Wednesday, April 20, 2016

Finality

This week both horses had appointments with the Traveling Vets who come through town twice a year. Since the appointments need to be made nearly three weeks in advance, I had tacked on a lameness exam in conjunction with the normal Spring teeth floating and vaccines.

And when the Vet showed up this morning for our exam and asked if I still required a lameness exam, I stopped and thought for a minute and decided it wouldn't hurt to get a professional and formulated opinion. We would be limited to what we could do, since this was a "farm" call and not all equipment is mobile. (The Vets travel 5 hours to get to our little equine community)

I rode her Tuesday evening - just a short walk ride around
the street.
The appointment began with me showing the Vet the span of several hundred (I wish I was kidding) videos from the last month, a detailed recap of her chiropractic appointments and the stretches and such I have been completing daily with Suzie. I felt quite confident in the prognosis we had achieved through the body work, but I certainly was not expecting the finality of the diagnosis the Vet gave.

Let me preface by saying that the appointment did not go the way I intended.

To begin the work-up on Suzie, the Vet utilized a hoof tester and found that she had incredibly sensitive heels despite her well-balanced hoof structure (the vet actually commented how nice her hooves looked). With an unfortunate confirmation of soreness in her hooves, the Vet watched her walk off and mumbled something that sounded a lot like "navicular". The hairs on the back of my neck stood up, and the Vet quickly addressed the concern that had now etched my face.

Based off of the videos, the unsteadiness in her left front leg and the failed hoof tests in both heels, the Vet diagnosed Suzie with "Heel Pain". I asked why she had initially spouted navicular and she had said that "it isn't called navicular anymore" and that Navicular is not as easily diagnosed as it was before. Apparently, the reality is that a lot of things and none of them cause navicular. However, the diagnosis of "heel pain" is supposedly a real and correct "disease name".



From thehorse.com, the following excerpt was found (thehorse.com brings peer reviewed articles from actual Veterinarians as opposed to COTH forums and HGS forums where personal owners discuss their own thoughts). Educated and formulated opinions with scientific data? Sign me up.

"the commonly asked question, "Does my horse have navicular?" is not as simple as it might seem at first glance."

"Not all of the imaging modalities need to be used on every case to come up with an appropriate working diagnosis and treatment plan. Also, some cases can develop heel pain and have no detectable changes using any of these imaging modalities, even if all of them were available and were employed. Used appropriately, however, they can provide important information on selected cases, particularly those that might not have responded as expected to treatment."
 I asked the Vet immediately if this was a Farrier issue, or something else. And unfortunately for Suzie, it is more or less conformation... She has heavily Halter (Coosa and Impressive) bred on top and has those teeny tiny dancers feet most Halter QH's have.


So, in a nutshell. She has Navicular - but it is not commonly referred to as Navicular anymore based off of new information in Veterinary medicine. The age old "cure" for Navicular way back when in the early 2000s was simply to perform a neurectom, which basically meant a vet would remove  a section from the nerves that serve the heel region of the foot, thereby at least temporarily removing the sensation of pain from this region. More and more this practice is being phased out and no longer looked upon as a satisfactory "solution".

At first, I thought "no, that can't be right", but reviewing even more articles, specifically this one by the Practical Horseman. How interesting that a lot of the key points are things that Suzie has been doing - specifically the resting with one hind toe hitched and one front leg splayed forwards. The whole "gets better/gets worse" thing strikes a cord with me, too.

Managing a horse with heel pain is difficult, but a lot of the times it can be helped through corrective shoeing. Mostly, farriers will come and use what is called a "natural balance shoe" which basically creates a false, but supporting break-over so it reduces the stress on the horse.

A natural balance shoe being placed to achieve
an appropriate breakover.
In addition to the heel pain diagnosis, the Vet performed flexion tests. She flexed both fetlocks and knees and Suzie failed all of them. She was uncomfortable, and moreso lame after the flexions on the left side and moderately so on the right side. It was noted that she had absolutely awful range of motion in her left knee and didn't have much ability to bend it fully during the flexion test.

The overall diagnosis after the flexions was something I wasn't necessarily surprised ot hear, but the conversation that followed certainly was.... The Vet confirmed arthritis in her fetlocks and knees - remember that bump that mysteriously showed up on her knee in January? That is called a hygroma and is formed due to high stress in the area - the Vet figures it was caused due to her poor range of motion and that Suzie had to "crunch" down on her knee and had given herself the hygroma that way.

