When it rains, it pours: back in front shoes

So Tristan had chiropractic work on Friday, after much angsting on my part and carving room in the budget for it. He felt much more free through his neck on Sunday, so I was glad I did it.

Then on Monday afternoon, the barn manager called. The farrier was there, and wanted to talk through Tristan's right front foot.

Yes, that right front. The problem child. It's been over five years since it first started causing problems. If you're new to that saga, start reading the abscess tag. Here's the foot progression collage. Short version: he had a stress fracture of the coffin bone that separated, got infected, abscessed, and had surgery, and that foot has never been quite right since.

It's always grown slightly wonky, thanks to the scar tissue from the original injury and the abscess insult to the coronet band. Well, the farrier was telling me over the phone that over the last few months it's been resulting in a mechanical instability at the toe - not due to bad balance, but rather to the way the foot itself was growing. That had now resulted in some separation at the white line, a bacterial infection, and a growing crack.

I knew the crack was there, and had already planned on talking it through with him, but I also thought it could be dug out with a normal trim. Joke's on me, nothing about that foot is normal.

Verdict: he needed to get it totally dug out back to healthy foot, stuffed with artimud, and then...back in front shoes for stability and protection.

Whooosh goes the money out the window. See, my budget is pretty tight, and it's built around him being barefoot, which, 95% of the time, has been a realistic projection!

Alas, not for the next few months.

So here's the foot all dug out.

It's tough to really tell, but that's a decently deep hole. The good news there is that the farrier really thought it was better than his worst fears.

Tris also got hot shod for the first time, this farrier's preference. New farrier from the last farrier who did shoes on him - anyone remember when Tristan had to get sedated for shoeing? Yeah. Good times. Thankfully, I distracted him with peppermints and he did not put a foot wrong the entire time. GOOD PONY.

Next step, artimud and dental putty.

Farrier said "if you want bragging rights, your horse's foot is so round that I have to use the draft horse pad."

Then, the shoe. Sigh.

GOOD PONY. So well-behaved.

I was grumpy but resigned (also freezing cold, it was 40 degrees and I am not yet acclimated to winter) but then I got on...and we had our best ride in WEEKS. He was forward, he was cooperative, he was loose.

Fine, pony. Fine. Have all the money.

Limbo Lower Now

So, let's recap.

Tristan comes in lame with a blown up RF. Yes, the problem foot.

Vet diagnoses abscess, and we go into full-blown neurotic mode: wrapping and poulticing for a week, with SMZs for that week. Wrapped constantly after that. X-rays are taken and minutely examined.

Two weeks later, it still doesn't seem quite right, and he is just not using that leg as he ought.

Two days after that, the vet comes out and he longes perfectly sound. Vet says keep on keeping on.

One week after that, he gets his feet trimmed all around, and the farrier is iffy about the foot. He thinks the abscess goes deeper, and it's not done yet. He takes out more foot to try and chase down the poor hoof quality channel, and then fills the hole with putty.

Five days after that, aka yesterday, I went out to the barn and had a come to Jesus moment with myself.

When Tristan first came in lame again, and it was an abscess again, I was not in a good place. I was by turns terrified, depressed, and foolhardy. I couldn't settle on a way forward, so I bounced between options. I felt nauseated and anxious whenever I thought about it, imagining a repeat of that terrible 9 months that ended in surgery. I couldn't believe this might be starting all over again.

Uncharacteristically for me, I backed off. I followed the vet's instructions to the letter, but did not go above and beyond. I immersed myself in other things - work, the new house, training the dog.

In a way, I let Tristan down. I don't mean to say that he wasn't meticulously cared for. This is hands-down the best barn I've ever been at for noticing things and maintaining horse care. They are truly extraordinary, and I'm grateful for that every day. I haven't worried even for a moment that they would not be on top of things. Trust me, I realize how lucky I am to feel that way!

But I didn't do anything extra for him, either. I would go and pet him on the nose, re-wrap his foot, and bug out. When his shipment of new vetwrap got waylaid and delivered to the barn owner's house instead of the barn, I sort of shrugged and trusted that it would arrive eventually. It did, but in the meantime I got dangerously low on wrapping supplies and honestly almost ran out.

I hosed off his hind legs when he spent a few days sleeping in his own pee, but not until weeks later. I just hosed them off, I didn't scrub them down to help the skin out like I should've.

I didn't really groom him, other than a cursory brushing and one or two sessions with a shedding blade.

