Back at the Fondouk

Michelle and I have been back working at the Fondouk for four days. I finally finished my long posts about our trip to Marrakech last weekend and now I can start writing about what we have been doing at the American Fondouk.

Michelle's patient with the eye laceration and edema

Monday was a fairly busy day. Michelle and I each took in a new patient. Michelle’s patient is a middle aged white mare that the owner recently bought at a sale. The mare was presenting for an eye laceration but the rest of her body had problems as well. Her limbs and ventrum were very edematous with some of the thickest legs I have ever seen on a horse. She had a few abrasions and wounds that needed tending too and she was very cachexic. She had focal areas of edema on her face and her left eye was very swollen. On top of all of this, she was icteric and had a heart murmur with tachycardia. On further exam of her eye, a large corneal ulcer was discovered as well as severe conjunctivitis resulting in necrosis of the upper conjunctiva.  She was a mess but a sweet little horse. We would try to do what we could for her.

The eye after staining. An image not for the weak stomached.
The area of necrotic conjunctiva would soon slough off.

 We cleaned her wounds and performed a third eye lid flap to protect her eye. We ran several blood tests and found that she was anemic, hyperproteinemic, but her liver values were mostly normal. An abdominocentesis found she had degenerate neutrophils, some of which looked like degenerate lymphocytes. At this point, we do not know what is wrong with this mare. My top differential has been lymphoma the entire time, but Dr. Gigi believes the cells found on abdominocentesis are degenerate neutrophils, whereas Michelle and I believe they look like lymphocytes, supporting the diagnosis of lymphoma. Medical management is all that can be done at this point and we will continue to monitor this patient. 

My diarrhea mare

The case that I took on was a little white mare presenting for diarrhea of one day duration. The mare was found lying down that morning and did not eat well so the owners brought her in. On her walk to the Fondouk, the mare was apparently dribbling diarrhea the whole way. On presentation the mare was tachycardic but did not have a high temperature. She was thin and week and looked in rough shape. We hospitalized her and started her on a dewormer, an antibiotic, and an NSAID, as well as offered her regular and electrolyte water, alfalfa hay, and grain. Since Monday she has started to show mild improvements. She is eating and drinking relatively well and her feces are more cow pie consistency, rather that water. Most likely she is infested with worms but we are testing for salmonella as well. It’s a little disturbing to think that she could have populated the side of the road with salmonella on her way to the Fondouk.

Dr. Mohammed aspirates the swelling on the donkey's back.

As usual, we’ve seen several more influenza cases, a gas colic that resolved, some incidental eye disease findings, some lamenesses, and some wounds. Yesterday, a donkey presented for a swollen painful area in the middle of its back. The owner said the donkey had fallen 10 days ago but the swelling and pain kept getting worse so he brought the donkey in. We found no abnormalities on neurologic examination. Its back was very swollen and painful and the donkey showed you how much it hurt by ducking his back down, kicking and biting. We put a horse sized muzzle on the little donkey to finish our examination. Michelle and Dr. Mohammed ultrasounded and aspirated the swelling. At this point, the swelling seems to just be from edema or fluid, not due to an abscess or hematoma. The donkey has been hospitalized to monitor the injury and treat with anti-inflammatories.

Incidental eye pathology found in a mule presenting for lameness.

A donkey presenting for hip luxation

Yesterday a donkey with a luxated femoral-coccygeal joint (hip joint) was abandoned at the American Fondouk. The poor donkey has been sold twice to unsuspecting owners until the current owner decided that this was enough and left the donkey at the American Fondouk. There is not much we can do for the donkey. His hind leg hangs rotated outward and unable to bear full weight. We will keep the donkey for several days to see if the owner will come back to claim him. Otherwise we have no choice but to euthanize the animal due to the poor prognosis of his injury.

Natasha practices floating a mule's teeth on her first day.

               On Tuesday night, Michelle and I went out to dinner with Matt and his two roommates. They met us at the Fondouk and I gave Matt's roommate Maddie a tour of the clinic. We took a new route into the Medina and wondered around trying to find a restaurant I had read about in my Lonely Planet book. With a little help from a local we finally found the Chameau Blue, or "Blue Camel" restaurant. It was a chilly night so we ate inside and enjoyed a delicious meal in each other's company. Matt helped Michelle and I find a cab and I said my final good byes. I gave Matt my email and link for my blog. Hopefully we can stay in touch. On the drive back to the Fondouk, the taxi driver must have misunderstood Matt as the taxi driver intended to drive us to the American Center, the school that Matt attends. We stopped him shortly after he passed the turn for the Fondouk and instead of turning around at the next street, he just stopped and started backing up. Luckily the two lane highway was not very busy and we safely delivered to the doors of the American Fondouk, just in time for 8 o'clock treatments.

Later that night, another American student arrived. Her name is Natasha and she is in her fourth year of veterinary school at Western University. She is very nice and has a strong interest in equine medicine. I gave her a working tour and orientation the best I could on Wednesday. She took on one of Terek’s cases, as he returned home on Wednesday, and got to do some equine dentistry on her first day. Azzis, another Moroccan student, also left today and we are down to only 6 externs in the student villa.

I discovered in this mule with ventral edema that male mules have both a sheath and teats. Amazing.

Another typical sight of a mule with tongue paralysis due
to the ancient ring style bits still used on working stock.

After today, Michelle and I only have one more day left at the American Fondouk. On Friday afternoon we plan to take the train to Casablanca, stay in a hotel overnight, and fly out on Saturday. I fly home Saturday morning whereas Michelle will fly to Uganda for another 2 weeks of externship in the middle of a bush village. Our time at the American Fondouk has been fun and has gone by so quickly. I can’t believe it is already almost time to head home. I will miss all the people I have met, the language diversity, the interesting cases and hands on experience, the food and the culture. It would be great to make it back to Morocco in several years to see how the American Fondouk has further changed and to revisit some of the wonderful places I have been. I have learned a lot on this trip, such as how to communicate without understanding each other’s language, how to barter, and how to just relax, go with the flow, explore things with less of a concept of time, and realize that in the end, everything will be ok, even if you don’t know where you are going.