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.


  1. Wow. Just wow. No words. Those chips are huge. Way bigger than the ones Pig has in his fetlock. Those are encapsulated, and don't cause any issue, other than puffiness.

    My fingers are crossed for Mikey. Sounds like he was a model patient. What a good boy.

    1. With all those chips and a torn tendon, he was only mildly lame. My trainer and I are hopeful for a full recovery simply because surgery got every chip that mattered and we're doing extra treatments that should help the tendon and cartilage, and then being almost sound pre-surgery with all those issues. Worst case is I will have a very well trained pleasure/trail horse. Best case I have my boy back, sound and ready to work- and its not long shot odds that the latter will be the case!