I honestly can't remember the last time I cleaned my tack, which is a good way to fill downtime. It's been at least 9 months. Maybe more. (I'm sorry to all of you who just cringed!)

I didn't really hang around the barn, either. I was completely surprised when the horses arrived back from Florida, because I hadn't been chatting to people daily. I was surprised when the grain room relocated to its new (better, more organized) location. things have been passing me by.

As you can see, I haven't been as on top of blogging as I'd like to be.

So yesterday, I tried to get my head back in the game. I gave myself permission to move on with a minimum of self-loathing.

I groomed Tris thoroughly, until he shone, and instead of a quick re-wrapping I carefully picked out any tiny bits of shavings with my fingernails, tested the white line and the sole, examined everything. I used my hands on him in addition to the grooming tools, feeling his body for any new bumps or irregularities - you know, the basics. I used to always follow the brush with a hand to constantly update my mental reference points on his body, so I would know what's new.

Then I put his halter on, and we walked and walked around the fields. I figured the grass would be less abrasive on his duct tape bootie, and that I really needed the exercise too. He dove for grass for the first few minutes, but then he was clearly so happy to be out and about. It was quiet and peaceful and sunny and it felt good - if pathetic - to feel the burn of hiking up the long gallop hill. Tris licked and chewed, and dropped his head to stretch out over his back as we went up.

It was only about a 20 minute walk, but it was good for both of us.

The vet will be at the barn for other horses tomorrow, and she'll jog him out so we can continue to keep an eagle eye.

In the meantime, I'll keep with the handwalking, I guess. Keep on keeping on.

Never mind

I went out yesterday afternoon and curried Tristan, and fussed over him, and reinforced the toe of his duct tape boot with some more tape.

Then I jumped on bareback, intent on repeating Sunday's ride: 30 minutes of walking, plus some loosening up.

Within a few minutes I got That Feeling. You know the one.

The barn manager was teaching at the same time, and I asked her to watch him. "Is he sound?"

Long, long pause. Too long, as we walked on.

"No."

We agreed between us that he wasn't in tons of pain - he wasn't head-bobbing, or obviously favoring that leg.

He just wasn't landing right on it. He wasn't using the leg the way he should've. Guarding it, maybe, just a bit.

I jumped off, led him back to his stall, put away his tack, went back to my car, and cried. A lot.

Then I called the vet, who will be out today or tomorrow.

sigh.

Momentum

I rode my horse yesterday!

Just for 30 minutes at the walk, but it was enough to get him loosened up, to ask for some acceptance of the bit, to do a few tiny leg yields and to reassure me that he has not forgotten everything.

the actual cutest.

He felt sound. At the same time, however, his duct tape boot split at the toe, after just 30 minutes. So I am not sure if we can do anything more than walk around for a little while until he can have that foot open again.

I re-wrapped. There was a slight sheen of moisture inside the hole. I can't decide if it was drainage or the last bit of saline from the last time I wrapped it that just didn't evaporate. So this time I rinsed it with saline and then dried it with a cotton swab, then packed the hole with gauze and added more gauze on top of that. I'll ride again today and rewrap and then we'll see.

I also groomed him for the first time in, um, about three weeks. I've been that busy, discouraged, tired, whatever. He was under a sheet the entire time. So yesterday it was in the low 70s for the first time since early October and he was nekkid and I thought oh my God my horse looks like a homeless ragamuffin.

That is my size 8 Ariat Terrain for sizing purposes. That pile is halfway up my shin. o.O

He was so happy, leaning into it. He had clearly been itchy. I'm the worst horse mom ever. But I fixed it, so that has to count for something. I'll go again today and scrape more off, and ride again, and maybe, maybe we will start to get back on track.

I'm staying in touch with the vet about the toe, and right now the plan is to wait until midweek next week when the farrier comes. We'll have him trim the toe (which is long, and I think putting some pressure on the open area), and see what he thinks. 

We discovered while riding that there is a new banner in the arena and that Tris is apparently one of the new mascots for the local university riding team. He was used in one of their shows once and was apparently such an exemplary citizen that he offered up a polite, balanced canter when one of the walk-trot riders put his heel too far back. Ha.

I laughed and laughed. L-R that's Skip, Tristan, Portia (I think? too many grays!), and Prince. They don't travel for IHSA yet so I think they had a limited number of photos to choose from, and apparently Tristan's beggar-face made the cut.

So, spring. Even with all the insanity, hope is returning.

