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February 15, 2007

Hard Work And Dedication Got Us Through A Strangles Outbreak

I shimmied out of my protective suit and stripped off my clothes. The thermometer barely reached 20 degrees, and a foot of snow stood on the ground. My skin was dry and cracked from the cold weather and constant showering. Laden with exhaustion, I stumbled through the door and stepped into the shower. Here we go again, I thought. I stepped under the hot water and proceeded to scrub myself raw. I dressed and made my way back down to the stables.

I raised my head into the wind to glance at the quarantine stable where I had been all morning. I shook my head in disbelief at the circumstance I found myself in. Who would have thought that I, the manager of a top-notch A-circuit show jumping stable, would be dealing with an outbreak of strangles?

I continued past the quarantine barn and headed for the main stable at Rodney Bross' Independence Hall, in Monkton, Md., where I was manager. Through the snow I saw José using the tractor to clear the ring for me. I entered the "healthy" stable, and the grooms glanced up in fear. These days they never knew what mood I would be in. Because of the highly contagious nature of strangles (scientific name is Streptococcus equi) I refused to let anyone else enter the infected barn. All duties fell to me. I was fearful of cross contamination and did not trust that others would take the same precautions and extreme measures that I willingly took. It was just easier to nullify the problem by only having one person enter the infected stable. That person was me, and the grueling routine was taking its toll.

Unfortunately, there were times that the grooms unjustly bore the brunt of my frustration. But today I glanced around and smiled broadly to lighten the mood. I said, "Where's the music and where's my first mount?" Immediately the tension dissipated, the radio was turned up and my first mount was brought to me. Davy threw me up onto the horse, patted my leg and said, "Flaca, you are doing just great."

Flaca was their nickname for me. It means skinny lady. I glanced over my shoulder as I trotted out of the barn and let out a wild whoop to let the boys know that the happy "Flaca" they had come to know was still alive.

Highly Contagious

Strangles is an infectious and highly contagious bacterial disease caused by Streptococcus equi. The bacterium enters the lymph glands via the respiratory tract and most commonly takes up residence in the guttural pouch (just behind the cheekbone). The extreme swelling of the lymph nodes causes the horse to sound as if he is being strangled, hence the name.

Severe inflammation and pain are caused by the bacteria invading the mucous membranes of the nose and throat. Abscesses most commonly occur in the throatlatch region or between the jaw bones. Treatment varies, and the vaccination is less than reliable. I can personally attest to its ineffectiveness. My stable was vaccinated, yet still contracted the disease. Antibiotics are often foregone in the treatment process because studies have shown that antimicrobials have difficulty penetrating the abscess capsule. This too I can personally attest to. The horses I chose to treat with antibiotics did not recover faster than those who did not receive antibiotics.

Strangles is one of the most common equine respiratory infections in the world. Most horses will survive, but complications do arise. Purpura hemorrhagica (widespread small bleeding with fluid accumulation of the limbs, eyelids and gums) may occur in association with circulatory antibody complexes with the Streptococcus equi M-like protein. This peripheral accumulation of fluid can be extreme, resulting in circulatory failure and death. Or other organs can develop abscesses, which grow and rupture. This is fittingly termed "bastard strangles."

Strangles causes major economic losses to the equine industry worldwide because of its prolonged course, extended recovery period and serious complications. Not only that, recovered horses can harbor the Steptococccus equi bacteria without exhibiting any clinical signs, thus becoming carriers of the infection. Barns like mine do not contract contagious diseases. We are too good, too careful, and too conscientious. Or so I thought. Here I was in week five of a classic outbreak of strangles.

Day To Day

Each day began at 5 a.m. in the quarantine stable. I fed the horses, cleaned the stalls and scrubbed the water buckets. While cleaning the stalls I would make a quick analysis of what treatment each horse would need, and make a mental note. Once the normal cleaning duties were done, I would drive the manure spreader to the far side of the farm and spread the contaminated feces in a secluded corner shielded from the wind by the nearby forest. Back at the stable I would then spray the tractor and spreader down with the bleach and water mixture I had come to love.

Then I took each horse out individually and conducted a thorough examination. Temperatures were taken and recorded. Size, location, and progression of abscesses were recorded. Locations and degrees of any swellings were recorded. Warm compresses were applied to the unopened abscesses to instigate eruption, and warm compresses were applied to erupted abscesses to help ease the flow of the pus. Some people will choose to lance the abscess, but we did not.

The work was tough, and the stench was awful. The smell of sickness was heavy in the air. The horses whose abscesses were openly oozing were covered in pus. It would stream down in thick, long white globs and stick to anything nearby. Constant hygiene and care were of the utmost importance. I would clean each horse from head to toe, using a warm, damp cloth to mop up the thick white mucous flowing from their nostrils, and I used a thick coat of triple antibiotic ointment to line the perimeter of open abscesses. Even the walls of their stalls were streaked with blood and pus. This too was cleaned daily.

I treated the horses who exhibited signs of extreme discomfort and agitation with the help of pharmaceuticals. I also medicated for swelling. Banamine (flunixin) or Bute (phenylbutazone) intravenously helped to alleviate pain and inflammation. Sometimes I would use Ketofen. Naquasone was also used to dissipate swelling.

Once their fever broke, their energy level inevitably built up, and they would become crazed due to being confined to a stall. In extreme cases of handling difficulty I used tranquilizers such as Acepromazine or Rompun (xylazine) and Torbugesic (butorphanol).

We treated two horses with antibiotics, not because they had a more severe case, but to see whether these two would heal quicker with the help of antibodies. They received 35cc of Gentocin once a day and 30cc of Penicillin twice a day. As I stated before, they did not recover at a faster rate than the horses that were not given antibiotics.

