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  Discussion on Septic arthritis of the coffin bone
Author Message
Member:
rosieint

Posted on Thursday, Sep 30, 2010 - 9:49 pm:

Hi Dr O,

I don't know if it is right to start another discussion but I thought that it fitted better to put what has happened to Pablo in this thread as now we are certain that he is suffering with a joint infection.

Here is a summary:

Pablo received a cortisone injection to his coffin joint two weeks ago to treat 1/10 lameness after an MRI scan showed mild swelling in the coffin joint and slight navicular changes but not consistent with navicular disease.

After the injection on approx day 3 he became more lame with a bit of swelling around the coronet band and then progressed to 5/10 by day 6, by day 8 the swelling was down and the lameness was back to 2/10 lame, by day 11 he was 5/10 lame again and the swelling was back up and by day 15 after a joint tap he was diagnosed with a joint infection.

He is undergoing an arthroscopic lavage tomorrow and he has been givcen 50:50 chances of leaving the hospital and coming home. The vet thinks that it is only worth doing one lavage as if it doesn't work the first time the chances of it working the second time are miniscule.

I desperately want to have my chap home soon and am in pieces about this. I would be grateful for any information anyolne has. I have spent the evening looking for information and would be grateful for any information possible.

Many thanks.

Rosie
Member:
rosieint

Posted on Thursday, Sep 30, 2010 - 11:09 pm:

Having undertaken a lot of reading this eveningn I have found some studies on the treatment and prognosis of septic arthritis. I wonder if you could give me your views on these Dr O:

There is evidence that repeated lavages until white blood cell count is less than 15 GI andbacterialogical culture was negative after which a single dose of a short acting corticosteroid was administered IV had a recovery rate of 81% in adults https://www.ncbi.nlm.nih.gov/pubmed/11008444

15 racehorses treated post septic arthritis caused by injection. 12 treated initially with antibiotic therapy and lavaged and all returned to racing. 9 at a poorer performance level and 3 at same perofrmance level. The later 3 had been treated with an arthroscopy and post surgical closed suction drainage. https://www.ncbi.nlm.nih.gov/pubmed/1459055

I have also found an article in which states that perfusion can help too https://www.ivis.org/proceedings/aaep/1998/Santschi.pdf

I would be grateful for your thoughts Dr O.

I am ever so grateful for your time.

Rosie
Member:
rtrotter

Posted on Thursday, Sep 30, 2010 - 11:55 pm:

Rosemary,

I am not a vet, but when my horse had a severe knee infection from an injection that he got before I bought him (long story). His knee was flushed out and cultured a number of times, not just once and until the culture came back clean, we continued to flush.

Now, it may be that because this infection is in the hoof that your vet is only saying to flush it once, but here in the US if a horse gets an infection from an injection the vet does everything in his power to make sure it gets cleaned up properly. The vets here do it to protect their valuable reputations because if they get too many joint infections and that fact gets around, not too many people will use them and their businesses will suffer.

So, quit being so nice to your vet and tell him if he doesn't do the right thing by your horse, you will take legal action. See if that doesn't straighten him out.

In my opinion, your vet rushed you into an injection you probably didn't need, your horse wound up with an infection caused by the injection and now he's basically told you you only have a 50/50 chance of having him come out of this in one piece. I think the vet should be shot. It seems to me that if you even suspected an infection, which you did, your vet should have backed you up and done a culture to see if it was or wasn't. Sounds to me also, that the vet was in denial and may have been trying to cover up the fact that there was a joint infection.

I wish you and your horse the best of luck for a speedy recovery.
Rachelle
Moderator:
DrO

Posted on Friday, Oct 1, 2010 - 7:56 am:

I agree with the conclusions of these studies rosemary: aggressive daily therapy until signs of infection abate will give a horse his best chance of returning sound following a joint infection.

Rachelle while I agree that rosemary should seek another opinion on the treatment of her horse, what is the basis of your opinion that "your vet rushed you into an injection you probably didn't need"? There seemed to be more than just a few indications of both coffin jt and navicular bursa inflammation from the initial very complete exam. Both of these are treated with a single injection into the coffin joint.
DrO
Member:
rosieint

Posted on Friday, Oct 1, 2010 - 5:19 pm:

Hi All,

Pablo had his arthroscopy today. The house vet and surgeon thought before the arthroscopy that they think it could be a flare because the sterile conditins in which the joint infection was made, make the chances of an infection very low. The joint fluid was not conclusive and although 2 out of the 3 tests pointed towardes and infection they are very much unreliable because of the steroids that are present in the joint too.

