Saturday, March 9, 2013

Surgery & After

Summary: Tris did really well for his surgery, and has been slowly improving since.

Tristan's stall at the vet hospital.
Hannah and I got there on Monday mid-morning, and Tris already had his catheter in his neck, for IV meds, etc. They had given him morning antibiotics and bute, and he was mad that he hadn't had breakfast and pacing a bit. We groomed him thoroughly and fussed over him and then left him alone for a bit to hopefully stop his pawing. I went and checked later and he was eating shavings in search of hay - doofus. So he had to wear a muzzle until his surgery.

Saying hi to Hannah. You can see his catheter under his mane.

Wearing his muzzle and getting a shot of antibiotics.
We went out for lunch and then after lunch I sat in his stall with him. He was clearly bored and a bit frustrated, standing and staring into the middle distance. The surgeon was running a bit late from morning farm calls, so they started prepping him at about 2:00. They tranq'd him, pulled his shoes, and did some x-rays to confirm everything.

Getting his pre-surgery x-rays.
The surgeon was incredibly nice, and pointed out the sequestrum - technical term for a foreign object causing infection, in this case the bone chip - as well as how they'd get in there. He was glad that Tris's abscess had come out the toe, too, because that gave him a clear channel to go through. He explained that he would make a hole about the size of a quarter, then go in through there with a tool that looked a lot like a very small, very sharp ice cream scoop. He'd remove the chip, and then scrape at the bone until he removed all the necrotic bone and debrided back to health bone. He described the sound of healthy bone as "crisp." (Ew.)

Pre-surgery x-ray with the vet's labels.
I had been doing okay all day but I got a bit teary and frightened when they led him into the room where they would tranq him for surgery. Basically, they would start the drip (he was not intubated, since they anticipated the surgery would take less than an hour) and then as he got sleepy they'd hold him up against the padded wall, encourage him to sit down like a dog, and then roll him down to his side. Then they'd hobble all four legs together and use a crane to lift him up and onto the surgery table.

Lie-down room on the right, recovery room on the left.
Hannah and I went to the waiting room for the duration, which was a very, very long hour and a half (including lie-down and recovery time). I read a YA fantasy book that basically went in one ear and out the other and checked my watch every five minutes and texted people. Sooner than I would have thought, though, the intern came in and told us that the surgery had gone well, he was in the recovery room, and they'd had to take a fair bit of bone but it was successful.

Surgical suite, with the door to the recovery room in background and the anesthesia machine foreground.
Ten or fifteen minutes later, they came to tell me that he was heading back to his stall. He'd recovered beautifully - apparently horses sometimes flail around, fall, crash into walls, etc., which is why the recovery room is padded. He'd just lain quietly until he could get up, and then stood.

Post-surgery, not a happy boy.
I visited with him for a little while, and told him how brave he was. He was staggering a bit, and not focused, very out of it - understandably! He was also bleeding right through the bandage. They explained that they'd put a tourniquet on the foot during surgery to help manage blood flow, and once they released it the blood would leak through for a little while until it clotted.

Bloody footprints leading from the recovery room to the stall.
The surgeon came to find us and show us the x-rays in a few more minutes. He said he evaluates surgery on two points: his gut feeling and the clinical signs. In this case, he said, both were good. He said he would be surprised if Tris didn't return to 100%. Hooray!

X-ray taken during surgery with a probe inserted to confirm that they were headed in the right direction.
Side view of same.
After surgery, with the hole and the missing coffin bone area. Not too bad, actually - there's still bone in the middle, they didn't take a clear slice out.
Side view of same. You can see the hole going up to the toe, and the scraping from both the top and bottom.
When we got back to the stall, we found Tristan enjoying a celebratory post-surgery bran mash.

Eating very slowly and very carefully.
His protocol going forward is actually fairly straightforward:
- 6-8 weeks of stall rest, the first 2 very strict, and possible handwalking or occasional turnout based on evaluation after that
- Bute am + pm for three days, then am for three days, then back to Previcox
- TMS tablets (sulfamethoxazole + trimethoprim): 10 am + pm for 2 weeks, possibly longer pending evaluation
- flushing and rewrapping every day for three days, then every other day for the duration
- checks with our local vet 1 and 2 weeks out

Here's what the hole looks like, basically; these pictures were taken the morning after surgery by the intern. I'll link to them instead of inserting them because they're a bit gruesome. Click here.

Tris will granulate in new tissue around the bone first, and then fill in the hole slowly, down through the sole, and then finally heal over the bottom of the sole. He'll be in his new boots for pretty much that whole time, and when everything is 100% healed over we'll see about whether he needs his shoes back on, or wait until he's back in full work or not.

As I'm now posting this almost a week after the surgery - I've been insanely busy - I'll follow up with a general post about the week since surgery, and then get back on a proper schedule.

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