What the Vet Found

You may remember that about three weeks ago, my farrier raised some concerns about the way Tristan's RF was growing out and healing. Based on his experience, he felt very strongly that Tristan had a keratoma growing within his hoof.

Yesterday, I arranged for my vet to meet my farrier at the barn, and we did a full workup on Tristan. I also had a list of other concerns; I was worried that his topline wasn't building the way it should, and wanted to ask about supplementing with alfalfa cubes, and had a few other miscellaneous questions. (The most important answer: yes, you can add bute while a horse is on Pentosan.)

Waiting for the vet.

We started by longeing him, and I explained that I felt he was actually moving pretty well: lazy, but evenly and without obvious hitch. Slightly stiff, and tracking ever so slightly behind on the RH, but nothing that would even rise to the level of concern. We walked, trotted, and cantered, and then tested the trot/canter transitions. Then the vet took him in hand and spun his hind end to watch how he crossed over.

We did not flex. I can practically guarantee that Tristan would not flex clean, and to be strictly honest? I don't need him to. He is functionally sound and comfortable in the level of work he does. I'm still not sure if he'll jump again, and he certainly won't ever get to the level of dressage work that would require the carrying and thrust that would start to trouble him.

The vet agreed with me that he looked pretty darn good in his movement. Certainly he was just fine on that RF.

What's the catch? Well, when I asked about his topline, and we brought him out into the sunlight, the vet was immediately concerned. Keep in mind she saw him in March for spring shots, and before that in the fall, and then the previous summer and spring every 2-3 weeks for surgery follow up. She knows him pretty darn well, and she's a brilliant vet with an excellent diagnostic eye.

She didn't even hesitate. "I'm pulling blood right now, and we're going to test for Cushings. Even if he doesn't test positive, I'd like to start him on Pergolide. He looks terrible."

Keeping in mind that my vet is very blunt! Tris does not look like the picture of your typical Cushings horse, but he is 19 and he has a distinct lack of muscling on the topline. When we tossed the idea back and forth, other things fit with the picture. He's been urinating much more than usual over the last 6 months. He's been coughing more often in warmup over the last 2 months.

It's very early days yet, and Cushings is a very manageable condition. We should have results back next week. If his levels come back totally normal, the vet wants to pull more blood for general CBC panel and make sure everything else is adding up for him.

PSA moment: yesterday was a perfect example of why you should have a vet take a look at your horse once or even twice a year. I had a vague, pit-of-my-stomach feeling that things were not trending well with Tristan, but it took the vet who hadn't seen him in 4 months to immediately recognize the changes that had occurred in those 4 months. She had passed him with flying colors in March - even making a point of saying he looked terrific - and was able to clearly compare the horse in front of her with Tristan from March.

I admit, I was reeling a bit from her immediate diagnosis and all the research I was going to have to do to start managing him, and then we moved into part 2 of the day's fun and games.

The farrier and vet first conferred about why the farrier suspected a keratoma: the bulge in Tristan's hoof, and drainage holes at the toe. Farrier pulled the shoe, and we set down to work to take some x-rays.

Farrier had these super-nifty lifts rather than the vet's blocks!

We spent a good 20-30 minutes taking shots, looking at them closely, and then taking more shots from different angles. Vet needs to take a good long look at the x-rays at home, but on initial examination, everything looks clean.

Here's the neat thing: the farrier was 100% correct in what he detected. What he did not realize (or did not remember - since I had sent him the surgery x-rays before) was that Tristan's coffin bone was already compromised, that it had been carved up quite a bit during the surgery. The farrier was absolutely spot on in recognizing the subtle changes that came in Tristan's hoof once he was missing a piece of his coffin bone. I already knew I really liked the farrier, but I am HUGELY impressed.

What we'll have to do is compare the x-rays the vet took with the immediate post-surgery x-rays to make sure there is no additional bone resorption or remodeling. Vet and farrier both agreed, however, that if a keratoma really had formed at the coronet band and traveled down to the dark spot on the x-ray, Tristan would be very lame, and he's just not. 

VERY good pony getting his shoe back on.

The one remaining question mark is the drainage holes in Tristan's toe. They definitely shouldn't be there. They are tiny, but they are there. I offered to soak, and vet and farrier thought that wouldn't do much good. The farrier ended up packing the toe with Magic Cushion and putting the shoe back on. Vet said that if Tristan does come back positive for Cushings, that would explain why the drainage holes aren't closing - his immune system is compromised. 

So here's the takeaway:

• his foot is almost certainly fine, whew
• he almost certainly has Cushings, in the very early stages
• bloodwork will come back next week, and then we will start him on a low dose of pergolide
• I'll take an in-depth look at his diet and most likely switch his grain. Right now he's on Blue Seal Sentinel Senior, which I mostly like - but which according to some internet sources is fairly high in NSC, which he'll have to stay away from. Look for research posts about this in the future.