The surgeon came out of very pleased with how the arthroscopy went. I was able to watch it from a viewing room. The surgeon could not find any signs of infecgtion although it is not conclusive that it is not an infection and is still being treated aggressively. She put 15 litres of antibacterial solution through the joint and will continue to treat him with ia antibiotics, oral antibiotics and catheter antibiotics. The surgeon said that she prefered ia antibiotics as although they don't saturate the soft tissue as much as ia antibiotics, ia antibiotics are more aggressive and will get on top of the infection better.

The surgeon also said that ashe could see no signs of deterioratin of the joint caused by an infection. However, because the important part of the joint is nestling where the camera cannot reach it is impossible to tell if there has been any deterioiration there. This part of the joint is important as it is the weight bearing part of the joint. There was swelling of the joint but not an angry inflammation. She has now put Pablo's chances of leaving the hospital up to 70:30.

I think that the next stages are for Pablo to improve his lameness in order to be able to cope with living with the joint if it has deteriorated at all. AT the moment he is 5/10 lame and I think he needs to improve more in order to have a good quality of life and to make it out of the hospital. The next 4 days will tell if he is going to improve.

The joint fluid will also be tested over the next 4 days to establish if there is any other evidence of an infection. Obviously if we cannot kill the infection it will deteriorate the joint and he will not be able to walk out of the hospital.

All in all I don't think that today could have gone better. There were no signs of infection (pus/snot like formations), no signs of deterioration of the joint, and the vet have increased his chances of success.

Does anyone have any information on flares? I have tried to find information out but have not been able to find much on the internet. I don't think that they typically cause any long term damage but just present like an infection. I am hoping that if he has had a flare this will be chalk down to experience and he will have no adverse effects from it.

As Guy said in another thread Pablo's journey started out in, under long toe, low heal, which is now my positive affirmation type message - Pablo is a warrier and I am sure he will make it home. He has done anything that has been asked of him and pushed himself all the way to the top of eventing competitions and competed internationally so I am sure he will fight to come home. I am willing it to be so. Please do that for him too anyone that reads this.
Member:
scooter

Posted on Friday, Oct 1, 2010 - 5:29 pm:

Hi Rosie, Glad things are looking up for Pablo, will keep positive thought flowing you way

What is the flare thing you are talking about?
Member:
rosieint

Posted on Friday, Oct 1, 2010 - 6:02 pm:

A flare is a reaction to the steroid. It is relatively rare but not as rare as an infection from a sterile steroid injection. It is not usually life threatening as it does not eat away at the joint as it is just a reaction not an infection. It can be treated like any inflamation e.g. cold hosing but you run the risk if you leave it to settle down that you have misdiagnosed and let the bacterial infection populate quickly as the joint has no immunity through the steroid injection.

I really don'tknow much more than that. I am still looking around the internet for studies, differences in how the symptoms of septic arthritis and flare present themselves so I can try to get see if Pablo's symptoms are indicative of either, etc etc.

I am so grateful for your positive thoughts for Pablo. This is the first internet community of strangers I have met and I am so thankful for everyone seeing how he is as it makes the journey easier to bare when you are not alone. My friends and family are there for me too and asking lots of questions too and checking in with me. People on this site seem to have been down not dissimilar journeys and it is nice to share our experiences and metaphorically hold each others hands on the difficult path! I never thought I would be on this road, it neer happens "to you" does it?! :-)

R
Member:
rtrotter

Posted on Friday, Oct 1, 2010 - 6:42 pm:

Rosie,

I am glad Pablo looks to be on the mend and I apologize for sounding rather cross in my earlier post, you really didn't need that. It's just that I don't like cortisone injections or in general any injections unless I have tried everything else and that is the only option open.

IMO, vets are very quick with using a needle because it is the quickest way to get a horse sound. And while it may work for a time, usually what happens is that the horse needs to be injected more frequently over time because the injection is causing more harm than good so the duration of how long it lasts gets shorter and shorter.

I know its too late now, but had this been my horse( and he is not) I would have yanked those shoes off, balanced him and left him barefoot or used boots, glue-ons or Sigafoos shoes on him to see if he could be managed and still be a useful member of the equine society. I am not saying I would leave the shoes off permanently, but I would have given it a shot before I injected him.

