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May 23, 2013

This document is prepared to summarize the care of Mylla Lewis for the past 61 days. Mylla presented to

the KSU-VHC following long distance transport from California to the Kansas City area. The planned

course of transport included a 4-5 day trip with daily removal from the trailer. Instead, Mylla was

transported over a 48 hour period of time from March 11 to the 13

th

, 2013.

MYLLA PRIOR TO TRANSPORT IN CALIFORNIA March 2013

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At the time of arrival in KC Mylla was in apparent shock and had severe abrasions located on her left

tuber coxa, right hind fetlock, pastern and right lateral hoof wall. Mylla was managed by Dr. Kent

Jackson for her illness and wounds. By March 22ndMylla had not recovered from her wounds and had

developed a severe cough and was therefore transported to KSU-VHC for evaluation of transport-

associated injury and disease.

Mylla was at a very high risk for transport associated disease due to the fact that her transport was

performed over an abbreviated period of time. The number one risk factor for the development of

pleuropneumonia in horses is head elevation1-4. Due to the fact that she was not transported over a

appropriate period of time, her prolonged head elevation placed her at a high risk for complications 5. In

addition, being placed next to a stallion for this trip put her at an even greater risk for disease, secondary

to severe stress. Finally, having the stallion located to her right resulted in making every effort to move

MYLLA, LEFT SIDE AGAINST

TRAILER WALL. RIGHT SIDE

ADJACENT TO GYPSY VANNER

STALLION.

GYPSY VANNER STALLION ON

THE RIGHT SIDE OF MYLLA.

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her body to the left side of the trailer, even to the point that she sustained severe trauma as a result of

leaning to her left.

It is common knowledge among equine professionals that in tact stallions are more aggressive toward

other horses. For instance, in our hospital we have a specific location for housing of stallions to avoid

unnecessary interaction with other horses. Breeding farms specifically design stabling and paddock spaceto allow for separation of stallions from other horses for the safety of all involved. Placing an intact

stallion immediately next to a mare was an inappropriate decision, particularly for a professional equine

transport company. Subsequently, during and throughout the course of transport from California to

Missouri Mylla was in extreme stress based on the fact that she was in the trailer stall next to a stallion.

Evidence to support her effort to get away from the stallion is based on the nature and location of her

wounds that occurred during transport. Her left tuber coxae was severely damaged during the course of

transport. This trauma was a result of pressure necrosis from her pressing her left hip against the left wall

of the trailer in an attempt to get away from the stallion that was on her right side. Wounds sustained on

her right hind limb were a result of her scrambling with her hind feet and therefore abrading her right hind

limb on the lower portion of the partition that was on her right side. The stallion on her right side resulted

in her pressing her weight on her left side with constant leaning on the wall of the trailer.

Area of severe pressure necrosis o

her left tuber coxa, measures 8 cm

cm with the depth of nearly 6 cm

Currently, 74 days following gettin

on the trailer in CA, she is now nea

healed. This wound resulted from

severe pressure necrosis sustaine

while in the trailer from CA.

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Also, as previously stated, Mylla has been managed for severe unilateral, left-sided pleuropneumonia

since March 22nd. Although the most immediately apparent evidence for transport trauma was apparent

on her left hip area she also sustained trauma to her left thorax which contributed to the development of

left sided pneumonia. During the course of her evaluation at KSU we had enough concern that she may

have left-sided rib fracture(s) that we performed ultrasound of each individual rib on her left side.

Thoracic radiographs were also carefully assessed to determine if rib fractures were present. It is myprofessional opinion that the development of Myllas current condition was multifactorial in nature. It is

highly unusual for horses that develop pleuropneumonia to develop disease more severe on the left side

when compared with the right. Most commonly the disease is more severe on the right side due to the

fact that transport associated pleuropneumonia is a result of reduced clearance of particulate material from

the respiratory tract as well as aspirated material from the trailer environment (e.g. hay and dust in the

air). Anatomically the branching of the airways begins on the right side, meaning that the right side of the

thorax will receive aspirated material before the left side, this leads to the right side of the thorax being at

greater risk for aspiration associated disease when compared to the left side. Even less common is a horse

that develops transport-associated pleuropneumonia to have unilateral disease. Collectively, Myllas

disease of unilateral, left-sided pleuropneumonia was a consequence of long distance transport combined

with trauma sustained while attempting to physically move away from a dangerous situation (stallion).

Because she could not get away from the danger of the stallion but continued to make every effort to be as

far away as possible from him in a contained area she suffered severe injuries and pleuropneumonia.

Mylla continues to show evidence of improvement with an appropriate response to medical and surgical

therapies. A left-sided thoracotomy was performed on Tues. May 21st, 2013. This surgery resulted in the

removal of several pieces of necrotic lung tissue.

Left sided thoracotomy incision.

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In summary:

Mylla, a 14-year-old Arabian mare, presented to the Kansas State University VeterinaryHealth Center on March 22

nd, 2013. She was shipped to Kansas City from California on

March 11th

and arrived in Kansas City, MO on March 13th

.

Mylla was observed to be in shock and have multiple lacerations present when she wasunloaded from the transport trailer on March 13

th.

At the time of arrival in KC she was shaking uncontrollably, had severe abrasions locatedon her left tuber coxa, right hind pastern and lateral hoof wall. Mylla was managed by

Dr. Kent Jackson for her illness and wounds. By March 22nd

Mylla had not recovered

from her wounds and had developed a severe cough and was therefore transported to

KSU-VHC for evaluation and treatment.

Mylla was treated for superficial wounds in addition she was treated for severe, unilateralleft-sided pleuropneumonia.

Necrotic lung tissue removed from

left-sided thoracotomy site 5-22-13.

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On May 21stMylla underwent thoracotomy surgery to remove necrotic pulmonary tissuein an effort to resolve her ongoing pleuropneumonia.

At this time (5-23-13) Mylla remains hospitalized at KSU-VHC and will remain under our careuntil resolution of her disease process that was a direct result of complications from long distance

transport. It is anticipated that she will remain hospitalized until approximately June 17th.

Elizabeth Davis, DVM, PhD, DACVIM-Large Animal

Professor and Head, Equine Medicine and Surgery

Kansas State University

References

1. Chaffin MK, Carter GK (), Equine bacterial pleuropneumonia. Part 1. Epidemiology,

pathophysiology, and bacterial isolates, Compend Contin Educ Pract Vet1993;15: 1642-1650

2. Raidal SL, Love DN, Bailey GD (), Inflammation and increased numbers of bacteria in the lower

respiratory tract of horses within 6 to 12 hours of confinement with the head elevated,Aust.Vet J.

1995;72: 45-50

3. Racklyeft DJ, Love DN (), Bacterial infection of the lower respiratory tract in 34 horses,Aust.Vet J.

2000;78: 549-559

4. Racklyeft DJ, Raidal S, Love DN (), Towards an understanding of equine pleuropneumonia: factorsrelevant for control,Aust.Vet.J.2000;78: 334-338

5. Raidal SL (), Equine pleuropneumonia, Br.Vet J.1995;151: 233-262