LP’s Tiger (aka “Elle”) is the most challenging rehab case we’ve ever had at LOPE. A true warhorse, she raced 141 times and retired at age 10 from the track. Elle is a petite mare (@15.1H) with an elegant, feminine build — and the huge heart of a champion.
A village of aftercare groups came together to help Elle after her race career ended. CANTER PA transitioned her from the track. Mid-Atlantic Horse Rescue took her in at their Maryland facility, where she could relax, enjoy pasture turnout and restart under saddle again. Elle then came to LOPE in 2017, to join our Racing Warrior Program and to be our 2017 RRP TB Makeover candidate.
Elle’s Symptoms: Physical and Behavioral
However, a complication came up. Elle developed ovarian anomalies in summer 2017. She began producing extremely large, persistent follicles that created intense discomfort and hormonal imbalances. Symptoms included an unusual form of lameness behind, pain in the ovarian region and highly reactive stress/emotional response to minor changes in her environment.
I can’t stress enough the intensity of Elle’s symptoms. It started with an odd lameness. At times, she would suddenly not put any weight on the sole of her left hind. Her toe would stay on the ground only, while she hopped on it. And then she would walk out of it normally. The frequency increased, so that eventually it recurred several times each day.
Elle had always been a boss mare of the highest order. But her behavior became downright aggressive and completely unprovoked. She was in a large private paddock. If she was haltered and led down the driveway between the paddocks, she would pin her ears flat and try to kick out at every horse through their paddock fence. Elle was quite serious — she put a great deal of vehemence, speed and accuracy into her attempts to elude the lead rope and hurt the other horses.
Rearing and striking became a common behavior for Elle on the ground. Her version of rearing was to go fully vertical (at times even teetering slightly backwards) and to come down striking at the lead rope or anything within range of her front feet. Trailering her was an interesting process, as I’m sure you can imagine.
All of this behavior was accompanied by a tremendous emotional response. I could tell that Elle hated being out of control and uncomfortable. She was throwing all of her heart and soul into fighting off whatever was attacking her. But it was her own body that was the culprit. Elle could never make the discomfort stop — she couldn’t kick it away or smack it down, no matter how hard she tried. And we know from her race record that Elle is a gritty and tough champion — it’s in her nature to keep climbing back into the arena and trying to defeat her opponent. She’s not one to give up — ever.
When Elle became emotional (which soon began to happen almost daily), her lameness would increase dramatically, to the point where she would desperately fling herself around on only three legs. It was heartrending to watch this (even if she was angry and charging at the time — you still felt bad for her as you ran like hell for the fence).
Diagnosis, Initial Treatment and Veterinary Drama
After multiple ultrasounds and hormonal testing that confirmed the ovarian anomalies, our vets (Austin Equine Hospital) recommended that she be placed on Regumate (a medication that stops reproductive cycling in mares). But after three months on Regumate, Elle was still showing signs of distress. There was some reduction of intensity, but she still clearly was at a discomfort level that was difficult for her (and me as her ground crew) at times.
Rearing and striking was still happening (though she didn’t try as hard to actually hit something with her forelegs, an improvement I appreciated). She continued to have aggressive responses to other horses. Periodically, Elle would have anxiety episodes (pacing frantically, neighing, kicking out) both in her paddock and when stalled. During those episodes, I sometimes had to give her Ace to alleviate her behavior and make her manageable. (Note: I rarely use Ace; in fact, it had been years since I last used it.)
So clearly something was still going on with Elle. Austin Equine Hospital then did a series of weekly ultrasounds to see if they could correlate the symptoms with changes in her ovaries. After several weeks, the tests results were clear — Elle was still ovulating and producing large follicles through the Regumate (which is unusual, as most mares stop cycling completely while on Regumate). The ultrasound series confirmed that Elle’s symptoms increased dramatically during the ovulation phase in her cycle. Only a small percentage of mares don’t respond to Regumate fully — and unfortunately, Elle was one of those mares.
Surgery Saga: Two Attempts
Our vets recommended surgery to remove her ovaries as the only way to permanently ease her discomfort. Typically the ovaries are removed via laparoscopy in a standing surgery. The horse is sedated, rather than placed under general anesthesia (so that the horse can stand during the surgery). But Elle had a history of kicking (with impressive accuracy) when she was uncomfortable during veterinary procedures. For safety reasons, the vets decided to put Elle on the table, under general anesthesia, to perform the laparoscopy and remove her ovaries.
