I continue to be amazed at how much Reuben has been forced to endure, and how well he is enduring it, all things considered.
We are now 15 days since Reuben was exposed to fire. Some of the damage from fire is inapparent, at least initially. So, for example, while it was readily apparent – from the dark red urine that we saw on the first day – that the heat was so intense that it caused red blood cells to burst inside Reuben’s blood vessels, other damage was not initially seen, and is still showing up.
Reuben has lost a good bit of skin, but most of what he’s lost is superficial, at least as far as I can tell. While he’s lost sheets of surface cells, now that those are removed, you can see islands of hair growth staring back. You can even see his eyelashes growing back over the right eye. To me, the new hair growth is a sign of hope, kind of like the first green grass that you see in the spring.
Even so, it’s apparent that he’s still fighting hard. His heart rate is still way above normal. A normal horse’s heart rate is 32 – 36 beats per minute. Reuben’s hovers around 70. I think that there are two reasons for this. First is that he’s got so much inflammation going on in his body. Second is that he’s in some pain – even though we are taking very aggressive measures to control pain. My sister, who is an emergency room physician, and has had to treat many burn patients, says that all of that would be expected if Reuben were a human burn victim. So that helps mollify my concerns, at least to some degree.
Still, Reuben’s moving quite stiffly. His right fore and hind feet have lost a good bit of skin on the lateral (outside) coronary band, and that can’t feel good. He’s also got some separation at the coronary band, especially on the right hind hoof. Assuming that his hoof stays on (and I think it will), this will require at least half a year to grow out.
As stiffly as he’s moving, my concern has been that he’s going to develop laminitis, which would be almost a death sentence for Reuben. I X-rayed his front feet again today… and, like the first time, a few days ago, the bones are right where they are supposed to be. That’s wonderful, from a prognostic standpoint; but he’s still hurting. He’s on four different pain-relieving medications. For help in deciding which drugs to use, I have to thank Dr. Monica Aleman, at the University of California, Davis, who is not only helpful, but also gave me her cell phone number so I could call her directly. Caring veterinarians tend to do stuff like that.
I’m beginning to switch up the ointments a bit. Most of this is trial and error anyway. On areas where the skin is dry, and the hair is starting to appear in little patches, I’m using an antiseptic ointment in a zinc oxide. You know zinc oxide – it’s the white ointment that people put on their noses to protect them from the sun, or on baby bottoms to treat or prevent diaper rash. Zinc oxide has been shown to aid in new tissue growth, wound repair, skin healing, and prevention of inflammation. It’s also helps prevent sun damage. On areas where the skin is weeping – such as on the sides of his right fore and hind feet – I’ve just switched to an antiseptic ointment that has a little bit of hydrocortisone in it. That should help with inflammation, as well as to control “proud flesh.” Kinetic Vet, a maker of skin products for horses, has generously donated several pounds of ointment – we may need more. I’m still putting SSD cream and honey over a good part of the right side of his body: less, as things get better.
His attitude is remarkably good, all things considered. Reuben’s eating and drinking great, too. There’s still room for plenty of hope.
One other thing. People have expressed concern about whether it’s cruel to try to bring Reuben back. Here’s how I look at things. I know for sure that I can make Reuben dead. I don’t know if I can get Reuben back all the way, or, at this point, even at all (he’s still not out of the woods). But there’s a good chance he will come back all the way. I want to give him that chance.
I also know that if Reuben is going to come back, he will be in some discomfort. There is absolutely no way that I can get rid of every single bit of Reuben’s pain. So, to me, as long as Reuben is showing signs of progress – and he is showing signs of progress – I think that discomfort, though heart rending, is an unavoidable part of the process. If he were to stop showing signs of progress – let’s say today’s X-rays showed that the bones in his feet had moved – I’d be thinking differently. But he’s trying, it’s been 15 days, and he’s coming along.
I’m pretty attached to Reuben at this point, and while it makes me sad to see him hurting, it would make me sadder to see him dead. I can only imagine how I’m going to feel if he makes it back. Reuben’s working hard. The least that we can do is keep working hard for him.