Here is my wonderful boy, waiting for the nerve block on his left front foot to take affect.
After 15 minutes we went back out and did another flex test of the left front leg. First Kaswyn was just trotted up and back on the pavement, and you can hear Doc saying "It's to help him get used to the block." And then he says "Looks pretty good, doesn't it?"
Yes sir, it does look good.
Then the flex test of the left front. Negative.
Finally, lunging.
Clearly we had pain relief with the low block of the left front foot. So the next order of business was to get x-rays of the suspicious area. Kaswyn was very cooperative and stood still for the x-rays. The didn't even have to give him a tranquilizer. Such a good boy.
To get the most out of the x-rays, it's helpful to be able to compare them with older images so you can have some idea of how the structures have changed over a certain amount of time. Fortunately my horse has tons of images of the left front foot from several different years, so Doc was able to compare the images from 2006 to the ones that we took that day. Kaswyn definitely had changes in his foot in the last four years. Dr G was kind enough to let me video him while he did the x-ray analysis, which is awesome. This man blows me away.
When I rode Kaswyn on Thursday night, I knew something he was very off. Susan happened to be at the barn and said that it looked like he was lame in the left front leg. Now, you're probably wondering why I would ride him on Thursday if I was already planning on taking him to the vet on Friday. Well, Dr. G has told me in the past that when we are trying to diagnose a lameness by treating certain parts, like injecting the hocks, that I should keep Kaswyn working so that whatever still hurts him will hurt him while he's at the vet. If I completely lay him off, then he might get a little better and then we have nothing to go on at the vets. It's hard to diagnose lameness if the horse is not lame!
So my friend Z trailered Kaswyn and I over to the new vet clinic. Dr. G had been in the same small location for years, but has now partnered with many equine vets for form a fantastic team of horse health professionals. They had been working out of two locations, but then they built an outpatient clinic for Dr. G at the big clinic. It's a really nice place!
We arrived at the clinic and put Kaswyn in a stall to wait our turn to see Dr. G. On the wall of the lobby is a very nice photo of Dr. G. He's doing an ultrasound on a horses leg, and you can tell by the machine just how old the photo is.
The first order of business with Kaswyn was to do a lameness exam. First Dr. G examined his legs and palpated them. I wish I had thought to video that part, but I forgot! After the exam came the flex tests. With a flex test the vet holds the foot in the air, hyperflexing all the joints in the leg and then the horse is trotted to see if the horse is exhibiting lameness in that leg or not.
Here is a video of the initial trot, then flexing of the left front leg. I didn't get the correct angle on this so you can't really see how lame he is. But he comes up positive for lameness. Remember, this is the leg where Kaswyn had navicular problems, was nerved, and then had a splint bone injury.
Flex test of the left hind. Negative
Flex test of the right hind. Also negative. Between the tests Dr. G told me that he has never seen this horse travel so well behind. That made me feel good about injecting the hocks.
Finally, flex test of the right front. Negative!
Next up was to lunge him to find out if he was more lame trotting in one direction or the other. Here is video of the lunging. Kaswyn is clearly lame on the left front leg, more to the left than to the right.
So the next step was to nerve block the leg to find out where the pain was. So Dr. G started at the bottom with a low block, with the plan being to work his way up the leg until Kaswyn was sound. Dr. G actually blocked the foot below where Kaswyn was nerved, just in case the lameness was due to auxiliary nerves that may be growing back and providing some feeling in the foot.
Kaswyn was brought back into the exam room and his leg was shaved and scrubbed. Then Dr. G injected Carbocaine (a local anesthetic) low in the back of his pasterns. This should have blocked out any pain in the foot. You can see the injection sites in the picture, because they made big red welts on his skin.
Then we waited about 15 minutes for the block to work, and took him back out for flex test and lunging.
I rode Kaswyn Tuesday night, and he's just not right. He's not lame, but he just doesn't feel right. Again. So, while I can't say the hock injections were a total failure because they probably made him feel better, they didn't solve the problem. Again.
As a result, on Friday I'm having a friend come pick us up and take us to see Dr. G. I think it is time for x-rays. Maybe all that running the fenceline in the pasture did something more serious than just strain his hocks.
