Friday, May 8, 2020

Blunt Force Trauma

When the vet asked me “can you trust him not to be an idiot in turnout?” I nearly laughed in his face. I can’t trust Eeyore not to be an idiot in his stall, in turn out, under saddle, heck he will even be an idiot across the Rainbow Bridge. It’s who he is.

https://drive.google.com/uc?export=view&id=1pWUwAqIhC0wcOvxiuc-OoKy7tUHdvYQB
Case in point. He was fully intact at 7 am when put into the Fat Pasture after breakfast. At 735 am I saw this when I went to load him in the trailer. He can’t even behave for 20 minutes!

But I need to back up, don’t I?

Eeyore had his 6th non routine vet visit of 2020 today. I didn’t sleep well last night. I was really worried about what the results would be and that it would be career ending before we really even got a chance to start. 

Not knowing how much face to face time I was going to get with the Vet, I wrote down a time line starting exactly 1 month ago on April 8th with the left front leg spider bite and detailing all the treatments up to Friday including the xrays and US a week prior. He probably thought I was psycho but I really needed him to get the full picture and I didn’t trust that the entire lengthy tale would get translated well from the tech. 

He came out after a quick exam to talk to me before putting Eeyore on the lunge in the arena. I must say that my experience at this vet during COVID was far superior to my previous one where they whisked him off out of sight and yelled at me across the driveway. I never saw the studies or got to watch him trot. 

https://drive.google.com/uc?export=view&id=1ow-KOGtjzv8AuE2HH6P23VD8NWu4HBla
Eeyore got a Cush stall with a view and had his head happily hanging out until he saw me sitting on the picnic bench beside it. Then he sulked while glaring at me like this was all my fault. 

This time the vet included me as much as possible including during trot outs and even showed me the US images. Anyway.... Eeyore was 2/5 lame on the right front on the circle and this increased to a 3/5 on the gravel straight line. 

This made the vet go “hmmm..this just got interesting”

My professional mantra that I tell patients daily is that you never want to be interesting in medicine. Text book all the way. 

He had put hoof testers on him during the exam in the barn and said he wasn’t reactive but the worsening on gravel shouldn’t be from the fetlock. He then proceeded to block just the heel and try again. An interesting fact: horses will offload the painful area much like humans which for Eeyore would be loading the outside hoof more to avoid the painful inside. Once blocked they can’t do this so if it was the fetlock alone he should get worse with the heel block. 

He was 90% improved. “Huh”.

His fetlock was still swollen focally to the posterior medial aspect so an US was in order regardless, but the recommendation here was to go back to front pads to help his heel pain. That should get him mostly sound again. But onto the US....

https://drive.google.com/uc?export=view&id=1Cv63w5vHfP3LEL-Gg9efR77Q4YVBy6F3
The annular ligament in cross section. Inferior edge of the ligament is at the top of the image just below the black line. If you look to the right of the mouse pointer you see healthy, intact annular ligament in white. The mouse is pointing T the black central hole on the ligament. It’s supposed to be white all the way from right to left. 

I got to see the images and go through them all with the vet this time which was enlightening. The good news first: all suspensory branches, bone interfaces and the main body are fine. There is evidence that he had a tear of the medial branch at some point (because of course he did) but it’s fully healed and no issue now. The tendons are all normal. No signs of abscess. 

The bad news: he tore the superior medial aspect of the annular ligament. 

https://drive.google.com/uc?export=view&id=1uzITA7qEV28jMTOtmXB3C2W_1R4gjq6c
Another view though in a different plane. The pointer is on the tendon that lives behind the ligament. Just above that is a black ellipse (sorta looks like a closed eye with long lashes to me). This is the suspected point of impact of whatever he hit himself with. 

My first question was “what did I do to cause this?” To which he responded “nothing. It’s caused by blunt force trauma to the back of the leg”

Because of course it is. Only my idiot horse would somehow have blunt force trauma to the back of his leg outside in a 15 acre open field. Of course. 

Of note, the vet’s personal horse did something similar only to a more severe extent by sticking his leg through a gate and pulling back. So he had personal experience along with his medical knowledge on this one. 

https://drive.google.com/uc?export=view&id=1aG_r21zbCbHiIABnKqRK6wh85A_-W9oA
All bandaged up and ready to face the next 30 days

There is some good news still mixed in with some bad. The annular ligament takes a long time to heal but is easier than a suspensory plus he has only a partial tear of one small area so it isn’t at risk to blow apart. The main risk at the moment is two fold: 1) reinjury caused by another blow to the area which can turn it into a full rupture and 2) compartment syndrome if we don’t get the swelling down as the tendons lay right behind the annular ligament and swelling can constrict them resulting in the need for surgery. 

