the foal. I know we did the best we could," Patino said. "It's always challenging, but as long as we make the decisions based on science and experience, we know every step we take has a good basis."
When the mare, Sierra, was brought to Washington State University's Veterinary Teaching Hospital, her uterus was twisted 270 degrees clockwise. The complication is known as a uterine torsion. Only about 65% of mares and 32% of foals survive the condition past 320 days.
For hours, WSU veterinarians and veterinary students worked diligently to save the pair. They anesthetized the mare, laid her on her side and positioned a plank to hold her uterus in place. They, then rolled the horse gently multiple times to correct the torsion.
When this proved unsuccessful, WSU equine residents next tried to surgically repair the torsion - the best chance for both animals to survive the pregnancy.
While this corrected the torsion, a new complication emerged: the placenta had detached from the uterus wall - cutting off the blood supply from the mare.
There was now only about 80 minutes to remove the foal before it would die. The team, running out of time and facing the chance of losing them both, opted for a terminal Caesarean section to save the foal, after consulting with the owner.
"It was our best chance," Patino said.
Shortly after, Margie, a newborn filly with an attitude was born.
Without mom, Margie lacked valuable nutrients including colostrum, or first milk.
"She was weak, low on oxygen. She couldn't stand up on her own, and she had lax tendons," said veterinary student Maclain Tomaino, who took over the case the morning after surgery.
Tomaino looked over Margie for most of her two-week-stay. He supplemented the foal's food with plasma to get her needed nutrients, feeding her out of a bucket her first few days of life.
"People were calling me mom because I would feed her, and she would whinny at me when she saw me coming," Tomaino said.
Eventually, Margie was introduced to a surrogate mare.
"It took about two or three days for her to learn where the teats were," Tomaino said. "We were trying to hold her head in place so she would get the idea."
Eventually, Margie would latch on. In addition to making it easier on Tomaino, the surrogate helped the young filly "be a horse."
"Now she has someone she can look up to and teach her manners," Tomaino said. "It's a relationship thing; you want the foal to grow up and learn from the mare."
When Margie left the hospital, she was running and bucking with a positive prognosis.
Dr. Ahmed Tibary, WSU's lead theriogenologist, called the feat "a success story."
"It's never easy to lose a patient," Tibary said. "It's medicine, you do the best you can, but sometimes you lose animals. You can't forget that foal would not be alive if not for the efforts of our students, residents and interns."
On average, the WSU Veterinary Teaching Hospital can see as many as 50 foals during the peak of foaling season, which lasts from mid-March to early June.
"It takes a village," said equine medicine veterinarian Dr. Jenifer Gold. "Without the entire equine service working as one collaborative team, these successes just aren't possible."
