Yoga ball guides a warmblood foal's first steps

Back in June, Alix Morrison from Purcellville was eagerly awaiting the arrival of a very special foal and had made plans for her nurse mare surrogate Critter to foal out at a specialized facility, where the birth could be carefully monitored.

Critter was showing no typical signs of imminent foaling, so Morrison wasn’t prepared for what she found two weeks ahead of the expected foaling date: Her newborn foal, soon to be named Squirt (after the turtle in “Finding Nemo”) had arrived overnight, frail, and unable to nurse.

Emily Schaefer, clinical assistant professor of equine emergency and critical care and her team were ready and waiting at the Marion duPont Scott Equine Medical Center when Critter and Squirt arrived for emergency evaluation and treatment.

Schaefer's evaluation revealed a cascade of problems: prematurity, neonatal maladjustment syndrome, sometimes called "dummy foal" syndrome, or failure of passive transfer (FPT), and incomplete ossification of the cuboidal bones in Squirt's hocks and knees.

The bone issue posed the greatest long-term threat. In a premature foal, the cuboidal bones haven't fully calcified. If the foal stands and bears weight too soon, those soft bones can crush, leading to arthritis and fused joints that would compromise comfort and any future athletic career.

Squirt would need to stay down, for days, possibly weeks, until her bones developed enough to support her.

Despite this sobering evaluation and the expected ‘roller-coaster ride’ in the following days to months, Morrison was committed to continuing Squirt’s treatment journey.

“Squirt is a foal out of my very special mare Emma Snow and is the result of five rounds of intracytoplasmic sperm injection (ICSI), which resulted in a beautiful 7-day embryo that grew into our beloved Squirt,” said Morrison. With ICSI, the egg is fertilized and developed under controlled laboratory conditions, and the resulting embryo is later transferred to a nurse mare surrogate.

The first days brought one crisis after another. Squirt arrived with life-threatening low blood sugar and severe dehydration. Without colostrum from her dam, she had no passive immunity. After testing her immunoglobulin IgG levels, they were found to be dangerously low, requiring several plasma transfusions. A blood infection from her compromised immune system compounded the danger.

To prevent the crushing of the cuboidal bones, Squirt would not be allowed to bear until a certain grade of bone ossification was reached, which can take days to weeks.

Squirt would need 24-hour intensive care to deal with the musculoskeletal and multi-factorial problems she was experiencing.

The Equine Medical Center, as an emergency equine hospital, is staffed 365 days a year, 24 hours a day, and is supported during the foaling season by a team of dedicated volunteers. Volunteers help the Center’s staff by keeping a close eye on compromised foals.

They help to lift and turn recumbent foals every two hours, protecting foals from pressure sores, umbilical infections, and their precious lungs from developing pneumonia. Their willingness to assist with everything from monitoring expectant mares to helping with newborn foals allows our clinical team to focus on delivering the highest level of care.

"I am in awe of the dedication of our volunteers and patient care staff. Because of their dedication, we were able to keep little Squirt safely restrained on a mattress for 10 full days without any of the complications expected from prolonged recumbency like internal infection, bed sores, urine scalding, etc. said Megan Marchitello, clinical instructor of equine medicine.

In addition to this two-hour regime, Squirt needed physiotherapy to ensure that she would know what to do with her gangly legs when it was time for her to stand.

Once the filly’s condition was stabilized over two days, Schaefer purchased yoga balls that would prove to be necessary. When Squirt was ready for controlled exercise, she was placed on top of the yoga ball every six hours and rocked back and forth, providing her with the opportunity to become accustomed to using her legs and developing a little muscle tone in preparation for standing unaided. This gave her the chance to strengthen her muscles and bones and provided enrichment without risking the health of her forming bones.

“It was an exciting mission to go buy the yoga balls because it meant that Squirt had overcome the threats of her first few days as a premature foal and we could start looking at the longer-term future,” Schaefer said. “Alix was very committed to the best possible outcome for her filly, and it was an honor to have been a part of the team that got her there.”

After the initial couple of days of intensive care, Squirt came under the supervision of Marchitello, who kept Morrison apprised of Squirt’s progress via daily texts and phone calls. Marchitello and her clinical team introduced Squirt to bucket feeding, which after an initial objection she took to well.

Nutrition is an important factor when a foal is encouraged to remain recumbent. Providing nutrition through an IV is not the healthiest option, and after being taught to drink from a bucket, Squirt had lost the instinct to nurse.

Compounding this problem, Critter, her surrogate mare, rejected her. This was resolved with a hormonal bonding protocol, which recreates the hormonal surges of giving birth and encourages natural maternal instincts to kick in!

Ten days after her arrival, repeat radiographs confirmed that Squirt’s bones had improved to a grade 2 ossification. After group consultation between the medicine and surgery team, it was decided that casting her legs would keep her legs straight, preventing uneven weightbearing that could result in crushing of her developing bones. The casts enabled her to stand unaided. As the days passed, Squirt continued to strengthen and enjoyed spending more and more time on her feet.

When Squirt was considered neurologically normal, and her bones had improved to a grade 3 ossification, the splints were removed, and she was allowed to return home under strict stall rest for an additional two weeks.

“Everyone that saw Squirt during those 20 days, all of the vets, techs, and staff were so collaborative with me, my vets at Piedmont Equine Practice, and the several other vets at big hospitals who also consulting on the case,” said Morrison.

Squirt’s remarkable progress is the result of expert clinical care, round-the-clock support, and a community united in giving her the strongest start possible.

From yoga-ball balance sessions to the tireless work of volunteers and clinicians, every step brought her closer to the healthy, energetic filly she is today.

Now back home and thriving, Squirt’s story stands as a powerful reminder of the lifesaving impact of specialized neonatal care and the extraordinary resilience of foals.

“Every year it is beautiful to see how foaling season brings out the most generous and compassionate side of the equine community,” Marchitello said. “I can't wait to see Squirt win at Upperville!