Thursday, August 23, 2018

Well F**k

Alternate Names for This Post:

Feels like Groundhog Day: 7 more weeks of walking!
Reasons to buy a horse with straight legs.
GO TO A CAPABLE VET FOR YOUR PREPURCHASE FOLKS.

He likes it at VEI, he just watches out the window and in general is very relaxed!

I'm going to bet you've gathered Penn's recheck didn't go so well. It's really not all gloom and doom, but this is something I could have avoided by not buying Penn. True story folks.

Oh yea, this also happened on our drive down. A dime sized chip in my truck's windshield.

Let's rewind a bit, last we left off, I had gotten bored out of my mind and trotted Penn briefly because he felt mostly sound at the walk and I wanted to see how the trot went. I knew walking into this appointment that he was still lame. Doing better, but lame. I expected 4-6 weeks of additional walking.

First thing they did was take his temp (they're now monitoring all horses, taking their temp before they set foot in the barn), and do a general body evaluation. She noted that he kept his muscular conditioning beautifully, and I mentioned that I'd been making the most of our tack walking by really encouraging self carriage and lightness of the forehand ("It can only help take weight off the front end right?"). I was worried that actually working him at the walk would be bad, but she approved wholeheartedly about it and didn't tell me to stop what I was doing. She liked how his shoes were- they have great breakover and the toe is short enough. She'd like the shoes set back even more for more heel support though. The RF medial branch is wonderfully wide to support the inside tendon as it heals.

The first test she did was watch him walk and trot on the straight line, where the RF lameness was still there, but only a 1/5! We went down to their covered hard surface round pen, and he trotted again. He was <1/5 unsound on the RF when tracking left, and 1.5-2/5 RF when tracking right.

Back up to the barn we went and did some flexions: The hind flexions didn't bring up anything worth noting, but they did flex positive. Dr Cricket wasn't concerned about them because he didn't trot lame in the other tests; in fact, his hind end was more sound than it was 10 weeks ago (and we had resolved his previous hind end lameness by blocking the front legs). The front flexions were interesting though. Flexing the lower RF made him more lame on the RF (as expected), and flexing the lower LF made him more lame on the RF (what?). She didn't explain why that would be, but happily noted his LF lameness from the previous visit had gotten better.

Look! It's my pretty garden! I'll use it to break up some text.

The next thing she wanted to do was nerve block directly below the strained tendon on the RF. He hadn't gotten that much sounder on the RF in 10 weeks, so she wanted to know if it was hoof or tendon injury that was bothering him.

Nerve block done, off we went for the straight line and circle trots.

Fuckity fuck fuck.

He was 90% sound.

So the problem isn't mostly the tendon, there's a problem in the hoof. Off for x-rays. I asked her to do some shots of the LF too, because we had discussed him possibly having sidebone and I wanted to know. We opted to leave his shoes on since his foot shape is quite wide, and it's a 5 hour drive home. They thought they'd be able to get the angled shots through the shoe (I'm not sharing those because I don't really know what they show), and if they couldn't get what they needed to see, they were going to pull his shoes and I would call GP Trainer and ask for her farrier's number to put them back on.

Well his feet are a bit of a mess internally, and I doubt any of it is new. From what I can glean from his PPE x-rays, now that I know exactly what I'm looking for, I can see traces of all of it. His PPE x-rays are so blurry and low res that it's really difficult to see... so I can see why some of it was missed, but I'm kicking myself now. I would have sent Penn back to his breeder if I got the below news 3 years ago. Sorry buddy. I love him, and I don't really regret buying him, but I would have done the extremely hard thing of sending him back.

Red cicles: remodeling of the coffin bone, worse on the LF, which also has remodeling on the P2.
Red lines: Neutral palmer angle (I may have drawn the line wrong, sorry), aka flat footed.
Yellow arrows: The horns of the coffin bone. They should sit next to each other on this view, not be offset.
SO CROOKED.
Lower red circles: mismatch/crookedness of the joint- the outside of both legs have less space than the inside.
Upper red circle on LF: Sidebone
Vertical lines: The coffin is shorter than it should be from this view (flat footed).
Horizontal lines: The coffin is also crooked. The RF is worse. There is more sole on the outside edge of each hoof in addition to the leg itself being crooked.

