Botulism can be such a dire diagnosis that neither Dr. Erin Pearson, a large animal internist at the NC State College of Veterinary Medicine, nor Dr. Elizabeth Treece, an equine internal medicine resident, had ever treated an animal that survived it.

Until Mocha.

To the doctors’ delight, the much-loved miniature horse recently emerged from 16 days of continuous care at the NC State Veterinary Hospital and burrowed back into the arms of an ecstatic Emily Haas, who calls her mini Mocha her soulmate.

“She’s basically me in horse form,” says Haas, an intellectual property attorney. “We have the same personality traits. We have the same trauma responses. She is my girl, and they saved her life. I cannot say enough good things about her care team at NC State.”

Mocha’s prognosis had been, optimistically, 50-50.

Used to be, Haas was so afraid of horses that she asked God to help her overcome her terror.

“I don’t want to sound too woo woo, but God told me to adopt a horse, OK?” she says. “And it did not go away, and it did not go away, and
I gave in. I got Mocha, and I just fell in love.”

That love eventually grew to include three other rescues — Darcy the hinny, Joanna the mule and Erik, another miniature horse — and a farm in southern Wake County. Diagnosed in her 40s with ADHD, Haas bought the property last fall so that she and the animals could live and work together on overcoming their traumas.

“Working with Mocha has taught me a lot about myself,” Haas says. “I’ll see how she handles things, and I’m like, ‘Oh, I do that. OK. So this is something that I need to work on in my life.’ We have just been super close since the get-go.”

In late December, Haas noticed food falling from Mocha’s mouth and sent a video of the animal eating to some friends. Doesn’t look like choke, they said, but keep an eye on her.

When Haas next took the animals fresh hay, three eager faces greeted her, but the usually munchy Mocha simply lay down without eating. With alarms going off inside her head, Haas called her local veterinarian, who immediately came and checked the horse for choke, colic, dental disease and even laminitis. Much to Haas’ surprise, she then suggested that Mocha could have botulism.

Animals typically contract the bacterial infection from eating contaminated feed, but only Mocha was sick, so it wasn’t the hay. Clostridium botulinum spores, however, are endemic in soil throughout North Carolina, and they produce a toxin when environmental conditions are right. Mocha had a history of eating dirt.

“I bought her a farm,” Haas says incredulously, “and the farm tried to kill her.” 

‘The Tip of the Iceberg’

Mocha’s primary veterinarian consulted with the Equine Internal Medicine team at the NC State College of Veterinary Medicine and referred her for further evaluation. When Mocha arrived, the team realized she had numerous signs of a neurologic disease, notably being unable to blink or retract her tongue.

“When Mocha presented, she couldn’t really move her tongue at all,” says Treece, explaining that botulism binds itself to neuromuscular junctions in the body and stops the release of a critical neurotransmitter called acetylcholine. “Your muscles and nerves need acetylcholine to talk to each other. Botulism causes a flaccid paralysis because, when the toxin binds to the end of the nerve, the nerve can no longer tell your muscles to work.”

With no rapidly available diagnostic test, confirming botulism is a matter of observing clinical signs and ruling out other maladies. As Haas waited for results of the initial examination, she researched the infection on her phone and found that Mocha was ticking off all of the symptoms. Time was of the essence.

“What you see when they arrive is kind of almost the tip of the iceberg,” says Treece, who received her bachelor’s degree and DVM at NC State. “And the more you stimulate them, the worse they get. So, oftentimes, just the act of getting them to the hospital can push them over the edge.”

In Mocha’s favor was the fact that she walked into the hospital on her own.

Once an animal shows signs of botulism, only the anti-toxin can help reduce the effect of any unbound toxin. Oftentimes, as the toxin circulates, the diaphragm and chest muscles become affected, leading to respiratory failure. How quickly the signs spread and whether an animal will recover depend on how much toxin was ingested. 

“Unfortunately, horses are exquisitely sensitive to botulism,” Treece says. “If you have a dysphagic animal and you’re considering botulism, provide anti-toxin as fast as possible, because once it’s bound, it’s bound. You can’t do anything about it.”

Mocha had gotten out of Haas’ under-construction pasture and visited a neighbor’s yard the day before, so Haas will never know definitively where the horse contracted botulism, but she is quick to say how she survived it: NC State.

As soon as the equine team examined Mocha, they gave her a dose of hyper-immune plasma to provide the anti-toxin and placed an IV. An animal with botulism can become dangerously dehydrated after losing the ability to eat or drink.

“Especially horses of her size can have problems with negative energy balance, because they mobilize their fat to try and give them energy,” says Pearson, who has been an internist at NC State since 2024. “It’s called hyper-triglyceridemia, and things can go south pretty quickly. Mocha was definitely dehydrated and imbalanced. Her veterinarian did a great job getting her here.” 

Once Haas approved a personalized treatment plan for Mocha, everyone settled in for an unpredictable ride, with the doctors on guard for potential complications. Mocha eventually required an indwelling feeding tube. Every day, Haas visited her mini horse in her hospital stall, brushing her and reading and singing to her.

“You’re just playing a time game,” Treece says. “You have to wait for them to form new connections between their nerves and muscles. Unlike small animals, horses can’t really be put on ventilators for long periods of time. They’re not meant to be lying down for that long, and their muscles and nerves can’t tolerate it.”

Because horses that can’t blink often end up with eye complications, the team ordered a consult with ophthalmology, and an emerging corneal ulcer was quickly dispatched. Frequent checks for pneumonia, a common complication in recumbent large animals, led to catching an infection before it became serious.    

 “If we were anywhere else, we wouldn’t have caught it in time,” says Haas, who praised the doctors for calling and giving her updates twice a day. “NC State knew what could happen, and they were waiting for it so, at the first sign of any of those things, they could swoop in and save her. When she made it 72 hours, I started to breathe a little bit.” 

A Little More Time

After a week of intensive care, the team tried to feed hay to Mocha to see whether she could eat. 

“She was able to swallow, but she wasn’t able to move the food from the front of her mouth to the back,” Pearson says. “To be able to eat, their lips have to work, their tongue has to be able to move the food to the back then they have to swallow. She just needed a little more time.”

On the 16th day, a Wednesday, Mocha was eating and ready to head home to the farm. Two days later, Haas stood at her kitchen window watching Mocha bask in the morning sun as Darcy guarded the herd’s newly returned leader.

“I don’t have words to explain how thankful I am,” Haas says. “The English language does not have those words. I did not know it was possible to love something the way I love that little horse.” 

Haas plans to share the healing she has found in her animals with others. Erik, the size of a large dog, is in training to become a reading therapy horse. Darcy and Joanna are destined to train as pack animals for use during natural disasters, thanks to Haas’ memories of Hurricane Helene devastating Western North Carolina.

But Mocha? 

“I was finally medicated for ADHD in my 40s, and it was like, ‘Oh, wait, this is how other people have felt all the time?’ Oh, my God,” Haas says. “And, whenever I got Mocha, I was like, ‘Oh, this is what other people talk about in terms of love.’ Because when it comes to her, yeah, I would step in front of a car for her. I never understood.”

Until Mocha.