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  Discussion on Would you neurectomize this horse?
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Member:
lindas

Posted on Tuesday, Jun 22, 2010 - 6:01 pm:

Hi Dr. O., I need an objective opinion. I am in this so deep with a horse I am very attached to, and I am concerned that I don't know when to cut my losses. His doctor is a board certified equine surgeon who,incidentally, completed his residency at our alma mater.
I have had my 8 year old Paint gelding, Reno, for 3 years. After 6 months of blissful horse ownership with no problems (reining and trail) he suddenly developed a high suspensory desmitis in his left front leg. Shock wave treatment and about nine months of stall rest with increasing trot sets and he was healed. Interestingly, the ultrasound showed scar tissue in the ligament, indicating a prior injury. However, I watched this horse for almost two years before buying him, and he never took a lame step. It must have happened when he was very young, before the previous owners bought him. Then about two months after returning him to full work he pulled up lame during a slow reining pattern on the same left fore. Diagnosis this time, by ultrasound, was an injured superficial digital flexor tendon. The suspensory was fine. More shock wave therapy with increasing trot sets, and gradual return to full work in about 6 months. After 3 months of normal turn out and full work with no problems he started stumbling, and it gradually got worse until he could no longer jog without almost falling. This was in December '09 and January '10. He blocked completely in the left fore heel, but had a very mild lameness on the right, which resolved completely with a heel block. Radiographs were inconclusive. There is mild remodeling of both navicular bones but I have seen normal horses with worse radiographic signs. He has extensive calcification of his sidebones, but my vet does not think that is a concern. We put him in an egg bar shoe with pads, and continued to be diligent about shortening his toes to improve breakover. We also did two weeks of bute initially. He did improve with that, but not completely. In April we decided to pursue Tildren therapy and IRAP in the left coffin joint. His coffin joint fluid, at first, was of very poor quality and after 3 IRAP treatments was normal. So we thought we were on the right track, but today, at his two week post IRAP #4 recheck he is still lame. Estimate 75 percent improvement overall. He blocked completely in the left heel, trotting enthusiastically with no lameness on the right front.
Today we decided the IRAP helped some, but there must be something else injured, probably deep digital flexor or one of the other many structures "down there". So the next option is an MRI (which I cannot afford), Neurectomy, or a 6 month turn out. The neurectomy will be done under general anesthesia using the two incision technique, by a boarded surgeon. My hesitation is the fact that he has had two prior tendon/ligament injuries in the same leg. I am afraid, after all of this, he will reinjure the suspensory and we will be back to square one. My vet thinks if we turn him out he may reinjure himself and make things worse. What would you recommend if this were your patient?
Moderator:
DrO

Posted on Wednesday, Jun 23, 2010 - 7:44 am:

Hello DrS,
What are your riding goals and does this horse figure in those goals? If this horse cannot make those goals what are the goals for this horse in particular?
DrO
Member:
lindas

Posted on Wednesday, Jun 23, 2010 - 11:03 pm:

I am not interested in showing anymore, just in having a sound horse to enjoy riding in the arena and on mountain trails. We do long trail rides (6-8 hours at a time) in the NC mountains, sometimes on rocky terrain. This is the best horse I have ever owned, and I have spent several thousand dollars attempting to make him sound again. He is well suited for my needs, however right now he is a nervous wreck outside of the arena because he has been stuck in the stall for so long. That problem dramatically improved last fall, when he was sound for 3 months, and I expect with time and patience I can make him bomb proof again. I have accepted that I will probably have to retire him from competitive reining and cow work, because the small circles and spinning are hard on the suspensory ligament. We can just practice slow and easy in the arena. He still trips sometimes at the jog ( I haven't mustered the courage to lope him since he almost fell with me in January) and I am afraid he will fall with me on him. Last but not least, he is my "baby" and I don't want him to hurt. I will never sell him, but I don't want to retire him either. He is not safe as he is, with a grade 2 lameness and all the tripping.
Member:
gramsey1

Posted on Thursday, Jun 24, 2010 - 7:22 pm:

Linda,
I am going to start with a quote from your first post "My hesitation is the fact that he has had two prior tendon/ligament injuries in the same leg. I am afraid, after all of this, he will reinjure the suspensory and we will be back to square one. My vet thinks if we turn him out he may reinjure himself and make things worse."