Spring in the foreground, winter in the background.

What the Vet Found

Apologies for the delay - the last few days have been very full and I have not felt much like self-discipline. See also, the frozen pizza I had for lunch.

So, the vet came out on Friday, and we got to work figuring out what the heck was going on with Tristan now. (As mentioned previously, he was lame with a badly stocked up RF leg.)

We walked him out and he was still lame, though not falling-down three-legged lame as he had been on Wednesday and Thursday. The vet had me walk him in some small circles, and then brought out the hoof testers. Immediate strong positive...right where we didn't want it to be.

Next step, looking at the foot itself. The vet cleaned the bottom of the foot off, and then began carefully paring away at the toe. There was still a nasty defect at the white line from scar tissue; she cut that out and almost immediately saw a spiderweb of cracks underneath it.

I was super nervous about cutting away that foot that we worked so hard to grow, but she was being incredibly careful. She'd cut just a little bit, then clean it out. She went back to her truck and got a dremel to keep the edges smooth and pare just a tiny bit at a time. She followed her instincts about where to trim, and slowly but surely the cracks faded out until there was one, and then with one last tiny paring - pus welled up.

Abscess. Again. Some more.

I was a bit discouraged, I admit. The vet, even though she'd expected it, was somewhat resigned. We talked options. I brought up the idea of a regional perfusion of the limb, ie, get whatever is in there the hell out NOW. She got what I was saying but said that she felt that was too aggressive right now, and was really very painful for the horse.

We kept talking while she got out her equipment to x-ray, because of course. That foot, seriously. We couldn't take any chances.

Thank God, the x-rays came up clean. In fact, the coffin bone looks pretty darn good. I'll put them up here in another day or two when I pull them from the flash drive. You can see the abscess drainage hole, but it's tiny.

Vet used a needle to get betadine way up into the crack, and then did a final cleaning up with the dremel.

If you click on this photo, you'll get a blown up version. Look within the pink of the sole, that's within the betadine stain. Now look just off center, to the left: there is a tiny black pinprick. That's the drainage hole.

If we can keep this draining freely, and keep it clean, we should be ok. Tris is on sulfa antibiotics for a week to be neurotic, and I am poulticing every day for a week with sugardine, then wrapping the foot for 3 weeks after that.

ready for battle.

It's been a few days, and a few things are evident. First, he and I remember our foot-wrapping dance very well. After one brief heated discussion, he's stood patiently and quietly, and my hands have remembered the motions. Second, he's practically sound again, thankfully. We seem to be on the right track.

So, I am obviously bummed that this is another setback, that it's still related to that initial disaster in his foot (2.5 years and counting!), and that I can't ride and get him legged up and back on track for the spring like I'd planned.

But I am glad it's not what it could've been. His leg was so hot and fat I was worried he had done something truly dire to a tendon or ligament.

Just wrapping. I can wrap. And waiting. I'm getting pretty good at that, too.

Frying pan, meet fire

So, as I mentioned yesterday, the barn manager let me know that Tris came in from turnout with his RF fetlock swollen again and quite lame.

Last night at midnight, after getting back from my 15 hour workday with a program in another part of the state, I checked on him.

RF was swollen and hot from fetlock to knee. No definition to the tendon sheath. Three-legged lame.

Fuck. Everything.

I paced, and checked it again, and paced some more, and finally left the barn. I couldn't cold hose, since it was still going to be below freezing overnight and the hoses wouldn't run. I didn't have ice, and it was midnight - I couldn't get any. I thought briefly about liniment, but that felt like flicking drops at a fire, and I didn't have any Sore No More - only Absorbine, which I kind of hate.

While I was driving home, I formed a plan that I carried out this morning. After about 5.5 hours of sleep, I returned to the barn. I stopped for iced coffee and a bag of ice on the way, and when I got to the barn filled a gallon bag with ice, added a little water, and wrapped it on to his leg with a snug polo wrap.

He was turning up his nose at his grain - he really hates his new bute - but chowing down his hay and happy and cheerful otherwise. I was struck by how much his leg looked like it did back when he had his first abscess. You know, the one that started the year of misery and vet bills and surgery and rehab.

On the one hand, of all the personal nightmares I do not want to revisit, that one is pretty high on the list.

On the other hand: if it isn't an abscess, there is something very, very wrong going on in his fetlock. That has all sorts of possibilities that I don't want to think about right now.

The silver lining is that I am so maxed out on stress with the house and work that while I am worried and upset and stressed about this, I am not quite freaking out. Yet.

