Saturday, September 11, 2010

Journey to the Center of the Hoof

OK, here is the beginning, at least, of the veterinary saga that has been Keebler's life since July 4th.

Week one:  LAME, suddenly, after having a few days off after the South Farm HT.  Vet happened to be there and blocked the foot and he was sound with the palmar heel block.  He also about fell over when we did hoof testers, so the working diagnosis was bruise or abscess.

Week two:  Soaking, poulticing, soaking, poulticing . . . no improvement.  Pulled the shoe, no sign of bruising or abscess.  Stress level starts to go up a little at this point! 

Week three:  Another exam--this time the heel block left him still completely lame--WTF?!  So we blocked up higher and he went sound.  OK, now what?  X-rays show a big old sidebone, quite a surprise in a small, light, elastic-jointed, easy-moving critter like him, but possibly an issue?

Week four and five:  No improvement, tentative plan is just to see how he comes along.  I'm not much LIKING this plan--too many question marks.

Week six:  Off to Michigan State for another exam.  Still stinking lame, and this time he blocks to the heel again.  Oy vey!  I find it absolutely and completely maddening how the diagnostic process takes place when the patient is non-verbal.  X-rays give a better view of the impressive sidebone, but at this point we're all thinking it's In The Foot.  A bad place for a lameness to come from--lots of moving parts in there.

So we did an MRI of the foot, and there it was--a lesion in the Deep Digital Flexor Tendon just at the "pulley zone" where the tendon runs over the navicular bone.  The navicular bursa is sort of torn open and all the fluid has leaked out.  Here is a picture . . .
So I am FAR from an expert in interpreting MRIs, not to mention my last close examination of hoof anatomy was in 4H Horse Bowl in like 1979, but just above the frog there (the biggest, medium-gray structure on the bottom) is a black structure which is the DDFT.  Over to the right side of that structure, up top, is a tiny little gray indentation--that's the tear in the tendon, which is SMALL.  To the left are two bright, white parallel lines--that is the "healthy" part of the navicular bursa.  (Again, this is an amateur interpretation!)  The part above the little divot/tear in the tendon should look the same, but it's all dark there, indicating the disrupted part of the bursa.

Pretty cool, except when it's a dearly-loved animal that is in your care. 

So the consensus after MUCH discussion with the expert lameness vets at MSU was that Keebler's best shot at future soundness was probably surgical exploration of the area with debridement of any torn tissue, adhesions, loose bodies, etc.   For those of you who like to look at the veterinary literature, a citation of a small review of cases was provided and you can read the abstract of that here.

Basically the options were to give the horse 6-9 months off and see what we had, and that would be the horse to go on with, or do this exploratory surgery in the hopes that it would give him a better chance.  The surgery is not terribly invasive, and Keebs had tolerated the anesthesia for the MRI very well, so his owner gave the go-ahead and the date was set.

Surgery was this past Wednesday, and Keebler did very well.  When I got a post-op call, the vet told me Keebler had just pinned his ears and showed him his spotted rump, busily scarfing down the hay he'd been kept from that morning.  I figured that meant he was behaving normally.  No apparent effect on mood, anyhow!  The actual tendon lesion was not too bad, and the vets were hopeful that they were able to clean things up as well as possible.  Of course he's going to form more adhesions and scar tissue, but this gets him a head start on a proper recovery, with the help of 3-degree wedge shoes to raise his heels and take a little strain off the tendons.  They are aluminum and very light and are the Natural Balance style that I actually like very much--Gwen wore them for the whole time I had her and did beautifully in them.

Here is a picture of the inside of the navicular bursa:

The messy-looking, ragged stuff on the left is adhesions where the bursa used to be.  The part on the right is the normal half.  The instrument you see is 4mm wide, giving you an idea of how small a space this is!

So Keebler came home with his space-age shoes yesterday, and is floating around very comfortably in my very large foaling stall.  It's large enough for him to canter circles in it (I have seen him do so) but so far he is being very sensible.  We have had a few discussions about his daily Gastrogard paste, but it's getting done, and thank GOD there is peppermint-flavored Bute!  Only about another week on pain meds, and stitches come out next week, at which point no more bandages.  He's allowed to walk five minutes three times a day, gradually increasing to an hour twice a day, and that will be a good opportunity for me to make up for the fitness I'VE lost by not riding much for the past two months!

More to come . . .

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