Lily was a solemn little girl with wild black braids, and I used to love watching her with her beloved horse, Angus, a bay Quarter Horse. Lily adored history classes at school, and her favorite activity was acting out her recent lessons.

Angus would obediently jog in a slow circle while Lily pretended that they were the Pony Express delivering mail in hostile territories. Sometimes Lily and Angus were a mounted army general riding along battle lines to boost the morale of weary troops, or a doctor and his trusty steed delivering medicine to fight dysentery in the camps.
Whatever the script, Angus always fell right into character, and it was hard to say who had more fun, Lily or her big, gentle horse.
Growing Up Together
Angus had been my patient since Lily was a toddler. Angus was a 2-year-old then, and was one of the calmest and most well-behaved youngsters I’d ever been around.
I was cleaning up my gear on that first visit when Lily’s mom Greta walked Angus by, a tiny bright-eyed little girl with a mop of black hair sitting on his back. Normally, the sight of a toddler on a young horse would stop my heart, but even then, Angus knew that Lily was his little girl, and he was going to take care of her.
As Lily grew, it wasn’t uncommon for her parents to find her down in the barn, climbing Angus like a tree, standing on his back, and pretending they were circus performers, or on one memorable occasion, falling fast asleep against his side as he slumbered.
Lily would do her homework in his stall or paddock, host tea parties for Angus—always the guest of honor (though he preferred oats to tea)—and there was a framed photo of Angus and Lily on the bedside table in her room.
Time for a Diet
As children and horses will, Lily grew older, and so did Angus. When Lily started middle school, soccer practice and friends took up more and more of her time. While she still spent as much time as she could with her beloved horse, it just wasn’t the same. Angus was gaining a little weight, and Greta and I put him on a diet.
By the time Lily started high school, her schedule was so full that she had little time to ride. Angus was often just a dot in the field, far away with his herdmates, munching tasty grass and dozing in the sun, which isn’t a bad way for a horse to live—except Angus was supposed to be on a diet.
Greta did her best, but since the horses all went out during the day, she didn’t want to leave Angus in by himself, and hiking out at midday to catch a horse who didn’t want to be caught was out of the question for two school teachers and a high school senior.
The family switched the turnout schedule, letting the herd out at night and keeping them in during the day. They mowed the fields down as far as they could, and even tried a grazing muzzle, but Angus was an expert at getting it off and losing it.
Lily hired a friend to exercise Angus several days a week, and he now had a beautiful dry lot pen with a roomy loafing shed and a 30-year-old mare to share it with. Lily still spent as much time with her horse as she could, and while Angus didn’t lose any weight, he was bright-eyed and content. Lily took their picture from her bedside table with her when she left for college.
Something Amiss
I was out to vaccinate the herd one spring day and was alarmed by Angus’s appearance. I hadn’t seen Angus since the fall, and the difference in him was startling.
His neck had developed a thick crest, his eyes seemed to be bulging and watering. There were fat pads on his sides and tailhead. His coat was also looking unusually shaggy for spring, plus he had a horrible haircut, which didn’t help.
Greta was somber when she led him over to my truck.
“Dr. Diehl, I know he looks awful. We’ve done everything that you recommended, but I just can’t get the weight off! We took him off pasture completely and he only gets soaked grass hay, but nothing helps. Lately he’s had so little energy, we haven’t had the heart to exercise him too much. I don’t know what to do!”
I pointed to a line of jagged hair and clipper marks along the horse’s side and raised an eyebrow at Greta who laughed.
“That’s Lily’s handiwork from when she was home last week. I told her not to quit her day job, but she wouldn’t stop fussing over him. Her roommate’s dad is a horse trainer, and I think they were putting ideas into her head.”
I was half listening. “I need to draw some blood, Greta. He has all the symptoms for Cushing’s disease, as well as equine metabolic syndrome, and if I’m right, we need to get him on some medication right away.”
The horse was as patient as ever as I slid the needle into his jugular vein and dark red blood welled into the blood tubes that I switched out as each filled up. I had two red top tubes to fill, two large purple tops, a blue top and a green top tube, and Greta clutched them as I handed them over one at a time.
“What on earth, Dr. Diehl! Is he going to have any blood left?”
I laughed. “He’s got plenty left, but I still need a few more tubes filled. Hang in there, Angus.”
Angus didn’t care. I finally pulled the needle out and held some pressure against his neck for a minute. I took my hand away from his neck, and Greta and I took turns petting the big horse and talking about Angus and Lily’s adventures and laughing at a memory of Lily and Angus covered in mud and chasing each other in the rain.
Mysterious Bleeding
A drop of blood splatted wetly on the top of my boot, and I looked automatically for the source. I was alarmed to see a large swelling over Angus’s jugular vein where I’d drawn the blood. Another large drop was forming, and I pulled some gauze out of my nearby kit and held a wad firmly against the horse’s neck.
“He’s got a hematoma over the jugular vein, Greta.” I said apologetically. “It can happen sometimes. I guess I didn’t hold the pressure on long enough.”
I kept the pressure firmly against his shaggy neck, but when I released it after several minutes, the bleeding continued, and the swelling was even larger.
This was not normal at all. I left Greta holding pressure on the neck while I ran for some abdominal packs and Elastikon tape. I rolled up the thick cotton pack and pressed it over Angus’s jugular and bandaged it in place as snugly as I dared.
I checked his vitals. He had an elevated heart rate and respiratory rate, but his temperature was normal.
I lifted his lip to check his gums and was dismayed to see a line of purple splotches across the tissues of his mouth, and his gums had a faint yellowish hue.
“Those splotches are called petechia,” I said to Greta. “They’re caused by leaky blood vessels. Something is causing his blood not to clot, and he also looks jaundiced to me.”
“What would cause that?” Greta asked anxiously.
“There are a few possibilities,” I said. “Liver disease, blood parasite, even cancer. There could be an infectious disease causing it, but we usually don’t see it in this region of the country. There are a few genetic diseases that could explain it, but those usually manifest much earlier in life. The bloodwork will hopefully answer a lot of questions.”
Stay tuned for the conclusion to Angus’s story, coming to HorseIllustrated.com next week.