From Praying To Braying

Elf the donkey survived a potentially deadly cascade of crises because of the problem-solving and compassionate care of NC State’s exceptional equine team.

By Burgetta Eplin Wheeler

When nearly everything that can go wrong does go wrong, Elf the very sick donkey and his persistent and grateful owner learned that the NC State College of Veterinary Medicine is exactly the right place to be.

Through Elf’s pneumonia, severe diarrhea, bacterial infection, viral infection, autoimmune response to plasma and several rectal prolapses, the NC State Veterinary Hospital equine department stayed steady. The team that included an assistant professor, an equine internal medicine resident, an experienced equine technician and two fourth-year students worked relentlessly to save little Elf, whom owner Shana Martin now calls her phoenix.

Dire was the situation when Elf arrived at the veterinary hospital’s equine emergency department late on a Saturday evening in early January.

His heart rate was 120, double the normal rate. His mucus membranes were purple. His ears and legs were ice cold. All of the signs pointed to extremely poor blood perfusion, meaning his oxygen delivery was catastrophically low. The prognosis for the 110-pound brown boy with the bushy blond bangs was poor.

Martin, an Emerald Isle, North Carolina, resident, had bought Elf and his sibling Mistletoe at a livestock auction before Christmas. Martin and her husband are building an equine rescue farm in Kentucky this year and already have saved 16 Belgian horses and seven hound dogs as well.

While the 5-month-old donkeys were quarantined – a normal procedure before they could head to the boarding facility Martin had acquired for them – a local veterinarian went out to examine and vaccinate them. When the veterinarian found both animals with severe pneumonia, she sent them at Martin’s request to a local animal hospital.

“Mistletoe recovered nicely, but Elf was just progressing the other way,” Martin says.

The antibiotics that helped Mistletoe actually started Elf down a path toward doom, destroying his good gastrointestinal tract microbes and causing endless diarrhea. The local veterinarian told Martin that nothing else could be done at the hospital and suggested she take him to NC State Veterinary Hospital.

‘HE WAS VERY LIKELY TO DIE’

The on-call emergency equine team put Elf in isolation and got him stabilized then Dr. Breanna Sheahan, assistant professor of equine medicine, and Dr. Kimberly Hallowell, a second-year internal medicine resident, took over the case with the help of Karie Tucker, an NC State equine technician for two decades, and two veterinary students completing their clinical rotations.

Tests showed that, in addition to pneumonia, Elf was suffering from a virus and an overgrowth of Clostridium difficile, a bacteria that can live without incident in the GI tract but dangerously proliferates in some animals treated with antibiotics.

“Using ultrasound, we looked at his colon, and it was really concerning because he had gas production within the wall of the intestines,” recalls Sheahan, whose research lab at NC State focuses on equine gastrointestinal disease. “There should be no gas there. It indicates that he had bacteria so deep in the wall of his intestine that they were in his tissues. It told us he was very sick and very likely to die.”

C. diff, as the bacteria often are called, can cause extreme diarrhea that robs the bloodstream of needed fluids and can inflame the colon so much that no nutrients get absorbed.

“I called Mom,” Hallowell says, referring to Martin. “I said, ‘He’s very sick and the odds of not surviving are very high. But if you want to pursue treatment, we’ll fight for him. We’ll take it 12 hours at a time, and as long as you’re game to continue and he’s responding, then we’ll fight for him.’ ”

Martin, for her part, was never going to give up. Her passion is saving the sickest of the sick. Elf was just a sweet baby, and he deserved a chance to live, she says.

Sheahan and Hallowell put Elf on intravenous antibiotics to better combat the C. diff in Elf’s tissues and a continuous plasma infusion to maintain perfusion.

During his 31-day stay, Elf’s care team expandedtoincludeNCStatenutritionists, anesthesiologists and surgeons.

Dr. Korinn Saker, one of fewer than 100 board-certified veterinary nutritionists in the country, devised an intravenous nutrition plan based entirely on the sick animal’s own needs. The anesthesia team put together a pain-management plan that included an epidural.

Elf started to look a bit brighter. His feet were not ice cold for the first time in days. His legs were warm, and his GI tract started working again. But then.

“Every day there was a new complication,” says Hallowell, a DVM graduate of Tufts University in Massachusetts. “If X, Y and Z were better, now we have this new problem to fix. We would weigh what are the risks and what are the chances Elf gets this complication? And we realized, even if no one else would, he would.”

Bring In The Surgeons

Elf started passing blood in his diarrhea and suffered a rectal prolapse, which the surgical team repaired. Next, his blood work started to show that he was having a delayed immune reaction to the donor plasma, attacking his own red blood cells and platelets.

“We started him on steroids to limit the autoimmune response,” Sheahan says. “He responded really well to those. The hard thing is, we can support him as well as we can from a medical standpoint, but we can’t magically make his gut heal or stop the bleeding inside. All that just takes time.”

About eight days after Elf was admitted, he finally gave them a hopeful sign.

“He brayed at us,” Sheahan says with a smile. “I don’t know whether you’ve ever heard a donkey bray, but they are adorable.”

He started eating. He started interacting with his caregivers.

Once Elf’s diarrhea was blood-free, they gave him a fecal transplant: a healthy horse’s manure administered through a tube into his stomach. With all of the mucosal lining of his gastrointestinal tract shedding, with the overgrowth of C. diff bacteria, and with all of the antibiotics the donkey had been given, Sheahan says they knew he didn’t have the normal gut bugs he needed to recover.

Three days later, Elf had normal manure and maintained that progress throughout the rest of his hospital stay.

“Elf’s story is really a story of how many people helped to save him,” Sheahan says. “Every department in this hospital has helped this donkey live. That’s what I love about this place. Whenever you have a question or a need, there is always someone to help you out. And that’s the beauty of being at a teaching hospital.”

OPPOSITE: Equine technician Karie Tucker (left), Dr. Breanna Sheahan and Dr. Kimberly Hallowell accompany Elf for some fresh air near the end of his stay.

LEFT: Dr. Korinn Saker, one of fewer than 100 board-certified veterinary nutritionists in the country, devised an intravenous nutrition plan based entirely on Elf’s own needs.

As for Martin, she will be forever grateful that she found a team of medical professionals who were willing to fight as hard as she was. Phoenix Farm has always been what they were going to call their 125 acres in the heart of horse country. Now they know why, Martin says.

“Elf is here for a reason, a purpose, a big purpose,” she says. “Out of all the monstrous draft horses I have, that it would be my little donkey? Elf is now the center stage to it. He’s the miracle. He ’s the little fighter. He is the phoenix.”

“One of my favorite memories is taking a road trip to the beach with some classmates for a Mobile Hospital spay and neuter clinic. We practiced procedures, had pizza night sleepovers and almost crashed a wedding. This community has become my family over the past four years, and I would do it all over again to meet these people.”

— MORGEN DUGAN, CLASS OF 2023 PRESIDENT