One year later, Peanut is back to being a goat again

Anne Bush knew what she was getting into. Mostly.

Bush runs a small farm animal rescue outside of Richmond, leaving a 25-year career as a pediatric nurse to care for animals full-time. Last spring, when someone asked her to take in a 4-week-old La Mancha goat born with a cleft palate, she said yes. 

"I knew he was at risk for aspiration pneumonia and failure to thrive," she said. He seemed to be doing well for several weeks, Bush said, and was under the regular care of a local veterinarian.

By May, she was making calls. She reached out to several veterinary hospitals looking for someone willing to take a look. The Veterinary Teaching Hospital at Virginia Tech called her back the same day. 

A treatment plan

Elaine Claffey, assistant clinical professor of large animal surgery for the Virginia-Maryland College of Veterinary Medicine, was direct with Bush from the start — honest about the risks, clear about the uncertainty, but ready to try. 

"I felt really good about that first conversation," Bush said. "She was very realistic about the challenges, but she was also really willing to take a look at him and see if she could help."

What Claffey found when Peanut arrived in June was more serious than anyone had expected. The cleft was complete — running from just behind his front teeth all the way through his soft palate. His X-rays showed aspiration pneumonia already setting in. He was not a surgical candidate. Not yet. 

"The palate forms a crucial division between the nose and the mouth," Claffey said. "When that doesn't fuse, any food or saliva contaminates their airway — and they aspirate all that and get very sick."

The first procedure was to place a feeding tube directly into Peanut's esophagus so he could receive nutrition without anything passing through his broken palate. The goal was to give his lungs a chance to heal. 

Preparing for surgery

Katie Wilson, clinical associate professor of internal medicine, managed Peanut's care alongside Claffey through months of medical treatment, setbacks, and hard conversations with Bush. 

"This case could not have been successful without all of the parts," Wilson said. "The aspiration pneumonia and the nutritional aspects required an internal medicine specialty. Surgery needed specialized surgeons. And we relied on our food animal colleagues to help us with nutritional questions."

The team ground up hay fine enough to push through the narrow feeding tube, working to develop Peanut's rumen — the fermentation chamber that allows ruminants to digest forage — before he could eat on his own. Veterinary students on rotation helped with daily care, tube feedings, and the vigilant supervision a young goat with nothing to chew on requires. 

"He took a lot of nursing care," Wilson said. "The esophagostomy tube technique we used isn't something we do in large animals very often. Our anesthesia team actually showed us how because they place them in dogs and cats all the time. The students saw things that were applicable to what they'll do in practice, even in a case this specialized."

Even so, weeks of treatment weren't closing the gap. Because the cleft was still there, Peanut kept aspirating — even with the feeding tube in place — and his lungs couldn't fully recover. Waiting longer wasn't going to change that.  

At a follow-up visit, the team delivered difficult news: His pneumonia wasn't improving enough on its own. The only way to stop the cycle was to repair the cleft itself, even with lungs that weren't ideal.

"Dr. Claffey told me that surgery was really his only option," Bush said. "And I felt very strongly that if we were going to put him through this, we had to do everything in our power to get him through." 

A technically demanding operation

Cleft palate repair is among the most technically demanding procedures in large animal surgery.  

Goats don't open their mouths as wide as dogs, making the back of the mouth difficult to reach. The hard palate repair involves freeing the tissue on either side of the roof of the mouth and rotating it to form the bottom of the nasal passages — sutured in multiple layers in an animal that will immediately go back to chewing its cud. 

It's also a procedure that frequently requires more than one attempt. Partial dehiscence, where part of the repair fails to hold, is common. 

"I love surgeries that aren't perfected yet," Claffey said. "There's a constant evolution happening — because it has to. We're getting better at these, and every case you think, what didn't work as well last time? Can I change it for the next one? That's the most rewarding part of veterinary medicine to me."

Peanut needed two surgeries. The first went well, but a small area near the front of his palate dehisced after surgery  — the hardest area to close.  

For the revision, Claffey used connective tissue from his leg, a technique she adapted from small animal literature. In a previous case, she had used ear cartilage for the same purpose. Peanut is a La Mancha goat, a breed with almost no external ears.

"Every case is really different," she said. "You just figure out what you have to work with."

Bush spent the summer driving eight hours round-trip, often weekly, managing tube feedings at home between hospitalizations. From June to November, Peanut was in the hospital for roughly six weeks total — in stretches, then home, then back again.

"I was talking to his doctors at Virginia Tech sometimes almost every day," Bush said. "It was hard being four hours from the hospital. But we got through it." 

What a teaching hospital makes possible

Cases like Peanut's don't often happen in general practice. They require a surgeon with residency-level training in a procedure most vets are unlikely to attempt, an internal medicine team, a food animal nutrition service, and an anesthesia team capable of keeping a compromised young patient under for a multi-hour surgery. 

"We can only get to that surgical procedure because we have internal medicine and surgery and anesthesia there together," Claffey said. "Our team is what allows us to do these surgeries. And the owner is what allows us to advance in our technical skills and our ability to teach. Every student who sees it may get inspired. They may want to do that kind of procedure someday."

For Bush, the experience changed how she thinks about what these animals are owed. 

"Best case scenario, we saved Peanut," she said. "Worst case, we learned something that could help another animal down the road. I knew they were pulling every resource together — looking for journal articles, consulting with other doctors, everybody contributing. It was a lot of people that made this work."

Peanut was cleared at his November follow-up. He still occasionally pushes bits of food out his nose when he chews — a small remnant of the original defect — and he overheats easily, so Bush bought him a cooling vest for the summer. He gets a gated-off area in the barn so he doesn't have to compete with the herd for food. 

He runs out to the fence when he sees Bush coming. He eats animal crackers. He's not entirely sure he's a goat.

"He's just a happy little guy," Bush said. "We managed to reconstruct a palate, his lungs healed, and he's not aspirating. He'll always need a little extra support. But we just let Peanut be Peanut."