Wednesday, February 11, 2015

OSU Visit: 2/2 Monday - Surgery Day

**There are some pictures that some people might find disturbing. I took some pictures of the actual surgery, so just a heads up.**

We got up and had breakfast at McDonald's before going to the vet hospital. I mention it because we got to pay with love!

When we got there they had already sedated him and had him out for x-rays and an ultrasound. I panicked that I had missed saying bye to him because I never got a definite time in his surgery, just that he was first and only that day and they'd pick the time in the morning. I ran into a tech and she let me know where he was and that he was coming back before surgery.

I managed to snag a pic of him in his muzzle, but it was hard because the students were working on him and prepping him for surgery. He's got a happy guy sedated face. He wasn't so out of it- whenever he heard plastic crinkling, he was looking for mints!

I did scare Mikey's assigned student though. He was supposed to put Mikey's neck catheter in but was too nervous to do it in front of me. I do understand that but I'm happy a non-nervous student did it. She was very nice, and explained to me what she was doing (even though I was standing on the other side of his neck because I can't watch that kind of thing, it gives me the willies), and what she was shooting into it (pre-surgery antibiotics).

The vet doing the surgery, Dr Alicia Bertone, came by to talk to me and pulled me away to show me the new x-rays. They are digital and much more clear than what my own vet took. They also painted a more grim picture. Mikey had slipped or been kicked in a way that he hyper extended the inside tendon and tore it (this part was news to us, they ultrasounded it while they had him out) and crushed the outside bone, creating at least 8 chips, if not more. It's already classified as an 'old' injury since it's a month old. Apparently that was enough time for some of the chips to float around and destroy cartilage and to move down to the lower joint. basically it'll make it more difficult to remove them, if they can be removed at all. The body may have already encased them which would make them impossible to find. The few she thought would be hard to find wouldn't cause him harm in the long run, especially if she was going to cause more damage finding them and getting them out. They seemed to have low densities in the x-ray and had a good chance and being properly encased and reabsorbed if she couldn't get them out.

She did say she wasn't comfortable with him going home the next day because it looked like the surgery could be more complicated, but we could if we still wanted to. Obviously we said he'd stay until Wednesday, that wasn't an issue.

You probably have to click on the pic and make it bigger to see it, but there's two chips circled in red.

All of those broken bits in the red circle are chips. There's a flat section that was broken off as well in the circle. All of those needed to come out.
They jogged him on pavement and flex tested him before sedating him and taking x-rays. He was mildly lame jogging, but completely crippled after the flex test. I am glad I missed that part.

I was able to go back and see him briefly before they truly sent me away to the viewing room while they took him to the drop room. They said it would be about a half hour from when they took him until the time they brought him in. They took him to the drop room around 10:25.

My mom and I were showed the upstairs and waited for him to come in. He came in pretty quickly and he was in the room by 10:50. I kind of wanted to see how the drop room worked but I'm sure that's something they purposely do not let the owner see.

Surgery room waiting for Mikey to come in.
And he's in! They're getting his bad leg tied up at the angle they want.
There were so many people! so many people there to help fix my horse. My OTTB who will never be a million dollar horse is anyone's eyes but mine. It was overwhelming that all these people were there to help my insignificant-to-everyone-but-me horse. It was very surreal that a decision I made brought all these people together.

Partway through the surgery a student came up to check on me and let me know how surgery was going. Some of this info is filled in below as appropriate, but most is from the incredibly awesome view I had. I think I responded to his surgery ok by being able to detach myself from it. I was fascinated. My mom couldn't even look down into the room, she got too upset seeing him like that.

I watched them scrub his hock down (it had already been shaved), and organize their equipment. He was on his back (as you can see from the above pic) and on a ventilator. They covered him up from shoulder to tail and wrapped a iodine soaked cling wrap around the hock.

Seeing him on his back unconscious wasn't that bad. His legs were held up, and I could see his belly moving from the ventilator before they covered him up. He looked like he was in a state of perpetual rolling instead of dead. After he was all covered up, it was just his head and neck, sheets, hock, more sheets. I couldn't even see most of the horse.

The first thing they did was drain the fluid in the joint. It was bloody and full of nasty things. First extra bad sign.

Cutting into his leg (or through the iodine wrap, not sure), right before draining fluid.
They brought out the scope and cool enough, the cable glows! I could see the screen (but not what was on it) and all the students crowded around behind the surgeon to see it. They came in from the inside. There was a red light in it, I could see it shining out from under the skin on the outside of the hock.