The conversation that followed the findings in Suzie was.... disheartening and dismal.


Basically - the Vet does not feel she will be an "arena horse" anymore. She said that Suzie will not hold up to the demands of an arena horse, especially bend to the right and tracking right on a circle. The Vet agreed that the body work has helped, but the ultimate diagnosis is the heel pain and arthritis which is a bit of a double edged sword... Mostly because horses who are arthritic should be kept moving... but horses with heel pain do not make good trail horses.

In fact, the Vet said to me, "She just can't do it anymore. She physically cannot put up with the riding you want to do with her. If you want to do that riding [showing, etc], you will have to buy another horse."

So that's it.

It's the end of Suzie's career as an arena horse and until we test out these natural balance shoes, it is highly undetermined as to whether or not she can be a trail horse with the occasional easy jogging and loping.

For now, my heart is heavier than the weight of lead and my head is spinning with so many thoughts.

We had discussed the possibility of injections and this new drug called Tildren, but as much as I'd loe to explore injections and new medicenes, reality is a hard truth. The Vet and I mulled over the tentative cost for injections (I would have to haul to the clinic to have a sanitary environment and Suzie would have to stay for a few days to ensure the sites do not get dirty... Injections themselves cost about $350/leg and prior to injecting, the Vet said she would need to perform a scan to see where she would inject to get the most "bang for my buck".) and at a staggering $1000-1200 for injections that may or may not work, I had to opt out. The drug Tildren also runs about $1000 for a month's supply, and it is not conclusive if it helps much with the heel pain or not.

The vet was quite sympathetic and basically told me that I am not a shitty owner for being realistic, and it's not life or death to get injections or otherwise. My priority is Suzie's wellness and like I had said to the boyfriend, if she required injections to be sound in the pasture, I would do them. To have her endure injections just so I can ride? That's selfish.


So for now... I am tentatively hanging up my riding bridle and going to cry over the unfortunateness of my mare growing old. I am going to think about all the wonderful things we achieved last year and I am going to thank my lucky stars that my mare is still living and breathing and that I am still able to love her every single day. She deserves so much peace and love - she has done her fair share of carrying riders around and has had her fair share of wet saddle blankets. My own need to ride may only become a little 20min hack around the neighborhood once in a blue moon, but I think I will be okay. It's going to hurt for a while, and I'm going to ache with longing.... but Suzie deserves love.

She will be with me until the day she crosses over. I had made that promise to her when I brought her home, and I am not one to make bad on my promises.

50 comments:

  1. Hugs for you & Suzie! Sorry the news was so heavy - and here's hoping the corrective shoes are a winner!

    ReplyDelete
  2. Oh I am so sorry. I was worried about her too after seeing the videos and hearing about her. I've seen some amazing things done with corrective shoeing. Another, less expensive option, for arthritis is previcox. You could look into that as well. I admire you for your dedication to her. (((hugs)))) this is so very hard.

    ReplyDelete
    Replies
    1. Thank you for your kind words <3
      She is actually already in Previcox, which the Vet wants me to keep her on for now. If the pain is not managed through these corrective shoes though, we will explore other pain management options.

      Delete
  3. Hi there. I sincerely hope everything works out for the both of you, fingers crossed!

    ReplyDelete
  4. Phoenix has been in natural balance shoes for about a year now and he is so much more comfortable. I hope they help your girl too!

    ReplyDelete
  5. I am sorry that Suzie has Navicular. My horse has Navicular and how we treat it is with corrective shoeing and with Previcox. Hopefully the corrective shoeing helps. :)

    ReplyDelete
    Replies
    1. This comment has been removed by the author.

      Delete
    2. Thank you for taking the time to write!
      We'll see how these shoes do for her. And she is already on Previcox :)

      Delete
  6. i'm so sorry - my heart is breaking at the possibility that Suzie might be hanging up her shoes, but i remain optimistic about corrective shoeing. a TWH at my farm had some sort of similar recurring and seriously problematic lameness that was eventually diagnosed as navicular too, and she is doing well in what i believe are some type of bar shoe. i can ask for more detail if you think that would be helpful. all the same, i'm sending hugs!

    ReplyDelete
    Replies
    1. Thank you for your kind words, Emmma.

      And I believe the type of shoe you are referring to is a "keg bar" shoe. I've already researched into them as well! The Farrier comes this Monday so we'll see what he thinks!

