Day 8: A Trio Of Neurologic Donkeys and Some Pretty Fancy Warmbloods

Good evening blog friends. Anna and I have just had a fascinating but emotionally draining day at the American Fondouk as we started our second week of work. The day started out with a case that really wore on our souls. A beleaguered woman came in with an infant strapped to her back and a young boy at her side. The boy was pulling a cart that carried a half-dead sheep inside. They had clearly walked quite a distance to get here. The ewe had such a severe anemia that her blood was like water when I took a sample. The woman pleaded for us to help the sheep. Jeremy casually said to me "hey, have you ever done a blood transfusion on a sheep?" and I was proudly able to respond "sure...I did one last summer." (Insert shout-out to Dr. Enger here). We were perfectly well equipped to try a blood transfusion at the Fondouk but we needed another sheep to act as a blood donor. Houssine told the woman that if she came back with another sheep, we could try the blood transfusion. She agreed. Not 10 minutes after this woman left with her two children, the sheep passed away on her own. The woman returned with a donor sheep several hours later--clearly exhausted--only to find out that her second trip was for nought. As the tears flooded down her cheeks, I wanted nothing more than to give her the several dollars it would have required to buy a new sheep. My heart broke in half as I listened to Houssine say there was nothing left that we could do for her. 
We saw a bunch of mildly colicky mules this morning, all of which required rectals and tubing. This hospital is providing invaluable hands-on experience to the vet students (and Anna), all of whom are becoming increasingly proficient at tubing. One interesting thing I'd love to mention is the curious fact that about 85% of the mules who are tubed here develop a bloody nose during or immediately after the tubing. Because only 1 out of every 100 horses I tube at home develops a bloody nose, I assumed that this significant difference was largely due to the inexperience of the students passing the tube. When I commented on this to Dr. Frappier, he said that even when there aren't any students around, the mules still bleed. He told me that he passed an endoscope on a couple of them soon after he arrived in Fez to see if there was some anatomical explanation for their increased bleeding tendency. He never found one and no one at the Fondouk bats an eye when blood comes pouring out of the mule's nose during a tubing.
Mid-morning, we had an unexpected meeting of two worlds. While the Fondouk's courtyard was filled with overworked and over-burdened pack animals, two enormous and regal warmblood horses were marched in. They were jumpers owned by a wealthy person in Casablanca. One had come in for lameness and one was there for a pre-purchase exam. I found the dichotomy of today's patient load to be almost too great to wrap my head around. While we watched the very expensive horses jog up and down the concrete walkway next to the Fondouk as part of their lameness exams, a whole group of dumbfounded and bewildered Moroccan men watched as they dragged their own lame animals into our clinic. Dr. Frappier is very highly regarded in the world of fancy show horses and I must say that I did learn a bunch of interesting and new lameness tips from him while we worked on these two horses. We did an incredibly thorough exam for the pre-purchase horse and since they had driven 400 km to get here, we blistered her stifles while we were at it so as to save them another round-trip drive. There were also x-rays taken and hocks injected.
There was so much going on this morning, that I felt like I was being pulled in a thousand directions. There was drama with every case and we were spread pretty thin. When we were finishing up with the fancy horses outside, a small green van pulled up alongside the Fondouk. Inside was one standing donkey and one recumbent donkey. We were told that the recumbent donkey started acting neurologic 10 days ago. 2 days ago he became unable to rise, eat or drink. We had the van pull rightinto the Fondouk and between Jeremy, Houssine and the men who brought the donkeys in, they were able to lift the down donkey out of the van. He was unable to lift even his head and due to the rapid progression of the disease and the degree of paralysis, we decided that euthanasia would be the most humane option. We discussed possible differential diagnoses for this donkey. I suggested botulism. Dr. Frappier said that was certainly a possibility but that West Nile Virus (a devastating disease that we vaccinate for at MHVP) was just as likely. We told the donkey's owners that we would try our best but that he would likely die. As most Muslims are against euthanasia (because it is not Allah's will), we could not be up front with these men. We euthanized the donkey this afternoon but the men will not learn of his fate until they come back on Friday. Interestingly we had a different man bring in two other neurologic donkeys today. They will likely also decline to the point where euthanasia is necessary. There was no connection between the first donkey and the second two--they live on opposite sides of the city--but those of us in veterinary medicine know that bad things come in threes.
One of the other more interesting cases of the day was an old emaciated mule who came in with a prolapsed rectum. Other than the sheep with the prolapsed uterus last week, I'd never seen any animal with a prolapsed anything--neither had Jeremy. Now we've seen two prolapses in the last few days. This mule's prolapse most likely occurred because his diet it too coarse and his bad teeth don't allow him to chew the straw enough for proper digestion. This poor mule had probably been colicky in the last couple of days because of an impaction he was trying to pass. We surmise that he strained and strained and strained until he passed his own rectum. 
After we tubed and oiled the mule, Houssine, who is truly an incredible man, went to work fixing this prolapse. I will spare you the details--it was too gross, even for me--but this mule wound up with all body parts where they belonged. We treated him to some dental work, gave him some more pain meds, and we'll see how he's doing in the morning.
You can imagine how such an emotionally tumultuous day can wear on a person. Anna and I opted to stay in and have a quiet evening tonight even though our friends were headed out for dinner. We need to decompress a bit and maybe we'll even try some of that famous Moroccan wine we bought at the grocery store.