***Disclosure: This is the post that contains images of Stanley’s corneal ulcer and surgical procedure. Some images may be graphic, but they are medically relevant and show our journey***
About halfway through June…only 2 weeks after returning from an amazing adult eventing camp, I walked into the barn on a very hot day. I had just come from auditing a wonderful clinic locally and wanted to check in and give Stanley a snack of electrolytes. It was a whopping 103 degrees Fahrenheit.
Stanley was quiet, he looked at me and as I approached his door I noticed a hay net wrapped around his back feet. He wasn’t overly sweaty…just as much as you’d expect for it being above one hundred degrees. The stall wasn’t overly messy so it didn’t appear that there was a struggle. He calmly lifted each leg as I pried 5 strands of hay net out from between his hoof and shoe. I don’t know how he did it but the hind shoes were still tight after everything. His front shoe was slightly cockeyed. I was alone but from my assessment at the time he was ok. The next day my farrier came to reset the front shoe but we found he was very stiff on the hind end and not terribly willing to lift his leg like he was the previous day. I called the vet.
On vet assessment no joints or bone seemed to be affected. We didn’t need to confine him to stall rest, but we did put him on a heavy regimen of muscle relaxers, and he continued with his normal night turnout. Since then, he had body work done to help loosen the soreness and get things moving and softening.
Fast forward four full weeks. I went to Maine the 3rd week but I was given reports that he and Tiger were running around the field and playing so it was promising. I had scheduled my vet for the fourth week to recheck and see if he could begin work. The Sunday before the Tuesday recheck, we noticed that Stanley’s eye was really running, and he was holding it closed. I couldn’t find any debris, so I thought it was allergies. I cold compressed it and cleaned it up. This was Sunday night. It wasn’t better by Tuesday morning, so I asked my vet to take a look when she arrived. Once she dyed it, we could clearly see a sizable corneal ulcer.
To our knowledge, the ulcer and the hay net incident are very separate instances that unfortunately happened back to back.
How did he get it?
Likely from rubbing his face on anything and everything. He rubs more when he’s warm and this year has been WARM. It’s most likely he rubbed his face on his hay net and stabbed himself in the eye with a piece of hay.
We began an aggressive treatment schedule of serum and ointment applied 4x/day while giving him atropine to dilate the eye once a day. We also began him on banamine for the pain. Again, we continued turnout but kept a clean fly mask on him 24/7. I started to get nervous by Friday because it didn’t seem to get much better. Instead, I thought it was getting worse…so I asked about infection. My vet agreed we were on the same page, so we added doxycycline twice a day. For two days he started to look better and suddenly he was back to painful again.
By Thursday…ten days in …we shipped him down to Rhinebeck Equine, a referral hospital about 1.5 hours south of us. We met with the vet and she was wonderful. She talked to me about what she was seeing, about the device she had placed to help deliver eye medication, and what her plans were overnight. The device was interesting to see…called a sub-palpebral lavage system (SPL). I had heard of it but hadn’t seen it before. Rest assured I will post more eye research over the next few months as I myself learn more.
I got home that night at 11pm tired and had to work at 6am the next morning.
The vet at Rhinebeck called me in the morning called me to discuss the latest. Stanley’s culture came back and he was indeed fighting a fungal plaque on his eye as she suspected when we met her. She was optimistic that it wasn’t terribly deep but it was hard to know for sure; she recommended a standing surgery. Unfortunately, because there wasn’t an ophthalmologist there he would need to go to yet another hospital. I was given the choice of New England in Dover, NH or Cornell in Ithaca, NY. I chose Cornell. But now it was so much pressure as I have NO sick time left at work (I used it with my other emergencies this year…see My Year So Far: Lessons in Resilience, Reflection, and Rationality) and this was happening fast. I had to do what I had to do.
By some miracle I was put in touch with another client at the hospital who’s horse had come in only 20 minutes after Stanley. He was dealing with nearly the exact some problem. The horse’s owner owns a farm and happened to live much closer to Rhinebeck than I do. If I were to haul, I’d have a 30 min drive north to pick up the trailer, a 1.5 hour drive south to Rhinebeck, and a 4.5-5 hour drive to Cornell. After talking with the other horse’s owner we agreed I would pay her farm manager for her time to haul Stanley with her horse and we split gas money. I didn’t have to miss work and he got where he needed to go.
I was desperate, and it’s not typical for me to entrust people I don’t know to drive Stanley so far without me there…I can be a control freak. But I had a really good feeling about these people after we spoke.
