Monday, December 17, 2007

In hock

With all the Deleted Post drama I neglected to write that Kaswyn was very short on his left front when I rode on Thursday. Dr. B already had an appointment to see another horse at our barn yesterday, so we added Kaswyn to the list.

In a rare turn of events, Dr. B came to the barn hours early because of many cancellations in his schedule due to the weather. My trainer called me to tell me he'd be there early, so I finished my work as soon as I could and headed out to the barn. He had already examined Kaswyn by the time I had gotten there, and was preparing to ultrasound the other horse. While that horse was getting clipped and prepped for the procedure I was able to chat with Dr. B and my trainer about Kaswyn.

My thought going into this vet visit was to find out if this left front splint injury was ever going to heal. I wanted a straightforward answer from Dr. B as to whether he thought Kaswyn would ever heal or be sound on that leg or not. Because if it's a lost cause I'll stop trying to make it better and just retire Kaswyn. It's not what I want to do, but I'll do it if it's the best thing to do.

Dr. B's thought before he examined Kaswyn was that he wanted to confirm that we were seeing lameness associated with the old injury and not something new. He planned to nerve block up the leg in steps until Kaswyn went sound. However, lunging and flex tests showed no lameness in the front legs at all. In fact, Dr. B said that it was the best he'd ever seen my horse move in front.

The back end was another story. Kaswyn was definitely flexing positive for hock problems, with the left hind being just a little worse. This wasn't surprising, considering his age and discipline. One of the main causes of lameness in dressage horses is hock problems due to the fact that dressage horses are asked to put so much weight and stress on the hocks. And since he's been doing dressage for 12 years he's had a lot of stress put on those hocks. Dr. B said it's not terrible, and that Kaswyn isn't what he'd call lame, but he wasn't perfect. He didn't think there was any damage to the joints since this just started. He said I could get x-rays if I wanted, but that it wouldn't change his diagnosis or his suggested course of action, because he was pretty sure that we'd see very little change in the joints if we saw anything at all.

The conclusion was that the hock issue has probably been building for years, but that this last injury to the left front has made Kaswyn put more weight than usual behind. The concern now is that if Kaswyn's hocks hurt that he might put too much weight in front and either continue to injure the left front, or at the very least hinder it's healing.

Dr. B was actually thrilled that it was his hocks. "Hocks I can fix! That's easy!" I knew what his suggestion would be before he even said it - inject the hocks with hyaluronic acid and cortisone. The hyaluronic acid is basically what the joint fluid is, and the cortisone is to help heal any inflammation of the joint. Some dressage horses have their hocks injected two or three times a year just to keep them comfortable. There is a common thought that once you start injecting the hocks that you have to inject more and more often.

I asked Dr. B about this, and here is what he said -

Take horses A and B, both are clones of each other. Horse A is worked until he has a problem, and is injected. He has a week or two of light work and then goes back to work. Every now and then he has to be reinjected, but his time off is less and the joint is saved because the injection keeps it from degenerating. Horse B is not injected, and when it has lameness issues it needs months off to heal. Eventually the joint gets big as the horse lays down bone in response to the stress. Horse B eventually goes back to work but has to keep having long periods of time off when the joint becomes painful. Both horses will probably reach the same end potential, but the joints on horse B are big, ugly, and have more damage. His thought - better to inject.

Armed with this information, I asked Dr. B the big question - is the left front going to heal or is injecting the hocks a useless exercise? He smiled, looked at me and said "Well, he was totally sound on that leg today. So I'd have to say that the prognosis is very good for him to heal completely."

That sounded good to me. So we injected the hocks. The hocks have four joints in them, with the upper two being very movable joints (like your knee) and the lower two not being flexing joints but more like spaces between joints that move a little but mostly provide cushioning. The last time that Kaswyn had his hocks injected (my calendar said April 24 of 2006, just in case you're interested) he had all four joints done in both hocks. Dr. B said he only wanted to do the lowest two. He said the top two weren't causing him a problem so it wasn't necessary.

Kaswyn was doped up, scrubbed up, and Dr. B injected the left hind first. In both joints he first aspirated the needle to see how much fluid was in the joint. Both joints were dry and had no fluid. This is not very good, so it's no wonder that his joints were bothering him. After the aspiration he injected the hyaluronic acid and cortisone. The lower joint on the right hind was the only joint that had fluid in it. As I recall, all four of those joints had at least a bit of fluid in them the last time they were injected. So I see this as a good thing to have done, as it will heal his joints and prevent damage by providing fluid in those joints.

So now it's hand walk (oh how we LOVE to hand walk!) for two days, no turnout (which makes the hand walking SO MUCH more fun!), turnout and light ride on Thursday, and back to work on Friday. I'm sure this will help.

And what about that left front? Dr. B says call him if he goes lame on it again. Then we can block it for an accurate diagnosis. But he said "He's gotta be lame next time or that won't work!"

Makes sense to me.

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