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.

Feet Update - 1 year post-surgery

I missed an important milestone last week: one year since Tristan's surgery. One year ago today, he was on stall rest in recovery, and now he is back in full work. I am amazed and indescribably grateful that everything worked out so well.

Here's a front foot comparison, for the record.

1 week post-surgery. The chip out of the front separated during surgery;
there were additional abscess holes at the top of it and the hoof wall
was just that weak.

Yesterday! The bit of white is the absolute last remaining sign of the surgery/abscess.
You can still see/feel a sliiiiiight bulge but it is continuing to fade, ie far less
noticeable at the coronet than at the toe.

 Also! Remember last summer how worried I was about white line in his hind feet? I could carve out chunks of his quarters and his white line with the hoof pick, it was that mushy. Check out his hind feet today. Gorgeous.

In late April, the shoes come off the front feet and we are back to all-barefoot, all the time. FINALLY.

Product Review: Easy Boots Rx

EasyBoot Rx

After Tristan had his surgery, the debate was between hospital plate and hoof boot. Hospital plates are a special kind of shoe that supports a flat piece of metal that covers the bottom of the hoof. They're protective and supportive.

However, in those days, Tristan's hoof was actually open on the front as well (see the foot progression collage for an example of what I mean) and needed protection all around.

The vet clinic recommended these EasyBoots, so I measured away and ordered them. He wore them 24/7 for 8 weeks on both front feet - both shoes were pulled and we wanted to keep them even so there was no compensatory lameness. The first 5 weeks or so were entirely on stall rest, and the remaining three were on limited turnout in a small gravelly area. His RF (the surgery foot) was wrapped 24/7 under the boots.

I ordered two size 4 boots, which were the correct size for him, but had to buy a size 6 from the vet clinic - in the first early weeks, we were wrapping his foot with multiple layers of gauze, vet wrap, and then Elastikon on top of that. Eventually we transitioned down to the 4 on both fronts.

Pros: they were really easy to use, opening up in the right way and sliding on. Sometimes it wouldn't settle 100% on the hoof but usually asking him to pick his foot up and put it down again fitted the hoof right in. They do exactly what they are advertised to do, and it was rare for me to find even a shaving down inside. He only pulled them off once or twice. They function very much like the SoftRides and are a much better price (usually running about $75 per boot, as opposed to $200 per pair). They are also sturdier than the SoftRides and can be used for limited turnout.

Cons: they are not really for turnout. Wear & tear accelerated significantly when Tris started going out a little bit. The elastic that tightens the top of the boot wore out relatively quickly, but I was pulling it extra tight to try and keep more of an antiseptic environment. The boots weren't exactly going to fall off, but there was noticeable stretching. The fabric tore a bit in the area where the two pieces come together - you can see it in the bottom left of the photo above. They MUST be worn barefoot - a shoe would have shredded the inside of the boot in short order.

My biggest complaint: those air holes? Did not work AT ALL. His feet were constantly damp. I tried shaking in talc powder to soak it up and that mostly created a paste inside the boots. His soles and frogs were a wreck after 8 weeks, because they were constantly steaming. Thrushy and mushy. I had to do a fair bit of remedial treatment to get them back online after he came out of the boots. He was just standing around his relatively clean stall, too - at no point did these boots EVER come in contact with serious moisture. If he could have spent even a few hours out of them I think that would've allowed everything to dry out, but he couldn't. Better than the alternative of re-infecting the surgical wound, but the moisture was a constant battle.

In conclusion: these do what they say they do, and for a decent price. They are useful if you find yourself in a situation that requires therapeutic booting.

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:

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.

The State of the Foot

I'm not saying I won't be checking back in with pictures of Tristan's foot as the last of the awfulness grows out, but these are the last for a little whole. Here's what his right front currently looks like, after the farrier worked his magic.

HOW AWESOME IS THAT?

We had our fourth ride tonight, circles and one or two lateral steps in the ring then a walk up the hill and around the dressage ring, back down the hill and a few more minutes in the ring. He will get tomorrow night off, as he was a bit tired tonight, and on Saturday we bump up to 30 minutes.

Here's my view these days.

YES

I RODE MY HORSE LAST NIGHT.

For the first time since August 14, when I finished my weekly lesson with a feeling of disquiet and thus started our endless diagnosis/treatment cycle, last night I saddled my horse, put his bridle on, and sat on him.

He was good as gold. Even though I'd closed every door to the indoor and alerted the barn manager, he stood at the mounting block and walked off sensibly. I don't know why I expected him to forget everything he's ever learned in the past 9 (!!!) months, but he responded willingly when I asked him to stretch down, to have a teensy bit of bend in the corners, to go on a 20 meter circle.