The surgery was scheduled for January but it wasn’t successful. Elle had excessive gas in her colon, which created significant visibility reduction and limited instrument access to her ovaries. The surgery was stopped — the surgeon couldn’t see or get to the ovaries safely. After the surgery, Elle had an extremely negative response to coming out of general anesthesia. She went into full fight and flight mode — and it was impossible to safely restrain her. Fortunately, she didn’t seriously harm herself (or others) — but it was clear that general anesthesia was high risk for her and needed to be avoided for the future.
A few weeks later, Austin Equine Hospital decided to try the standing surgery approach for Elle. In standing surgery, the horse isn’t put under general anesthesia. Instead, the horse is sedated and placed in stocks. The laparoscopy is performed while the horse stands. Because of Elle’s behavioral issues (strong kick response), the vets took extra precautions. All of the senior vets participated in the surgery and a special mix of sedation was given to Elle. Although she is a small mare, Elle had shown a high tolerance for sedation in the past — often shrugging off dosages that made the tallest horses sleepy immediately.
The procedure had a good start. Elle handled the early stages well (such as draping, initial sedation, and so on). The surgeon made small incisions on her left flank and inserted the initial camera device. They were able to locate her left ovary and then began the next phase, which involves filling the abdomen with carbon dioxide to allow visualization.
Elle became extremely reactive at this point. Despite the sedation, she began to kick (with impressive accuracy, even through the stocks and sedation). Elle also shifted her weight back and forth, trying to alleviate her discomfort. It was impossible to continue the process without serious risk to her and the surgery team. So the surgery was stopped, for safety purposes.
Last Options to Help Elle
Everyone feels for this fierce little mare and wants to help her (ideally without being kicked, if at all possible). But the options were narrowing now. After the second failed surgery, we saw only three options:
1. Remove the ovaries via a full abdominal surgery (like a colic surgery). This would be the last remaining surgery option available. Elle would be placed under general anesthesia. The surgeon would make an abdominal incision and manually remove Elle’s ovaries (as opposed to using the laparoscopy technique). Recovery would be 6-8 weeks stall rest with hand walking. Pros: Her ovaries would definitely be removed in this procedure. Cons: Elle extreme reaction to coming out of general anesthesia greatly increases the risk that she would fatally damage the fresh abdominal incision immediately. She also isn’t a great candidate for dealing with abdominal discomfort during many weeks of stall rest. The financial cost would also be high with lower odds of a successful post-surgery recovery (because of Elle’s reactions).
2. Euthanasia. We don’t like this option, but as responsible stewards we need to consider whether it’s time to look at euthanasia. Pros: She won’t continue to live with discomfort. Cons: She won’t continue to live at all.
3. Aggressive rehab/physical therapy plan: With this option, we would keep Elle on Regumate and give her intense physical therapy/rehab (cavaletti, ground work, lunging, ponying) to see if that will ease her symptoms. We would put her on Adequan (to see if it helps her stiffness and intermittent lameness behind). If we can help her get stronger/more supple behind, that might alleviate her discomfort during ovulation. Putting her into a busy, regular schedule of groundwork might help her unwind mentally. Pros: The rehab plan wouldn’t harm her and might help her. Plus we could at least determine if she can improve with this approach, which would be helpful for future decisions. Cons: Intense PT will make her muscles fatigued and stiff initially (with eventual outcome of strengthening them) — which may make Elle more reactive in the short term. The rehab plan will take a fair amount of staff time and focus over the next several months. And Adequan will be expensive (though not as expensive as the abdominal surgery option).
After much discussion and consultation with our vets, LOPE has decided to go with the intense rehab/physical therapy plan for Elle. We will plan for six months of rehab but will re-assess her after three months, to gauge any progress and make adjustments to the plan if needed.
LOPE was reluctant to put her into this type of rehab plan earlier (especially when laparoscopy surgery was still an option). At that time, it seemed unreasonable to expect her to handle intense PT when she had hormonal/discomfort issues that would make the process difficult for her. But now (after two unsuccessful surgeries) it seems like it might be worth a try to put her on a workout plan. Her ovaries aren’t going anywhere in the near future — the abdominal surgery has too many risks for Elle — so the rehab plan seems like her only option at this point.
