A tetanus survival story

By Amanda Stout

Over the past 11 years I have learned a lot from taking care of my dairy goats.
Probably the most interesting experience ever was when two of my goat kids
contracted tetanus. This usually fatal disease in goats can be prevented by a simple
yearly vaccination shot. I wish I had known that then. One of my goat kids died.
However, I was lucky. In cooperation with my vet, and with a lot of tender loving
care, the other kid, Ebony, survived. I believe her story is truly exceptional and I
hope that other goat owners will find it inspiring and valuable. I also hope everyone
takes the time to properly vaccinate their kids this year!

Part One: The Story

On September 19, 2002, one of my three-week-old goat kids, Thor, got tetanus and
died the next day. This happened even though we had given him an antitoxin shot
as soon as we suspected he had gotten sick. We wondered how he might have
caught the disease.

Tetanus is a disease that affects the muscles, causing violent contractions and
making it hard for the animal to control its muscles. It almost always causes death. It
is spread by a bacterium that thrives in the dirt and doesn't need oxygen. It can
survive up to one hundred years in the form of a spore. We still don't know where
our tetanus came from, but it's likely that the tetanus bacterium was in our barn.
Because my goats hadn't had a preventative shot/vaccination, or a yearly booster,
they were susceptible to the disease. Therefore, the only thing necessary to make it
possible for my goats to get tetanus was a wound for the bacterium to enter through.
We had removed the horn buds on our goats when they were one week old, and the
wounds left from this are most likely what allowed the disease to enter.

Once an animal has tetanus, veterinarians usually give an antitoxin shot to

counteract the poisons spread by the disease. However, this is done without much
hope of the animal recovering. Thor, the first of my kids to get tetanus, was given the
shot, but died soon afterwards. Because I didn't know the source of the tetanus, I
thought it was an isolated case. Little did I know, I would soon have a second
chance to fight tetanus.

On the 24th of September, Ebony, Thor's sister, also got tetanus. That morning we
observed that she would occasionally fall down and lie rigid; unable to move, but
later would be back to normal. Although not advanced in her illness, as Thor was
when we found him, we saw that this was similar to what Thor had been through and
called the vet. By noon, Ebony had had her antitoxin shot. By that evening, I had
given all my goats preventative booster shots!! I also began injecting IV fluids into
Ebony's system using a syringe in order to keep her hydrated, all according to the
vet's instructions. So far, she was still rigid, because the shot takes several hours to
take effect, if it works at all.

Two days later, Ebony was still alive and not as stiff, but couldn't move at all on her
own. She had not had anything to eat since getting sick, so I tried feeding her a
bottle of milk. She was able to open her mouth and drink at this time, and drank
about 1/3 of a cup of milk.

Later that week, we gave Ebony another dose of antitoxin and penicillin, and did this
again one week later in an effort to get the disease out of her system. Each time she
improved some, and was even able to move her head and then support some weight
on her back legs when we held her upright. She had survived tetanus, but if she
couldn't move on her own, she would be an invalid for the rest of her life. So,
inspired by the physical therapy my dad had when he broke his shoulder, I began
moving Ebony's legs all around to try to increase movement. I developed a physical
therapy routine for goats, watching normal goats move to see how I should move
Ebony. My routine evolved to movement sessions, three times a day, two to three
minutes for each of four legs.

During the month of October, Ebony continued to make progress. I kept doing her
physical therapy three times a day. By the end of the month, she could support
herself on her back legs, which were still rather stiff. She could also get up on her
front knees and then scoot around on her own! Also, her left rear leg could bend in a
normal way, but the right leg couldn't bend properly at the hip joint, and something
seemed wrong with her thigh muscle.

During November, Ebony kept walking on her front knees because her "wrist" joints
were too weak and would collapse if she tried using them. However her rear legs
continued to support more and more weight. The right one still could not bend
normally.

On December 2nd, we took Ebony to the vet, and he examined her for the second
time since she had gotten sick. He hadn't had any patients survive tetanus before,
and seemed to be following Ebony's recovery with interest. I wanted him to see her,
since she hadn't really been improving in walking for a while. He said the right rear
leg would probably never move normally, as the nerves could have been damaged
from the tetanus. However, he told us how we could make splints to strengthen her
front legs.

Ebony wore these on both front legs for a week. Right away, she was able to walk in
a normal position with the splints on, although she was clumsy. When I took the
splints off after a week, I discovered the right leg was still not strong enough to
support weight without the splint, but the left one was just fine. This could mean that
her whole right side was somewhat damaged, since her rear leg had trouble, too.
However, after another week with a splint on her right front leg, the joints were
strong enough and Ebony could walk on her own!

About this time another breakthrough happened for Ebony—she was weaned. All
this time I had been feeding her with a bottle, and at four months old, she was finally
on solid food. Although Ebony and I were both excited about her progress, it was still
sad to see how far behind she had fallen. Goats are usually weaned at two months
of age, and Ebony was four. She was smaller than she should have been, too. It
seemed that she was not gaining weight for a while, but she has since caught up on
her weight and muscle tone.

