A Case Study of Trauma-Informed Treatment for a Foal with Severe Illness
Juno is a bright, playful, and sassy 16-month old buckskin filly. She is friendly and welcoming to those who come to Pecan Creek Ranch. She walks up to people and nudges them with her nose, lines her body up to some and prods them with her muzzle until they pet her. She playfully unzips jackets, tugs on keys, and explores new objects and situations around her with a healthy balance of curiosity and caution. She gets along well with the other members of the herd. She has figured out how to open some gates if we’re not diligent in latching them securely. When something unfamiliar and new enters her space, Juno very quickly recognizes it and moves towards it to find out more. She doesn’t spook easily, but when she does spook at something, she quickly and freely returns to it and examines it, making accurate determinations of what is safe and what is not. She regularly engages in play with her siblings, eats well, naps regularly, and appears to have a healthy attachment to her mother and to her herdmates. On the whole, Juno seems to be developing very well, something that might not have been expected given Juno’s early life experiences.
One month into life, Juno developed a severe bacterial infection that came close to killing her. Because of their newly developing immune systems, foals can easily die from something that would not have such an impact on a mature horse’s immune system. Swift action was taken and Juno spent a week and a half in a small stall with her mother in the equine hospital. After release from the hospital, her and her mother spent 6 weeks in isolation from the herd while we continued her treatments.
In the hospital, she was given IV fluids daily, IV medications, oral medications, and frequent examinations. She was poked and prodded and made to do things that were scary, uncomfortable and painful. No one was mistreating her. These were all necessary actions being taken by caring professionals who were doing their best to save her life and help her heal. But it didn’t appear Juno saw it this way.
Juno was very physically weak and unable to fight but she pinned her ears (often a sign of distress, fear, and/or aggression in horses) at the vet techs when they entered the stall. She clenched her jaw and tossed her head and resisted treatments as much as she could in her weakened state. This improved somewhat over time and the vet reported that she complied with her treatments but still pinned her ears and clenched her jaw anytime one of them walked into the stall. When Juno is overwhelmed with stress or feels threat she cannot escape, she will put up a good fight. This is quite different from her mother who tends to flee, submit and/or dissociate when she is faced with similar situations.
At Pecan Creek Ranch, we are very aware and sensitive to these expressions and behaviors in our horses. Because we are trained in Natural Lifemanship along with many other trauma-informed mental health models, we are keenly observant and watchful of the mental and emotional condition of our horses. Many of the same experiences and situations that can cause post-traumatic stress disorder, developmental trauma, and attachment disorders in humans can also alter the course of development and attachment for domesticated horses.
Here are some of the factors that had the potential to hinder the normal course of healthy development for Juno.
Overwhelming inescapable stress involved in her treatments
Compromised immunity and illness that lasted a long time
Confinement and separation from community (isolation from her herd)
Stressful continual interactions with humans that caused her inescapable pain and fear
Stress and dissociative tendencies of her mother (Athena can become depressed and despondent when stalled and away from the herd for long periods of time, making her less emotionally available for Juno.)
When Juno was released to us and we became responsible for her treatment, we were prepared to help her overcome this potentially traumatic situation and turn it into an opportunity to build resilience. We knew what we had to do to keep her from experiencing post-traumatic stress, and move her towards post-traumatic growth.
Our specialized training and experience in treating mental health and trauma has helped us become adept at recognizing the circumstances and experiences that can cause delays and roadblocks in healthy development for all mammals. It has also provided us with the tools to mitigate these factors and help others not only overcome these types of challenges, but turn them into catalysts for growth and improvement.
There was no way around causing stress for Juno. The choices were to administer treatments that were incredibly distressing to a foal or avoid distressing treatment and risk her death. The stress was inescapable. Another layer of complexity was added for Juno as we, her caretakers, were the ones who had to administer a portion of the overwhelming stress to her on a daily basis.
Her treatment at home included daily injections, several disgusting oral paste medications, and uncomfortable baths and cleanings. She also had to be quarantined and isolated from a large part of her support system to avoid infecting our other young horses.
Juno’s primary caregiver, her mother, was also enduring an overwhelming amount of stress. Having rarely been stalled and isolated from the herd, Athena experienced a tremendous amount of stress from being in quarantine with her foal. She lost weight and spent some days eating much less than a nursing mare needs, even though more than enough quality food was available to her. She didn’t appear to get good rest and she had to stand by helplessly while our treatments stressed her foal out on a regular basis.
In order to mitigate these risk factors we:
Stuck to a strict schedule of administering Juno’s most stressful medication- her daily intramuscular injection of antibiotics. The reason: overwhelming stress that is predictable is less disruptive to the nervous system than overwhelming stress that is unpredictable. We took measures to ensure we could make the most distressing experiences as predictable as possible.
Managed our own feelings and stress around the experiences. We took care to support each other both in the work we had to do and in our emotional experiences of the situation. We spend our days trying to help others heal from traumatic experiences. It was incredibly difficult to participate in something that we knew had the potential to cause Juno long-term mental and emotional problems and pain. We had to take care of ourselves and regulate our emotions so that we did not add unnecessary distress to Juno or Athena when we were in the pen with them. We needed to remain supportive and empathetic, which meant we couldn’t let our desire to avoid our own discomfort get in the way of being there for Juno. Getting the tasks done could not take priority over caring for Juno.
