The critical-care team that responded to the emergency knew and loved the five-month-old patient arriving at New Bolton Center on a rainy Saturday night.
The gray gelding, lame with a severely swollen right-hind leg, was Boone, the colt born as the world watched on the New Bolton Center Foal Cam. His mother, New Bolton Center mare, My Special Girl. His owner, New Bolton Center veterinarian, Dr. Rose Nolen-Walston, who rushed them in from her nearby farm.
“Within minutes of arrival, he had four vets evaluating him with some of the best training in surgery, imaging, and internal medicine,” said Dr. Nolen-Walston, Assistant Professor of Internal Medicine. “It was odd being on the other side of things, as a client not a clinician, but I got to see first-hand how empathetic and reassuring my colleagues are in an emergency,” she continued. “I felt really lucky to have a resource like New Bolton so close."
Star of New Bolton Center’s Foal Cam
Boone’s birth – at 9:22 pm on March 29, 2014 – was broadcast live via a Foal Cam, the first in Penn Vet history. More than 170,000 people in 120 countries tuned in to the live feed from My Special Girl’s stall in the Neonatal Intensive Care Unit the month before the birth. Thousands more watched the birth live. And they continue to view the birth video on Penn Vet’s website: www.vet.upenn.edu/foalcam.
Boone, in particular, is a very special foal because he represents the first successful pregnancy by Penn Vet using the advanced reproductive technique used in human medicine – intracytoplasmic sperm injection, known as ICSI – which involves injecting a single sperm into a mature egg. This ICSI embryo was transferred to My Special Girl in early April 2013.
Boone and My Special Girl spent a month in the NICU after the birth, and then moved to the Hofmann Center for Reproduction. He was adopted by Dr. Nolen-Walston, in partnership with longtime trainer Lisa Fergusson. The mare and foal moved to Nolen-Walston’s farm on July 24. A month later, on August 23, Nolen-Walston found Boone lame.
"It was a Saturday afternoon," Dr. Nolen-Walston said. "A quick examination showed that it was clearly something serious that needed specialist care. I didn't hesitate in putting him and My Special Girl on the trailer and getting them right to New Bolton Center.”
Boone Needs New Bolton Center’s Care
The clinicians on duty to handle Boone’s case the night he came in – including Dr. Megan Burke, a Resident in Surgery, and Dr. Michelle Abraham, a Resident in Emergency and Critical Care – took radiographs and performed ultrasounds, as well as blood and fluid tests.
The bone was not fractured, the ultrasound did not show any soft-tissue injury, and there were no wounds or lacerations. However, blood and fluid tests indicated an infection, although at that time it was unclear exactly where.
Boone was given antibiotics and anti-inflammatory medication, and he and My Special Girl went back to Dr. Nolen-Walston’s farm for evaluation over the weekend.
A few days later, Dr. Nolen-Walston said he was no worse, but he was no better. “We needed to go through more testing to pinpoint the problem and decide on a course of treatment,” she said.
Boone and My Special Girl returned to New Bolton Center on Tuesday, August 26. Dr. Virginia Reef, Chief of New Bolton Center’s Section of Sports Medicine and Imaging, performed an ultrasound examination of his fetlock, but did not see a problem with his tendons or ligaments.
The next morning, Dr. David Levine, Staff Surgeon, assisted by Dr. Burke, performed minimally invasive arthroscopic surgery using a video camera inserted into the joint to examine the cartilage and surrounding structures and to flush out the infected fluid.
After surgery, Boone received the first of 10 daily regional limb perfusions, in which high levels of antibiotics were delivered directly to the blood supply of the affected leg.
That afternoon, he had an additional full series of radiographs. As the clinicians looked at the films, they clearly were very concerned.
"This is serious,” said Dr. Levine, examining the images of Boone’s complex fetlock joint. Visible was a dark grey circular area in the white image, indicating an infected abscess inside the bone.
The diagnostic tests confirmed an infection in the lateral sesamoid bone, a small but vital structure in the fetlock joint. The clinical team believes bacteria originally entered Boone’s body through his bloodstream and settled in the fetlock joint. Although New Bolton Center sees many patients with this type of infection, it is considered unusual.
The team decided to continue the aggressive regional antibiotic treatment throughout the Labor Day holiday weekend. Blood tests the following week confirmed that the infection was subsiding.
Boone was obviously improving, walking more easily without pain medications. He even bucked a bit on his way to radiology, and kicked the radiographic plate square in the middle, sending it flying.
“Well he’s feeling a lot better,” said Dr. Burke, who was holding the plate.
The veterinarians decided to continue the course of regional and oral antibiotics once he was discharged and transported to trainer Fergusson’s barn in Cochranville, where he had a month of stall rest and continued treatment.
Back Home, Boone Shows Steady Improvement
Returning to New Bolton Center for an exam a month after his diagnosis, Boone showed signs of improvement. Radiographs showed that the fetlock bone was healing well. Boone also had his front hooves trimmed by New Bolton Chief of Farrier Services, Patrick Reilly. Dr. Nolen-Walston measured Boone at nearly 13.2 hands, or 54 inches, at his withers.
The steady improvement allowed Boone to return to Dr. Nolen-Walston’s farm, where he enjoys many visits from her 10-year-old daughter, Alice. During his month at Fergusson’s farm, Boone was weaned from My Special Girl, who returned to her job as a teaching mare at New Bolton Center.
“Boone is doing wonderfully! He has one of the best temperaments I’ve ever seen in a foal his age,” Dr. Nolen-Walston said in an interview at the end of October. “He is living in a small field with his friend Phunny, a famous racing Shetland pony, who is half his size, and Brendan, a gentle retired foxhunter. The three of them spend their days grazing and socializing with the other horses over the fence.”
“His leg looks terrific and he is perfectly sound on it,” she continued. “I'm feeling very optimistic.”
Bone infections are serious, and can take a long time to heal. Bone does regenerate, so the abscess created by the infection may fill in over time, Dr. Burke said.
“We don’t really know what is going to happen with the bone. We are pleased the infection responded to the antibiotics," she said. “He is still growing, and so he has more regenerative capacity than an adult.”
We won’t know for years whether this infection will impact Boone's performance, she said. “If he stays comfortable and sound,” Dr. Burke said, “we will be happy."
Check out our blog about Boone’s life, and My Special Girl’s pregnancy at www.vet.upenn.edu/boonesblog
To view more photos, visit Boone’s albums on Penn Vet’s Flickr page:
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