His surgeon checking the joint with the scope.
They were doing a lot of moving around. I noticed they brought in a sprayer of some kind, cut a slit in the outside of the joint, and were flushing the entire thing. They started pulling chips out at this point, from both sides of the hock. More flushing, not a lot of blood, and chip after chip after chip. So many. They were laying them out on a tool table.

They pulled in an x-ray machine and started taking pictures. I thought they were done, but then they started digging again. The slit on the outside of the joint was widened to something they could pry the skin open and check it visually. It looked like they were checking to make sure that they got them all.

They brought in a bright light and that pretty much ended my view of what they were doing. His surgeon is sitting in the chair, and his supervising vet (who is a resident learning surgery) is standing working on the joint from the other side.
This was when the student came up to check on me and said that they were looking for the last few chips. They were still missing a couple. But she said he was doing incredible under anesthesia and the anesthesiologists weren't worried about a thing. Everything at the front of the horse was very strong and in good shape.

I believe they were sewing him up at this point.
Eventually they did stop and sew him up. The same student came up to tell us what was up and took us to get Subway from downstairs. I didn't want to leave but it was almost 1:30 by that point. She said Dr Bertone would be up to see us soon. We got back just after they had wheeled him out and were prepping to take him to the recovery box. I could see them getting him ready to take off the wheeled table and onto a hoist to take to the recovery box.

All done except the clean up.
I found out after from Dr Bertone that the bloody debris filled fluid was the first problem. The next was when they turned him upside down, the chips has migrated from the outside of the hock to the back of the hock. When they opened him up they couldn't see any of them. She said usually at that point, some surgeons call it a day and deem them irretrievable and sew the horse back up. She decided to try the plantar method of getting them out, which worked for most of them. There were two that were proving difficult, one they eventually found, but the other they could see on the x-ray but just couldn't find. It is probably already encased but shouldn't cause him any pain or effect the joint's performance. I believe it's the higher chip in the first x-ray above. He was already under for a long time and she had to decide how long was too long and how much damage she would do if she tried to find it. So she pulled the plug and sewed him up. She said that hock will probably always be larger because it had already started encapsulating itself, and he'll always flex positive on that joint.

She still considered the surgery very successful. She said it was one of the most complicated joint surgeries she had ever done. We were so glad we had opted to take him to her instead of a local surgeon, who would have probably opened him up, said this is beyond my skill, and closed him back up and then the horse would have had to travel to OSU anyway and be put under a second time.

While she was talking to us she got a call that he had stood up in the recovery room. Yay! That was my biggest fear- that he'd break himself waking up. OSU has a great recovery team and from the sound of it, a low incident rate when horses wake up.

We then talked about where to go from there. I was crushed to hear he had a good prognosis, but all that meant was he had a 50-70% chance of being sound enough for competition. She said that without the surgery, he would have been permanently lame for the rest of his life, and in pain as the chips slowly became a problem. She said we had done the right thing by him.

I told her my goals for the two of us, Prix St George, and asked if there was anything we could do to help raise the odds. She said they just finished a study on stem cells and tendon repair that was incredibly promising and had a statistically significant difference in improving the joint. It was an option, but a $1000 one. She said he was a lovely horse to work with and she could tell he was an athletic, capable partner, and because of that she felt comfortable recommending the procedure to us. She said if he wasn't a competitive horse, and such a lovely horse, she wouldn't have recommended it, but because of the goals we have and the incredible success they've had with it in the past, she didn't think it would be a waste of money. We agreed right then to do that this week.

It takes a few days for them to culture the right cells in Kentucky, but they'll be here by 9am Thursday. They have to be injected very soon after delivery because they are live cells. She put the order in while she was talking to us.

I asked if there was anything we could do for the cartilage damage since they had so much experience with stem cells and research in that area. She suggested an APS treatment that they did a research study on last year, which also had incredible success. They had a dressage horse come through that had a mess going on in one of his joints, he got the stem cell and APS treatments and is now just fine, going along as if nothing had happened. I think I'm remembering the details right for that horse, I was getting overwhelmed. Either way, it sounded like it was a similar thing as Mikey, so with the two treatments, Mikey should have a good shot. No promises because no two horses or injuries are the same, but a good shot. It was either the stem cell treatment or APS, I just can't remember, but only around 70 horses had had that particular treatment.