This really sucks badly. He was going really well, and now this. I know I could eliminate a lot of the potential for injury by not putting him outside, but I would hate for him to live like that. So outside he will go, and act like a horse.
As usual when Kaswyn is off, I'm contemplating our future. We've always come though these times and been fine, but each time I'm scared of the one time when we don't make it. That will be the last time.
Today I took advantage of Susan being at the barn, and used her to videotape the riding activities of the day.
Macey came out with me to ride. I asked Lily if she wanted to come out too, but she didn't. I think she is not going to be a rider. Every time we go to the barn she complains that it smells bad. And then when I come home from the barn she says "Mama! You smell like horse! Ewww!" Yep, definitely NOT a horse girl. Ah well, maybe she'll come around in a few years.
Today, Macey was first in the saddle on Albert. Everything was going well, and she was trotting on the lunge line, when she said she wanted to canter. I said she could not do that until she got really good at trotting, and she begged me. So I got on Albert with her, bareback, and we cantered. We tried it with a saddle, but I kept sliding forward and pushing her up onto the pommel. Then she was saying "Ow! Ow!" because her poor little lady parts were banging on the saddle. The bareback pad took care of that issue.
And Albert was such a good boy! He was a little concerned about what was going on, but still did what I asked of him. Such a star!
Then I got on Kaswyn, and had Susan shoot video of him each direction. I think he looks pretty good. He still looks weak in the haunches, but at least his energy level has returned and the right lead canter feels better.
Unfortunately, as you can hear in the background, Macey was ready to go home. If she's not actually riding, she gets bored. Usually I don't bring her to the barn with me when I'm going to ride Kaswyn, but last time I brought her bubbles with us and she happily blew bubbles while I rode. This time the bubbles didn't do the trick, and that kid whined through the whole video. It was hard for me to concentrate on riding while she was carrying on. Also, you get to hear my "Mom" voice in the video. Little booger knew I was on a horse and I couldn't get off to put her in time out.
But sit in time out, she did. As soon as I got off of Kaswyn (her tantrum was still in full swing) I made her sit in time out on an overturned bucket in the tack room until she calmed herself down. Even though she was ready to go home and was throwing a fit, I still did all the barn chores that needed doing instead of just grabbing her and leaving. I put stuff away. I swept the aisle. I cleaned tack. I didn't want her to think that she could just throw a fit and we'd leave. I also wanted her to realize that going to the barn means more than just riding. There are other responsibilities, and we weren't going to ignore them because she wanted to go home.
So in Macey's video, she's all smiles and laughs. In my video, it's one big fit. Poor Macey. Sometimes it's really hard being four years old.
After two mesotherapy treatments and four days of topical anti-inflammatories, it was time for the final vet visit to see if we had solved the problem of Kaswyn's "lameness." I put that in quotes, because he was never really lame, but just not quite right. For two weeks in February Kaswyn was a dingbat and ran the fence line when it was time to come in from the pasture. All the running and sudden turning probably did a number on his hocks, which eventually translated to back pain. The vet came out last night to see our progress.
First, Dr. C asked me to ride Kaswyn to see how I thought he felt. He looked and felt fine, he just didn't want to work. On any other horse I'd say it's just laziness, but with Kaswyn I always have to wonder what else is going on since he's usually quite happy to work. Dr. C and I discussed what his problem could be. He felt a little lazy Tuesday also, and we stopped the treatment with the Surpass anti-inflammatory cream on his hocks on Sunday. That means his hocks could still be bothering him.
Then I took off Kaswyns tack and Dr. C checked his back. The back is totally healed and pain free, but Kaswyn still had pain down over the back of his right haunch. Dr. C said it all pointed towards pain in the hocks. Then I started thinking about Kaswyn's past, and asked if it were possible that Kaswyn actually had re-injured his left front and that it was showing up in the right hind.
So we went back out into the arena and did a flex test. Left front - slightly positive. Right rear - positive. Right front - negative. Right rear - positive.
The discussion began again - what could this be? The back was fine, there was no swelling anywhere, all signs were pointing to the hocks. Dr. C said we could go with bute and Surpass cream for a week and see if that took care of the problem. I asked him what the chances were that it would do the job, and he said "Very little."
