Rectal Prolapse

Severe bilateral high and low ring bone in an aged mule

                Today was another great day here at the American Fondouk. The morning was appropriately busy with some spare time in the afternoon to work on reorganizing the new store room.  There were several lameness exam performed, which can be quite entertaining watching people chase these horses and mules (that are not used to trotting in hand) up and down the slightly inclined courtyard. One mule had one of the worst cases of ring bone I had ever seen with a severely negative solar angle. A white cart horse with a right front limb lameness was found to have suspensory desmitis. Unfortunately when the owner was asked how much time he could afford to rest this horse, he replied one hour, significantly less than the 4-6 MONTHS recommended.  So the horse saw the farrier where the long toe was shortened bringing the break over back and hopefully relieving some of the stress on the suspensory ligament. Unfortunately, not much else could be done if the owner could not afford to rest the horse.

A lameness exam is performed on the grey cart horse in the court yard of the American Fondouk

The colic mare's prognosis remains a mystery
with the diagnosis of a ruptured ureter

                In the afternoon, results came back for the colic’s lab work. The abdominal fluid contained creatinine, a kidney specific enzyme, at levels high enough to confirm that urine was leaking into the abdomen. Since no defect could be found in the bladder on endoscopy, and methylene blue was not found in the abdominal fluid, there is likely a ruptured ureter. What can be done for this? In this setting, I’m not sure. Perhaps the rupture is only a small hole and will heal on it’s own or perhaps the mare will have a persistent uroabdomen that may not end in her favor.  The mare remains bright and alert, eats and drinks well, and urinates and defecates normally. Her impaction remains on palpation so she was once again started on oral fluids. If her abdomen fills with urine again, as it has every other time we have started fluids, then it will be drained. This is a very interesting case and it will be interesting to see how it pans out. How often does a horse rupture a ureter? Did the massive impaction displace and rupture the ureter?  Dr. Gigi’s husband suggested that I should do a case report on this horse, so I will continue to diligently track her diagnostics, procedures, and prognosis.

The massive rectal prolapse

                I was involved in another more medically graphic case today. This time a rectal prolapse that occurred yesterday. If you think the picture is graphic, it doesn’t even begin to do it justice. I performed an epidural on the mule and after about a half an hour of ice water compress and manual compression, the prolapse was finally replaced. I placed a purse string suture around the anus which the patient did not appreciate and sutured the rectum closed. In addition to my intensive monitoring of the colic mare, I now must empty feces from this mule four times a day. That process involved two hands tonight, one to reach in and gradbthe feces and the other to hold the prolapse in. It seems I have been selected as the extern in charge of all the intensive cases this week!

Performing an epidural on the rectal prolapse mule

With more than a half hour of ice cold water compresses and manual compression the prolapse was successfully reduced

The mule standing happily in her stall. She's quite a donkeyish looking mule with a short little face.
I later learned this is a typical appearance of a hinney, a mule born of a donkey mother, sired by a stallion.

Ilham with her calico kitty friend I later named Nala

                The weather was again perfect with the high at the peak of the day in the upper 60's. I had mint tea for the first time and enjoyed it in the company of the other externs outside next to the pool. I was asked if I had mint in America and I explained to them yes, but more commonly in the extract form. When I explained that I enjoyed mint most in chocolate they thought that was the strangest thing and couldn't imaging the taste of mint and chocolate together.  Communication between some of the other externs is starting to go better as those less fluent in English attempt to speak in English, even if I have to help with with several words.  I am continually getting better at recognizing cognates and the few words of French I have learned. Though conversations in the student villa are almost always in Arabic, I'm getting used to just hearing the flow of the conversations and jumping in or asking a question when I think I understand what is being discussed.

The sunset from the roof of the student villa

               Tonight I met some friends of Dr. Gigi’s son., Paris  Gigi suggested they involve me in their festivities this weekend and I stated I would like to return to the medina. We decided we would go tomorrow afternoon and I am so excited! I will have to put together a shopping list? Any orders?

                Living it up in Morocco,

                Michelle

A lemon tree in the light of the moonlight