Of course by this point, it's all red alarms going off in my head ("My horse is so crooked he's never going to stay sound while in work."). I knew his legs were turned when I bought him, but the twists keep going all the way to the ground internally. The idea I got from his PPE was he would just have some flail in his front legs when moving. Not that I need to be actively getting x-rays taken to ensure we're shoeing him correctly for his internal confirmation. The vets had a very difficult time getting x-rays straight on enough to make an evaluation. Dr Cricket did say something about his navicular bones, but honestly I can't remember what because it was low on her list of issues to deal with, and sounded like it should get better as we correct all the other things.

Any sadness I feel is really being offset by the anger I feel towards his PPE. I can see the sidebone in the PPE x-rays, albeit faintly, but it's there (but it is NBD for now). This level of crooked isn't new. That tilted coffin? Yea, I can see it because in the one side shot, they angled the machine in such a way that the coffin looked straight... and the shoe he was wearing curves right off the bottom edge of the x-ray image and all you can see are the far side nails reaching up to the bottom of the shoe on the near side. I could have sent him back, or I could have prevented a lot of his issues by simply having him shod to the x-rays. He's heavy on the inside of each hoof, meaning without correction, he'll probably keep tearing the medial branch of the suspensory tendon. Don't forget the fetlock joint remodeling that Dr Cricket found in our June visit. That was one the PPE did find and called it nothing. I didn't know any better and I was still deep in Mikey's loss and didn't question it.

Speaking of buying him, we celebrated his 3rd Gotcha Day same day as his recheck. Oh the irony of his PPE being almost 3 years to the day as this recheck.
I got him a belated present, a name plate for his every day halter, just what every horse wants! Lol!

On the bright side, we can shoe to correct a lot of these issues, now that we know they're there. It'll take time, but it's doable. What we can't fix is the coffin remodeling (or fetlock, but that doesn't appear to be an issue as it is significantly less). That will only get worse as he ages and as he works. We decided to inject both of his coffins, even though the RF is the one that's hurting. The LF is actually worse off, so it's actually a good thing that he has more pain in the RF.

Bandaged after coffin injections, and receiving his shockwave treatment.

Another bright side, the ultrasound showed that the attachment of the medial branch of the suspensory is looking great. It is almost identical to the good lateral attachment, but the tendon itself isn't as 'dense' as the good tendon. All that means is he needs more healing time, and more shockwave if we can manage it (we will manage it). He got a shockwave treatment at VEI, and he'll get another 3 weeks later, then he has a recheck at VEI 4 weeks after that.

I finally remembered to ask about a prognosis. She kind of didn't answer the question, but she said we can keep injecting the coffin to keep him comfortable (we'll come back to this), and this is first and foremost a soft tissue injury, which takes a solid 6 months to fully heal. Cue the ridiculously long tack walking... we'll be 17 weeks of tack walking when he goes back for his next recheck. I know she is looking at this in the long view- sound to perform his job like he did before. She's hopeful he'll be healed enough to start trotting after his next recheck. That's about all she was willing to commit to.

I get the feeling that he shouldn't have a problem returning to full work in time- maybe by the first quarter of 2019. I can appreciate that she's looking at this for long term soundness with a low reinjury risk and is taking an ultra conservative approach. Either way, Penn won't be leaving me, ever. I won't sell him or give him away, not knowing what I do now (not that I was planning on it, but things happen). If he can return to 3rd level, but not progress further, I'll work on completing my bronze bar. If he can't do 3rd... we'll see what he can do and I'll work on what part of my bronze bar I can. Then depending on his level of comfort, find a nice AA lady who wants to lease a lower level horse with a ton of experience.

I have a long term tranq on order. He's been generally good, but he's starting to get a little feisty when he's not being ridden. Can't wait for it to get here! I'll stop worrying about him doing stupid things. In the last 2 weeks he's ripped a flysheet, cut his hind leg, and rubbed holes in both hocks. No one ever sees him do more than mosey around and eat hay. If they saw more, they'd catch him and bring him in!

For now, he's having every whim catered to. Including breakfast outside because he simply could not tolerate being in his stall a moment longer, even though he had to be carefully bubble wrapped after his coffin injections.