During the next six months, Ebony practiced her walking all the time, and even
began to run, jump and climb some, as all goats love to do. She was well on her way
to becoming a normal and fully functional goat.
It took four long months of working with Ebony to help her reach "normal" movement
again. There were plenty of times I didn't know if my methods were doing any good.
We were almost completely on our own, since few animals have survived tetanus.
We were lucky Ebony survived at all, much less that she learned to walk again. I
think our "good luck" was a combination of: 1. Discovering she was sick in time to
give her the antitoxin, 2. The good advice we received from our veterinarian, 3. The
physical therapy I used, and, 4. A strong will to survive on Ebony's part. All four
things were essential to her survival and recovery.

Although Ebony should have been immunized to prevent tetanus before her
disbudding, I can now look back on this experience as an adventure in which I
learned a great deal.

Author's note: After Ebony's recovery, I decided to do more research on tetanus

and how physical therapy could help tetanus patients recover. The following is a
more technical and detailed report on my research.

Part Two: The Details

This report explains the source of tetanus, how it enters the body and spreads
throughout the body, and gives details about symptoms, treatment, and prevention
of tetanus. Furthermore, physical therapy and how it was used in treatment of
Ebony's case will be explored.

Tetanus is caused by the bacteria Clostridium tetani. Clostridium, a genus of

bacteria, includes such bacterium as botulism (Clostridium botulinum) and gas
gangrene (Clostridium perfringens), as well as tetanus. All bacteria in this genus are
anaerobic (able to live without oxygen) and can form spores.

Clostridium tetani spores were most likely present in abundance in Ebony's

environment long before she was born. These spores lie dormant in the soil
worldwide. Tetanus also naturally resides in the intestines of many mammals, most
predominantly in horses. Normally, these cause no harm, but horses may add
tetanus spores to the habitat through the feces. No one is sure how long tetanus
spores remain potent, but it is probably for several decades. Our barn, which is a
dirty environment, and once housed horses in the very stalls my goats now live in,
probably provided an excellent habitat for tetanus spores.

If the spores of Clostridium tetani enter a wound, their spores open, provided the
conditions are ideal. These bacteria cannot grow in normal tissue, as the blood's
circulation provides too much oxygen for anaerobic bacteria. Deep puncture wounds
provide the best opportunity for growth when dirt or other foreign objects enter the
wound and kill a small area of tissue. Dead tissue is not oxygen-rich, which provides
the correct environment, and the wound provides an entrance for the bacteria. My
goat kids' wounds from their disbudding had quite a bit of dead tissue, as their horn
buds had been burned off. This is likely where the infection began.

Once the spores open within a puncture wound, the incubation period of tetanus
begins and lasts about one to two weeks. During this time, the tetanus bacteria are
multiplying within the area of dead tissue. The incubation period ends when
Clostridium tetani has filled the area of dead tissue. At this point, the bacteria
release their toxin, tetanospasmin. 
There are three theories as to how the toxin is spread.1 The toxin is most likely
absorbed by motor nerves near the site of the infection, and is carried throughout the
body by the central nervous system. The toxin may also access the nervous system
through the lymph glands or the blood stream. Which of these is correct is yet to be
determined. The toxin then stimulates nerves throughout the body in such a way that
the muscles are ordered to contract and are not allowed to relax. Often, contractions
take place first at the site of the wound, where the toxin is first released, and later
take effect on the rest of the body.

The effect the tetanospasmin toxin has on the body may be compared to a reflex.
This sensation of having one's muscles stimulated and controlled by an outside
source, without one's brain having any say in the matter, is exactly the predicament
tetanus patients are in. However, this sensation lasts for an extended period of time,
and with more pain and complications.

Within the first 24 hours after the toxin's release, the entire body is affected. The
spasms become more violent, and loud noises or other stimulus may excite the
animal, causing more spasms. Eventually, respiration and circulation are constricted;
dehydration and hunger take their toll, and general exhaustion results. The mortality
rate of tetanus averages around 90%.2

The best way to defeat tetanus is to prevent it. The tetanus toxoid injection,
developed in the early 20th century, is nearly 100% effective in preventing tetanus.
This passive, or preventative, injection is used widely on both domesticated animals
and humans. It must be renewed yearly for animals and every 10 years on humans.
Everyone should keep their tetanus shots up to date to protect themselves from the
bacteria surrounding them. All my goats now receive this shot annually.

The antitoxin injection, an active immunization, is the only treatment available when
someone actually develops tetanus. It is also used as a precautionary treatment
when a puncture wound is treated. Unfortunately, the antitoxin is only effective if the
nerve tissue has not yet absorbed the toxin. Therefore, in treatment of tetanus once
symptoms appear, time is of the essence.

