Since Thanksgiving

Since getting back home, Penn's life has been turned upside down.

He's still a pretty happy, cuddly guy.

Activity Level. He's back to tack walking and the first few rides were interesting... He was hot and spooky and was as naughty as a horse can be without actually doing anything bad. The first ride back, I brought him into the indoor and he proceeded to stare at the footing and snort at it for 15 min straight. Seriously dude? Though, he's never done well with time off.

He's being aced for turnout and tied in his stall when he wants to stall walk. True story, sorry not sorry. This will continue for months sadly until we figure out a long term situation for him and for when his ligament damage is more healed/not freshly healed.

Snoozing in an ace-and-sun-aided trance on an unusually warm December day.

Interestingly, his stall walking may have played a roll in the collateral ligament tears. Did it do the actual tearing? I don't think so. Did it not help the situation? I think so. Penn has been an avid stall walker for the 3 years I've owned him. I've tried a bunch of things to make him stop (Quiessence, Total Calm and Focus powder, CBD were the big ones), and they did help to some degree but didn't make it stop. For the record, the CBD made the biggest impact on that aspect of Penn's life. It brought the stall walking down from an intermittent night time affair with mad walking at feed time to "I only walk at breakfast and dinner while I'm waiting excitedly for my food to arrive."

Penn always, ALWAYS stall walks to the left. That puts both collateral ligament tears on the inside and he pivots hard on them. I meant to mention the stall walking in my previous 2 posts, but I simply forgot because we didn't really think of it until the drive home.

HALP ME

Silent protest

New Shoes and Accessories. He got his new duds, that my farrier so graciously made for him ON THANKSGIVING, so they'd be ready to put back on ASAP. He got them back on the Saturday after Thanksgiving.

You'd think by now I could take a picture that wasn't blurry.

They make very unique footprints.

I ordered him new bell boots on Black Friday, since my favorite Italian Pull Ons can't be removed once his larger than life shoes are on his feet. I tried. The vets tried. We gave up and took them off after his shoes were pulled for his MRI.

He's a Back on Track poster child.
The medium BOT bell boots are actually slightly taller than the large KL Select Italian bell boots. I was very happy that they would provide the same excessive heel coverage that Penn needs! And if there's anything to the product, they'll help increase circulation in the hoof, which won't hurt Penn at all!

More X Ray Review (last bit, I promise). I got a little focused on the P1 imbalances in Penn's front legs for a hot second, because why not? I have all these images, may as well obsess over them and do some learning. I should have had this ready for the last post, but honestly I just didn't think about it. The program that handles the x-rays and the online viewer has a measuring tool. I decided to measure how different each side of Penn's P1s are.

Right Medial: 3.96", Right Lateral: 3.74", 0.22" difference
Left Medial: 3.76", Left Lateral: 3.43", 0.33" difference

Uh, that's a big difference. I think I'm lucky to have gotten to 3rd Level with him. Apparently some difference is normal, but I don't have a value for the max of normal.

Other Medications/Supplements. As the group think tank started cranking after we got home, we figured one thing: the healing of the collateral ligaments is so low because the hoof has poor circulation. What can we do to increase the circulation in his feet? Vasodilators and blood doping techniques. Blood doping, the way it was explained to me: athletes draw an amount of blood out of their body, oxygenate it, and at least a month later after the body has replenished the blood drawn, they have the drawn blood put back in. That way they have more red cells available to carry oxygen for sporting events. That's not really an option for Penn, so we focused on the second one: vasodilators. A common drug for navicular horses is isoxsuprine hcl. I asked home vet and VEI vets if it could help him, and got the same answer from both: It probably won't help him, but it certainly won't hurt him. I did get him some, with the logic of: it's relatively cheap, it should increase blood flow to the hoof which may help, and he's got a shit ton of navicular issues so why not?

All the meds.

The other thing I did was up his CBD to 150 mg per day, 75 in the morning and 75 in the evening. It's right in the middle of the chronic pain dosage. Overkill? I donno. It was easy enough and I found someone who would split the 10lb size, which we bought on a huge discount on Black Friday. It's enough to see him through until April for a "reasonable" price and then we can reevaluate his situation. Again, it should promote healing. If it doesn't, oh well. I can truly say, I tried everything.

I also put him on OrthoPur Si from HorseTech (he's been on it for a month and a half now). HorseTech makes products like SportWerks, Hylasport, Hylasport CTS, Reitsport, etc. A farm friend and I got talking about supplements and she had really good luck with that company. She called them and together with vet information, they made up a support plan for her horse (who had a freak accident involving a porcupine of all things and shredded his suspensory). I did talk to rep from the company and gave them a detailed run down on Penn's issues, and they custom made a supplement for him and recommended OrthoPur Si as additional support since it's more bio-available than dry silica. I'm not ready to make judgement on the custom mix (which I'll probably be changing in light of his last vet visits) or the OrthoPur, so we'll see how that goes!


I found a horse I can borrow for a couple months at least while Penn's situation develops. There's more plans in the works for another horse for me, but I have to stop hemorrhaging money on Penn first. I have some other fun horsey plans scheduled for the end of January, so I'm working hard to get back into real riding shape instead of just tack walking shape!

