One day, Marla Gilvin heard whinnying uncharacteristic from her 5-year-old Kentucky Mountain mare Cocoa Rain. “I went out to see what she was doing and called her to the barn,” Gilvin recalls. “She didn’t move. Her 4-month-old foal was running circles around her.”

Frank Brown, DVM, of Mount Sterling Veterinary Hospital in Mount Sterling, Ky., was summoned. His physical exam found that Co-coa had an uncoordinated gait, generalized weakness, and muscle fasciculation (twitching) of her shoulder muscles and lips. Labora-tory testing confirmed his suspicion of West Nile viral encephalitis.

Brown administered intravenous (IV) butazolidin, dimethyl sulfoxide (DMSO), and a corticosteroid to keep Cocoa comfortable and to try to reduce central nervous system inflammation. He also gave her an IV electrolyte and glucose solution to support her metabolism and outlined detailed care instructions. Brown and the owner were committed to caring for three lives: Cocoa, her fetus, and the foal by her side. Brown wanted Cocoa out in her pasture where she was less likely to get cast and the ground was cushioned with grass should she go down. Her foal would also be able to move comfortably around her.

Cocoa was able to move unsteadily for a few days, then she began falling. Gilvin says, “When she fell, it wouldn’t be to her side, but she went down end over end. Her hooves cut her each time she fell.” Cocoa worsened to the point she could not rise