      Delete
  7. My heart is so heavy, reading this. I went through almost the same exact situation with my first horse (he just had bone chips on his coffins instead of heel pain). Reading this brought that time back for me, and I am so sorry you're going through it. It's so hard to see our loved ones grow old, but regardless of how it is spent, rejoice in the time you can still spend together. Love and hugs to you both <3

    ReplyDelete
    Replies
    1. Animals getting old just stinks :(
      Thanks for your kind thoughts, Tracy.

      Delete
  8. I'm so sorry. I"m sending you hugs and positive thoughts!

    ReplyDelete
  9. I'm really sorry, that's not the news anyone was hoping for. Fingers crossed the shoes are a help and Suzie has many comfortable years ahead of her .

    ReplyDelete
  10. I am so so sorry... it's heartbreaking to have to see our loved ones get old. I hope that you are able to make her as comfortable and happy as possible!

    ReplyDelete
    Replies
    1. I 100% will do everything I can to make that a reality for her!

      Delete
  11. Oh, my aching heart. Dang it. That was not the news I was hoping to read either. But, you still have your beautiful girl to look out into the pasture too, and to spoil rotten. Which I know you will!

    ReplyDelete
  12. In terms of joint injections, the prices should would be dependent on what is being injected. ALWAYS ask what the injection is...not enough people do! Usually its a combination of antibiotic (gentamicin or amikacin), steroid (depo-medrol), and hyaluranic acid. $350 a leg seems like a lot to me if you are only doing one joint on the leg, but then it's one of those things that varies by where you are located. Xrays obviously can help you make some educated decisions, and you can never have too much information, but they are not absolutely necessary to inject joints. A physical exam/ flexions can give a vet a lot of information about where injections could be most beneficial.

    In a perfect world where money wasn't a factor, she's go to a sterile clinic and have a bunch of xrays and all these tests, but the reality is that joint injections are done in the field every day. That's the reality of equine medicine. When we do them, we do full surgical scrubs and the vet uses sterile gloves and aspectic technique is observed. If it's a close to the ground joint (ie a coffin joint) we bandage and always leave the horse in for 48 hours. Obviously, any time you put something in a joint there is a risk, but if she's really sore, it's definitely something to consider to get her more comfortable. A good vet would never inject a joint that doesn't need it.

    Tildren is expensive as heck, but I've had friends who have had luck with it. The concept behind it is that it inhibits bone resorption by cells called osteoclasts. It's given IV (very slowly). I don't know if your vet mentioned it, but there is an intramuscular alternative to Tildren called OsPhos. It is much cheaper, so maybe ask about it. The idea is that these drugs last several months.

    ReplyDelete
    Replies
    1. I didn't ask about where we would be injecting, since the Vet mentioned she would want to do a scan (I think that is the right word) prior to injecting to see which points/where the best place to inject would be. And I believe it was $350/leg with the rough estimate of 1-2 injections per leg. It all is very "up in the air" as to cost until I would haul her out and get everything scanned and sorted.

      The reality is that we would need to haul to the clinic, stay for a day or two, and it may not even give her "that much" relief. And the fact that the injections would only be for my benefit (to keep riding), it just doesn't seem right to me.

      Glad to hear your friend has had success using Tildren! A friend of mine just told me about OsPhos - I'll ask about it! Thank you!

      Delete
  13. I'm so sorry to hear this news. I hope the shoes make a difference for her. Susie deserves the best and she certainly has that with you as her person. I'm sure she's greatful for all the care and love you give her and you both will enjoy spending time together even if you can't ride.

    ReplyDelete
  14. I am so sorry to hear this. I'm crossing my fingers and sending prayers for you and her!

    ReplyDelete
  15. Sorry to read this. Sometimes it's nice knowing a final answer though, so you can move on and make a plan. Plus she'll be a lot more comfortable with an easier life, which is good news for her.

    ReplyDelete
    Replies
    1. I actually feel much better that I now KNOW what is going on instead of second guessing everything. I can now make a real plan for her.

      Delete
  16. I'm sorry about the diagnosis. She's lucky to have you. I'm sure she'll be more comfortable with the corrective shoeing. Maybe get some previcox for the arthritis?

    ReplyDelete
    Replies
    1. Thank you for taking the time to write <3

      And yes, she is already on Previcox :)

      Delete
  17. I'm so sorry to hear this. Hopefully the shoes will work. She's lucky to have you to care for her.