Ahh, but it took me 31 years to learn this, I've only spent the last 4 years being a holistic racehorse trainer, and sometimes my passion gets in the way, only because I want the best for everyone's horses, not only mine.

Again, my apologies and heres to Pablo being back in your barn soon.

Rachelle
Member:
vickiann

Posted on Friday, Oct 1, 2010 - 6:53 pm:

Rosemary,

Hoping for the best for your horse.

You have both been through so much. Hang in there.
Member:
frances

Posted on Saturday, Oct 2, 2010 - 9:03 am:

So glad it all went so well.
Moderator:
DrO

Posted on Saturday, Oct 2, 2010 - 11:44 am:

rosemary, delighted the arthroscopic findings were so encouraging. What were the initial cytology findings on the joint fluid? Are they planning to continue to monitor the level of inflammation and flush if high?

rachelle, you have presented a one sided and incomplete story on intraarticular steroid use. Every horse with DJD, even without steroid injections, would have a progressively worsening disease if continued to be used at a high level of athleticism. It may not be the use of the steroid that may be the problem but the trainer who continues to run the horse that needed the steroid to go sound that may be the real abuse. To the degree that the veterinarian knows this is the case and injects anyway is also culpable.

It is certainly true that steroids can be and are misused but to present the down side (steroid arthropathy) and not also illuminate the good that can be done in relieving acute inflammation that can lead to DJD is to lead some who read these posts to bad decisions.

It is wrong to think of steroid use as a single entity that will always have a good or bad outcome. The particular steroid used, dosage, after care, and what you do with the results of treatment all effect whether this is good medicine or abuse. Some steroids have been shown to be beneficial to the long term health of a inflammed joint. It is from this perspective of weighing the good and the bad that we discuss it's use in our articles on arthritis and it's treatment.
DrO
Member:
rosieint

Posted on Saturday, Oct 2, 2010 - 3:09 pm:

More good news thankfully!

Pablo came out the box walking better than yesterday and looking sound. He was still lame at trot but that is to be expected as he has had surgery on his joint.

He had another intra articular treatment of antibiotics into the joint under sedation. A joint tap was taken which showed that the white blood count was down from 49 to 4. White blood cells are present when fighting infection and so this is indicative that the infection has been caught or thre was not an infection at all. The joint fluid also showed a reduction in the levels of protein which are present when there is inflamation so this shows that the inflamationis also reduced. The surgeon was very pleased and said that she didn't expect the results to have been so good.

Unfortunately Pablo is not having any painkillers as the comfort test on the joint is one of the key factors for showing successful treatment of the infection so he is feeling quite a bit of pain and very out ofsorts with his head hanging low. He shoes spirit though when people walk past the door or say hello to him so he is not totally depressed. He was showing signs of colic around lunchtime which can occur after a lot of sedative and he didn't want to eat so he was examined for this but as there was nothing impacted it may have been that this was his reaction to the pain and not colic. He has subsequently been given 1 bute to take the edge off his pain.

Pablo is going to be walked out and trotted up tomorrow and so long as he is no worse than today, will be left to recoup without any invasive treatment just catheter antibiotics. On Monday IA antibiotics will start again in his joint and another tap of the joint fluid will be taken. The results of the tap will be compared to today's results to check that we are going in the right direction. This will be the first major mile stone.

Despite him being in pain and suffering it was a very very good day for the warrior.

Keep your fingers crossed for him
Member:
vickiann

Posted on Sunday, Oct 3, 2010 - 11:43 am:

Glad that things are looking encouraging, Rosemary, and hope for continuing progress.
Member:
frances

Posted on Sunday, Oct 3, 2010 - 11:57 am:

Good news - fingers duly crossed!
Member:
canter

Posted on Monday, Oct 4, 2010 - 7:11 am:

Hi Rosemary,
I've been away for a few days so am just now catching up on HA. But wanted to add my best wishes for a successful outcome.
Member:
lilo

Posted on Wednesday, Oct 6, 2010 - 10:53 am:

Rosemary, I am hoping Pablo is recovering well from his surgery.
Take care,
Lilo
Member:
rosieint

Posted on Sunday, Oct 17, 2010 - 3:56 pm:

Good news. Pablo is at home and recovering from not only the operation but also from colic that he suffered whilst in hospital!