Stanley arrived at Cornell with his new best friend “V” around midnight Friday night. All day Saturday we heard nothing. I finally called at noon. I simply called the answering service and explained he came in late and I hadn’t received a call since so I wanted to make sure they had my number.
I received a call 20 minutes later from the vet on call for the weekend. We chatted for a bit and I already felt much better. Unfortunately, I was under the impression they were brought to Cornell for an emergent procedure but my misunderstanding this was not considered emergent (to be fair the risk is losing his eye not his life). So we waited until Monday morning.
On Monday morning I received a call bright and early from Stanley’s ophthalmologist, Dr. Knickelbein. She introduced herself and explained what she was seeing. After her assessment she worried the originally planned standing surgery would be too risky; his eye was fragile and at risk of rupture.
YIKES!
Instead, she recommended a surgery under general anesthesia. He would be laid down, she would scrape away the infection and put two grafts on the affected areas.
As I understand it, the majority of his infection was affecting his peripheral vision. For that part she placed a conjunctival graft to provide blood flow and tectonic support to the eye.
For the smaller part of the infection that affected Stanley’s main vision our doctor placed a biosynthetic graft.
I am not particularly knowledgeable about current practices in general anesthesia of horses. I didn’t imagine ever needing to worry about it. My only thought about it was the injuries in laying a horse down, the injuries in waking a horse up after laying down…I thought about Ruffian flailing after her surgery and shattering her other leg.
Our conversation about the risks helped. Our vet clearly went through each risk and how they manage these risks. I had to remember this is something they routinely do and technology has advanced quite a bit. I had to keep my faith.
I never thought about it until recently how they hoist horses up by lifted them using hobbles around their fetlocks. I’m glad I didn’t think of that at the time!
On August 5th I anxiously went about my normal routine as Stanley was prepped for surgery. Dr. Knickelbein was phenomenal with her communication. She texted me right as they were heading back into surgery. For hours I tried to stay busy while I waited. I delivered a beautiful mounting block and saw my mom(s); my mom and her best friend (my second mom).
I went to my farm to see friends.
At 7pm I got the call I was waiting for. Stanley is up. Surgery was as routine as possible. It took him a little longer to get up and he didn’t succeed on the first try but when he tried again, he got up smoothly. Phew. That’s a start.
When I saw the picture I was astonished. I never could FATHOM suturing an eyeball! But she did an amazing job!
I spoke to our doctor every day while he was in the hospital. Each day he was doing better and better. She began to see healing with new tissue forming over the grafts. Excellent news! On Friday she was ready to discharge him from the hospital (ICU, basically) and into a layup facility. Cornell has a state-of-the-art facility barely 5 minutes away for layups. Stanley and his best friend travelled over together and got settled in for the weekend.
Monday, he’s healing even more.
On Tuesday I picked my mom up and we drove out to visit. We arrived around 10am. He has a large spacious stall, clean water, good hay. He has a powerful fan above him and a window to look out. It’s a lot cooler in the barn than outside in the best way.
When he heard my voice he turned around and came to visit, eagerly accepting a carrot. We went for a walk in the field and I let him eat grass for as long as he could stand it. We were out there for about an hour when the bugs got too annoying.
I walked him back and spent some more time in the stall with him. Finally, I spent some time talking to the wonderful folks providing all his care.
It was a great visit, and I got to meet his friend “V” and give him a carrot, too (with permission from his owner).
Each day brought more news of his healing. On Friday, however, our ophthalmologist noticed he seemed more agitated. On closer look his SPL had slipped down some. She took it out and on Saturday morning replaced the device but placing it in the lower eyelid instead.
Upon replacing the SPL, Dr. Knickelbein noticed he was bleeding more than she would expect from such a procedure. We opted to run a blood panel and tested coagulation and Vitamin E. All results came back normal.
Fast forward to this past week.
Yesterday (Friday) Stanley had a number of his sutures removed and his SPL is due to come out. We are in the process of getting him ready to come home.
The plan currently is for me to pick him up on Tuesday (I want to avoid Labor Day traffic). I don’t know what his life immediately coming home will look like just yet but rest assured there will be updates!
Once I know he is fully home and healed up I can begin working with him from the ground up. He has been confined to a stall for over a month now and has lost a lot of muscle. It’s sad but I’m grateful to have a chance to rebuild him back up…and I am so excited to have him back soon!
The Green Horseman 
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