Asked both Athena and Juno to connect and rest with us before and after we administered treatments. We tried to share our calm with them during, before, and after the chaos. Some days this took longer than others because we would have to help Athena move through her checked-out state in order to be present and connected. Some days Juno put up such a fight that it took everything we had not to just give up or use unnecessary force to get it done. We had to structure the treatments to allow plenty of time for whatever was necessary to secure emotional and mental well-being for everyone involved.
Offered Athena regular support in ways that are meaningful and helpful to her. Athena loves touch and grooming. She often requests scratches on different parts of her body. She received regular grooming and careful, empathetic touch from us and from one of our volunteers throughout the course of quarantine. Athena also began receiving equine bodywork treatments when the quarantine was lifted. Juno was also offered grooming and touch if she wanted it. We were careful to allow her to choose it rather than force it upon her. Often, when we would groom Athena, she would, in turn, groom Juno.
We spent undemanding time with both Athena and Juno, making sure we were offering a supportive presence and experience rather than a stressful one.
When Juno kicked or bucked or expressed her feelings about what was happening, we let her express it. We did not tie her down, trap her, or lay her down on the ground until she appeared calm. While we did have to hold her still to administer her injection, we only did so for as long as we had to, then we let her go and do with her body whatever she needed to in response. We did not punish or discourage her for trying to buck or charge or kick at us. When she did these things, we simply moved and kept ourselves safe and stayed with Juno, being present with her, understanding her feelings about the situation and us, and waited for her to calm down and approach us when she felt safe. We didn’t leave her to deal with the aftermath on her own. We stayed with her and Athena until they could come back to an alert resting state. We would engage Athena in connection and support while Juno expended the energy in her body around the pen. We would often wait until Juno began to engage her normal curiosity before we would leave. This is how we knew she felt safe and whole again. Eventually, Juno figured out to nurse from Athena immediately after her injection instead of running and bucking and kicking. Athena would wait nearby, ready to accept Juno when she was done with her injection. Both would enter into a calm alert and curious state immediately after this brief nursing session, and Juno would easily accept the oral pastes without much or any resistance. Not long after she figured this out, she began engaging in play with us immediately after her treatments.
Eventually, the treatments no longer appeared to be distressing to Juno. She didn’t like them and they were stressful, but they were no longer overwhelmingly stressful. They had become something she could tolerate. During this time, she also managed to figure out that she could turn to others to help her alleviate overwhelming stress, rather than fight and or flee from others in the face of fear and pain.
It is worth noting that while the injections were the most stressful and painful part of the process for Juno, she does not seem to have any traumatic stress symptoms related to needles or injections. We recently had to give her two injections, 3 weeks apart. Both times we were easily able to do it with her at liberty (no halters, ropes, hands, pens, stalls, stocks, or other tools were used to hold her in place). She expressed curiosity about it, remained present and connected during the injection and displayed no signs of distress before, during, or after.
Here is a brief overview of the strategies that contributed to Juno’s resilience in the face of a potentially traumatic experience.
Stressors were made as consistent and predictable as possible.
Caregivers structured treatments to ensure there was plenty of time to facilitate the experience in a trauma-informed way.
Caregivers were patient, genuinely caring, and maintained unconditional positive regard for Juno and Athena.
Caregivers allowed Juno physical reactions and expression to her stress and avoided trapping and limiting her movement as much as possible. They maintained empathy and compassion for what Juno and Athena were experiencing.
After the stressful situation, caregivers remained present, connected and regulated while Juno reacted or responded to the situation. They did not leave her in a dysregulated state.
Caregivers supported Athena in her stress so she could better support Juno.
Caregivers engaged in undemanding time with both Juno and Athena outside of the treatment times.
Juno has not lost her curiosity, playfulness, or desire for touch and affection from humans. What could have caused her to be leary of humans seems to have had the opposite effect. She will reach out to humans to help meet her needs. For example, when she calls for her mother out in the pasture and Athena does not respond, Juno will approach a human nearby, nudge them and engage them until they point her towards or take her to her mother. When she was still nursing, we would feed Athena some grain and supplements in a pen separate from Juno. We would usually go about doing other chores while Athena ate. If we did not let Athena out soon enough, Juno would seek us out on the property and follow us around and interfere with what we were doing until we walked over to let Athena out. She continues to explore new things and people with little or no fear, unless or until fear is an appropriate response. She freely expresses her feelings or opinions about situations and requests and rarely submits, dissociates, or freezes when humans engage with or “handle” her. If she flees, she does so as long as she needs to feel safe and then re-engages of her own accord and curiosity. She is not easily overwhelmed or distressed and is generally eager to meet new people and try new things. Through her continued growth and resilience, Juno serves as an example of what healing, strength and post-traumatic growth can look like at Pecan Creek Ranch.