We won't know if there is any long term damage to the joint if it was an infection in the joint that he suffered. If it was a flare he should have no damage and return to the 1/10 lameness he had before he had the injection. I will then have to consider the options very carefully as to whether he has another steroid injection...

For the moment we are working on getting him comfortable on the leg. He has stable bandages on both legs. He is on 2 forms of pain killer and has rocker shoes which enable him to move more easily. Does anyone else have any tips on how to recover from an inflammed coffin joint?

I want to say how grateful I am to all your support messages. THey really got me through this tough period that I went through. I hope that my story will help any other people.

Rosie
Member:
scooter

Posted on Sunday, Oct 17, 2010 - 6:04 pm:

Great news Rosie, hope he has a swift and uneventful recovery
Member:
lilo

Posted on Monday, Oct 18, 2010 - 9:37 am:

Hoping for a good recovery for Pablo.
Best wishes, Lilo
Member:
vickiann

Posted on Monday, Oct 18, 2010 - 11:37 am:

Thanks for sharing this good news about Pablo.

I hope that things will continue to go well.
Member:
canter

Posted on Monday, Oct 18, 2010 - 12:29 pm:

Wishing Pablo all the best as he recovers!
Member:
rosieint

Posted on Wednesday, Nov 3, 2010 - 7:31 pm:

Hi Dr O,

I wonder if I may pick your brains again. Pablo has been home nearly three weeks now which is a total of about 5 weeks after arhroscopy and lavage.

We did not know for sure whether he had a septic joint or a flare from the cortisone injection but treated as an infection just in case it was.

I am wondering whether you will be able to tell me what the normal progression is for recovery in this situation. How quickly should he be becoming sound. What sort of grade of lameness should he be experiencing at this point if he was on the road to full recovery?

Although he is improving week on week he is not yet sound at walk. He is probably 3/10 lame. Does this mean that as he has not got better more quickly that it points to it being likely to be irrepairable damage for example to the cartilage?

He had a cartraphen injection into his msucle yesterday and is going to have one a week over the next 3 weeks to try to help him recover. His joint is still swollen but it seems to be less warm than it has been to the touch and getting slightly less swollen although it is quite hard around the coronary band and swollen still.

The only part of Pablo's recovery that puzzles me is that when he first had the arthroscopy he was sound for about a week after. Then the farrier trimmed him hard back and he immediately after went lame and had digital pulses in all his legs. Since then he hasn't gone back to being sound and the trim was about 4 weeks ago. Just to let you know he had a joint tap after some days after the trim and the joint didn't appear to be infected and he is progressively getting better allbeit slowly. Can you shed any light on why he would be sound after the arthroscopy and then go lame?

I look forward to your thoughts on the mystery of why he was sound after arthroscopy and then lame and also information on how quickly he should be recovering and being sound following the treatment he has had.

Best wishes.

Rosie
Moderator:
DrO

Posted on Friday, Nov 5, 2010 - 7:06 am:

Rosie, why do you think this might be the joint and not the overly trimmed soles? Concerning the progress of the joint following your history above. I would expect soundness within a few weeks but the main key is that the lameness be improving steadily over time. However this is not a certification of degenerative joint disease as this can develop over the next year.
DrO
Member:
rosieint

Posted on Friday, Nov 5, 2010 - 2:05 pm:

Hi Dr O,

I thought that if it was overly trimmed soles that he would be better from this by now. It has been about 3 weeks since the trim and the shoes were fitted. Could it be that he is still sore from the trim? He did have digital pulses after the trim but he doesn't have that anymore.

He is definietly getting better still though. He is on box rest but we are beginning to walk him a bit now as he is still swollen around the coronary band so we thought walking may help with the inflammation. Don't want to do too much though and cause more inflamation!

What do you think on all of this? Is it too early to say that he is not going to get sound/ going to get sound?

Rosie
Moderator:
DrO

Posted on Sunday, Nov 7, 2010 - 5:02 pm:

Yes this could still be the soles and so it is too early to tell.
DrO
Member:
rosieint

Posted on Monday, Nov 8, 2010 - 7:20 pm:

Gosh I would never imagein that he could still be sore from the trim. He doesn't seem sore all over on all the feet though so I think that it is the arthroscopy and/or damage to the cartilage that is making him lame still.

Does the swelling in the coronary band give you any indication as to whether there is cartilage damage or do you think that this swelling could be due to the arthroscopy even though this was now about 5 weeks ago.

