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.

Post Appointment and Further Information

I'm still waiting on the discharge information from New Bolton, but the good news is it's not bigger. It's getting a little better, and slowly, but surely, it's coming along OK. I say OK because they can now see where the puncture to the area was. They could also see the old bow better in another area because of the new images. So it seems that leg just "has issues." I know it's not ever going to be the same, I just hope we can go back to doing the riding thing at some point. It's now 40 minutes of exercise with 2 minutes of it being trot for week 1. Each week after gets 2 minutes of trot added up to 15, I think? They really need to send me the discharge sheet so I know what to do and what everything was called so I can look into it more.

Another development/discovery is in Spyder's heart. He has different issues on each side, but the murmur is the more common and lesser of the two worries. The other side of the heart has a leaky valve, and they aren't sure if it's in a bad spot or not from just listening. In being asked to ultrasound the heart, I asked a few questions. 1) Will it change his performance? 2) Does it change his life expectancy? Both answers seemed to be no assuming that it wasn't anything more than what they heard. I was assured it's nothing that will make him drop dead while riding, it may just become a conditioning issue. They recommended ultra sounding it if I was a worry wart to know that it wasn't going to be an issue. Since there is nothing that can be done for it, I figured I'd wait on seeing if anything comes of it before checking it out, if at all.

2-3 months will go by before we go back for yet another ultrasound to see if the trot has gotten it to heal/get more stable/build more fibers. They seemed happy with where it is, but he still can't be turned out. He'll have a good old time keeping it cool (aka bored out of his mind) in the round pen which brings us to almost a year (in May). And so we wait some more.

Hey, stop making fun of me. Hay in his tail is from sleeping in it in the sun today.

Mr. Baldy Legs

Checkup

Spyder's checkup is going to be a week from tomorrow, January 27th at New Bolton Center at UPenn again. I have a shipper ready to go because I still have yet to install the trailer floor due to the weather - meh.

I am both excited and worried (because it does seem a bit stocky again), and I hope we see some healing this time around. It'd be nice to stop hand walking him since I have been doing it for months now. Of course, it's what he needs, and I'll do what it takes, but I'm ready to get back in the saddle. I can only hope that spring will bring getting back on and that his attitude will be adjusted from last year. May will mark 1 year in this journey of lameness. Time will tell, and I'm so anxious.

Wrapping Up 2014

OK - So I've been far removed from this blog for reasons such as a lame horse, no riding, grad school, and the holidays. I can't even think to look at my 2014 goal list because I'm sure nothing really happened. I'll update on how that all went...

On my list...

• Get off the farm with the trailer... a truck would help.
• Canter straight. Stupid, but I can't even think of where to start
• Do a CTR or the like - there is a trail riding group in the area that should be helpful with this
• More trails - need to explore around the farm
• De-spooking - he doesn't spook much, often, but what fun it'll be to play with pool noodles and plastic bags
• Clinic - do one, do something
• Look into endurance - ask questions, network, decide if it's a fit
• Another hunter pace - pony club is scheduled to do another in April, I'm in

OK, so I got a truck, but the trailer needs work so it hasn't gone anywhere except to the welder. I did the CTR and learned about endurance. Sure, I did the hunter pace, too, but that's when everything went down hill. It's been that way with Spyder since May... great. So all of what I thought we could work on is still on hold, and it's been a TBD since May.

I left off with we'll talk about my lessons and how the 25 mile competitive trail ride went, but then I got lost. I haven't been riding, and I haven't even had the desire really. Spyder's showing no improvement (they said a maybe on fibers coming back in last they checked), and he's been a jerk about it. He's miserable (and lashing out about it) and his leg is puffy again. He had colic on December 14th when I wasn't even in the country, and he got an emergency tube. He's been miserable ever since, and that leaves me plain miserable. YAY 2014!