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!

New Shoes

Life goes on, and part of Penn's rehab is "corrective" shoeing up front. It's not all that corrective, but it isn't as simple as plain shoes.

Please ask your farrier to adjust his front shoes as follows: set the shoe back to better support the caudal heels and shorten the toe. For the LF foot, we suggest an Onion style shoe, which has a wider branch at each heel region to provide a greater base of support. For the RF foot, we suggest a wider webbed medial branch and narrower lateral branch with a beveled edge at the lateral edge. This is to support the medial suspensory branch while it heals.

So red in the last light of day!

I opted not to reschedule his existing farrier appointment- he was due to be reset a week after our trip to VEI, so I let that roll and didn't take him for as many tack walks that first week.

This appointment took a long time- like 2.5 hours. My farrier has done onion shoes before, but not the shoe with widened medial branch. He did a lot of forge work- checking the fit of the shoes, going back to the forge and heating the shoe, hammering it, cooling it a little and then rechecking the fit. That on top of manually hammering out the wide parts of both shoes, and grinding the RF shoe down on the lateral branch, meant that this shoeing job took a while to do.

Luckily, out home vet was at the barn that night and was an invaluable resource. We were able to run the RF shoe by her before it was nailed to his hoof. She suggested a few changes to it, Farrier made them, she approved it, and on it went!

Barn cat Syndrome kept Penn company one evening.

It was neat to watch Penn's stance as the shoes were put on. I could tell he was instantly more comfortable because he stood squarer and more evenly on each foot. His right side that has been dramatically sunken (I had the saddle fitter out to refit his saddle because of it and she was astonished at the difference in shape because he's been very evenly muscled the entire time she's known him), and when the farrier was done, his right side had lifted up to be almost even.

There isn't much to say about a farrier appointment, so off to the shoes themselves!

Shortened toes. We're going to stick to no more than 4 week cycles to keep his toes short.

The heels of the shoe are a little further back than usual. I was told to go buy major bell boots so he doesn't accidentally rip them off.
The hole in the RF is where he stepped on himself many months ago (see below) and destroyed the coronary band, which resulted in a very deep hole. I was cleaning it every day to make sure nothing got packed in, which was annoying. Instead, I stuffed it 2 or 3 shoeing cycles ago with Keratex Hoof Putty. The putty is a little pricey but gets an A++ for longevity. I thought I would have to stuff it weekly, but I haven't had to restuff it once.

The original injury.

The LF: onion shoe
Onion shoes are wide at the end of the bar to provide heel support.

The RF: Wide medial branch that is thicker than the lateral branch, and beveled edge on the lateral edge of the lateral branch.
The vet wanted the medial branch thicker to prevent the tendons on that side from stretching as much as the ones on the lateral branch.

I took Penn for a spin after he got his new shoes, and he felt much much better. He has a habit of shuffling off the block, to the point where he looks lame. The time he spent doing that was significantly less, which was very exciting. He felt freer in his front end and shoulders and moved from collected walk to an extremely stretchy free walk easily and with continued reach and overstep.

New bell boots that will cover down to the ground and then some... they will drive me absolutely batty, but they should provide adequate coverage to keep his shoes on!

I took the pictures for the blog, but also to send to Dr Cricket at VEI. Since we had some confusion about how the RF should be set up, the farrier and I wanted to double check with her. Good news! Dr Cricket was extremely happy with the shoes. She said the onion shoe was well done, but she wants the medial branch of the RF to be even wider, and she wants the shoes set back even further to provide even more support for the heels. I told her we were doing a 4 week cycle to keep the toes short, and asked if she wanted him reset immediately or if the changes could wait. She said it was perfectly fine to wait until his next reset because these are more than adequate, so we now have a plan for the next visit!

His hips are almost even again. This is one week post-shoes, 6/20/2018. I wish I had taken pictures of him before!

His back is almost back to normal. The right side is no longer dramatically sunken.
I'm going to have to call the saddle fitter to come out and fix his new saddle! She was out for the 30 hour recheck at the end of May, and his right side had sunken so much that she had to add flocking to it... well now it needs reflocked... again. I tried to find his back tracings for this post, but I think I left them at the barn. :(
Also, I promise I'll write about his new saddle soon!

I am so grateful that there are no egos with any of his care: Home vet loves VEI and is happy to do whatever they want. Farrier is happy to do shoes the way VEI wants and is OK with me having VEI check them. Barn owner is happy to follow VEI's turnout plan and has been bringing Penn in as soon as his stall is done in the morning to get him out of the weather and bugs before he starts pacing in the dry lot, as well as keeping him in overnight when we get horrendous amounts of rain (like Wednesday afternoon and overnight). I was worried he'd lose weight in the dry lot since there's very little grass... I didn't have to worry! They throw hay to him every night, give him as much hay as he'll eat inside, and they've been liberally feeding him the Alfa-Lox I have sitting outside his stall. He's actually gotten a bit chunky! That's fine, the summer heat is coming and he'll be back to work soon enough!