The plan is stall rest not because he isn’t allowed to move, on the contrary he is allowed a lot more movement than I had anticiapted though I will get to that shortly, but to prevent any re injury to the site while it heals. Hence the question of trusting him not to be an idiot in turn out. If he was like Gem, he could be in the Fat Pasture but no. I most certainly do not trust him. 

He can have hand walks and hand grazing to my hearts content. I can also tack walk him all I want even on a trail if it is flat and even. The motion won’t harm it, but any more trauma to the area such as a hind hoof kicking it, will set us back to square one or even worse. With that in mind he needs to remain in a standing wrap at rest and in either polos or a protective boot when in work. 

https://drive.google.com/uc?export=view&id=1xNgDZok2dZl8hd8rjDs_8KKXhWOLUl4r
Even better news? This allowed for a guilt free trip to the tack store to get supplies. I had stopped by Trainers barn on my way home to discuss things with her. I asked what her favorite leg boot is and this is it mostly. She likes the older Woof Boots with four narrow straps versus two wide ones but I couldn’t find those. 

He is against NSAIDs as they slow healing down but did recommend a class IV laser which will penetrate to the annular ligament due to it being more superficial than the suspensory. Both the Hubby and I have a class IV laser at our respective offices (recall the other vet said it wouldn’t be useful when thinking this could be a suspensory) so he will be bringing his home for me to use three times a week since his has animal settings and mine human. 

We will recheck with another US in 4 weeks. If things look good, we can start short trot sets then and work our way up from there. Vet is hopeful we can begin cantering again in 4 months and jumping in 6. Stall rest anywhere from 3-5 months though if it is going well I can make a small paddock for him in 30 days. 

Not the best news, but not the worst either. Honestly I’m just super relieved I didn’t cause this while riding and he did it to his own darn self. I’m also glad that I can tack walk him as much as I want. While walking under saddle isn’t as thrilling as jumping, there is still a lot you can work on at the walk and he didn’t limit me to hacking only. I’m free to work on collection and figures and the like at the walk. I could even take a walk only lesson if I felt like spending the money to do so. 

I don’t though. I’ll be riding Trainer’s horses and working on me for the next several months while walking with Eeyore at home so he gets movement. It may end up working out pretty well by the end of all this and it’s not like we had any grand show plans even if there were still shows. So again, not the worst news ever. I still have my Big Orange Doofus ears time look through even if at a more sedate pace. 

15 comments:

  1. Wow what an update. Obviously not the one you were hoping for, but not a terrible one either! Glad this vet was able to really get to the bottom of the issue and get you some answers. Now Eeyore just needs to GET WITH THE PROGRAM. haha.

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    1. It is better than a suspensory but not the answer I was hoping for. I'm not sure he will ever get with the program. He has zero self preservation skills and will likely kill himself in the pasture doing something dumb one of these days

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  2. Glad you got resolution and a plan!

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  3. I am so glad that you have an answer. And a plan. Plan are good.

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    1. He is responding really well so far and I'm really hopeful

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  4. Glad you found out something. Padded stall he is in for the rest of his life but glad you can ride him!! I have a set of Magyk Equipe boots if you are interested in borrowing them for a while I NEVER USE THEM.

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    1. I'll shoot you an email!! Thank you so much!

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  5. ugh there is so so so much about this that just feels.... unfair. ugh. i'm sorry. fingers crossed that recovery is smooth.... but damn :(

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    1. After 2 laser treatments his leg is nearly normal and the big man is feeling good so I am really hopeful that this goes ok.

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  6. I am so glad you have an answer, even if it's not a very good one. At least it sounds fairly straight forward and you should be back to it in no time, and at least he has done it while there is nothing fun to look forward to as well!

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    1. That was what I said to the vet: at least there aren't any shows right now. But we were just getting to a really great spot in our dressage work too. I feel like we will be starting all over again

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  7. Hopefully it heals well - at least you know exactly what is going on and have a treatment plan. It totally sucks, but fingers crossed he recovers 100%

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    1. Thank you. It could always be worse I suppose and I am glad it wasn't the suspensory, but come on Eeyore. Throw me a bone here

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  8. Oh FFS, Eeyore. Only you. Only you.

    Sara, I'm glad you have answers. I'm sorry he's so difficult!

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