I'm hoping to work on my trailer floor (have everything to do it, just need to make time) so that I can get him back to the hospital to re-ultrasound him and see what's going on. Let's hope they see improvement this time around or I'll have to come up with a Plan B for what to do with him. I know if I give him back, he doesn't stand a chance of a life like he has with me, and certainly that's not an option before I know for sure if he'll be sound again or not. If he won't be sound, I will be heart broken because keeping him isn't really an option. Spyder, get well soon.

Spyder's Checkup

On October 8, which would be 2 months since the initial diagnosis and 5 months from the suspected injury, we went back to New Bolton. I was worried about the news I would get because I haven't seen Spyder do more than walk, and his lameness isn't apparent in that gait. I was both excited and nervous to see him trot, but he was so much better than the first time around, even to the left. There was no head bobbing, but he was still having trouble bringing that leg up to speed. Sure, it was better than last time, but it was still apparent.The discharge papers say, "A mild, less than 1 out of 5 degree, right front lameness is evident most pronounced when circling to the left. This is significantly improved from his last visit."

On to the ultrasound. They were already happy with the lameness exam and seeing that most of the fluid dissipated. It was a quick move to get the ultrasound completed because they knew exactly what to look for when poking around. More good news! It looked like there were fiber patterns in the previous areas that were torn. They were black spaces the first time with no fibers seen, and now,  the area was turning gray because of the rebuilding. Whoo! The old injury which I forgot to talk about before (because I forgot what it was) remained the same. It says, "The old superficial digital flexor lesion is unchanged." Hmm, wonder if he had that before I got him or if that was part of this same injury

Now what?  We're still hand walking and waiting for more fibers to regrow. The progress is headed in the right direction so we'll go back once we get up to 45 minutes of walk. The suggestion is another 2-3 months. If that appointment brings more good news, some of the walk will turn into trot and we'll go from there. I can get on him to do the exercise, but for now, we're keeping it on the ground to work on his manners. I'm glad it's been good news and hope for even better news next visit.

I did have a lesson that went over heels again, and I did a full jump course which was a blast. There was a lot of cantering and sinking into my heels as well as two-point... and even an attempt at posting the canter. Yes, it seems impossible, and I did try, but I failed. I'll talk about that and my ride this coming weekend next post.

Recovery - Less than 2 Weeks

Back at the barn, stall rest lasted 2.5 days. Yes, you read it right two and one half days! Spyder was just plain miserable being confined to a stall even with other horses on reverse turnout in with him. He was pacing, ramming into his gate, using the walls to try to rub off his leg wraps, chewing wood, licking metal, and rearing when people would go by to say, "hey, get me out of here!" Day 2, I saw that his door was closed instead of the gate allowing him to reach out, and those are the reasons why. Oh, and he would go down/lay down/roll after rearing to get attention. So now what? This jail sentence was going to causes Spyder to get more hurt, colic, and potentially go crazy (more than he already was).


The first day of hand walking went just fine, but he could not stand still on the cross ties to get wrapped. He couldn't stand in his stall to get wrapped, even with hay. He decided not to eat hay and instead, just pace in his stall until someone did something making a mess of his hay. He was becoming a danger to himself and others that have to deal with him. Day 2 of hand walking, he decided to rear in the barn while on the lead. Well, that was a first! I decided to pretend like it didn't happen after punishment with the chain (yes, I resorted to the chain) so I wouldn't get myself worked up or scared that he'd do it again. It was day 2.5 (my lunch break) that I decided this was it. He wouldn't stop acting up, and it was time to put him out.

He hates me. Haha

He went out to the round pen, and don't you know, there were ponies in for weekly board while the owner was on vacation. They were all worked up and galloping in the field which got Spyder going. Rearing, squealing, trotting, tail up, fire breathing, STOP! He was going to hurt himself even more, but I thought maybe he just needed to get that out of his system. Since then, things have been a lot better. There haven't been stories of "your horse did this bad thing... or that..." I'm glad I haven't been hearing anything because I couldn't watch him let loose in the round pen or drive himself up a wall, literally. Sure, stall rest and hand walking are important, but his sanity, health, and safety of others is more important. I'll sacrifice a few extra months of board payments while not riding if he will keep his cool.