He was given a cartraphen injectin last week and is so much better. I don't know if this is from the injection or from time and mother nature. Just glad that he is getting better. I wonder how much better he will get though... He is currently much sounder. He is much more rhythmical in walk on all surfaces and no longer winces when he is on uneven surface and still stays quite rhythmical on uneven surfaces. The corners are still difficult from him and he struggles with them and has to shorten his stride on his sore leg. I haven't really tested him at trot as he is still so lame at walk.

I would be grateful for your views on how he is progressing and what I have written above. What a long slog this is for me and him. I appreciate your thoughts and analysis.

Best wishes.

Rosie
Moderator:
DrO

Posted on Tuesday, Nov 9, 2010 - 7:34 am:

rosemary, the coronary swelling does not help me much as it can also be due to solar bruising. Concerning his progress, you say he is getting better, that sounds good!
DrO
Member:
kpaint

Posted on Tuesday, Nov 9, 2010 - 7:45 pm:

Hi Rosemary, are you able to post pictures of his front feet? Glad to read that he is getting better.
Member:
rosieint

Posted on Tuesday, Nov 16, 2010 - 3:58 pm:

Hi there,

Pablo is still progressing. He is looking sound at walk on a straight line. He is still sore on the corners. I trotted him in a straight line and he was only just lame compared to hwat he has been, perhpas he is currently 2/10 lame at trot. His joint area and coronary band area is no longer warm and is lot more spongey to the touch which makes me feel like the inflammation is coming down. It is still more solid than the other foot to the touch so it is still inflammed I think. He is still on 2 bute a day and I am going to cut this down to 1 bute a day now.

He is due to be shod tomorrow. I am considering taking his shoes off and letting him go barefoot. I am concerned aobut his feet breaking up so I may just take the back shoes off and shoe him with a PLR and pad with magic cushion on the front.

Dr O - what do you think of his progress generally? I would love your opinion on his recovery and whether you think that he is going to get 100% sound...

Best wishes.

Rosie
Moderator:
DrO

Posted on Wednesday, Nov 17, 2010 - 5:58 pm:

Hello Rosie,
As long as he is getting better there is hope but until we know why he is lame we can only guess at a prognosis.
DrO
Member:
rosieint

Posted on Wednesday, Nov 17, 2010 - 7:13 pm:

I would have thought that he is lame from the arthroscopy and/ or cartilage damage from the infection if there was one (as it may have just been a flare rather than sepsis). If he was sore from the trim 6 weeks ago I would have thought this would have settled down by now?

He was lsightly lamer today than normal. The vet said to expect his recovery to be a bit up and down. His right knee (the leg he did not have the arthroscopy on) was a bit puffy. I have noticed t has been a bit up and down recently. I think that it is probably him compensating on his good leg, does that seem possible to you?

I am confused by your short reply saying you are not sure what is causing him to be lame. I have written a lot on this site about his lameness and the treatment he has had. He has been through thorough diagnostics on his leg including MRI's so I think that we have got a good understanding of what is causing the lameness.

Although it is in the realms of impossibility that he has something completely different to what he is being treated for, what I was hoping for your advice on was the condition that we believe him to have from all the diagnostics and hospital treatments i.e. lameness and recovery from septic arthritis caused by infection from cortisone injection or a flare caused by the cartisone injection and recovery from arthroscopy.

I would really appreciate your view on Pablo's recovery to date from this condition and from the stage of recovery that he as to whether he is on course for a full recovery. Just to remind you, he is now 6 weeks post coffin joint arthroscopy and is on the whole sound in walk now although sore on corners. He is possibly 2/10 lame in trot in a straight line.

I joined this site as although I have read a lot online about his condition it was attractive to me to be able to get another vet's opinion and read online materials regarding his condition. I am not able to access some of the journals and case studies that are available to the veterinary community and therefore I hoped with your assistance I could get a better understanding of his condition or perhaps links to extracts from these journals. Would you be able to have a search on your databases to see if anything has been published that you could send to me?

Perhaps there are some case studies of recovery from sepsis and how the horses that went sound progressed through their recovery. I really look forward to hearing from you as to the information you have on recovery from septic arthritis of a coffin joint.

I am also interested to hear what methods of recovery other horses have been put through. We have given Pablo cartrophen and have been trying to get him to walk to the edge of being comfortable as we don't think that total box rest will be helpful but indeed do not want to cause more inflamation to the joint by stressing the leg if he is not comfortable on it. It has been a fine balancing exercise. I wonder how other horses recovery program has been?

