Vet Adventures: The Gloves are Off (for an Equine Rectal Exam)

A difficult patient with a difficult diagnosis leaves a lingering impression.

equine rectal exam
Photo by Eastern Light Photography/Shutterstock

Sage stood miserably in the corner of his stall and didn’t react as I approached him. The sour barn manager held onto his lead rope loosely and looked at me in disgust. This was highly irregular.

Her reaction was fairly normal, but my mere presence was usually enough to send Sage into orbit. He did not care for shots, dewormers or having his teeth checked or floated, and he had me firmly pegged as the source of such indignities. I could sweet talk him, attempt to scratch his neck or rub his face, but it gained me nothing except a good view of the bottom of his feet, his gnashing yellow teeth and the whites of his eyes. I was the devil and that was that, as far as Sage was concerned.

I auscultated Sage’s chest, marveling that his feet remained planted on the ground. In fact, he did nothing at all as I worked my way around him, but I was fairly certain the barn manager pinned her ears and shook her head threateningly as I ducked past her, and I resisted the urge to step firmly on her foot.

Something’s Not Right

Sage had a normal heart and respiratory rate, normal lymph nodes, and a temperature of 102. His gums were a little pale, gut sounds were morbidly silent, and his flanks were drawn up. I’d never seen this version of Sage, this quiet stranger not trying to kill me, and I was worried.

I drew some blood, planning to run a full CBC and chem panel, as I needed more information. Sage didn’t bat an eye as I slid the needle into his neck, and this was a horse who would usually react so violently to a shot that it took three or four of us to get it done.

I also gave him an antibiotic shot, although I didn’t know what I was treating yet. I passed a stomach tube with ease and got no reflux or gas back. I cautiously gave him a small dose of electrolytes and warm water.

Time for an Equine Rectal Exam

As I was pulling the tube out and rinsing it, I realized that I hadn’t done a equine rectal exam, and looked doubtfully at my patient who was staring glumly at the wall. The Sage I knew would turn me into a grease spot if I even touched his back end, yet I’d been able to take his temperature without issue, so maybe I could get this done too.

I looked in my tote for a rectal sleeve and some lube, but didn’t see any, so I made a quick trip back to the truck. I pulled the bottom drawer of my vet unit open and reached into the box of sleeves but my fingers hit cardboard. I must have used my last one earlier that day ultrasounding a mare.

Dare to Go Bare—When a Vet Has to Improvise for an Equine Rectal Exam

Skipping this diagnostic was not an option, and admitting I had no rectal sleeves to the barn manager for their horse’s equine rectal exam was also not an option. Well, maybe she wouldn’t notice. I marched confidently back to Sage, stripped down to a T-shirt, smeared lube all over my arm and gently worked my hand into his rectum.

The barn manager’s eyes bulged.

“Are you doing that without a glove?” she exclaimed.

“Oh yes,” I said airily, trying not to grimace as the gritty manure coated my fingers and arm. “You can feel so much more without a sleeve. It’s a much more thorough exam.”

I did a careful palpation of Sage’s insides and pulled my green, evil-smelling arm free. I had a wash bucket ready and swilled soap and water over my skin, but I knew from experience that the smell would not go away for a very long time. In the past I’d tried bleach, vinegar, lemon juice, toothpaste and even gasoline,
but nothing worked except time.

Sage had a small, soft impaction in his small colon, and his intestines had seemed tender to palpate. What on earth was going on with this horse?

When I ran his bloodwork later that night, a light went on in my brain. His white blood cell count was frighteningly low, and when I considered the low-grade abdominal pain, fever and depression, I realized that I had a Salmonella suspect on my hands. Literally.

Prepare for Blast-Off

And he was probably about to blow sky-high with severe diarrhea. And I’d had my bare hand and arm…oh no. Did I have any cuts on my hands? Yes, of course I did, I was a horse vet and I lived in Band-Aids. This was not good.

I was able to convince Sage’s owner to hospitalize him, and as he walked from his stall to the waiting trailer, the diarrhea began in full force. He remained in the hospital for a week and a half, then moved back to a quarantine stall at the original barn.

The lab confirmed Salmonella in Sage’s fecal samples, and I grimly waited for the fever and diarrhea that I was sure would hit me any day.

Miraculously, I avoided getting sick. I still don’t know how, given my bare-armed Salmonella spa treatment. And when I went to re-check Sage one day, he and the barn manager wore identical expressions of loathing as I entered the
stall. I knew that things were back to normal and that he was going to be just fine.

This article about an unusual equine rectal exam originally appeared in the September 2019 issue of Horse Illustrated magazine. Click here to subscribe!


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