At the time of the outbreak the weather was freezing. Often the mounds of pus flowing from the abscesses would clump together, thus inhibiting the flow. After a warm compress I would gently pull open the abscess to let the pus flow freely. I knew that this must be done to expedite the healing process.

But the infection did not always show itself in the form of pus. Some of the horses were subjected to prolonged increases in temperature and abscesses that had yet to burst. These were the cases that brought the fear of laminitis into the picture.

Laminitis is caused by inflammation of the laminae, the tissues that connect the hoof wall to the coffin joint, and can be induced by a high fever. I was well aware of this because only a year before I dealt with such a case, and that horse died. So I iced their feet and medicated them to keep their temperature down. Luckily this worked; none of them foundered. These morning rituals took around 31�2 hours. I would then go through the decontamination and showering routine before entering the main stable to begin riding.

Taking Care Of Business

I rode as many horses as possible during those morning hours. My wet hair would freeze into icy clumps, and my fingers would be numb, but it did not matter. I did what I had to do. Out of 28 horses, we had managed to contain the infection to only eight.

Midday I would return to the quarantine stable and alternate the sick horses in the two paddocks that I had designated to be used solely for the turn out of the infected horses. The natural infection fighting qualities of the sun's rays are powerful, and I was willing to do anything to combat the disease. The winter weather was not conducive to such an experiment, but the noontime hours provided the strongest rays available. So I took advantage.

Besides relying on the sun's rays we outfitted the entire barn with black lights. As far as I know, there is no conclusive evidence as to the effectiveness of black lights in fighting disease, but what did I have to lose? The main aisle of the barn was left with the normal white fluorescent bulbs, but all other fixtures were replaced with black lights. At night the barn resembled a '70s disco.

The horses were turned out each day but not for long because I had to watch them closely to make sure they did not act foolish. The last thing I wanted was an injury on top of the infection. After they returned to their stalls, I headed back to the house for another round of decontamination. The rest of the afternoon was spent riding as many horses as possible. Once the setting of the sun prohibited me from riding anymore I would thoroughly examine each and every horse that was deemed "healthy" in the main stable.

The grooms who worked with me were great. They would relay the temperatures they had taken from each horse. They would describe any peculiarities in behavior or any swelling that they noticed. I had trained them to look for any minute changes in personality, any rises in temperature and any swellings along the cheek and jaw. They knew that as soon as they spotted a red flag, I was to be notified immediately. Those guys were amazing. They accurately caught the last two cases on their own.

The day at the main stable usually ended at 6:30 p.m. The grooms would retire to their house and I would trudge my way back to the quarantine barn. Getting that protective suit on at night was less than easy. A couple of times I actually tipped right over and fell into the cold, wet snow just trying to get my boot into the foot of the suit. The suits literally covered me from head to toe, hoodie and all. Comical now, not so funny then.

This last trip to the quarantine barn began with a quick cleaning of the stalls. Constant care and cleanliness are crucial in fighting any infection. These horses spent very little time outside, and I wanted to prevent the manure from piling up. I openly admit that the nightly cleanout was hard. I was tired, worn out and cold, but I made myself do it everyday—no exceptions. Then I would clean and treat the abscesses and fevers, feed them and close the barn doors. That completed my day. It usually ended at 10 p.m. I would disrobe and shower once more before going to bed myself.

Back To Normal

Eight weeks were spent at that grueling pace. Streptococcus equi literally changed my life, even if for only a short while. It brought to light many new ideas and interests that had previously evaded me. It made me realize that sometimes we must experience something personally to fully grasp the concept and the wide range implications of disease, contamination and containment.

My willingness to take such extreme measures can not be solely attributed to my compassionate nature and love for the horses. The economic implications that accompanied the outbreak of strangles were unfathomable. Our business revolved around travel and competition, which became impossible when plagued with a contagious infection.

Adding fuel to the fire was the fact that the outbreak occurred at one of the most crucial times of the year--the two months preceding the three-month Winter Equestrian Festival in Wellington, Fla. I knew that sick, contagious horses could not leave the state, and I also knew that if we did not make it to Florida the business would never recover financially. I had customers hounding me for dates and deadlines, my boss, Rodney Bross, totally distraught, but totally supportive, and the veterinarian was wary and cautious.

I took it upon myself to implement measures to ensure that all that could be done, would be done. It paid off. We got our horses to Florida, clean and free from disease. We competed, and the business was no worse for the weary. I cannot take full credit for the successful outcome because I was more fortunate than most. The surgical veterinary clinic we had on the farm made testing, diagnosis and sterility much easier to accomplish. The close working relationship I had with Dr. James Jezwiak gave us both security and confidence in the other's ability. We had worked together closely for five years.

Because of the contagious nature of Streptococcus equi, Dr. Jezwiak only entered the quarantine stable once. At our biweekly meetings I would relay information and progress regarding the infected horses, and he would guide me in the treatment process. Together we forged a path, and at the end of it all he gave me the greatest compliment I have ever received. He said that in all his years of veterinary practice he never would have believed it possible to contain the contagious infection the way we had.

He chuckled and said, "Remember when I told you there was no way you would get these horses to Florida? Well, you proved me wrong." To this day we still reminisce about the outbreak.

It was an all-out team effort. The grooms, Rodney, the veterinarian and I kept a close working relationship and open lines of communication. If we had not joined together as a team, there is no doubt in my mind that the result would have been different. Looking back, I am amazed at the feat we accomplished. It makes me proud, and it makes me realize that it can be done.

 
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