Barn manager, who I am nominating for sainthood as soon as I can figure out the paperwork, is negotiating with the vet right now for an appointment today or tomorrow for Tris as well as another horse in the barn. She'll pull and periodically re-ice through the day today, and I left it up to her discretion whether to put him in standing wraps otherwise.

Onward, I guess. I just wish I knew where.

TOABH: Costly

What has been your horse's most expensive injury to date? Let's exclude maintenance things, like hock injections and the magical monthly package of MSM. What single episode blew your savings or left you boiling ramen? If you want to get technical about it, time is money, too.

hahahahahaha.

 

ha.

ha.

I've covered this at length in the blog, but for newcomers, here's the short version. In August 2012, Tristan blew his first ever abscess. It was really bad. He blew at the coronet band, and then at the toe, and then a few weeks later midway down the hoof. Cue 6 months of NQR; he would almost come sound, and then he wouldn't. On and on. In March, he had surgery to remove the cause of the abscess: a bone chip from his coffin bone that had become badly infected, as well as portions of his coffin bone that had died from infection. Upon recovery from that surgery, which took months (if we're counting the time back to normal hoof status), he came sound and has been ever since, though I would not call him 100% recovered - he still has to wear front shoes to keep that foot stabilized, because it is still not growing evenly enough to stay balanced barefoot, 2.5 years later.

Here's what I call the foot progression collage: photos taken at monthly intervals from initial abscess to final recovery.

Here's the post about his surgery.

And here's the post where I broke down and tallied up every penny I spent on that injury and what it went towards (three sets of x-rays, supplies, surgery, umpteen vet visits, specialty shoeing, the whole nine yards). So, to answer the original question: $6,100.08, which does not include lost opportunity costs or even begin to approximate time.

If you're really feeling in a reading mood, check out the abscess and surgery tags. Dozens and dozens of update posts there.

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.

Onward

Hell of a week so far.

Tuesday night, I was so upset about the possible keratoma news that I couldn't force myself to go to the barn. I played with the puppy and read and puttered around at home and had a good crying jag.

Wednesday, I put on my big girl boots and went to the barn, determined to at least sit on him. It wasn't anything fancy; I kept making myself put one foot in front of the other, do the next thing.

We ended up having a rather nice school: 30 minutes of dressage work, with some nice moments in the lateral work, some nice work in the canter, and just a generally harmonious ride.

Last night, not as much fun but I tried hard to read the horse I had underneath me. I had intended to do another 30 minutes or so of dressage. It was SUCH a gorgeous night I couldn't bear to be inside, even though I knew he would not be nearly as rideable. Often, we get to the outdoor ring and he just wants to canter madly around on the forehand, which benefits exactly nobody.

We walked all around the field and when we headed into the outdoor I immediately saw that a) he was not going to cooperate and b) the footing had been rained on, hard, and not dragged in a while. It was not dire - we probably could've managed just fine - but it was enough to push me into going in to the adjacent field instead.

Nothing fancy: walk and trot around the field, working on rhythm amidst terrain and elevation changes, staying focused. A few strides of canter. A hack up and down the dirt road to finish.

I set the date for his vet appointment: August 6. We'll do a trot out for the vet (he does not feel off on that foot, but since his comfort level will largely dictate how aggressively we move, it makes sense to get a baseline), pull the shoe, do an x-ray, and have a long chat with vet, farrier, and myself.

Tonight, road hack; this weekend, a wedding out of state, so no riding for me. Pentosan today. Onward and upward, I guess.

The Hoof Drama That Never Ends

[insert primal scream here]

Farrier did Tristan yesterday, and the barn manager called today to have a chat.

There is still an abscess hole in Tristan's toe. It's been nearly two years. That abscess hole should NOT be there.

Farrier suspects that there is now (or perhaps always was?) a keratoma at the coronet band, and it's causing the abnormality down to the toe. Could've happened when the original abscess blew out, and grown back now that the scar tissue from that has gone. Could've caused the orginal abscess, coffin bone chip, whole ball of wax.

So, what next? I'll call the farrier and talk to him directly. I'll probably call my vet and do an x-ray when he gets his next trim.

If it really is a keratoma, we may be in for another invasive procedure and hoof resectioning. More time off. More rehab.

I just...really kind of numb right now.