All during his surgery, our house refinance people had been calling and emailing me. I was so angry at them - the refi isn't happening and I was arguing that our credit was more than good, everything checked out, why the hell not?? By the time his surgery was over and the surgeon had spoken with us, I had fire for blood and I think that kept me from crying over Mikey in surgery, might not have a complete recovery, he's safe and sound awake and back on his feet etc.

We were finally allowed to go down and see Mikey, and he was one miserable pony. I'd expect no less, he hadn't had anything to eat in a long time (by the time he got back to his stall and was allowed to eat it was almost 4:30, and he was muzzled at some point the previous night), and I'm sure that leg was hurting pretty good. They had given him IV bute earlier, but it either had worn off or wasn't enough. He had his muzzle off and hay in front of him, but he was pawing like mad and then biting/chewing on the rubber mat flooring. His supervising vet came and talked to us. She said he couldn't have more bute for a few hours (too much and he could have kidney damage, I think that's what she said), but she did say she'd sedate him a little since he was so upset. A few minutes later he slowed down on the pawing and became a little interested in his hay. She suggested we leave him alone for a while because he'd had so many hands on him that day that he probably wanted to be left alone. It was at that point she asked if I was ok, because I kind of looked like I was about to cry. She assured me that we had done right by him and that they would check on him in about 15 or 20 min to make sure he had quieted down.

She gave me his bone chips and we left to go tell the hotel we needed to stay until Thursday morning. We also switched hotel rooms to one with a fridge and microwave, at a cheaper price (20% OSU discount!). I don't remember where we ate dinner, or if we did. We went back around 9pm to see him and he was much more comfortable and munching on his hay. He was still doing feng shui with the straw in his stall though.

The chips.

OSU Visit: 2/1 Sunday - Waiting Day

Sunday was boring. We got up, ate leftover turkey sandwiches from Saturday, checked on Mikey, went shopping at Kroger and got gas, looked for Panda Express, left Panda Express because I couldn't fit my truck in any on street parking in Columbus, so we settled on a chicken finger place for lunch, hung around at the hotel and chilled the wine we got at Kroger, went back to see Mikey (I fetched his brushes and brushed him for a long time), then went back to Applebee's to start watching the superbowl. Thrilling day. Not so thrilling for Mikey, he got his muzzle on sometime that night so he was forced to stop eating, but not drinking.

I spent some time Sunday getting more pictures of his stall and the orthopedic wing. Mikey was the only orthopedic horse in the wing for most of the week. Later in the week some young thing came in... it was literally climbing up the walls. I walked by and it was rearing. I'm glad I have a well behaved boy! A rescue horse came in too- someone had pulled him out of a field and was trying to make him a pleasure horse. He had surgery on both front legs on Thursday. Poor guy looked miserable, but should be in less pain from now on.

The orthopedic wing also holds the school's blood donor horses when they come to donate blood. I asked about them- they rotate to the vet hospital from an off site farm for some amount of time every 3 months to donate blood. They are always geldings, and are rescue horses that would have been euthanized. There were 4 at the hospital while Mikey was there.

Mikey eating hay. I think I took this one to get a good look at the ceiling.
Panorama shot of Mikey's stall. The silver person door and the wood square door in the back corner go to a back isle that stores hay and straw. The metal grate at the bottom goes to a conveyor belt that takes manure and straw to a composter thing outside.
The back isle.

 The orthopedic wing and the entry room.

Oh! I did get to find out where he would most likely go to be laid down and see the room (but not go in since it is a sterile room). They'll put him in a padded standing stall that has a wall that will slowly squeeze him as he goes unconscious and falls down. It'll slow his fall and help ensure he doesn't hurt himself. They'll get him on the table there and wheel him in to the surgical room. There are details I'm glad I'm not thinking about until now... Like to lift an almost 1200 pound horse from the floor to a table probably included tying his legs together and hoisting him with a crane or something. Not a picture I wanted to think about.

Some cute pictures of Mikey while he was still a happy go lucky boy with no idea about the misery that is to come. He's a silly boy!

Mom and I got a bottle of wine, and drank it out of the hotel plastic cups. Cheers! We toasted to a good surgery for Mikey.

Next post, surgery day.

Monday, February 9, 2015

OSU Visit: 1/31 Saturday - Arrival

Saturday was a whirlwind day. I picked up my mom, then we got gas and breakfast, then we picked up straw from the feed guy and headed to the barn.

We dropped off the straw, then were faced with the task of digging my trailer out of 8 inches of snow. After that, the wheel chalks were frozen to the ground and we had to use hot water to release them. Loads of fun.