Back to the vet thing. The local vet seems to think something is missed. What if his shoulder is really hurt? What if I didn't ask enough questions or have them look into things more? Could it just be the check ligament?  What if he doesn't heal? What happens if I can't ride him? I'm trying to take things day by day, and the next ultrasound can't come soon enough. I want to see progress because I don't want to think about the worst. I feel awful, terrible. I haven't been dealing with this well, and I regret not doing right by him. But did I? I didn't know any better because I didn't have a diagnosis, and he wasn't always inflamed. I feel guilty, I feel sorry for myself (and Spyder, of course), and I feel scared. I did send everything over to another vet to take a look, but I haven't heard back from them. The local vet hasn't told me what to do otherwise, and I haven't heard from her since the questioning (which is 2 weeks today). I'm assuming no phone call was put in, and I'll continue down the path of rest and slowly work up exercise as I've been told.

In the mean time, I need to find saddle time. I have thought of lessons again just to keep moving and keep in the spirit since I'm out at the farm every day as it is. I did have the chance to do a trail ride on an Arabian with endurance experience, and that was a blast! If anyone has ideas/suggestions for staying in shape that doesn't involve riding (since the opportunities seem limited), let me know!

The Hospital Visit

I found a hauler that met me at the farm early in the morning. The appointment was set for 10am, and the place in PA was about 2 hours away without traffic... Well, Philly is guaranteed traffic on a week day so we hoped for the best. I loaded Spyder into his HUGE box stall (1/3 of the whole trailer) where he had a chunk of hay and could move freely. He was super spoiled on the way up with all of the space.

I beat the trailer up there and checked in at the office upon arrival. I was told to wait by the trailer while they paged "the crew" because Spyder had arrived. A whole team came out to greet us and unloaded him for me. A resident vet was part of the mix, and she let me know that the vet we would be seeing was on her way. We went through an automatic garage door to the evaluation room. It looked a lot like a science lab, and had 2 stalls in each front corner of the room. The vet student did all of the vitals, his hoof test (in which he has incredible feet), and put Spyder in his holding stall. A volunteer was also there getting hours for vet applications and another employee that led him around all day. All of "the crew" was very, very nice!

They took Spyder out of the stall when the doctor arrived, and I got to tell his story. The doctor couldn't believe how great his feet were - yay standardbred feet! From there, they palpitated his fluid filled area to get an idea of what might be going on. They thought for sure that it was tendon or ligament, and wanted to get him over to the ultrasound department after doing the lameness evaluation. They took him outside, and Spyder saw his first cow! It was super scary and he acted like a fire breathing dragon for that and the huge garage door he was going in and out of all day. Even the 5th time (and sedated), the door was still scary. I didn't have to touch him for any of the evaluations, as they did everything! An employee trotted him up and down the driveway as well as on a circle to see his head bobbing madness. They were all puzzled because there was a lot of weird movement going on. From there, I was asked to get on...

I tacked up and we walked to the riding ring (but not before seeing the cow again). The indoor was BEAUTIFUL. There is all natural lighting and the best footing I have ever seen in a ring. I would trailer my horse to work to ride in there if that's where I worked! I rode, and they were baffled by his movement to the left. We got in some circus moves and funky steps, and they weren't quite sure if the area that was swollen would be causing that. My audience of 5 people made me nervous! They did mention he's not a bad mover when they could see him move without pain which was reassuring (for a standardbred... as everyone likes to add). I untacked and we went to ultrasound. I was so nervous for what they might find.

