Getting ready

I am so very bad at waiting. Truly awful. I want to be doing instead of anticipating.

I am making lists - packing lists, medical history lists, lists of questions to ask.

I keep thinking I should send him with something. When our dogs went for surgery we sent them with blankets that smelled like home. Horses don't really think like that but I keep returning to the thought over and over. There's nothing, really. Hay and grain and water, halter and lead rope. No toys or stuffed animals or blankets.

I groomed him nose to tail last night, combed all the snarls from his name, trimmed his bridle path, curried the scurf from his belly. I kept thinking, what if I lose him on Monday? In the macro sense this is routine and will be handled by good, competent people. In the micro sense, I couldn't bear it. I would lose my mind.

I hate waiting.

Planning

Okay.

I have ordered two boots, size four EasyBoot Rx. I called the clinic and said, sorry, I don't mean to be obnoxious, but don't horses with coffin fractures usually do hospital plates? They explained since they'll be basically removing all the chips there's not anything to stabilize. Plus they want me to have easy access to the surgical site to clean it out regularly. Which makes perfect sense, so: boots!

I also ordered a bunch of things from Smartpak: more vet wrap, a Jolly Ball, more betadine, etc. Things to keep him happier in his stall, and things with which to wrap his foot. I did an inventory of his foot-wrapping supplies and I'll put together a tupperware with everything in it that I can grab quickly and have everything together.

I'll go by Tractor Supply tonight and pick up a few more syringes as well as some bandage scissors because I forgot those, whoops. I'm trying to decide whether to do a sheath cleaning now or next week; he needs it pretty badly. I think probably tomorrow night, so I don't have to make him suffer through that while he's recovering.

I'll put together all his paperwork tonight, Coggins, vacccines, etc. He may need a tetanus booster as he's close to the re-up for that anyway.

I've asked the barn to haul him up to the clinic - my truck is more or less still stuck in the driveway. It was never intended to be a winter driver, and my trailer is solidly snowed in. I'd have to drive up into the mountains to pick up a friend's trailer, and I don't want to haul with a strange trailer in my unreliable truck when I'll be so nervous about everything else.

I think that's it for now.

Sea Change

Wow. I'm not even sure how to start this post. Begin at the beginning I guess?

Before I do, here's the very short version: Tristan has a pedal fracture of the coffin bone that is badly infected and likely has been for some months. He will have surgery for it on March 4, a week from Monday, and if that goes well he has a very good chance of returning to riding sound.

Long version.

Item #1 on my to do list came back quickly. My vet heard from the consulting radiologist first thing in the morning on Thursday and called me at around 10:30. She told me his findings: pedal fracture, with infection and bone loss. Tris would need to start on antibiotics ASAP, and would get a hospital plate put on in the next few days while we tried to decide - with more consultants' help - if he would need surgery.

Here's what the radiologist report actually says:

Along the dorsolateral solar margin, there is a triangular, moderate sized fracture fragment. The margins of the distal distal phalanx are moderately irregular. A focal area of osteolysis is present, medial to the osseous fragment. Smaller rounded osseous fragments are present along the lateral solar margins  A long toe conformation is present that is slightly concave along the distal dorsal aspect.  There is a small amount of gas tracking between the sensitive and insensitive laminae.  

The navicular bone is within normal limits.  The remaining osseous and soft tissue structures are radiographically normal. 

Here's the view that made him say that. You can see the triangular fracture fragment pretty easily in this picture, as well as the irregular margins. Osteolysis is a fancy word for bony changes, which you can see between the fragment and the rest of the coffin bone. The "smaller rounded osseous fragments" are bone chips.

Long toe and concavity is something we knew we had, and that's been present practically since day one of the abscess. The gas tracking is also due, presumably, to the massive hole of the abscess. You can see both in this side view. This view was taken before a second, more aggressive trim of the toe that we did based on the x-ray, so the long toe was corrected.

Finally: hip hooray for everything else looking ok!

I sent off the x-rays from June and September and the radiologist saw the pedal fracture on both. He also guessed that the infection in the coffin bone has been going on for some time, based on the amount of bone loss. Which leads to the chicken or the egg question: did he abscess because of the fracture & infection, or did the infection come only with the abscess, or was the abscess incidental and confusing?

I drove out to the vet's house Thursday night and picked up the antibiotics - enrofloxacin, trade name Baytril, which seemed a good combination of easy to dose, easy on his body, and broad-spectrum enough to fight the infection and get down into his foot. I stopped by the barn afterward to leave the drugs, dosing instructions, etc., and to cry all over him.

Friday afternoon I heard back from the vet, who had a long talk with the surgeon at the Vermont Large Animal Clinic in Milton, VT. They recommended surgery without question, and offered to take him the next day - Saturday morning. The vet was headed out of town the following week but would be back and take him first thing the day he got back, Monday, March 4.

My vet said she felt comfortable with his diagnosis, liked him enormously as a surgeon, and sent me the original files of everything so I could send them down to Tufts to get a second opinion, just to be neurotic. I trust her enough that I have made the appointment at VLAC and spent about half an hour talking to the surgeon's intern (who has discussed the case with the surgeon, who was not available at that moment), who was extremely nice and able to answer all my questions.