Unloaded the trailer... we wouldn't be needing any of the horse show stuff... then loaded hay and feed. Loaded horse. It was strange that all I needed was hay, feed, no bows to come home in, and the horse.

Five hours later (!!!) we had finally arrived at OSU's Galbreath Equine Center. Talk about a freaking cool facility. If you ever get a chance to tour the place, do it no matter the drive. It is incredible.

The entrance.
My truck and trailer fit easily inside. I think almost any truck and trailer would fit. Five of me would have fit.
Stunning ceiling. The entry hall had weird orange lights. I thought they must be dimmed for the evening or something, but nope, they're always like that.

I took Mikey's boots and blanket layers off immediately after unloading him, before we went to his stall. One, because the building is heated to a normal building temperature and he'd start to sweat quickly (I sure did). Two, because I would have had to bring all those blankets back to the trailer! I did send his Rambo Whitney Fleece Cooler to his stall on the off chance he got cold. He didn't need it.

Our arrival seemed to draw every student out. Other than a couple emergencies that were there before us, I think we were the only ones that arrived over the weekend. They said several of the horses that were scheduled to arrive had cancelled their surgeries because of the impending snowstorm. It was why we came a day early. Mikey got rounds of "What a nice clip job!" and "What a handsome horse!"

Mikey was weighed (1,140 lbs) and then we took him to his stall to settle in. First thing he did was sample the straw in every corner. Second thing was to take a big pee. Good job Mikey.

After getting weighed. The scale is the dark rectangle on the right.

Comfy in his stall drinking water.

Stall front.
Visiting is never restricted for a horse's owner, but the veterinary hospital does have standard visiting hours so the techs and students can get their work done, so they ask that you try to respect those hours. However, there aren't visiting hours on the weekends because there isn't much going on; it's emergencies only. Standard hours are 9am-6pm. We really tried our best to stick to those hours, but a couple times we couldn't.

After he was settled in, my mom and I checked in to the hotel and got some dinner at Applebee's. We went back after to check on Mikey again. I was at a loss of what to do for him. We had traveled, stabled away from home, and I wasn't supposed to take care of him. Or ride. And no hand walking or grazing. All I could do was pet him and talk to him. For someone used to doing everything herself, and then sitting in front of the stall waiting for Mikey to need something, it was unbearable.

Mikey seemed happy, but he wasn't keen on them putting his hay in the back of the stall. His water was up front, and he likes to dunk and eat. His student caregiver figured it out the next day though. But I may have moved Mikey's hay Saturday night :-)

Cotton Sheeting Hell

So does anyone have a favorite cotton sheeting that they are dying to tell me about?

I am currently using Gamgee Highly Absorbent Padding, 12" x 11.5' from Tractor Supply. I am very happy with it, but at a price tag of $12.99 per roll, I am running out of money! We use one roll per bandage change (nice and thick- the incisions staying clean is too important).

I am having trouble getting it because Tractor Supply only gets like 4-5 in, and then people like me come in and buy it all. I just ordered 10 rolls from Smart Pak praying that it is the same thing in different packaging and will come in quickly.

Any cheaper human equivalent that I can buy in a CVS or Rite Aid or Walgreens or anywhere? Or cheaper equivalent in general?

More Updates

I'm slowly working on the posts that document our visit to OSU. I want to be thorough, partly to share, and partly so I have a written record of what happened because it was a very expensive and eventful week.

Mikey is home, and finally settled into his new routine where he stays in his stall at all times except to have his bandage changed. That is what his life is going to be like for the next 30 days. After that, he'll be allowed to handwalk for 15 min once a day for another 30. After that it looks like we can evaluate his soundness and comfort and start adding work back in. Somewhere in the second 30 days he'll have an APS treatment. That stands for autologus protein solution, which is a solution of plasma and white blood cell proteins that will help reduce inflammation.

Here's what his leg looked like Saturday morning. I wasn't thinking when I took these pics as you can barely see the stitches. He has two incisions on the inside of the hock, and two on the outside. The small one on the outside is the one that's still oozing, and the biggest is the other one on the outside that's on the widest part of the hock. Sorry for the poor descriptors!

I know the vets at OSU said there was a lot of swelling still, but we looked at it and almost cheered because there is less swelling than before the surgery. The back of his hock has some creasing, I'm guessing that's due to the amount of swelling he had that isn't there anymore and the hock wrap holding everything together. I hope it goes away, but if not, oh well. Yesterday he was climbing up his stall's walls and pacing and general panicky unhappiness. We weren't sure how he was going to make it until the stitches came out (7 more days), let alone another 3 weeks. Luckily today he seems to have settled in.

