Wednesday, November 19, 2008

A little poke here, and little jab there

Dr. B came out yesterday to check Kaswyn's hocks. Well, he really just came out to do a lameness exam, but I told him that I thought it was his hocks. When Dr. B does one of these exams he examines the horse while his assistant writes down any comments that Dr. B has. He started the exam by feeling Kaswyn's left front leg up and down, and found a little calcified area on the inside middle of his left front cannon bone. He commented on it, and as the assistant was writing it down I said "So what's that mean?" and he said "It means he probably hit himself while he was outside but it's all healed over. It's non reactive." He checked the neuroectomy site on the left front and found that to be non reactive also. Then he picked up the leg and brought the heel up so that it was touching Kaswyn's elbow, and said that was normal.

He repeated his exam on the right leg and found nothing. The he palpated the muscles down his back and found him very slightly sore but nothing to worry about. Then he checked Kaswyn's stifles by pushing on one hip sideways while pulling his tail in the other direction, kind of rocking back and forth. Then he said "Stifle laxity, zero." which means that Kaswyn's stifles are nice and tight as they should be. Dr. B then began just above the hock and felt all the way down Kaswyn's right hind, and when he got to the hoof he came back up and put pressure on a ligament just lower than the hock and to the inside of the leg. Kaswyn picked up his leg and brought it out away from his body. Dr. B said "Churchill positive."

I knew from watching him examine Kaswyn and other horses that a positive Churchill meant hock pain. The test involves pressing on a ligament that will put pressure on the two lower joints of the hock. So I said "Hocks, right?" and he said "Oh yeah, but I want to flex him too." He repeated the leg palpation on the left hind, with the same result.

Then he asked me to lunge Kaswyn, and when he started trotting he said "Yeah, he's stabbing behind." Then I said "Yes, but I'll bet this is the most sound you've ever seen this horse move up front." and he said ""No doubt about that, but now we gotta come over here and do this.." and he went over to the wall and knocked wood. Indeed, let's knock wood on that one!

Then he did a flex test, and pointed out that when Kaswyn trotted away from us after the hind legs were flexed that he could see a hip hike upwards in his stride. He asked which way he felt better, and I said "Well, he usually feels better on the right, but lately he's been feeling better on the left." and he said "Uh huh." To which I said "So the left is worse than the right?" and he said "You got it."

We discussed x-rays, but he said regardless of what he saw on the x-rays his diagnosis and treatment would not change, but if I wanted pictures he would take them. I said no, not if he didn't think it was necessary, and he said "If it were me I'd just save my money and not get x-rays." Sounded good to me, so we just went with his diagnosis, which was that Kaswyn's hocks were sore.

This is not surprising to me, and I figured he would want to inject them. I said that he had injected Kaswyn's hocks a year ago, and Dr. B said that was a long amount of time for injections to last, so it was good. I decided to go ahead and inject both hocks.

I told him that I had given him a Legend shot a few weeks ago, and he asked why Legend and not Adequan. I said because Dr. G told me to use Legend. Dr. B told me that he'd have picked Adequan between the two, but recently he's had quite a bit of success with polyglycan, which he says is Legend and Adequan both in one shot. The Legend increases synovial joint fluid viscosity and decreases inflammation, while Adequan gives support to the cartilage and decreases inflammation. However there has been quite a lot of discussion on some boards about Legend and Adequan versus ployglycan. Some people, including Dr. B, have had great success with it but it's not meant as an IV injectable for joint treatment. It's intended FDA approved use is for wound and joint flushing during surgeries. It's cheaper than Legend or Adequan, but independent studies (ie one does by the company that produces Adequan) show that while plyglycan had some benefits it's not as powerful or effective as Adequan. The same probably holds true for Legend but I've not seen results there.

Anyway, I have a five dose vial of Legend coming my way, so I will use that for the next five months and see how things go. Dr. B thinks that Legend is fine to use and that it will probably help increase the amount of time between hock injections.

Dr. B thinks hock injections get a bad rap, but that they really cut down on the damage done to the joint in training. Sure, you can cut down on that damage by not riding and training, but then you have a horse that doesn't have a job. Dr. B says that complications are rare, and for the most part it's a very effective and useful treatment. Since I trust my vet, I trust that he knows what is best for my horse considering his showing and training career. I also trust Dr. B to do the procedure with a high amount of skill, since he has done so many successfully. I asked if he thought Kaswyn had extensive damage in the joint, and he said "No, not at all. He just looks like many other dressage horses that I've seen. I wouldn't even call him lame. I'd say he has a 'gait deficit', but not a lameness."

So Dr. B deftly injected the lower two joints of Kaswyn's hocks, and told me to give him two grams of bute per day for three days, and hand walking only for three days. Then he wants me to ride him lightly at the walk and trot on Saturday, and walk trot and canter on Sunday. Monday he'll get off, and then it's back to business as usual on Tuesday.

While this all sounds great, I have two negative things on my mind. First, I just paid off my vet bill before this last visit. Ugh. And I forgot to have him pull a Coggins test while he was there, do I'll have to call him out again at some point. Secondly, I got in a car accident on Monday. Some guy slid on the ice and rear ended me. He wasn't going that fast, but it caved in my bumper and bent his up too. I thought I was okay, but tonight I'm starting to get pain in my neck and up into my head. Less than two weeks ago I had sent in the last payment for my car. Groovy, huh?

That's right. Pay off my vet bill, then call the vet out for an expensive procedure. Then pay off my car, and get in an accident. What I think I can learn from this is that whether it's got four legs or four wheels, it's going to cost ya.

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