Alright people it is STORY TIME https://twitter.com/DrT_DVM/status/1266129838810599424

Like I said in yesterday's followup, the call came in requesting that we rush to the farm to take a look at a pregnant mare who may or may not have been in labor 3 weeks early. We could not get any additional information about the situation.

The mare was at a breeding stable typically overseen by one of my senior colleagues. This DVM told me I would be fine to handle it, thinking it was just overreaction to a colic and I could take the Caslick out. Sure, that would have been fine...

When I arrived, the owner still couldn't give me more information other than that the horse was down in a shed in the pasture and didn't look good. I asked if it was a colic or truly a foaling so I'd know what supplies to bring. She said I'd better just take a look... helpful.

So I grabbed basic exam tools, lidocaine and scissors for the Caslick, sleeves, and lube (plus a sedative just in case). We walked out to the horse since the owner didn't think she could have been brought into a stall and found her down FLAT.

Red flag #1: there was blood splattered on the walls? Weird. That made me think it was a foaling situation, but on closer inspection she wasn't bagged up at all or loose in her ligaments. So I shifted gears to a colic workup.

Red flag #2: low heart rate. If this was a really bad colic, I would have expected her heart to be racing, but instead everything about her seemed to be slowing down. It all came together when I lifted her lip and found her gums to be GHOSTLY PALE. Got the diagnosis now?

It appeared to be a rupture of the uterine artery, meaning she was bleeding out on the inside. Unusual timing that it was 3 weeks prepartum, but nevertheless here we were. This article provides a reasonable summary: https://stablemanagement.com/articles/mare-loss-from-uterine-artery-rupture

I told the owner that the mare was minutes away from death and asked if they wanted to try to get the foal out, knowing it will be premature and therefore high risk. I got the go-ahead for a terminal C-section and sprinted to my truck to get the supplies....

...which brings us to the part where I was running with a gun and knife. I needed to work quickly since the odds of getting a live foal out were already poor, so I had to shoot the mare and open her up as quickly as possible. Unfortunately I was too late, and the foal was dead.

I don't even think I needed the gun since the mare was all but dead by the time the bullet entered. Her tissues barely bled when I got the uterus out and open, which further confirmed my diagnosis. The foal's heart wasn't beating but I tried compressions while the owner sobbed.

This was a valuable mare with an uncomplicated pregnancy up until this point. There is no way to predict or prevent (or even treat) a rupture of this magnitude, and the owner did the best they could by recognizing a problem and calling the vet out. We did what we could.

Freaky turn of events... What we initially assumed was overreaction due to a late-term colic turned out to be a fatal complication of pregnancy. The freakier thing is that this isn't the first case I've seen, and I haven't even been in practice a whole year yet!!

It was my very first rotation on clinics last year - a late-term mare came in for radiographs and farrier work to help support her increased weight. Because she came to a teaching hospital and not a regular farrier, she got a full PE by me, the student, before going to x-rays.

Everything looked fine on exam. The radiographs were taken uneventfully, her shoes were put on uneventfully, and she returned to her stall uneventfully. While waiting for her trailer home, she acutely collapsed.

I remember watching the internal medicine team racing over with the crash kit to no avail. She went from standing quietly to breathing heavily to paddling on her side to dead in a matter of minutes. Because we were at the vet school, she went straight to necropsy.

They got the definitive cause of death on their gross exam because they found the giant tear and a belly full of blood. Nothing traumatic happened over the course of the day and she wasn't close to foaling. It just ruptured.

Vet med is a wild ride. Sometimes we nail the diagnosis and save the animal, but this was a case where I nailed the diagnosis and was helpless to save her. It sucks. My colleague pulled down her mask to show me her full shocked face when I got back to the office and told her.

So there you have it. Another chapter in my own James Herriot story.