If her discomfort increases or her condition deteriorates (i.e. the ovarian issues became worse), then LOPE will consider euthanasia. We follow the AAEP guidelines for euthanasia — and if Elle can’t have a good quality of life by AAEP standards, then the decision would be straightforward. But she is not in that category now.
Why Bother? Why So Much Effort for One Horse?
This is a fair question. LOPE is a charity devoted to helping at-risk racehorses while inspiring young people through horsemanship education. Like most charities, our resources are limited. An unusual rehab case like Elle takes a great deal of organizational time, funding and physical space for months (and in her case, probably over a year when all is said and done). Other horses could come in Elle’s place — horses who are easier to rehab, retrain and adopt. Why are we doing this for Elle? How do we justify the time and cost?
It’s not like Elle has a big future in the show or performance world. She’s a short 12 year old TB mare with a feisty, opinionated temperament. After her long race career, her legs look clean but most likely have some arthritic wear and tear under the surface (hell, my legs do too — and I only ran track for about 4 years in school). And Elle is terrifyingly intelligent — she is one of those horses who would take over the world if she ever developed even one opposable thumb. She’s kind of like Captain Call’s famous mare (Hell Bitch) from Lonesome Dove.
So we’re pretty sure there isn’t going to be a huge group of people lining up to adopt Elle, even if the rehab is successful.
But here’s the thing. Elle is a beautiful, tough little warhorse mare (remember, she ran 141 races). She has so much heart — and the biggest personality we’ve ever seen packed into a tiny 15.1H frame. Elle is such a fighter. She throws everything she has into fighting off threats (real or imagined), beating the competition and claiming victory in any challenge she’s given. I’ve worked with hundreds of ex-racehorses at LOPE. Not one comes even close to Elle for grit, determination and try (which is an epic statement, if you know anything about LOPE’s history).
She’s also had some incredibly bad luck. Developing weird ovarian issues at age 12 is an unforeseen twist of fate. Being one of a small percentage of mares that Regumate doesn’t help is a massive bummer. Having really bad gas on the ONE day you are on the surgery table to remove your annoying ovaries is downright freakish bad luck. Add to that you have dangerously intense reactions to general anesthesia plus a wicked strong kick reflex with standing surgeries — and well, your bad luck is now reaching Biblical proportions (as in Book of Job).
So all of Elle’s fight and grit have been against impossible odds, insurmountable bad luck and veterinary drama beyond her control. Her strong will, keen intelligence and competitive spirit are formidable qualities — but they haven’t given her much of a chance against this particular set of unfortunate coincidences and unlucky combinations.
But we can give her a chance. LOPE can give her that six-month rehab and physical therapy. Yes, it’s devoting a great deal of time and resources to one mare. But we think she is worth it. Elle is heroic in her combative, never-give-up way. We applaud that in her — it’s what made her such a great racehorse all those years. A brave fighting spirit like Elle’s is rare, admirable and inspiring (in horse and human). We have already learned so much from her unusual veterinary case (as have her vets and surgeon) — as well as from her “take-no-prisoners” approach to life challenges in general.
Conclusion (with Shakespeare)
The least we can do is pay her back and give her another six months to teach us more. With some time (and a little luck, the good kind), Elle might respond well to the rehab and physical therapy plan. That seems worth the time and effort to us. Horses like Elle (with long-term, weird rehab needs) don’t have many places to go. But LOPE’s primary mission focuses on education (not just adoption) — and Elle’s case fits nicely into our program right now.
So get ready to hear lots of spring updates and summer progress reports about Elle. She’s going to be at LOPE for quite awhile. If you would like to help sponsor Elle or learn more about her case, please contact us.
In closing, we leave you with a famous quote that sums up Elle perfectly:
“And though she be but little, she is fierce.”
— Shakespeare, A Midsummer Night’s Dream
We like to think that quote applies to LOPE as well.
LOPE would like to express our deep gratitude to Austin Equine Hospital for their outstanding and dedicated care of Elle during her assessment, diagnosis and double surgeries — as well as their excellent (and ongoing) veterinary advice and expertise. Many thanks also to After The Finish Line for their generous grant to help with Elle’s surgery costs.