Spyder was a bit impatient for getting his leg shaved and standing in the standing stall for his ultrasound. He didn't like the gel they were putting on the instrument so sedatives eased his mood. He was right back to falling asleep while standing after some drugs. He behaved quite well for what I thought would be a total embarrassment. The ultrasound took a good hour and a half as they looked at everything! They could see all of the fluid, some thickening of ligaments, and a very, very small tear/area that had something going on. The fluid was a result of this area, and they couldn't believe the spot where the check ligament was injured. I ended up writing an e-mail to the vet to ask about this because I forgot to ask about the severity when I was there. It's a 30% injury to a small area that isn't common. This is where the "this area usually heals, but due to the nature of this injury, recovery is unknown." YIKES!

We went back to the prep area from the beginning of the day in between each move around the property, and this is where they did the block. After the block, they did some more w/t in hand and in the circles from earlier. Again, it was better, but not 100%. I got on, and it was a much better ride than earlier (and now I had a crew of 8 people because other students rotated in), but he still had issues to the left and resisted turning that way (weird side note: earlier he was tripping with the right front, with the block, he tripped on the left front). I had the option to get x-rays, but the doctor felt bad since I had already racked up quite the bill. I figured I was there, do it. I wanted to make sure there wasn't more in the area than the ultrasound could see, and his knee looked good once they got the images. There are no signs of arthritis, but they did see some kind of old injury. Interesting. I am glad that now I have a before on that knee in the event anything ever happens to that leg (for who knows how many times it's been a problem).

The solution? Stall rest and hand walking for controlled exercise for a minimum of 6 months. It usually takes up to a year to heal, but depending on the rest and exercise, it can take even longer. Ha, that'll happen with a horse that has a ton of muscle from training for long distance rides, one that just turned 7, and one that is out 24/7 because he loves to socialize and play. So is this good or bad news? I'm still not really sure. I'm going to schedule the follow-up ultrasound for mid-October to get an idea of the healing and go from there...

... to add another twist, the local vet isn't so sure of the diagnosis and thinks something was missed. Now, I'm lead to believe: 1) Is this what it really is? 2) Is there something else wrong? 3) What other vet can check it out? 4) What care instructions do I follow? Next post, I'll talk about how it's going so far.

The Diagnosis

Inferior check ligament injury. Yeah, maybe we can do something next year. I've been sucking at posting because I've been so stressed and had a lot going on, but I promise to update with my experience at New Bolton's amazing facility as soon as I can.

Next Week

We're going to New Bolton on July 31st at 10am. We'll have to leave early to get there in time for the appointment as it's a good 2 hours without traffic. I will be packing my car so I can ride to show them the lameness as they evaluate the situation. I hope he doesn't have to end up staying (as the shipper will wait for us if he doesn't), and let's hope we get a diagnosis... and one that isn't too detrimental for either of us.

More News

And so it's not the knee or below either...

The walk was great, to the right was great, and to the left is still a mess at the trot (2/5 on the scale). The slower he goes, the better his dragging leg can catch up, but he still hops up to burst into the canter or trips to make himself right again. The swelling is still there, and his week off  will hopefully bring that down. He got an injection of bute to decrease his swelling from the strain as well as the nerve blocking from the day before.

Next steps? New Bolton Center Hospital. They are a HUGE facility that is part of the University of Pennsylvania's network for veterinary care. They have many facilities, and New Bolton is the spot for large animals. They have everything that Spyder would ever need to be diasnosed in one place. First, they are going to block the shoulder/elbow. If they find something, more tests will be done to get to the bottom of his lameness. If they don't find anything in that area, they will move into diagnosing the problem with all of the equipment at their disposal.

I have contacted a company that will do the shipping, and Spyder will get his very own box stall in the trailer for the ride there and back. I am hoping that he doesn't need to stay and that the results will bring us news of recovery, but time will tell. Of course, I have a work trip that got scheduled yesterday, so we'll have to wait another week before the appointment. The referral is getting called in today so I'll be able to set it up for the week of the 28th. I am nervous, anxious, and excited to get to the bottom of this which all leads to excitement and stress. I know that we'll find out something, and I just hope it's good news.