VLAC wants him to go home in a boot, so I called the EasyCare company and they recommended their EasyBoot Rx. I'll measure him tomorrow and order them first thing Monday morning. I did email VLAC back to gently question the boot v.  hospital plate aftercare, as everything I'm reading (I know, I know, armchair owner) recommends immobilizing the foot with a hospital plate instead.

He'll go in at 1pm on Monday, and stay overnight. I'll bring him home on Tuesday. He'll have a minimum of 6 to 8 weeks stall rest while he heals. The good news is that he has a decent chance of coming sound enough for riding if the surgery is successful, and they've done this surgery before and are confident in it.

So...here we go.

To Do List

I do best with lists. Ideally, lists full of action-y things that I can do. So here's my list:

1. Vet has sent Tristan's radiographs out for consult, with comparatives from past views. We should have an opinion within 48 hours.

2. I will call our vet from MA and lay out what's happened since we left and see if he has any ideas based on what he saw of Tris initially.

3. Vet will look at Tristan tomorrow, Thursday, and block his foot to make 100% sure where the lameness is coming from.

4. I'll talk to her at that time. I'll get her ideas on what she sees, and float the following ideas by her:
a) should we cut his grain and/or switch to a low-carb grain just in case he is having laminitic flareups? (absolutely no other indicators that this is the case, but I can't think of anything else that would be causing periodic heat + lameness)
b) should we call in another Vermont vet who has ultrasound equipment and take a look at the foot? (said vet also specializes more in sporthorse lameness)
c) should we alter his turnout schedule in any way? (stall rest or 24/7 - the latter of which would theoretically be possible at our current place, but not without some negotiation.)

5. I will sit down probably Thursday night or Friday night and make a detailed, blow-by-blow chronology of everything that has happened. Luckily, I keep really good records, so this should be nothing more than a research exercise, rather than a reconstruction. I'll email that to the vet so she has the full copy, keep it updated in case we go to the other vet.

@$*%#@$

Tris walked out of his stall very lame on Monday morning. Monday afternoon, after turnout, still lame, heat in the hoof.

I talked to the vet this afternoon and suggested short laminitis episodes. She said nothing on the X-rays indicated that.

She'll send the X-rays out to a radiologist tonight for an extra opinion, and she's at the barn for another horse on Thursday. She wants to block him and do a full lameness exam on Thursday. I don't think I can be there for it - I have so much going on at work this week.

We'll see, I guess...

My Valentine

Don't tell my boyfriend, but this face? This is the love of my life.

Now, with video!

I asked the barn manager to film me jogging Tris out on Monday afternoon so I could send it to the vet. Good news: he actually looks not half bad! He's not 100% sound (that's too much to hope for) but he looks good enough that the vet was impressed. I've asked her if he looks good enough to start handwalking; still waiting on that answer.

Walk and trot from behind:


And walk and trot from the side:

Happy pony

Happy Monday! Here's Tris getting his massage yesterday.

Finally, encouragement

I arrived at the barn this morning around 10:30 to groom and play with Tristan before his scheduled massage at 11:00. Grooming was easy - he loves to roll and it's always great when there's snow on the ground, since he basically keeps himself clean.

Playing around was a bit less successful. Something about the clicker training is getting us to a certain threshold - but not quite sticking. I'm going to do some reading and re-thinking before we work together again tomorrow. He seems to associate the click with a desired action, but only up to a point. He'll nose the bucket but then won't come back again after the click. When turned completely loose, the "bucket" command seems to clearly work sometimes and not others. It's almost like he only follows it when he's bored of exploring other things. It works like a charm when we're standing next to the bucket, and he'll go on runs where he'll walk 10-15' to nose the bucket, but then I lose him.

We stood in the indoor for his massage, and he was mostly good. He got fidgety at the end, especially when Judith was working on his right side as he was tight there. He entertained himself for a few minutes by learning how to unzip the arm pocket on my barn coat, which was hilarious and adorable.

Overall, though, the news was good. She said he felt less tight, and when I walked him around after his massage he was clearly walking more easily. When I jogged him he took a flying leap and landed in a bucking canter - the first time he's shown any inclination to canter in a very, very long time. When Judith jogged him for me he clearly still wanted to canter! It was a little tough to read if he was off at the trot, as he was not moving evenly due to trying to break.

When I described the size of the abscess hole at his toe to Judith she said it made sense for him to be quite sore on it still, as it was expanding and contracting with each step and probably torquing his foot. I'm still hoping that's where the pain is from.

We still have probably another 2-3 months of waiting, but it's easier waiting at least for the moment, knowing that he was feeling better today.

Equine Intelligence Test

I am so trying this on Sunday!

Hat tip to Eventing Nation for this video:



My guess? Tris will pause long enough to GLARE at me, and then flip the bucket end over end. 2 seconds, max. I'll report back!