Foot Update

Tristan saw the farrier yesterday. Originally, our plan was for him to lose the front shoes back in April: from the front, it looks like the abscess hole was all the way grown out, and he's always been a barefoot horse before. I wasn't there for that farrier appointment, but the farrier put front shoes back on. I was confused but didn't have time and energy to follow up.

I asked the barn manager to check in with the farrier specifically yesterday and ask what was up, and chatted with her this morning.

The upshot: believe it or not, he's still growing out the abscess hole/hoof damage. Remember, this is the abscess that blew on August 16, 2012. Yes, that's right: this abscess hole has been growing out for 22 months now!

It's barely detectable, but it is still there, and there's bruising in the toe area leftover from the destabilized hoof. He was missing massive quantities of hoof wall for so long it's just taking a while to grow a completely healthy hoof, top to bottom. Because the abscess blew at the coronet band, there's still a lump in the hoof starting from that scarred area.

So he's still in front shoes. He probably will be in front shoes until the end of the summer at least. Farrier thinks he'll need some serious time to adjust to going barefoot in the front again, so I have to think about what would make sense as a timeframe for that, and what combination of toughening work & time off would help him out.

(I swear, I thought I was done with the abscess tag...)

Foot Progression Collage

I finally completed a project I've been wanting to do for some time: a complete collage of the progression of Tristan's right front.

For those who haven't heard this before, let me make a long story short: in August 2012, Tristan blew a massive abscess out his coronet band. Over the next few weeks, he blew it again halfway down the foot and at the toe. Eventually, we discovered that it was due to an infected stress fracture of the coffin bone, and in March 2013 had surgery to remove bone chips and dead bone.

(if you want the story in excruciating detail, check out the abscess and surgery tags)

Photos are as follows. The top left photo is from August 2012, the night I discovered the abscess. They follow through monthly, left to right, at roughly the same time each month. August and September 2013 were lost in a camera data card crash, and I don't have a November 2013. The bottom right photo was taken on December 18, 2013 and still roughly represents where his foot is today.

For anyone who has ever wondered what a massive abscess hole looks like as it grows down from the coronet band to the toe, look no further.

This will, please God, be the last entry in the abscess tag set.

Product Review: Davis Soaking Boot

Davis Soaking Boot - "The Medicine Boot"

In the bad old days when I was soaking Tristan's foot every single day, trying desperately to draw out the abscess that we thought was just stubborn and/or trying to keep the abscess holes clean, soaking was a chore. I used the tried-and-true feed pan method. Result: guaranteed spillage, frustration, and possibly tears. (If you want the whole abscess drama in real time, follow the abscess tag and then the surgery tag.)

One day, I found myself at Smartpak to purchase more Betadine and epsom salts, and cleverly placed alongside those vital supplies was a Davis soaking boot. It was $32.95, and as we know that is pretty darn cheap for something connected to horses. So I bought it. And it changed my life.

Chillin'

I'm not trying to be dramatic, but wow. Why did it take me so long? Within two or three sessions, we went from frustration, anger, and lots of cleanup afterwards to uneventful, straightforward soaking. I would put his foot in the boot, pour the epsom salt/hot water/Betadine in, tighten the velcro, toss a flake of hay in front of him, and he would stand stock still for as long as there was hay on the ground. I didn't even tie him. I often read a book. To this day, that training holds.

Some of the advertising for this boot seems to imply that you could, in theory, fill it and then turn your horse out in it. I believe that to be creativity bordering on bullshit. If you have a boot large enough to hold an appropriate amount of water, it's too large to stay on your horse. Also, it would get trashed, durable as it is. So don't do that. If you truly desperately want something to serve as a hoof dressing during turnout, do the old duct tape method and plan on replacing daily. But if you are looking for a way to make your life easier while soaking, buy one of these. It's a game-changer, and no barn should be without one.

State of the foot

As I mentioned, Tris is finally wearing normal shoes! Here's pictorial evidence:

For comparison, here's what that same foot looked like just about a year ago:

12 Months

This is to say that 12 months ago yesterday, I pulled Tristan up in his lesson because he wasn't feeling quite right. The next day, he was quite unsound on the RF. The day after that, he blew out his abscess, one year ago tomorrow.

Hell of a year.

Tonight we had what might be called our first really solid schooling session since that day. We warmed up, we worked on lesson homework, we worked through rough spots, we improved from start to finish, we took a break, and we picked the work back up and cemented it. He felt fit throughout and tired in a muscle building way at the end - it was the most time he had spent bending and forward and stepping under since last year. SO glad we are on the path forward!