Question: How would a neurectomy resolve these problems? I submit that it would not. Based on the second to last sentence in your second post.
It sounds like six months of hand walking and ground work are more in keeping with your goals.
Member:
lindas

Posted on Thursday, Jun 24, 2010 - 11:41 pm:

We have already been through 7 months of stall rest, hand walking and walk riding aimed directly at this problem, along with IRAP and Tildren therapy, which are the latest treatments for this type of problem. And before that, 18 months of walk riding, straight line trot sets, etc., 5-7 days a week in all weather. (On top of the crazy life of a full time small animal DVM and wife/mother...it's a bit beside the point, but I'm exhausted!) The suspensory and SDF tendon are healed, no problems in about 11 months with those. However scar tissue is never as strong as the original structure. He has excellent conformation, I can't figure out exactly why this happened. I understand that heel pain predisposes a horse to suspensory injury. If we control the heel pain through neurectomy, I wonder if it would help protect his suspensory ligament from further injury.
Moderator:
DrO

Posted on Friday, Jun 25, 2010 - 5:18 pm:

Got it DrS. From your goals by all means nerve this horse so he will be comfortable in the pasture but the tendon injuries give me pause as to whether you should continue to ride this horse. If the problems are all proximal to the neurectomy and completely healed I would not look on that as a contraindication. But if we have a distal flexor tendon injury it may lead to rupture of the tendon when put into work.

Prior to MRI we used a good set of foot rads which included a "skyline" view of the back of the hoof. If the flexor surface of the navicular bone was clean and the rest of the radiographs OK we deemed it OK to ride with a neurectomy.

Assuming all is well with the distal structures I am still concerned the combination of tiredness and irregular terrain that come along with 6 hour rides and possible proprioceptive deficits from the nerving may lead to an accident. You will have to slowly build up and see where this horse may go with the safety you require. It is the catch-22 of such a situation that you will not know when you have gone to far until the horse starts to stumble. That is best done at the lowest level of exertion possible.
DrO
Member:
lindas

Posted on Monday, Jun 28, 2010 - 9:57 pm:

Thanks, Dr. O. Sorry to step away from the conversation, we took off to the beach for a couple of days. I have Reno's digital skyline radiographs. He has minimal remodeling, really a pretty good looking navicular for a horse that has had so many problems. Wish I could afford an MRI but with my son starting college this fall I am going to have to skip that step. I'll have to see if I can download the rads onto this site to let you have a look. I have enough problem just opening them on my computer, so don't hold your breath!
I agree, if he is going to be ridden again, I'm going to have to work him up gradually, no 6 hour rides until he can do 30 minutes, an hour, two hours, etc. with no problems. And if he can't do it, that's just the way it will be. Will start with gradually increasing trot sets after his post surgical rest time, and work up from there. I do have a few places we can ride within an hour from here that have well groomed trails and the hills are not too steep or rocky. The last thing I want is a fall or to hurt him. I will consult with my vet and see what he thinks. The next step is to go ahead and schedule surgery. I think he will be easier to recover with stall rest during hot weather when he is not "feeling good" from the cold. Thanks for everything!...Linda
Member:
lindas

Posted on Wednesday, Jun 30, 2010 - 12:01 am:

Today I rode Reno at a walk and, since it had been a week since he had been checked I thought I would try him at a slow jog. He took half a dozen lame steps and then he stumbled and almost fell a split second before I could bring him back down to a walk. He has never been sore at a walk, but today he was extremely lame for about a minute after the stumble. He seems fine now. I talked to my vet and we discussed some of your councerns. He agrees, and thinks we need to gradually work him up to see what he can do. Due to time constraints during most of July, we will have to wait a few weeks. He will have a full recheck with re-blocking of the heel on July 27th, and if we still feel we are on the right track he will have surgery on August 3rd. I'll keep you posted.
Moderator:
DrO

Posted on Thursday, Jul 1, 2010 - 5:53 pm:

Thanks DrS, following along cases like this helps others quite a bit.
DrO
Member:
ekaufman

Posted on Friday, Jul 2, 2010 - 10:12 am:

Good luck DrS-- let us know how it goes and what you choose to do. For what it's worth, my nerved mare Rosie (seen in a prior thread documenting her neurectomy) is very comfortable in pasture. She does show proprioceptive deficits (catches her heels with her hind feet) and also an obliviousness to her footing that makes her, in my opinion, unsafe to ride.

- elk
Member:
lindas

Posted on Friday, Oct 1, 2010 - 8:32 pm:

Update on Reno: We are now 8 weeks post left fore neurectomy, he was bandaged for 21 days and stall rested/hand grazed for a month. Then 3 weeks of walk riding 30 minutes a day with stall rest. For the past week we have been doing 3 two minute trot sets along with the walk riding and he is completely sound!!!!!! Because of his history of suspensory injuries I am going to gradually work him up to 6 minute trot sets to stretch and condition his legs before turning him out in pasture. It's still early but a great start!
Member:
shirl

Posted on Friday, Oct 1, 2010 - 11:59 pm:

Great News Linda,

Sounds a lot like the routine I gave my horse.
Good luck

Shirl
Moderator:
DrO

Posted on Saturday, Oct 2, 2010 - 10:06 am:

Most excellent DrS.
DrO
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