Success Story of the Month: The LaMancha Emergency
Preventive Care and Preparation
Kelley Hines was the perfect goat owner and breeder – she understood good management, preventive medicine, and the complexities of breeding dairy goats. She incorporated top genetics and artificial insemination into her small herd because she was truly passionate about her flock. She keeps about 10 goats in her herd, which includes milkers, bucks and “keeper kids.” Hines never takes on what she can’t handle.
“Preventive care and read, read, read!” Hines said. “By my nightstand sits Goat Medicine 2nd Edition text. Keeping up-to-date with the latest in veterinary medicine and preventive care is what I try to do.”
Hines was always prepared for the worst; she had two primary care veterinarians in her area, but always used the UF Large Animal Hospital as a resource for complicated or emergency cases. Hines knew that when neonatal problems arose, specialists, along with the most advanced options and facilities for care, can save the life of a doe and kid in a complicated situation.
A Sudden Turn for the Worst
On January 27, 2012, Hines pulled two kids from one of her prize-winning goats. The birth was normal; the kids – Maddy-Lynn and her brother – were both big and strong. They drank colostrum well and were brought inside (all of Hines’ kids are bottle-raised and spend the first few days in totes in the house).
A few hours later, things took a sudden change for the worst. Maddy-Lynn was screaming and in shock. Her eyes and gums were gray and her mouth was cold. Her umbilicus was engorged with blood.
Hines knew there was significant blood loss, so she called her local veterinarian, Dr. Mara Ricci, who suggested that she take the kid to the UF Large Animal Hospital for treatment. The veterinarians on-call, Dr. Sarah Reuss, Clinical Assistant Professor of Large Animal Medicine, and Dr. Martha Mallicote, then-resident and now Infection Control Coordinator at the UF Large Animal Hospital, told her to bring in the kid for an evaluation.
Hines was on the road immediately and also brought along Martini, a prize-winning LaMancha goat with some miracle stories of her own (including a hernia repair surgery in 2009, and also received anti-venom treatment at UF for a rattlesnake bite). She has frequently been Hines’ “blood donor goat” and like a good breeder, Hines was prepared for the worst.
The large animal technicians brought Kelley and Maddy-Lynn to the ICU for an emergency examination with Drs. Reuss and Mallicote. Maddy-Lynn was flat out, her mucous membranes were blue, she was cold to the touch, and was open-mouth breathing. Her pulse was weak and her umbilical stump was full of blood above where Kelley had tied it off.
An ultrasound examination of her abdomen and umbilical structures showed swirling blood and multiple blood clots of varying sizes in the abdomen.
“Blood loss is critical, but especially critical to a one-day-old kid,” Dr. Reuss said. “We knew Maddy needed a blood transfusion. The engorged umbilicus and free blood in the abdomen was an indication that one of Maddy’s umbilical vessels had not clotted normally.”
The umbilicus has four structures running through it; an umbilical vein, two umbilical arteries, and the urachus which feeds into the bladder. Maddy-Lynn’s left umbilical artery was significantly enlarged and was the likely source of bleeding. Kelley had tied off the umbilical stump so there was no external blood loss, but Maddy was bleeding into her abdomen.
Maddy-Lynn was given oxygen via a nasal tube, and Dr. Mallicote skillfully placed a jugular intravenous catheter. Meanwhile, Dr. Reuss collected blood from Martini and gave Maddie-Lynn a whole blood transfusion. Thanks to Hines’ quick-thinking and existing herd, Martini was readily available.
“Martini is my ‘blood donor’ because she is dry and never pregnant and therefore not metabolically stressed out,” Hines said. “Throughout the process, Martini was fine. She’s a queen at home but very stoic when I take her places.”
The blood transfusion took approximately a half hour and both Martini and Maddy-Lynn handled the situation well. Maddy-Lynn’s blood pressure was extremely low which made the process difficult, but the case was none too big for the large animal neonatal specialists at UF.
“Maddy-Lynn was far too small to be able to handle that amount of blood loss without major consequences,” Dr. Mallicote said. “Even though internal blood loss appears less dramatic than an external injury, it is just as serious. We expected Maddy-Lynn to improve rapidly after getting her transfusion, but it was important to monitor her closely for any complications. Until the source of her blood loss was fully clotted and stopped, she was at risk for continued problems.”
“I just wanted Maddy stabilized,” Hines said.
Afterward, Maddy-Lynn was placed in a stall to be monitored and was given antibiotics, oxygen and fluids. The stall also had a heat lamp so she could rest comfortably and help to keep her temperature up. Maddy-Lynn was given colostrum and per Dr. Reuss and Dr. Mallicote’s orders, her umbilical stump was dipped in chlorhexadine every six hours in order to prevent infection.
After her transfusion, her color changed from blue to pink, she was no longer open-mouth breathing and she began to sit up.
A Healthy Recovery
After two days, Maddy-Lynn was sent home with antibiotics to prevent peritonitis (an infection of the lining of the abdomen) as well as omphalophlebitis (infection of the umbilical structures) and Kelley was given instructions to get Maddy-Lynn eating on her own. This task may have been daunting for some, but Kelley was more than experienced in this process.
“Once Maddy-Lynn was stabilized, she regained her appetite immediately,” Hines said. “Dr. Reuss and Dr. Mallicote wanted to see her for two rechecks to perform ultrasounds that showed her umbilical structures healing properly. After a month the umbilical changes were resolved.”
“Maddy Lynn bounced back quickly,” Dr. Reuss said. “She was very appreciative of Martini’s donation and was quickly acting like a normal kid. At her two-week check-up, all of her vitals were normal but her left umbilical artery was still slightly enlarged so we continued her on antibiotics. At her one month check-up, her ultrasound was completely normal and she was given a clean bill of health.”
The neonatal unit and services available to Maddy-Lynn were part of the UF Equine Neonatal Intensive Care Unit (ENICU), which also accommodates kids, calves, lambs and crias. The services and specialists have the capabilities to care for any case, 24 hours a day, 365 days a year.
“There are many things that all neonates need in the first few hours and days of their lives,” Dr. Mallicote said. “When something goes wrong, these moments are critical. Kelley’s quick response and emergency care we provided saved Maddy-Lynn’s life.”
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