Whew

On the one hand: I helped out with chores again today, and there were only two of us, and it was a completely packed and busy six hours. I was too tired to ride and came home and have been mostly flopped on the couch re-reading Pride and Prejudice.

On the other hand:

- all those calories burned!

- I have my first 30 minute lesson on Tuesday! I am incredibly excited to get back on track. It will be almost 11 months to the day since my last lesson on Tris.

- last night, we cantered all the way around the ring, once on each lead. I could've kept going forever.

In state of the foot news, farrier will trim him in the next few days, cutting off the plastic shoes with clippers, dremeling out the epoxy, and then we'll see what's left. He could go back in another round of glue-ons, back to regular shoes, or back to barefoot. It depends on how much foot is left after the trim and what quality it is. Here are pictures from this morning.

Doing the Math

If you follow the COTH forums long enough, you'll see multiple threads about horse budgeting - and in every single thread, at least one person says that he/she never actually looks at how much it costs to keep a horse.

I don't understand that attitude at all. When I first got Tristan, I was making just under $20,000 a year. I knew where every single penny went - most of them into him. I am doing better now, but I work in nonprofits. I'll never make so much that I don't know how much I spend on him.

With that in mind, here is the end result on a project I've had in my head for a little while: start to finish, how much Tristan's coffin bone chip cost. The period in question is June 8, 2012 through May 16, 2013, when he got his fancy glue-on shoes. I've broken it down by categories:

Veterinary Care - vet calls and treatment (hands on care)
Farrier Care - shoeing, which he would not have had had he not gone off
Diagnostics - x-rays, mostly
Medications - bute, antibiotics, sedatives, specific supplements
Supplies - epsom salt, vet wrap, duct tape, and the like

I could also do a category called opportunity costs - for the scratched Valinor and King Oak entries, for the 7-8 lessons I pre-paid and left behind when I moved to Vermont, and I'm sure for other things if I thought about it. Easily around $500 or so.

So:

• Veterinary Care - $2,037.59
• Farrier Care - $990
• Diagnostics - $1,070.75
• Medications - $1,313.70
• Supplies - $688.05

Total: $6,100.08

Some of my separations were silly; I split the surgery up several ways (vet care, board, diagnostics, medication) when the two days of hospital care, surgery, and drugs cost $2,189.20, which is DIRT CHEAP if you ask me. I am also certain that I missed a few epsom salt and duct tape purchases in reviewing my budget numbers, so that category may be off by $50 or so.

The medications column ended up being the longest, and it was mostly sedatives for his farrier issues. The big ticket items under supplies were his EasyBoots, the two regular sizes and then the third larger size he had to get at the vet clinic. The diagnostics were entirely x-rays, four different sets of them and the one radiologist consult.

Out of all the vet visits, if you look at each visit as a cohesive cost unit, the surgery cost the most, obviously, but after that it was that first visit, the one on June 8 for the first abscess diagnosis that was the most costly. (In more ways than one, since that was the one that sent us down the wrong track!)

In conclusion, this seems astoundingly low to me. In my head it was closer to $10k. Paying for it has still emptied three savings accounts (Tristan's, my farm down payment, and my tax return) and put a serious dent in my emergency fund. Still, it's a testament to those early days living on noodles and sleeping in all my winter gear on the couch in front of the wood stove because I couldn't afford to turn the heat up that I was able to cover it all and that I could pursue the problem to its final solution.

8 Weeks!

Yesterday morning was Tristan's 8 week check, and it went spectacularly all around. Vet was thrilled with his foot, with the care, and really with everything. She was not terribly worried about the crack in his foot.

The farrier is on his way back from Florida right now, and as soon as he arrives back in Vermont he will trim down Tristan's front feet, put his shoes back on, and then Tris is cleared to go back under saddle!

Possibly just as exciting, no more wrapping! I will spray some AluShield on the hole to form a barrier, and flush it regularly to clean it out and keep it pretty good, but at this point it can grow down and heal on its own.

I'm excited to ride again, and I'm excited to start getting the sole of that foot in better shape. It's really bad right now - crumbly and soft and just gross. I've ordered some Durasole to use on it to start toughening it up, and I'll probably also do some thrush treatment on it. The LF foot responded quickly once I started treatment; I expect the RF will as well.

Here's a comparison shot to show how far the original abscess hole has grown down, and to show the nasty crack:

And here's the bottom of his foot. You can see some of what I'm talking about with the sole!

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.