|
|
Discussion on Diffuse injury to proximal suspensory ligament in foreleg
|
| Author |
Message |
Member:
judyhens
|
Posted on Wednesday, Sep 12, 2012 - 3:02 pm:
Our 16 year old Peruvian Paso stallion has had a "picture perfect" health profile. Never lame, never sick, great horse, the grandkids can ride him all over the property. About 2 months ago we noticed a slight uneveness under saddle, but no swelling, no obvious injury, no lameness when not under saddle. We were leaving town, so we stopped riding him. He did fine and we didn't think anything more about it. Assumed that maybe he had a mild arthritis or something. I think he had a few days of bute. He has a large paddock and is rarely stalled. Last Sunday during routine worming, we noticed that one foreleg was huge - extremely swollen knee to pastern. He was lame, but weight bearing. We hosed it, gave him two gms. bute, put furazone on it, wrapped it, and covered it with a sports medicine boot. On Monday we took him to the vet after giving another 2 gms of bute and redoing the wrap. By the time he was at the vet's at 2:30 PM, the swelling was a little less. They ultrasounded it and found a diffuse injury starting at the top and going down a ways. They said stem cells might help or we could try stall rest, bute, hosing, furacin with DMSO, and wrapping the leg. Since he is not insured, we would like to try the stall rest option. By yesterday (Tuesday) the swelling was down enough that there was some small amount of definition. He was walking a little better also. Now we are wondering if the previous time when he was sort of off was really a warning sign. I think we may have been too fast to chock it up to arthritis because of his age and the fact that it went away rapidly. He has been a show horse, a teasing stallion, the main riding horse for my husband. He is in great condition and has never been a couch potato. This swelling happened out of the blue - we hadn't ridden him recently and he was walking fine earlier.
Question - they pretty much said to stall him and bring him back in 6 weeks. - In reading your article, it seems that hand walking should really start pretty soon. Thoughts on that if this is a severe, diffuse injury? He is walking pretty well now (3 days after injury) when we take him out to hose him & change the bandage. But he is on bute.
Oh - we thought the other front might be a little puffy and are thinking compensatory weight bearing may be playing a role. We put a SMB on it and the puffiness is resolving.
Just FYI - this stallion has short pasterns which are not floppy at all. We have seen a LOT of floppy pasterns in the Peruvian breed.
Any advice would be appreciated!
|
Member:
judyhens
|
Posted on Thursday, Sep 13, 2012 - 4:07 pm:
Update: horrible swelling going down little by little. We spoke with our vet about hand walking and he was supportive of starting a little at this point. From what your article states, it is important for healing to hand walk. Is 4 - 5 days post injury too soon? He is not sound, but is improving somewhat.
|
Member:
judyhens
|
Posted on Thursday, Sep 13, 2012 - 9:51 pm:
Second Update: The swelling this evening is less. We started the hand walking. You can see a 10 sec. view of his walking just after being hosed by going to https://youtu.be/V308xxkS9BI
I am attaching a picture also. We love this guy. Just want to do what is best for him to assure that he at least becomes pasture sound. Know its a long process. Is 5 minutes two times a day enough? He is still on bute. Should we walk him after we wrap his legs again after hyDrOtherapy when he has his sports medicine boots on?
|
New Member:
idorion
|
Posted on Thursday, Sep 13, 2012 - 10:30 pm:
i did lots of rehab programs, 5 minutes x days its fine, i would do the therapy after the walk. For a week. Then raise 2 min. Per day in a Week. If getting better, if not you stay the same time.
|
Member:
judyhens
|
Posted on Friday, Sep 14, 2012 - 9:03 am:
Thanks Isabelle,
Your suggestion to hose after the walk makes a lot of sense. You are appreciated!
|
Member:
dres
|
Posted on Friday, Sep 14, 2012 - 11:27 am:
Agreed with Isabelle ,, that is what i did with Danni on her long slow rehab ... remember slow and steady wins the race ... no short cuts .. stay the course..
On the first day God created horses, on the second day he painted them spots..
|
Member:
judyhens
|
Posted on Saturday, Sep 15, 2012 - 2:59 pm:
Hi Ann, I remember you long journey!Barbara, the Andalusian in Phoenix, is now being ridden and appears to be fully recovered. Tincture of Time is what it took. Legendario has such a great mind that he is not doing anything stupid when we walk him - even around a few mares. He stands ground tied for bandage changes. Something to be said for rehabing a 16 year old who is quiet.
Thanks for your encouragement!