He got a shot of Exceed today because of the incision that is still oozing synovial fluid, and the OSU vets were concerned about infection. Our vet will see him on Wednesday and give him another dose if he's still oozing.

He chewed on the wall yesterday, so my job today was covering his wall in hot sauce to make it less appealing to chew on. Mikey thought it smelled funny!

Hot sauce tickles his nose!
Chillaxing in his doorway Sunday morning.
Nom nom time! Blue camo vet wrap (tractor supply sale) and you can see the shaved part under his jaw where they had some stuff hooked to him for surgery.
I hung around Sunday for a while and my trainer offered to let me ride her 3* event horse (3rd level dressage proficient) on the flat while she taught another lesson. Last time I rode Cody, we did not get along in the slightest. I was not a good enough rider to not piss him off, and he had a low tolerance of not perfect riding. He tolerated me for about ten minutes before threatening me, and since he's an athletic SOB and I was just getting him out and about while my trainer was away, I bailed on trying to do actual work and put him through his back in the walk and we went for a road walk. Last time I also didn't have a choice of sitting trot or posting. I was posting because he was too big a mover for me to be able to sit.

He's much more educated now, and has learned to be polite even when his rider makes mistakes. I am a much better rider now, and didn't piss him off as badly (anyone who's not my trainer is going to piss him off!). I could also sit his trot easily! I had a great time with him. He made my holes very obvious, and was patient with me and all my mistakes. I'd love to spend more time riding him, but he is aimed at Rolex in April and playing rides will not be in the cards really. I got to play with his extended trot and a single flying change because I couldn't keep my act together to get the other one. I'm too afraid of messing him up! His extended trot is awesome by the way. Little bit of driving seat bones, gentle working the bit and he gives shoulder popping goodness. Tilt your hips forward out of the driving seat and back to collected trot he goes. I giggled while I played with it!

My trainer didn't mind my mistakes, she said that he's going to be for sale after Rolex and needs to get used to someone else sitting on him, and she likes to see him go too. I know he can be difficult in the dressage ring, but I wouldn't pass on the chance to take him down centerline! He has a lot he could teach me.

I'll leave you with a quick picture of Cody!

Cody. The light makes his eye look funny, but it's really just the same as the other one.
He was happy to have a mint when we were done!

Wednesday, February 4, 2015

When it rains it pours...?

The truck brakes went today when we were on our way to the Columbus Zoo. I now have a rental and we can't go home until the truck is fixed.

But Mikey walked on his own in his stall today!

Mikey turned himself around on his own to get his dinner! 

Tuesday, February 3, 2015

Quick Update

I'm trying this from my phone, so I apologize if it comes out like crap. I'll fix it when I have access to a computer.

Mikey is not coming home today. Or tomorrow. Hopefully Thursday but we are prepared to wait until he's cleared for the five hour drive home.

The short story is Mikey did very well under anesthesia, the surgery was successful, but it is questionable if he'll be competition sound again. He was slightly off jogging on pavement, and almost crippled after a flex test before surgery.

Surgery was long (he was under for around 3 hours, from drop room to prep and surgery to wrapping and recovery room) and was very complicated.

He recovered well and stood up about 30 min after going to the recovery room. The surgeon said it was one of the most complicated surgeries she has ever done and I am eternally grateful to her for changing strategies mid surgery and persisting on finding the chips.

After surgery he had a 50 to 75% chance at being sound again. Without surgery he would have been in pain the rest of his life and lame, so he's still better off. He had a torn tendon on the inside of the joint and crushed bone (where the chips came from) on the outside of the joint. The chips destroyed some cartilage as they floated around and some embedded themselves in a tendon. He will get stem cell treatment to the tendon on Thursday, which will give him a better shot at being sound. He'll get a series of legend iv after the stitches come out. After that he'll have APS treatment to the cartilage to help heal some of the damage. In about 6 months we can evaluate if he will be able to go back to normal work with our old goals.

I have a ton of pictures. I was able to watch the whole surgery from an observation room, which was very cool. But nothing before Friday or the weekend, I need a laptop to write a proper post, or more likely posts.

Mikey's chips/fragments. 

Long story here too, but essentially Mikey has the OSU staff wrapped around his little hoof so tight that he's being spoiled wonderfully. And I love it.