I look forward to hearing from you and to helping my best friend in his hour of need.

Best wishes.

Rosie
Moderator:
DrO

Posted on Thursday, Nov 18, 2010 - 6:07 pm:

Hello Rosie,
Your first sentence is exactly my point: is it the cartilage damage or the surgery? Also it occurs to me that there are perhaps unresolved hoof issues or the past chronic lameness that was originally treated for has surfaced. Six weeks is a long recovery from endoscopic exam and lavage but from his examination does your surgeon feel there is still soft tissue injury from the surgery that has not healed and causing lameness? These are questions that I have that I don't see answered above and until they are, accurate prognosis is impossible.

Concerning the prognosis of septic arthritis we cover this in the article.

Concerning the swollen knee, I would not expect a horse with the degree of lameness you describe to develop a compensatory swelling in the opposite knee.

Concerning treatment for possible onging joint inflammation you will find many helpful suggestions at HorseAdvice.com » Diseases of Horses » Lameness » Joint, Bone, Ligament Diseases » Arthritis and DJD: An Overview. As to exercise I certainly would follow my surgeons recommendations.
DrO
Member:
rosieint

Posted on Thursday, Nov 18, 2010 - 7:46 pm:

Hi Dr O,

Thank you for your thoughts. I really appreciate them. I am confused by what to thnk of his prognosis and chances for returning to soundness. The surgeon at the hospital thought that he would need to be on box rest for 6- 8 weeks. I presume that as he is only only 6 weeks that the surgeon expected some lameness. O~ne of the surgons said that they would not expect him to be under saddle in walk until 3 months after the surgery, the other said 6 months. I am very unclear as to what his recoery should be lookinglike. I want to be realistic about it and if he is not recovering in line with a typical return to soundness case then I would rather adjust to that now. Perhaps it is just very difficult to judge and I am asking too much to expect to have a good idea about it only 6 weeks post arthroscopy. I would be interested to hear on what basis you think that 6 weeks is a long recovery from this surgery. I would love to read some studies on how hoses recoery from sepsis of the coffin joint so I have a bench mark and something to compare his recovery with. Is this something that you might have access to? Perhaps there is an issue with copyright in reproducing articles here . I don't think that the underlying chronic lameness is likely to be giving him trouble as he was initially only mildly lame 1/10 lame and after MRI it was thought that this was becuase his dorsal palmer footbalance was not correct.

I look forward to your thoughts.

Best wishes.

Rose
Moderator:
DrO

Posted on Saturday, Nov 20, 2010 - 10:58 am:

Surgical incisions that are sutured heal in a few weeks so are unlikely to be causing ongoing pain 6 weeks later unless there is some wound complication.

3 to 6 months before riding seems sensible to me, mainly to allow the joint environment to return to as normal as possible. We don't have studies verifying that this is enough or too long but still a sensible time to me. If you are wondering why this recommendation has been made by your veterinarians, you should ask them.

The article deals with diagnostic, therapeutic, and rehabilitation techniques but every case is different and has to be treated using the information available on that particular case. I don't have any published cases that discuss the particulars of when a particular horse came sound, how long they were box stalled, how they were reintroduced to work, etc... The last adult septic arthritis I treated was a fetlock and was treated within 24 hours of developing symptoms with both systemic antibiotics and through and through lavage. The horse was left in the pasture between treatments and was sound within a week. The first case I ever treated was lame a week before diagnosis and though treated similarly, though rested more aggressively, never came sound and developed DJD.
DrO
Member:
rosieint

Posted on Saturday, Nov 20, 2010 - 1:27 pm:

Hiy Dr O,

Thank you for your thoughts. I now understand that you are saying that he should at this moment have no residual pain from the arthroscopy. The surgeon that did the key hole surgery did think that he could still be sore from this. I am confused by the conflict in opinion. I don't mean to be argumentative but simply understand the situation and perhaps my understanding of what is going on is not right.