Further adventures in stupidity

You know you're a horse person when you write a $400 check for vet bills without a qualm, but dither all day about getting your possibly broken foot examined because of the $50 ER co-pay.

Currently waiting on my x-ray results. I'd be surprised if it's broken, but better safe than sorry, I guess.

So tired of this...

Saturday night, about 24 hours after the farrier visit: heat back in the foot, swelling in the fetlock, lame at the walk.

I groomed him briefly, went home, and had a rather spectacular meltdown.

Sunday, I came out the other side determined to do stuff. So I took him out of his stall and groomed him thoroughly. I massaged his shoulders. I worked on clicker training with him: loading the clicker, then taking him into the ring and teaching him to touch his nose to a blue bucket. He was slightly bewildered at the idea of having to do things in order to get treats - kept glaring at me and nudging both my pockets and my clicker hand, once he realized the click meant treats. And one or two times I stretched my distance from the bucket too far and "broke" it, and he stalked off in a huff to the other end of the ring, standing at the door that led back to the aisle. But he came back, and I settled for one more good target on the bucket and then he was done.

Monday, I did the same thing, and when I saw that he'd had enough of the bucket I did a little bit of confirming his "back" command with the clicker, clicking when he moved a foot back in conjunction with the command. He once again didn't much see the point of having to work for treats, but he had clearly caught on a bit more than Sunday.

Still heat, though. Still a bit of swelling. Even through the bute.

New crazy theory: is he brewing another abscess? I'll try to call the vet this afternoon and run the idea by her, have her take a look at the x-rays and see if there's anything that might indicate that. The other thing that causes so much heat in a hoof is laminitis, and that doesn't make sense to me, based on all his physical and environmental factors.

I have a work thing until late tonight, so I'll check on him again tomorrow night, and by then I'll have decided whether to start wrapping the foot again and perhaps poulticing.

More Waiting

I'll be brief, because there isn't a lot of hard, clear information and because speculation makes me nervous.

The farrier tried to pull Tristan's shoes and begin to trim without sedation. No dice. Tris started flipping around as soon as the farrier picked up his foot. So he got tranq'd. I'm not sure how to solve this one now. He's been good as gold for me, and I can't in good conscience ask the farrier to expose himself to physical danger and take up large amounts of time working through this. He wasn't being pushy, unusually quick, or really anything - steady, gentle, purposeful movement and Tris just did. not. want.

So farrier pulled the front shoes and did an initial trim, and then the vet shot x-rays of the RF. She did quite a few, including a navicular series, and determined two things based on x-rays. First, medial lateral balance was off, but not spectacularly so. Second, she did not like the look of the navicular bone. She thought she saw a loss of bone density and possibly some changes toward the back that were new bone growth in compensation for out of balance foot. She also thought she saw some deterioration of the bone in his toe - third phalanges - but couldn't make a clear determination because the bad hoof from the abscess was so junky it was obscuring the x-ray. She's going to keep looking at them with more leisure on a bigger screen, and in comparison with all the other previous x-rays, and possibly send them out to a specialist.

X-rays also showed that the LF is clean as a whistle, so any damage to the navicular in the RF is because of the poor balance there. That says to me at least - though vet was being admirably circumspect and cautious - that the damage was caused externally and is, while clearly not reversible, able to be stopped.

Joints continue to look good, and sole depth is remarkable, so those are two things not to worry about. The hoof growing down behind the abscess is straight and solid. With the x-rays the farrier and the vet both agreed he could take off much more toe than it looked like he could from an external view, so Tris's foot got trimmed back again. The bottom holes are alllllmost to the ground now. He also set the hoof back fairly significantly to move the breakover back and ease pressure on the heel. With the vet's input, we left shoes off his hind feet, so hooray for that.

When the farrier pulled the shoe from his RF, the abscess hole was clearly visible from the bottom, and HUGE. I am really regretting not taking a picture. I could easily have put my index finger into it up to the first knuckle. It was awful. Vet and farrier were duly impressed, and said they could smell not current infection but a sort of rank smell from old, dank infection. Ugh. I can't wait until the whole thing is gone. At this rate, the upper hole will be probably another 3 trims away from the bottom, maybe 4.

So. Plan going forward. I'll send all previous x-rays to the vet for comparison (she's already got the fall's, but I'll send her the views from a few years ago). She'll let me know if she wants to send them out. Tris has dramatically shortened feet but better balanced feet, and he'll be on 2g of bute a day until Tuesday to help him adjust. Next Friday I'll drag M. to the barn and jog him out and get a video to send to the vet.

I am still hopeful. Perhaps foolishly at this point. I'm not exactly cheerful - I've been close to tears basically since Tris started flailing at the farrier yesterday afternoon, and that doesn't look like it will go away soon. But I have a sort of internal logic worked out in my head that says that if any damage to the navicular was caused by bad balance, we can correct the balance and compensate, and keep an eye on him. It may mean we don't jump any more, it may mean I get picky about footing, it may mean he's shod up front for the rest of his life. Whatever it takes to keep him comfortable and happy is what I'll do. I just hope that happens to coincide with being able to ride him again.