We walked for 20 minutes in the indoor. I didn't ask for anything complicated, just to stretch down a bit into my hands, bend a little bit, access the inside hind on a circle. He was quite short behind but even up front - I couldn't feel a hint of a problem in that RF. At the end of 20 minutes I could feel him getting the smallest bit muscle-tired, but he was definitely better in the hind end.

I could have ridden forever, and got a little teary at one point. He is the absolute best, and I am so glad to be riding him again.

The plan is to stay at 20 minute walks in the indoor through the next week at least, then start hacking outside for 30 minutes, whether fields or road work. I am a teensy bit nervous about how his soles will hold up on the dirt roads, with all their rocks, so I want to work on getting them tougher before we do that - lots of Durasole.

Tonight, I'll take pictures of his new glue-on shoes, which are kind of funky looking. The farrier also used epoxy to clean the whole RF up, so it looks practically normal save for the scar tissue lump that's slowly working its way down the hoof.

In conclusion, \o/

Patience, patience, patience...

The formalin/iodine mixture wasn't doing the trick on Tristan's scar tissue, so last night the farrier cut the tissue out and then cauterized the wound. He also took away a bit of Tristan's hoof wall to make sure the final bits of abscess hole are oxygenated, and that we have access to the last bit of healing tissue to clean it out regularly. I have to say, even with a little crescent cut out of the front of his hoof, this is the best it has looked in months - almost a year, in fact. I forgot to take a picture from the front, but here it is from the bottom.

The best part? Tris behaved for the farrier to do all of that without drugs, and without me even there! He texted me that he was going to go ahead and cauterize (which was something we'd already discussed as a possibility on Monday) and then when I got there he had just finished and said Tris was fine. This from the horse who back in November tried to kill the farrier when he tried to trim and shoe him. WHOO!

He should be getting his shoe on this morning. I made the extremely poor life decision of going to a midnight showing of Star Trek last night and registering for a 5K walk tonight, so even if I have enough energy after that walk my lack of sleep will still force me straight to bed.

Tomorrow, I pack breeches. \o/

One shoe down...

This morning, after much waiting and gnashing of teeth, I met the farrier to glue on Tristan's fancy new shoes.

I tranq'd him, and it took forever for it to kick in, because we moved him to a different barn and he was very snorty and fussy.

Then the farrier pulled of the duct tape booties and showed me the trim he did over the weekend. Tris stood great for the trim and for a CleanTrax treatment over the weekend, and his foot looks WAY better.

The farrier used a dremel to really, thoroughly clean out Tris's foot, getting the last of the dead sole carved out.

He also did some regular clean up trimming.

Then he started to glue on Tristan's left front shoe.

It took a long time set because it was so cold outside it was actually snowing, and even through the tranq he started fussing because he was so sick of holding his leg up - his shoulder was trembling for the last minute.

Then when we looked at his right front we saw that the small bleeding that had started in his scar tissue was still going. The vet who was there looking at other horses took a look, and we jointly decided to hold off puttin the right shoe on for a few days to heal and toughen up the scar tissue. So he will get a formalin/iodine mixture painted on the tissue for three days, twice a day, and hopefully by Wednesday it will be ok to take the shoe.

So I just have to be patient for a few more days...

Tris was still drunk when I left, leaning against his wall and napping pathetically.

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!

Another Day, Another Setback

I can't exactly claim to be surprised. This is exactly what the farrier predicted would happen.

Sometime in the last two days, the small crack leading from Tristan's surgery hole to the abscess hole has become a large crack. As in, I can now see daylight through it and with pressure move the two parts separately. The toe has grown out enough that walking on it has pulled the crack wider. Ugh.

He does not seem sore, but obviously his hoof should not move like that. I would guess that increased movement would put him at risk of an even bigger crack. So he's back on complete stall rest, poor lad.

I will check in with the vet and the clinic in the morning, but I suspect our way forward is to keep him quiet and get his foot trimmed and a shoe put on as soon as possible - which could prove problematic, as the farrier may not be back from Florida for another few weeks...

Six Weeks

Tristan's surgery was six weeks ago today, making this the low end of his recovery period estimate.

He is for all intents and purposes sound, and has been out of his boots for a week now. I am still flushing and wrapping his right front every two days, but finishing off the wrap with duct tape instead of his boot. He gets turned out in the indoor for as long as he behaves, which is longer some days than others. On days when he's not turned out we handwalk for 20 minutes.

He is still growing tissue in the hole, and it's tough to say how long that will continue. There is definitely some hoof growing back as well. The quality of his soles is not good from being in the boots, and his right front heel has rubs.