Rosie
Member:
rosieint

Posted on Saturday, Nov 20, 2010 - 1:56 pm:

PS. If you think he can't be lame from the pain caused by the operation, do you think that he is unliekly to return back to being sound then? The initial findings on the joint from the MRI I posted under the dorsal palmer thread. I would be grateful if you could take a look at this and let me know whether you think the dorsal palmer foot balance problems and mild navicular changes could be the cause of the lameness he is experiencing now. He has had three shoes since the MRI findings but I am not sure how well balanced the feet are now. I know that you suggested before that he could still be lame from the trim he received at the hospital as after he came round from the operation he was sound for a week before the trim. He is 5 weeks post trim. He does seem to be sore only on the operated leg though. If you have an email adress I can send a video too I would love to be able to send you it so you can see how he is looking.

I am grateful for your thoughts.

Rosie
Moderator:
DrO

Posted on Sunday, Nov 21, 2010 - 9:39 am:

I would go with the opinion of the one who did the surgery rosie and I do not believe I can accurately prognose your horses future.
DrO
Member:
rosieint

Posted on Tuesday, Feb 8, 2011 - 7:03 pm:

Hi Dr O,

I would love your opinion on how Pablo is progressing. As you know Palo is a 17 year old ex 4* CIC event horse. He put in the ocassional hop in his stride so I had a full lameness exam and it was found that on a tight circle on a hard surface he was very slightly off. We had an MRI in Sept last year which showed a mild old collateral ligament strain, some navicular changes but nothing serious and consistent with navicular disease and all in all he was considered in good shape and the slight soreness he was feeling it was thought would be sorted out by putting him back in dorsal palmer foot balance (he had long toes and underrun heals).

As a result of the MRI findings, at the beginning of Oct he had a steriod injection in the coffin joint to help cut out the slight pain he must have been feeling to make him slightly off on a tight circle on a hard surface. A couple of days after the injection the very slight lameness turned into full blown crippled 4/10 lameness. A couple of weeks after this 4/10 lameness started, and once the vets were convinced it was not an abscess, he had a joint tap and he was immediatley admitted to hopspital for possible septic arthritiis or a flare caused by the steriod injection.

To recap, he has the steriod injection at the beginning of October and two weeks after he was in hospital having an arthroscopic flush. The surgeon was optimistic as they didn't find any signs of infection or cartilage damage in the coffin joint. After a few days in hospital his tap showed the protein and white blood cell levels return to normal.

Immediately after the operation he was sound for about a week and by week 2 was 4/10 lame. He returned home during week 2 and was on strict box rest and cartrophen for about 6 weeks. He was then on ESWT and walked out his box to grass for 20 mins twice a day till December. From December till now he has continued to be on mainly box rest but also getting turned out in a lunge ring with a treat ball once a day for an hour where he potters around nuzzling the treat ball and also getting walked to grass for 20 mins twice a day. He has been slowly improving and is now pretty much sound at walk, it is only the corners when he shows the ocassional bit of soreness. He looks about 1/10 lame at trot. In summary , over the past 4 months he has been decreasing in lameness about half or a grade on the lameness scale every 3 weeks.

The vets are not sure whether he is suffering fromn cartilage damage as a result of possible septic arthritiis or whether he is suffering lameness as a result of the problems that he had prior to the MIR which is possibly an old collateral ligament strain.

I was wondering what you thought of this recovery. Do you think that he is on schedule for soundness? From what I understand cartilage damage and/ or collateral ligaments take about 5 months to heal and we are slightly shy of that time frame. I have no experience of whether those horses that come sound from cartilage and/or collateral ligament damage are 1/10 lame at the 4 month mark like Pablo is. I would be so grateful for your thoughts as to how the recovery for cartilage and/or collateal ligament damage typically pans out so that I have something to gauge Pablos's recovery diary on.

I will give Pablo all the time that he needs to recover but I have no clear ideas on how Pablo's recovery compares to horses that end up sound after a cartilage or collateral ligament injury. I would be really very grateful for your thoughts. Pablo means the world to me and some hope or realistic expectations would do us both the world of good. If you have any thoughts on how best to treat cartilage and/or collateral ligament damage I would be grateful for your thoughts in this regard to.

I look forward to your learned thoughts and response.

The very best wishes.

Rosie & Pablo
Moderator:
DrO

Posted on Thursday, Feb 10, 2011 - 7:46 am:

Hello Rosie,
Cartilage, ligament, and tendon injuries are extremely variable in recovery times so I would quit trying to measure your horse against others. A radiograph of the joint may help ease your mind on developing arthritis. That your horse continues to improve is a very good sign. As to treatment I would continue to follow the recommendations of those who have done so much work on your horse. Rest is the mainstay of treatment for ligament and joint injuries.
DrO
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