Dr. C thinks that the running back and forth in the pasture, with the spinning and sudden changes of direction, really did his hocks in. He admits that his hocks probably had some kind of mild inflammation before then, but that his escapades of running the fence put the hocks over the edge and set them up with a good amount of inflammation.
I had to have a hard think about what to do next. I didn't want to inject the hocks again unless I felt it was certain to help. The three other times we injected the hocks we did it because we didn't know what else would help. Due to Kaswyn's age (19) and the fact that he's been in pretty heavy dressage training for most of his life, his hocks have probably taken on a lot of wear and tear. So most vets would point to the hock first. In Kaswyn's case, injecting the hocks has never solved the problem. It might have taken pain away from the hocks so that we could finally pinpoint the real reason for the lameness, but it never solved the problem. That's why I've been resistant about injecting the hocks again.
This time, here is what we are working with. Kaswyn had pain in his back and down over the back of his right side rump, usually an indication of hock soreness. We solved the back pain, but were left with soreness in the right side rump. The Surpass anti-inflammatory cream on his hocks made him sound to ride, but didn't remove the soreness. Stopping the Surpass might have made the hocks sore again, thus making him lazy the last two times I rode.
So this time, we've solved everything else and we are left with the hocks. I took a hard look at my horse. He looked fine. But I know that he is very stoic about his pain. And he really wants to work, and make me happy. He manages his pain very well in order to keep working, which is why he gets pain all over from all of the compensating he does. And even with no work, his hocks could be in constant pain just standing in his stall. I couldn't do that to him.
"Okay." I said "Inject them."
When Dr. C stuck the needle in the first joint on the left hock, thin bloody fluid began to leak out. This is not good, for three reasons -
1) The fact that there was enough fluid to leak out says that there is excess fluid in the joint cavity because of inflammation. 2) The fluid was thin, indicating that the fluid being produced, which is thick at first, is being broken down my the inflammatory factors in the joint. 3) There was blood in the fluid, indicating the the body is increasing blood flow to the area in order to deal with the excess inflammation.
Kaswyn has never had lots of thin, bloody hock fluid before.
So this confirms that this was the right thing to do. The injection will stop the inflammation, replace the joint fluid with good, thick fluid, and hopefully make the joint feel better. And make Kaswyn feel better.
For once, I think I made the right decision to inject the hocks. Only time will tell though.
One of my blog readers commented that I must be sick of Kaswyn getting hurt. Yes, I certainly am. But there is an upside to this. I've learned more about horse lameness, and new techniques for treating it, in the past five years than I have in the 25 years before that since I started riding. Well, at least there IS an upside, because it's not the vet bill!
Yesterday I had two wonderful rides on the ponies.
Albert was first and he was very good. He is still shedding so he had a lot of hair, and with it being warmer out he got pretty sweaty before we had even done much. The trot work is really very nice but I need some help with the canter. He is still bearing down on the bit, especially in the right lead canter. I can get him sitting a bit more in the left lead canter, but he has a hard time holding it. I can understand that he needs to build those carrying muscles, but to the right I think he's crooked and that makes it harder for him to sit and push behind.
Before I rode Kaswyn I checked his back and haunches and couldn't find any soreness. Yippee! He felt fine when I rode him but he was also a little lazy. That, of course, makes me nervous. I decided to just go 15 minutes with him, just in case the laziness was a result of some discomfort that he was feeling somewhere. There was no soreness after the ride, so that's a good thing.
Tomorrow Dr. C will come out again and check Kaswyn. I'm predicting there will be no needles - not in his back or in his hocks. I hope I'm right.
Yesterday I went out to ride Kaswyn. After I groomed him I checked his back and his haunches. His back didn't seem sore at all, but he was sore over the back of the right side of his haunches. The left side wasn't sore at all, which is very good.
When I started riding him at the walk he felt very stiff legged. It almost felt like he was walking very wide behind and not bending his hocks. But after a few minutes he seemed to warm up and was walking normally. He felt very good for the rest of the ride, with no funny steps or funky canter strides.