This is where I'm reaching out the blogosphere think tank:

I am NOT keen to inject his coffins every 6 months to a year for the foreseeable future. He's only 9, if we're only looking at yearly injections, we could do that 10 times before he's 20. I don't think that's a viable plan. He'd need a step down in workload at that point, not injections. Note we're not looking to willy nilly inject him yearly on a set schedule- it'll be when he cues that he's hurting again. 6 months is as frequent as is "safe" but more than a year seems overly hopeful. I've been a bit lax on his Adequan this year (he hasn't had a dose in about a year), but he's going to go back on the single dose every 4 days for 7 doses, every six months. Home vet and I talked about doing Prostride coffin injections instead of a steroid. VEI said we can do steroids until that doesn't manage it, then step up to something I don't remember, then step up again to PRP/APS injections. I've had him on Doc's OCD since he came home from VEI the first time, since it should address bone problems. We will be doing yearly hoof x-rays to keep track of the remodeling.

I'm looking for things (preferably USEF show legal, but usable with withdrawal periods is fine too) that we can do to make his coffin injections last longer. Holistic is fine, a different option than Adequan is worth looking into (I'm not sure how effective it was for him), and cost can be moderate. Barefoot is not an option. He has a vet prescribed plan in place that I intend to keep to. Other than that, I am open to suggestions.

One suggestion I've already looked into is CBD oil (it'll be fed powdered or pelleted), which has gotten a warm response from two of the vets I've talked to that are involved in his care. I'm just having trouble getting a hold of solid information about its use in equine care. I find a lot of "Are you ready to be pain free?" in bold letters on information pages that say a lot without actually saying anything. It needs to be pure and THC free (meaning non-hallucinogenic), and that's about all I've got.

Let the opinions roll!

22 comments:

  1. Ugh. I'm so sorry to hear this! But I'm glad you can shoe to help him out. Such a bummer to have not known all of this sooner though. =(

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    1. I've learned to not ignore bridle lame. I went through some videos where he takes a few heavy steps, or bridle lame steps... and it's always lame on this RF. So at least I learned a lesson? I am happy we can shoe for most of it, which should actually help keep the inflammation down in general. Too bad feet need so much time to make changes!

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  2. do you want to join an "angry about prepurchases gone wrong" club? because i want to stab the vet who did mine on my last horse.

    You're the second person this week who's mentioned CBD oil to me, although the other mentioning was for something completely different. nothing helpful just... commiserating. and lending you a shiv for stabbing.

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    1. YES I WOULD LOVE TO JOIN. I'll bring margaritas to the next meeting...

      I'll admit I'm interested in the other effects of CBD as well, most notably the gastric calming. He's always suffered a bit of diarrhea, and I've got a really good handle on it now, but I'm always looking for new ways to keep him gastrically happy. I'd also be interested to see if it quiets his brain. He's a very bad stall walker and he's getting a bit too frisky for being in rehab!

      Commiseration in groups is a wonderful thing, as is a shiv lol

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  3. No suggestions here, just commiseration. I really hope taking this conservative approach brings him back to full work for you. <3

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    1. I've never done a rehab this long. Mikey had a bow from the track that flared up 2 or 3 times as we evented, but we also kept him to 2 to 2.5 months of stall rest and quiet turnout when possible, then back to work and turnout. I'm keeping everything crossed that a long rehab will mean low risk of reinjury!

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  4. Ugh, that just sucks so much. Finding a good lameness/prepurchase vet is HARD. The vast majority of vets I've dealt with good at what they do but they aren't specialists, and the majority of their clientele do not own high-performance horses. Which makes it just that much more challenging to find a vet that *is*.

    I've got my fingers and toes crossed and am sending Penn all the healing vibes I can!

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    1. This area is lacking in performance horse vets too, so I think things get glossed over a bit more... "oh it's not as bad as it sounds", while comforting, isn't the approach I want to take with a horse that I expect extreme performance from. I guess I feel lucky that I can drive 5 hours and get to a highly recommended one?

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  5. Sorry about that PPE. I'd be pissed too. Levi has sidebone (also not diagnosed in his PPE, thanks vets) and Sneakers as shoes have helped him a lot. He's also on Previcox, which is legal.

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    1. I've looked at the sneakers! They're something I'd be interested in trying, but maybe once things calm down. I ran it past home vet and she wasn't all that keen on them, so I didn't even ask Dr Cricket. Thank you for reminding me about Previcox! I completely forgot about it.

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  6. holy smokes..... that's definitely not the kind of picture i'd want to see..... i didn't take pictures of charlie's feet at the PPE (beyond what was visible in the images of his fetlocks) and often wonder if i should just for ... the sake of knowing, i guess. except i'm kind of afraid of what i might find... glad to hear your vet seems to feel confident in the path forward, hopefully Penn will respond will to the changes!