Judy
|
Moderator:
DrO
|
Posted on Sunday, Sep 16, 2012 - 9:10 am:
Hello Judy,
Sorry for the slow response we were on vacation last week. You ask several direct questions that I cannot really answer from the description of the diagnosis of, "They ultrasounded it and found a diffuse injury starting at the top and going down a ways." Were they more specific about the description of the particular pathology and I will assume this is the suspensory as you posted in this area. Your description of our recommendations had me going back and reviewing the article as they are not what we recommend specifically. Recommendations for the treatment of your particular horse must come from those who have examined your horse. Our recommendations for suspensory injuries is prolonged stall rest with careful returned to work. Careful return to work is intentionally nonspecific as it will differ from case to case, primarily based on ultrasound results. However, unlike tendon injuries, suspensory injuries need more rest and more prone to recurrence with too early a return to work. DrO
|
Member:
judyhens
|
Posted on Monday, Sep 17, 2012 - 10:50 am:
Thanks Dr. O. I will try to find out exactly what the ultrasound showed. We don't need him to be a work horse again, unless he gets sound enough for out grandkids to ride. Just want him to heal and be sound enough to be comfortable in the pasture. He is our main teasing stallion. It would be nice to get him sound enough again just to take him by mares. He is perfect for that function because he never gets "strong" just nickers and looks alert if they are ready to ovulate. He is actually about as good as an ultrasound. Better than any other stallion we have used. I read a UC Davis article that indicated that a little hand walking facilitated healing and - i think - maybe reduction in adhesions. Are you suggesting no hand walking at all? We have to take him out of the stall for hyDrOtherapy, so some hand walking is unavoidable. Reduced him to 1 gm bute yesterday, but noticed a little head bobbing late in the day and gave him another gm. In your practice, do you limit the amount of time a horse is on bute at 2 gms/ day if it seems to be needed? Will be in contact with the vet this week and will ask anyway.
Another important question: Legendario's feet need trimming. I am VERY hesitant to have the farrier weight him on the bad leg to trim the good one (which is also a little puffy, probably due to compensatory weight bearing). How do we accomplish this? I also think his feet may need picking. With all the hosing and him standing on the grass/dirt outside his stall, we may want to even put betadine or something on his feet. How do we deal with routine foot care when a foreleg is in bad shape?
|
Member:
dres
|
Posted on Monday, Sep 17, 2012 - 11:41 am:
Judy, some walking is inevitable .. when Danni was in a splint i would change stalls for her from South side to North side to help keep her happy in her 7 month complete stall rest ... THEN she started our hand "real " hand walking at 5 mins a day added 3 mins every 7 days ...
We had to change her shoes / orthodics as well , my farrier was very patient... he would work for just a few mins then let her have her leg back to balance and rest .. it took time ...
good luck .. i am complete confidence he will be able to do his job well in the future.
On the first day God created horses on the second day he painted them with spot ..
|
Moderator:
DrO
|
Posted on Wednesday, Sep 19, 2012 - 5:18 pm:
Considering that long feet can put extra stress on the suspensory, I would have the feet continued to be trim but carefully and in short bouts. In very bad injuries to the supporting structures sometimes a sling is used to help the horse stand on 3 legs.
While I cannot speak to your horse specifically remarkable injuries to the suspensory should only receive minimal exercise at first. However mild to moderate injuries (and severe injuries that show early signs of healing) should be hand walked but stalling and hand walking should go on for longer than 6 weeks. 3 months is often recommended.
DrO
|
Member:
judyhens
|
Posted on Friday, Sep 28, 2012 - 4:32 pm:
Update - turn for the worse re: lameness.
The tendons look markedly better. I am now wondering if he could have concurrent laminitis. He is lying down a lot, his front legs are trembling at times when he is up and he is weighting his back legs more. I am in a real predicament here because my husband is gone to a horse show with the trailer, so I have no way to get him to the vet. The vet x-rays in house only. We may have some acepromazine. Would that help until my husband can get back? I am really worried about him. He is stalled. Getting 2 gms. bute/day. Pain seems to have intensified.
Any feedback would help.
Judy
|
Member:
dres
|
Posted on Friday, Sep 28, 2012 - 5:09 pm:
shoot ... do you have a neighbor that can haul, i know the vet clinic here has a service ... might check into it...
