Faculty and staff at the Marion duPont Scott Equine Medical Center (EMC) love to hear from clients about patients that have undergone emergency treatment and are now healthy and enjoying a normal “horsey” life.

A client recently contacted the EMC to tell us that a foal treated for neonatal maladjustment syndrome in 2022 is continuing to thrive after receiving emergency treatment at the EMC. 

In June 2022, the then 5-hour old colt foal arrived at the EMC with his dam for emergency evaluation and treatment. The foal was reported to be overdue by three weeks, and foaling had been especially challenging. 

The foal, owned by Dale Proctor from Brookeville, Maryland, and since named Whip’s Whimsy Expense Token, was having trouble nursing, and was referred to the EMC by Roger Scullin, veterinarian from Damascus Equine Associates in Montgomery County, Maryland, for emergency care. 

When Token arrived at the EMC he was standing and moving unaided but was quiet with marked tendon laxity (instability) in his hindlimbs. He displayed a poor suckle reflex and was not following his dam as he should. 

Initially Token and dam – a maiden thoroughbred mare - were received at the EMC for emergency evaluation by Krista Estell, clinical associate professor of equine medicine, assisted by resident Bruno Malacarne and the EMC emergency clinical support team. After careful review of the foal’s history and clinical signs and a thorough physical exam and diagnostics, the diagnosis of hypoxic ischemic encephalopathy (HIE) was confirmed. 

HIE, sometimes referred to as “dummy foal syndrome,” is a condition that causes abnormal behavior coupled with neurologic deficits shortly after birth. Foals may wander aimlessly, have trouble nursing due to a lack of suckle reflex, can be disoriented and suffer seizures. This is thought to be the result of oxygen deprivation during the birthing process. Prompt veterinary intervention to manage these symptoms is critical to address the underlying causes and improve the foal’s overall chances of survival and to protect neurological function. 

“Foals suffering from HIE require immediate intensive care to ensure that they have the chance of recovery and to avert dehydration, bacterial sepsis, and organ failure that can occur secondary to HIE,” explained Estell. 

In addition to HIE, Token had azotemia – an accumulation of urea and creatinine in the blood which indicates an abnormal placenta or impaired kidney function, causing retention of these waste products in his bloodstream.  
Medical management was recommended, and Token was placed in a “foal box” adjacent to his dam’s stall and started on fluid therapy, plasma, antimicrobials, as well as supportive care in the form of lactase supplementation and gastric protectants. A feeding tube was placed, and Token was started on small amounts of Mare's Match Milk Replacer. 

During the first 24 hours, the colt was able to get up and down on his own but continued to show inappropriate udder seeking. His dam was still not producing milk, adding another layer of complexity to Token’s treatment.  

Repeat bloodwork the following day showed that Token was slowly but surely improving, and the amount of milk offered was gradually increased. Special shoes, with heel extensions were placed on Token’s hind limbs to help support them. 

Two horses looking out the back of a trailer.
Gelding Jackson with Token the foal in their horse trailer. Photo courtesy of Racheal Farb.

Two days after arriving for treatment Token was moved from the foal treatment box into the adjacent stall with his dam. The foal seemed interested in his dam and latched on a few times but didn’t consistently nurse. The mare was initially tolerant of the foal but became aggressive towards him during the night and mom and baby had to be separated.

By the following morning Token was bright and alert and a hormone protocol was started to try and bond the pair, which proved unsuccessful. Over the next few days Token was taught how to drink from a bucket.  His tendon laxity steadily improved and he was bright with normal vital parameters. After six days in the hospital, he was ready to go home.

This is usually where our success stories end, but in Token’s case this was just the beginning of his story. Now orphaned and back at home Token was initially turned out with a usually tolerant pony but the pony didn’t agree with the plan and it was back to the drawing board. 

This is where a part bred Cleveland Bay named Jackson entered the scenario. Initially inspecting the colt over a stall door on his way out of the barn for a trail ride, he stopped dead in his tracks on the return journey when Token nickered out to him as he passed. 

Long story short, Jackson and Token were turned out together and bonded quickly. They shared their field with two other Cleveland Bay foals and their dams who all welcomed Jackson as their new field buddy.  Jackson, a 17.1 hand Cleveland Bay cross gelding, took on the task of supervising all three foals during their exuberant playtimes! 

At the end of the summer, the two mares and foals that shared the field with Jackson and Token and a yearling, were shipped to the last show of the summer at Warrenton, Virginia. “Uncle Jax” and Token were entered into a mare and foal in-hand class, which caused quite a stir and a lot of initial confusion in the showring.

“Uncle Jax” was not quite done with his role as Token’s chosen “Uncle”. When it came time for weaning, the mares were separated first, leaving Jackson as designated babysitter for the foals remaining in the field. 

A little time later Jackson was officially relieved of his baby-sitting duties and quietly walked out of the field to return to his previous life – his work was done! 

Written by Sharon Peart for the Virginia-Maryland College of Veterinary Medicine.