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!