After the ride I checked his back and haunches again. He still had no soreness in the back or left side of his haunches, but the good news is that he was no longer sore over the right haunch. This makes me very happy!
So it would appear that Dr C is on the right track with the Surpass on the hocks. Since I saw improvement after just two days of Surpass, I'm thinking that I will not want to inject the hocks on Thursday. Of course I will ride again on Tuesday, and Kaswyn might be more sore on Thursday when Dr. C comes out again. But I'd rather take it slow and use the Surpass for a few weeks than go into those hocks again.
I think this injury is not as bad this time as his other injuries, mainly because I called out the vet as soon as I didn't like what I was feeling when I rode. Other times I just chalked it up to Kaswyn's funny way of moving sometimes. Now I realize that if he's moving funny, there is probably something going on that needs to be assessed.
So another ride on Tuesday, and a possible lesson on Albert (if working late doesn't get in the way). For Thursday's vet visit, I've got it in my head - no hock injections!
Dr. C came out yesterday and evaluated Kaswyn again. Unfortunately Kaswyn was still very sore over his haunches (what Dr. C called his whorl bones), although his back was better. He had me ride him and then checked him again. His back was even better after my ride, but his haunches were still sore.
He suggested another mesotherapy treatment, saying that we didn't get the dramatic improvement in his soreness that we got from the first treatment last time. While he was prepping the medications I thought about how Kaswyn had been running the fenceline at turnout for at least two weeks. Dr. C was interested in this, and I described how Kaswyn was running down the fence, stopping, spinning on his hind legs, and running back up the fence. I said "When I saw what he was doing I asked them to change the turnout situation because I was afraid he was going to hurt himself." Dr. C said "Well, I think he did hurt himself."
Dr. C said he suspects that Kaswyn strained his hocks and might be carrying inflammation there. Pain in his hocks would cause Kaswyn to not bend the joints, which would result in the stabbing motion we're seeing in the right hind leg. This stabbing movement makes the muscles that are behind the hip bones very sore. Normally he would just inject the hocks, but knowing Kaswyn's history he wants to try and decrease the inflammation with topical Surpass cream first. So Kaswyn got mesotherapy yesterday, another shot of Polyglycan, and topical Surpass twice a day on both hocks for four days.
I'll ride Kaswyn tomorrow, then again on Tuesday. Then Dr. C comes out again on Thursday. If Kaswyn's haunches are still sore, then Dr. C is going to want to inject the hocks. I'm not sure how I feel about this. Kaswyn's not really lame, but it is evident that his haunches are sore. Dr. C said "He's at about 90% right now, so you'd be injecting the hocks to get that last 10%. The question is, is that worth it?"
I don't know. I'll just have to think about it. Would time off make it better? Or should I just inject?
I think Kaswyn's back feels better since the mesotherapy treatment. I rode him on Monday and he felt good, and yesterday I lunged him and he looked good. He had tons of energy too. That might be because it's finally getting warm outside and he's feeling very springy!
Dr. C will come back out tomorrow, and I'll ride Kaswyn for him. Then Dr. C will check his back again to see if riding him made his back hurt. I'm a little concerned that the saddle is bothering his back, but I have had both the vet and the very experienced saddle fitter check it for me, and both said that the saddle was fine.
The one thing I might change is the gel pad I'm using. It's a bit small for the saddle, in that I think the gel pad should be bigger than the footprint of the saddle on his back by at least three or four inches on the sides. My gel pad is actually about an inch too small on either side of the saddle. So that might be causing a problem. I just need to find a gel pad big enough for the panels of the saddle. They are kind of big and wide so that the saddle can distribute the weight of the rider better.
Hopefully Dr. C will say that Kaswyn doesn't need another treatment. I hope I'll get to ride Albert Friday too. I've been short on time lately and he's been getting the short end of the stick. Not that he minds - he's been rolling in the mud like crazy and is currently crusted on both sides with that stinky pasture mud. Now that it's warm I predict lots of baths in his future, and he hates the wash rack! Poor Albert!
Sheri Israel is Dressage Mom. I'm a wife and mother struggling with health issues. I don't ride anymore. And I'm not sure what my horse future looks like. Stay tuned...