Ebony and Thor (another of my goats, who died from tetanus) were both given this
injection when they developed tetanus. Unfortunately, Thor was too far advanced for
the antitoxin to work. Because we recognized Ebony's symptoms early on, we were
able to give her the antitoxin injection at an earlier stage, and the toxin was
neutralized before it's fatal effects fully took hold. Once we knew she was
recovering, the vet supplemented the antitoxin with penicillin to kill the clostridium
tetani.

When it was clear Ebony had defeated the tetanospasmin toxin and the tetanus
bacteria, her recovery was beyond the point most veterinary medicine or medical
books describe. Now, both the vet and I were in uncharted territory as to how to help
Ebony regain her movement and muscle tone. When I began using physical therapy,
I was following no protocol or research, but simply trying to help her use her muscles
and move them in the ways they normally function. Only after the fact, when I began
doing more research, did I begin to understand how my treatment worked.

During a paralyzing illness, such as tetanus or a stroke, muscle capacity is lost

dramatically. Physical therapy helps patients regain this by repetitive movement and
exercise.

I began Ebony's physical therapy within a week after she developed tetanus.
Patients first need assistance in movement before they can move on their own, so
Ebony and I changed our methods as she recovered. While I remembered some
basic principles of physical therapy from my family's experience, I was really
conducting an experiment throughout Ebony's recovery, and didn't know what to
expect for results. However, looking back, I can now see that Ebony and I were
moving our routine through the following stages: passive movements (I was moving
her limbs for her) to active assisted exercise (using various methods to help her
move normally on her own) to active exercise (normal control) to resistance exercise
(strength building).3

Passive exercise: For a period of about four weeks, from September 30 to October
30, Ebony's therapy was mainly passive exercise. To help her become ambulatory, I
focused on leg exercises. Laying her on her side, I worked all four of her legs in the
following ways:

Front limbs:

Rotate each shoulder 8-10 times, clockwise and counter-clockwise

Flexion and extension of cubital joints, ("front knees") 5-10 times

Flexion and extension of carpal joints, 5-10 times

Flexion and extension of the shoulder, cubital, and carpal joints in combination.

Rear limbs:

Rotate each hip 8-10 times, clockwise and counter-clockwise

Flexion and extension of hock joints, 5-10 times

Flexion and extension of tarsal joints, 5-10 times

Eventually, I was also able to flex and extend the hip, stifle and hock joints in
combination.

Active Assisted exercise:

Once Ebony's joints could move freely with my help, (with the exception of her right
rear leg) we began to use methods classified as active assisted exercise to help her
walk on her own. The period of Ebony's recovery involving Active Assisted exercise
ranged from around November 1 through December 20, when she was able to walk
on her own. In retrospect, I spent longer than was necessary in transferring Ebony to
and from this stage. This was because I was trying to devise methods to assist her
as we went along, and was not always sure what the next step would be.
Throughout this period, I often doubted whether Ebony would really ever walk
again. 
However, Ebony was making slow progress towards her recovery. Her will to work
on improving her control encouraged me to find methods of assisting her. She even
devised some of her own exercise routines! Here are some forms of active assisted
exercise we used:

 I held Ebony upright for several minutes each day, and let her put as much
weight on her limbs as possible.
 Ebony learned to support herself with her cubital joint before her carpal joint
was strong, and used the wall to brace herself for practice.
 Eventually, I used the vet's suggestion of PVC pipe splints, which finally
strengthened her front legs enough to walk.
 Another good idea for someone using active assisted exercise would be to
hoist the tetanus patient off the ground using a sling. This would allow the
patient to remain upright for extended periods of time, and make better use
of his or her limbs, and gain balance control.

Active exercise

Since January 1, 2003, Ebony has had nearly normal control of her body's muscles,
except for the right rear leg. She has had normal amounts of exercise, giving her a
chance to use her walking skills. 

Resistance exercise

As soon as Ebony mastered walking at a fairly normal level, she began building her
strength even beyond walking. She has managed to climb up on things up to 12
inches above the ground. She attempts to force gates open using her head. When
trying to handle her, we are often met with resistance if she does not want to
cooperate, and are surprised by how powerful she is. I hope to aid her in building her
strength by providing her with more obstacles to climb, or building her endurance by
walking farther distances.

In summary, tetanus is a dangerous and constant threat that should be prevented by

immunization. However, there are possible treatments for tetanus, and, in my
experience, aids for physical recovery. Ebony's recuperation is living proof that
tetanus can be defeated. 

Ebony survived and thrived for three years after the disease. Since the lasting
damage from the tetanus centered in her rear leg and pelvis, we never attempted to
breed her. I still wonder whether she would have been able to reproduce and be
milked, but sadly, she died in March 2005, due to an accident unrelated to her
illness. I'm very grateful for the things I learned from Ebony while she was alive. I
hope to carry on in researching other animal diseases and eventually become a
large animal veterinarian. Ebony's ordeal played a major role in helping me choose
this career.
Source: http://www.dairygoatjournal.com/issues/84/84-1/Amanda_Stout.html