Thursday, June 15, 2006

Nerve block

Dr. B came out to see my horse yesterday. I had never met him before, so it was kind of like a blind date. We were "set up" by Dr. G., whom I trust completely, but you just never know. Instead of worrying if he's ugly or smelly like you would on a real blind date, I was wondering if he dumb or dismissive. Fortunately, Dr. B. was great. He was friendly and cheerful, and had already had an intensive meeting with Dr. G. concerning Kaswyn. They went over his file and discussed the x-rays, and Dr. G. told Dr. B. what he thought the courses of treatment should be depending on what we found out.

First Dr.B. examined Kaswyn in the stall, checking all his legs and back. Then he asked to see him walk and trot on the longe line. Immediately he said he saw that Kaswyn was taking a short stride with his left front leg, which we kind of already knew. Then I got on Kaswyn and rode both directions at the walk and trot. He saw the same thing, but also commented that he was short on the left hind as well. Then my trainer hopped on him so that I could watch him trot and Dr.B. could show me what he saw.

Then Dr. B. says "Okay, so now we need to do a nerve block on the left front foot to make sure that he has pain there." The idea being that he'd block the foot, I'd get back on and ride, and we'd either see an improvement if that's where the pain is, or no improvement if not. Usually when you start jabbing needles in horse's legs you want them nice and sleepy, so you give them a shot of tranquilizer first. But since I was going to ride, and since the tranquilizer would make him feel good all over, that wasn't an option. I asked "So, how are you going to do this then?" and he said "We just do it and hope he's good." As in, hope he doesn't try and kill us all when he gets a needle jabbed deep into his ankle.

Horses are big. Most of the time if a vet wants to find out how much a horse weighs they use this measuring tape and measure around their bellies. The tape is marked off with approximate weights. Kaswyn taped at 900 pounds at Dr.G's last time. But when he was at Ohio State Veterinary Hospital for skin testing (another story for another time) they have a huge scale that is built into the floor which weighed him at 1200 pounds. So the tape is off. Anyway, 900 or 1200, that is a lot of animal to deal with if it's pissed. Now, Kaswyn is a wonderful horse, and usually doesn't do anything stupid. But if he were to rear when this guy poked him, I wouldn't blame him.

Dr.B. loaded up the shot. I grabbed Kaswyn's halter. Dr. B. picked up the left front, got the needle ready, looked up at Kaswyn and said "I love ya, buddy" and started stabbing. Kaswyn didn't even move. Didn't jerk his leg, toss his head, swish his tail, nothing. Such a good boy. Then it occured to me that maybe his foot hurt so badly that a little needle stick was nothing. Boy did that make me feel shitty.

So we waited ten minutes for the shots to work, then my trainer hopped on him. Big difference. He was much better up front. Then I hopped on and I could definately feel a big change. I was convinced, as we all were, that the left front is without a doubt causing him pain. We put him away and started discussing what to do next. And here is what Dr.B. says. Of the two problems in the left front - the cyst and the bone spur that's torn away from the navicular bone by the deep digital flexor tendon (which is called an avulsion) - we don't know which one is the cause of the pain. This makes treatment difficult, because if the bone spur is rubbing on the tendon it could be doing damage if the horse is put on medication and worked. The medication would make him feel better, but he would continue to do damage and would evenutally be very lame indeed, possibly irreversibly. Time off would probably help with the cyst if it's active, but would not be necessary if the cyst is not filled with fluid or inflamed. The x-rays don't tell us the status of either problem, they just show that they exist. So the plan is to get an MRI of the foot and go from there. If the bone spur is causing damage or a lesion on the tendon, we might be able to remove the spur and, hopefully, solve the problem. If it looks like it's the cyst causing the pain, he would need stall rest, time off, and medication.

Dr. B. also said that the back and the left hind leg would probably get much better when the left front problem is resolved, but he does suspect that he won't be 100% in either area. He may need to inject the back to help it heal, and inject the hocks again. But we need to deal with the left front first.

So this all sounds like not very good news. But I have to say that I'm okay with it all. At least there is a plan, and the MRI should answer all of our questions about the left front. Until the MRI Kaswyn is getting pain meds and daily walks - no riding and no work. It will be hard on us both, since he does enjoy his work. At least he'll get lots of extra carrots.

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