    ReplyDelete
  18. This was so hard to read. I'm so sorry that this was the diagnosis. Hugs for you and Suzie. And fingers crossed that she gets a bit better with the shoes.

    ReplyDelete
  19. Big hugs, I know this isn't easy, but keep your chin up! She's a lucky horse to have you :)

    ReplyDelete
  20. Boo. Bad news sucks, especially when it comes with such special horses.

    The term "navicular" is basically a household term with me at the moment because I've been hauling a boarder to Oklahoma State vet school about every two weeks for a navicular study. This particular mare is DEAD LAME some days with horrible heel pain. The vets are working on finding a better system to treat the heel pain that includes coffin injections and therapeutic shoeing-this mare is currently in a wedge. It will be interesting to see what they find.

    I agree with Mare, check on the pricing for injections. My injections are more like $200 each joint and it lasts my guy a whole year. Perhaps she doesn't need every single joint the vet mentioned to be injected? Only the major stuff? Might keep her sound for light riding.

    And, I personally don't believe it's just for you. It's for her too. Not just to stay comfortable, but working is really important to some horses. I've seen some horses become very depressed when they suddenly stop doing their jobs. So, it's for her too.

    ReplyDelete
    Replies
    1. Thank you for the comment, Allie.

      And maybe I didn't really explain myself properly with the whole joint injection thing. The vet doesn't think she will need the injections to be comfortable in the pasture and IF these shoes provide just the relief she needs, she can indeed be a "light riding" horse. This may however, only be short 15-30min rides around the street.

      Interesting to hear about the mare - I'd be interested to hear how it develops with her! I hope things get better for her!

      For sure, depression is obviously something I want to avoid with her. As of right now, she doesn't seem to effected by it and tends to go long stretches, especially in the winter without riding (think 4-5 months some years). She will still get out for hand-walks, hand-grazing, grooming, and still give pony rides to my toddler nephew. Again, on her good days I won't hesitate to take her out for a little jaunt down the street.

      Delete
  21. I am so sorry to hear this. I know you had high hopes that she would remain comfortable to ride for many moons to come. It always comes too soon.

    I kind of agree about what they used to call "nerving" the horse. Basically had it done to myself, and while it took away the pain, now I have to be really careful to pay attention to any boo-boos I don't know about. And that's on my OWN foot. Can't imagine having to do it for a pony.

    I know my own red mare sends wishes for happy grazing to yours.

    ReplyDelete
    Replies
    1. Oh Mary, sorry to hera about your foot!! Be careful.

      And your last sentence had me in tears <3 Good tears.

      Delete
  22. This is definitely the suck, and I'm sorry to hear about Suzie's prognosis. I have a friend whose horse has "navicular" but more realistically "heel pain" who has absolutely no changes in his rads and no clear indication of WHY he should have such symptoms, but natural balance shoes and pads have been a lot of help to him.

    Another resource you might like is the Rockley Rehab Blog -- http://rockleyfarm.blogspot.com/. It's a fantastic blog that talks about barefoot solutions to heel pain in horses. It may not provide a solution but could help you pin down some of the things that cause Suzie's flare ups.

    Best of luck keeping Suzie happy and comfortable, in work or out. Thinking of you.

    ReplyDelete
    Replies
    1. That is crazy, isn't it? No indication, yet he is positive for "navicular". There is just so much unknown about it at this point and I honestly thought the diagnosis of "heel pain" was the Vet just making up a name, lol.

      Thank you so much for taking the time to link up another blog, I'll check it out for sure!

      Delete
  23. Having gone down this path with my gelding I can tell you there are new routes to be taken with managing heel pain and navicular. I do recommend getting actual radiographs of the feet in order to choose the best path. In my geldings case his bones were so bad and he was already on corrective shoeing, that Tildren was a terrible option as was nerving. For his individual case I had to put him down to save himself. If you ever want to talk about it my email address is Lnwillia at gmail dot com.

    ReplyDelete
    Replies
    1. Thank you so much for reaching out to me, L. I know how special your gelding was to you and I don't doubt that I one day will have to make that judgement call for Suzie, perhaps ahead of her time. It frightens me that I hold that much "power".

      I take your cautionary tale to heart, and do not think I am rejecting what you are saying or ignoring it. I would like to start with the corrective shoeing and see how she does. If things progress poorly, initiating a more thorough examination is something I will have to strongly consider. I appreciate you taking the time to comment. <3

      Delete