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    1. It was like, let me count the things in a 6 inch span that make you ill-suited the career chosen for you. Stupid feet. I hear you on being afraid of what you might find! I was sort of afraid to do the left front but it was a "let's make sure we know what we're dealing with". It is comforting that there's a confident path forward, and we're just going to truck along!

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  7. I don't know about pain relief, but there are two mares at our barn that have shown significant improvement on CBD oil as far as behavior. Less spooking and idiot behavior. May help him on stall rest at least? Other than that, I have Hampton on aspirin but damn it sounds like Penn may need something like Previcox daily? Legal I believe up until 5 days before show time. I've also done a round of Polyglycan with him - so similar to Adequan and/or Legend (has components of both). Sending you and Penn all the best. So frustrating.

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    1. The pain masking effects of CBD oil is why I haven't tried it yet. I'm looking for something to keep internal inflammation down (which of course is pain masking) to try and prevent the remodeling in the coffin from getting worse. I'm leery it might cover up pain that I need to know about. I think it'll make a huge dent in his stall walking and help him stay quiet while he's healing. His long term tranquilizer arrived today (reserpine) but it comes with a diarrhea warning, which he's already prone to, so he may not be able to continue on it.

      I'm also interested in hearing about polyglycan and your experience with it. The same vet who did his shitty PPE tried to strong arm me into it when I asked her if she had Adequan and when she didn't, I asked her to sign the online RX. It was actually one of the things that made me stop using her.

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    2. Just a word of caution on the Reserpine (feel free to tell me to MYOB). I used it successfully for my horse for surgery stall rest rehab, although he did have dark green, horrible smelling, slightly loose stool. But some horses can have a really bad reaction to it. Like, psychosis. I know 2 horses in real life that did. So, maybe keep an eye on your boy when you put him on it? And if he does well, be careful when weaning him off of it. My friend's horse ran through a high-tensile fence :( I don't mean to be an hysteria monger, but in the case of the 2 people I know, neither one was warned of the rare but possible side effects. I would hate to see anything happen to your nice horse.

      https://www.chronofhorse.com/forum/forum/discussion-forums/horse-care/9950372-violent-reaction-to-reserpine

      https://www.chronofhorse.com/forum/forum/discussion-forums/horse-care/10110486-experience-with-reserpine

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    3. Thank you Shauna! Def not a MYOB! I was warned about possible diarrhea, and the vet did reconsider it when I told her he's already susceptible to loose stool. I did not know about the other possible side effects, so thank you! I will read more about it before starting him on the test doses I recieved. I am so deep money wise, and emotionally, into this horse that I'm being paranoid about everything!

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  8. Ugh this is horrible, I'm so so sorry you're going through this. Rico is currently on previcox for his neck arthritis and it's really helped him. Fingers crossed that the slow rehab + corrective shoeing will take care of the majority of the pain/inflammation and that something as simple as previcox or regular adequan/legend would work to keep him pain free. He's so lucky to have an owner so dedicated to his recovery! I have everything crossed for you.

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    1. Thanks! I still can't believe I forgot about Previcox. The shoeing should take a lot of inflammation out I think. We'll have to see if it stays gone as his workload increases.

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  9. If I'm totally off base just ignore me - I haven't really delved down the path of "boat loads of maintenance" (Carlos was approaching that when he got his life ending navicular diagnosis :( ) What about just injectable glucosamine? IM and pretty cheap, it's a once a month thing.

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    1. You're not off base! I've just tried it all already, and noticed zero difference. He's been on Adequan since I bought him and many different feed through joint/bone supplements too. I guess I'm looking for the "what's next?"

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  10. I’m so sorry that you and Penn are having to go through all of this! I don’t really have anything useful to suggest, other than what you have mapped out and have already done. I have heard some information about the oil affecting how horses sweat. I don’t know how accurate it is, but I do know it is a vet looking into it. Anyway, if you do try it, keep an eye out for that, just in case.

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    1. Interesting! I did try the oil, I'll have to post about it. It's yielded some interesting results, between Penn and the other horse in the barn who tried it. I hadn't heard anything about sweating- I assume you mean the horse doesn't sweat as much? I didn't notice a difference with sweating either way though.

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