Mentally, he would like to be off stall rest, and he could be if it weren't mud season. His foot is still not quite healed enough to disregard the muck and standing puddles.

Life after the surgery is starting to seem real. I brought my bridles home to clean and I am starting to think and talk about riding again. It's possible that we will start short rides soon, just keeping his foot wrapped and staying at the walk.

Here's what his foot looked like after flushing this morning.

5 Weeks!

Yesterday, Sunday, Tris got a massage. He was tight in some of the expected places: in a muscle that runs from his poll down to his right front, in his back from his colicky episode, and in his hind end from the funny movement in his boots and the hill work. All surface tightness - no adhesions or strains.

Then this morning the vet did a 5 week check on his foot. She was THRILLED with the way it has responded to the metronidazole, said it looked (and smelled!) terrific. We jogged him out on the hard dirt road and he has a teeeeensy bit of residual tenderness in the RF when turned on a hard circle, but totally understandable given that he still has exposed tissue there.

She was concerned about the deterioration of his soles, however, an in consult with the surgeon decided to leave the boots off when he is in his stall, put them on for turnout and handwalking only, which should start to dry them out and toughen him up. Surgeon also recommended treating with Wonderdust occasionally 1-2x a week to start toughening up the tissue.

Finally, he got two more vaccines - West Nile and Potomac Horse Fever - and then had his teeth floated. He did really well for that and the vet let me feel around in his mouth to feel the sharp edges and what they felt like once he had them floated down. It was really, really neat!

In conclusion: drunk dentist pony.

Happy pony

Tristan's wound is definitely starting to turn into hoof material - it's hardening and the edges are crowding in. He continues to be sound and last night and today we hand walked outside. It was even dry enough outside today that I put him in a small paddock with a pile of hay before I left, and the barn staff kept an eye on him for an hour or two of turnout.

Massage on Sunday, 5 week checkup on Monday, and then another few weeks of being careful and maybe I get to start riding!

Here he is as I left him this morning.

Farrier checkup

All's well! Tris was stoned out of his mind from the dermosedan gel, and did great for his farrier appointment.

Hole continues to look good, 4 weeks out today, and the bottom holes are allllmost gone. They'll go at the next appointment. Once the foot grows that far, we'll start to worry about the next hole, the big one. It's got a crack leading up from the smaller one and a bit of hoof wall that may well separate and be wide open. We'll address that when we come to it. The mushy bit was just dead sole, not an abscess. His sole is in tough shape with the constant moisture of the boot.

In the meantime, keep on keeping on. Up to 15 minutes handwalking each day now, and incorporating poles to work his back a bit.

Scroll down for the updated foot pic.

Spring(ing)

So much for my well-behaved pony - it really was too good to be true. Last night I thought I'd do some handwalking outside, maybe incorporate some hills. Tris started off great, and then threw a bucking fit for the remainder of the walk back to the barn, when he wasn't jigging.

Tonight, we went up to 15 minutes of handwalking, and he only had one short fit, but when I turned him loose in the indoor he rolled and rolled (flipped over 7 times!) and then came up bucking like a lunatic. He circled the ring bucking and cantering and came to a sliding stop in front of he when I called him over.

Flushing and soaking tonight was not the easiest - I mistimed it and the other horses got dinner while we were soaking. He did not approve, and took a few steps back toward his stall out of his boot.

The tissue is starting to grow in hoof-colored, which I am assuming is keritanizing, so that's good. The worrying part is that there is an area just to the left of the hole that looks and feels mushy - with what looked like a small hole - and I am wondering and worrying if perhaps it was an abscess that has burst with the soaking. It might mean there is still internal infection. I've sent off another email to the clinic. We'll see.

Progress Pony

No drainage except for a teeny drop of blood. Huzzah!

Farrier on Monday which means I am coordinating with the vet to pick up a tranq. It will be interesting to see a) if he goes back to his normal self, or something like it and b) how much of the holes are trimmed off.

Soaking seems to be working well, and tonight we accidentally hand walked for nearly 15 minutes and he was just fine - he also decided that trot poles were for trotting when I asked him to walk over them. Oops?

In conclusion, I present to you our soaking routine.

One Less Worry

First things first: Tris went outside last night! I took him to one of the small turnouts near to the barn and threw him a flake of hay. He behaved beautifully, just munched away happily. He went on a bit of a walkabout in search of a puddle to drink from, but that was it.

Unfortunately, the mud/puddle situation is such that I don't think he can go on more frequent turnout until he is more healed or it's drier. His boots are too porous. They are really meant for stall rest. So he will get occasional, supervised outings but mostly stick to handwalking.

In the good news department, he has finally started shedding! I spent a whole currying away while he was eating his hay. Spring is on its way!