When Patricia Frederick arrives home from work each day she is usually greeted by her 15-year-old mule Jasper, who waits impatiently outside the barn for his evening meal. So when Jasper was no where in sight when she returned home one summer afternoon, she knew something was wrong. Patricia walked around the barn to find Jasper down in his field, covered in mud. He was not rolling, but just laying on his side with a hugely distended belly.
Because she lived close to Auburn University, Patricia knew it would be cheaper and quicker to trailer Jasper directly to the hospital than ask an ambulatory veterinary service to come to the farm. She called the clinic to let them know she was on her way.
When Jasper arrived at the clinic, he was sweating, with an alarming heart rate of 70 beats per minute. The typical heart rate is 40 beats per minute, and a rate as high was Jasper’s is typically associated with severe pain. The mule’s distended abdomen was “tight” as a drum. He hung his head low and his gums were dry and tacky, with a refill time of almost 3 seconds, all of which were signs of shock.
The medical resident started an ultrasound examination and immediately found distended loops of small intestine, showing up as large black fluid filled circles on the ultrasound screen. No motility was detected, meaning the intestines had stopped working. On the plus side, the insertion of a nasogastric tube showed that no fluid had accumulated in Jasper’s stomach.
The resident explained that, based on the information they’d gathered, there were two likely causes for Jasper’s colic: a small intestine twist, which would require surgery, or an impaction of hay at the end (ileum) of his small intestine. Coastal Bermuda grass hay is very fine and can form a wad that obstructs the narrowed section of small intestine before it joins with the cecum and colon. He then asked what type of hay Jasper was eating and Patricia confirmed that she had just received a new batch of Coastal hay only a few days before and, because of a recent cold spell, Jasper had not been emptying his water buckets as quickly as normal.
This scenario was a typical history for an ileal impaction, so the veterinarian focused his efforts on the most likely cause. Jasper was dehydrated, so he placed a jugular catheter to being delivering intravenous fluids. He also gave Jasper a dose of Banamine and moved him to a stall for observations. If it was an ileal impaction, there was a good chance that with pain relief, rehydration and time, it may well clear on its own. However, if it were something more serious, his condition would deteriorate over the next few hours. The problem was that mules tend to be very stoic compared to horses and often do not show signs of pain that would help the doctors decide if surgery was required.
Patricia returned home, but the resident called later that night with an upsetting update: Jasper was showing more severe signs of colic and was now producing reflux, which meant his stomach wasn’t emptying. Both diagnoses?the ileal impaction and the small intestine twist?were still possible, but the resident wanted to know if surgery would even be financially possible for Patricia and her family.
Patricia was faced with a difficult decision. Her husband, Philip, had just been laid off, and the family was struggling to keep up the payments on the small hobby farm as it was. Realistically, colic surgery was not an option. Jasper was considered part of the family, but times were tough. Patricia let the resident know that it was not likely that surgery would be feasible, but that she wanted to continue with the intravenous fluids and other medications in case the problem was an impaction.
Jasper’s abdomen was still distended from the fluid filled-intestines. The amount of small intestinal distension we saw on the ultrasound examination had increased, and nothing was moving through his gut. Jasper became recumbent, and the clinical staff thought a walk might help a blockage move, but no matter how hard the students pushed and pulled him, Jasper?a mule through and through?refused to budge. Since he was lying quietly, he was left alone to rest.
The next morning Jasper’s condition had not changed. Patricia returned to the hospital to visit and the resident shared his concerns. Most ileal impactions would have resolved by now, and Jasper’s abdomen was still markedly distended. He inquired again about continued medical therapy as opposed surgery, but it was clear the cost was really going to be more than the family could afford. Jasper stood at the back of the stall, heavily sedated, his bottom lip hanging, and his long ears poking sideways. Patricia quietly attached a lead rope and took her beloved mule for a contemplative walk around the clinic grounds.
Meanwhile, the surgeons at the clinic were getting anxious. They were convinced that it would soon be too late to have a chance at performing a successful surgery. Ultimately, if there was no response to the medical therapy, euthanasia would be the only option. These cases are heartbreaking for everyone involved?the veterinarians, the technicians, the students and especially the owners. Things were not looking good for Jasper.
As Patricia and Jasper walked, the sedative we have given the big mule was gradually wearing off. As his pain returned, Jasper became increasingly stubborn. Finally he refused to budge, leaving Patricia stranded in the middle of the lawn. A resident hurried out to check on them and tried to encourage Jasper back into the stable. Patricia was pushing as the resident was pulling, but Jasper would not move. As a group of passing first year students offered to help, Jasper took control and threw himself to the ground, scattering the onlooking crowd.
Jasper rolled violently from one side to the other, kicking painfully into the air. Textbooks and notepads fluttered around him as two students keen to be of assistance jumped to safety away from the flailing hooves. The resident raced inside for more sedation, and one of the students took the lead rope from Patricia and tried to steady Jasper. Patricia was crying now and two of the students put their arms around her, as the resident came racing back with another dose of sedative. Patricia did not want to give up on Jasper, but she hated to see him this way knowing that he may not make it.
The students started walking Patricia back to the barn as the resident prepared to resedate Jasper. Before the syringe could be emptied into the catheter port, though, Jasper again took charge. He threw himself over, rolling violently from right to left to right again. Then he got to his feet, shook his almighty head, and let out the most shrill donkey-like “heee-haw!” The surprised student let go of the rope and Jasper was off, trotting back toward the stable and into the stall. He darted inside and a resident slid the door closed behind him.
The humans caught their breathe as they looked at Jasper in the stall. He again “hee-hawwed” and appeared to be laughing at the great commotion he had caused. By now Patricia and the other students had joined the group outside the stall. Jasper impatiently pawed against the stall-door, and pushed his muzzle into the empty feed bin. This was a different attitude to the sullen, depressed and painful animal of moments before. He seemed curious, impatient and even?happy.
The resident cautiously entered the stall and completed a short examination. Jasper’s abdominal distension was markedly reduced, his heart and respiratory rates normal, and loud, rumbling gut sounds announced that his intestinal motility has returned. As everyone stood around, trying to process what they’d just seen, the group arrived at an astounding conclusion: Japser must have had an ileal impaction that suddenly passed as he rolled. This allowed all the distended fluid filled small intestine to empty into the cecum almost instantly just like removing a cork from a champagne bottle! Jasper was fixed. The resident shook his head in absolute amazement. Ileal impactions can certainly resolve with medical therapy, but never had he actually seen one resolve right in front of his eyes.