Friday, February 13, 2015

Discharge Papers

They are finally here!!!

History: SPYDER is a lovely 8 year old Standardbred that presented for re-evaluation of right front check ligament injury. Since the last examination, he is confined to a stall and small paddock. He is walked for 45 minutes daily. Intermittent tendon sheath effusion has been noted.

Clinical Examination: The gelding was in general good health. Mild carpal sheath effusion was noted in the right
front limb. Mild thickening was noted in the proximal palmar metacarpal region. The check ligament was not sore to palpation. Cardiac auscultation performed by Drs. ter Woort and Slack revealed a 2/6 murmur over the pulmonic value consistent with ejection murmur and 2-3/t murmur over tricuspid valve consistent with tricuspid regurgitation. Normal heart rate and rhythm was noted.

Diagnoses: Diagnosis 1: Check ligament injury, RF

Prognosis: Regarding the check ligament injury, the injury continues to heal during his rehabilitation period. The ligament may never return to normal size but we are very encouraged but the quality of healing and his relative soundness today. We recommend continued increase in controlled exercise. His prognosis for returning to previous athletic endeavors is good. Regarding his heart murmurs, both murmurs are unlikely to affect the gelding's life expectancy or athletic ability. Echocardiogram was offered but declined. If the heart murmurs increase in intensity and/or the gelding exhibits signs of fatigue or exercise intolerance, further evaluation is indicated.

Treatments and Progress:
LAMENESS EXAMINATION
The gelding was walked and trotted in straight lines and while circling on the hard pavement. The gelding took an occasional lame step in the right front limb when circling to the left, but otherwise sound.
ULTRASOUND EXAMINATION
Sonographic evaluation of the right front palmar metacarpal region was performed and compared to previous examination. The inferior check ligament injury continues to heal. The previously noted hyperechoic region has filled in with ligamentous fibers. The ligament continues to measure larger than normal which is expected but adequate healing has occurred.

Recommendations:
1) Continued regular management.
2) Gradual increase in the amount of controlled daily exercise:
-Week 1: walk 40 minutes, trot 2 minutes
-Week 2: walk 40 minutes, trot 5 minutes
-Week 3-4: walk 35 minutes, trot 10 minutes
-Week 5-6: walk 30 minutes, trot 15 minutes
-Week 7-8: walk 25 minutes, trot 20 minutes
3) Daily exercise can be performed with a rider or in a horse-walker.
4) If lameness recurs, please stop the trotting and contact us.
5) Re-examination in 8 weeks.