On the first day God created horses, on the second day he painted them with spots..
|
Member:
mrose
|
Posted on Friday, Sep 28, 2012 - 6:33 pm:
HI Judy,
I was just reading this. I think it's very possible that he has laminitis. If you can keep him bedded very deeply plus make some boots for him. Use styrofoam or anything like thick carpet, heavy sponge...anything you can find that is cushioning and that will stand up to his weight also. Cut to roughly the shape of his foot and tape on with duct tape. If you haven't done so already, read the article on here about acute laminitis. You might want to up his bute to 3 gr. for a few days. Then, take it back down to 2 gr. Some people believe in soaking the feet in cold water. I think that if it is done when the inflamation first starts it helps, not sure about after it has been going on for awhile. If you treat it right away you can probably prevent any rotation or at least minimalize it. Read the article; I have but it's been awhile. thehorse.com has good info on laminitis also.
|
Member:
mrose
|
Posted on Friday, Sep 28, 2012 - 6:35 pm:
If you have to haul very far, it will probably make the laminitis worse. You can usually feel increased pulse rate down by the hoof and heat in the hoof if it's laminitis. If you aren't used to Norm for the horse though it's sometimes hard to pick up on what's not normal.
|
Moderator:
DrO
|
Posted on Tuesday, Oct 2, 2012 - 7:44 am:
Hello Judy,
Founder does not require a radiograph machine to diagnose. Have you had your veterinarian out again to assess the horse? We have a whole section on founder at HorseAdvice.com » Diseases of Horses » Lameness » Diseases of the Hoof » Founder & Laminitis.
DrO
|
Member:
judyhens
|
Posted on Tuesday, Oct 2, 2012 - 11:02 am:
Well, we did get a trailer borrowed immediately and had him admitted to the tertiary care center near us. They said it looked like laminitis, but on exam he was NOT sensitive to calipers on toes or other portions of the feet. Because he had that leaning back stance they also x-rayed his feet which were perfect. But they still thought it could be beginning onset laminitis without rotation so blocked all his feet. He had no relief at all. They then ultrasounded the two front legs and he has torn some of the right fore ligament also. So...two damaged front suspensories. They changed his meds and kept him there for several days. He was discharged yesterday, a lot more comfortable. He is up and moving around the stall, eating again, and not leaning back on his hind end. We want to give him every chance possible, but understand the prognosis is very poor. They said we might try Kemsey splints, but that historically the long term outcome is not the best after they are removed. He is almost 17 years old. We have no expectations of him ever doing anything but being a couch potato. But...if we can't maintain good pain control, we don't want him to suffer. Tough situation. Thanks for everyone's response.
Blessings,
Judy
|
Member:
canter
|
Posted on Tuesday, Oct 2, 2012 - 11:21 am:
Sorry to hear the news, Judy. I hope you can manage him comfortably and that he beats the odds.
|
Member:
dres
|
Posted on Tuesday, Oct 2, 2012 - 1:49 pm:
Judy thanks for he updates ... we used the Kemsey splint on my mare, only one hind leg ,,she wore it for 7 weeks i think ...
Good luck in treating him . He is blessed to have you as his horsey god mother ..
On the first day God created horses, on the second day he painted them with spots .. 
|
Member:
judyhens
|
Posted on Tuesday, Oct 2, 2012 - 2:54 pm:
Hi Ann, the vet felt that while they might help, long term they might not. The cost we were quoted was almost $1000 for a pair of them. Were you able to find the splint at a more reasonable cost? I have looked on ebay and amazon for a used splint, but so far haven't been able to find one. Actually need two. Did you order directly from the manufacturer or were you able to find them somewhere at a discount? I would love to just give it a try.
|
Member:
dres
|
Posted on Wednesday, Oct 3, 2012 - 7:42 pm:
Judy, our vet clinic rented the splint to me ..
On the first day God created horses, on the second day he painted them with spots..
|
Moderator:
DrO
|
Posted on Friday, Oct 5, 2012 - 7:52 am:
Hello Judy,
I am sorry to hear about the bilateral suspensory problems and hope you will be able to keep him comfortable.
DrO
|
Member:
judyhens
|
Posted on Saturday, Oct 6, 2012 - 8:05 pm:
Hi, Thanks for everyone's responses. I may call A & M and see if they rent the Kemsey splints. Our local vet doesn't. Legendario continues to hang in there. He is no longer trembling, is eating well, and seems interested in his environment again. Swelling continues to go down and he is moving better. While our goals with Legendario are modest (ie comfort) we continue to pray that he will improve little by little and if not that we will be given the wisdom to make correct choices. At this point, neither he nor we are ready to throw in the towel. I guess we will just take it day by day. Everyone's thoughts and prayers are appreciated.
|
Member:
frances
|
Posted on Sunday, Oct 7, 2012 - 1:39 am:
So glad to hear he's more comfortable now. Hope he continues to improve with your good care.
|
Moderator:
DrO
|
Posted on Wednesday, Oct 10, 2012 - 6:27 pm:
Hello Judy,
I am uncertain a Kimsey Splint is indicated here. Used primarily as a emergency first device to relieve pressure on the suspensory structures including the sesamoids I don't see it as a good option for stable suspensory injuries during the healing phase. In severe progressive suspensory injuries it may be useful but is that what we are seeing here?
This horse being a PP and now with bilateral disease the main concern for the disease process is one of degeneration and abnormal collagen repair I would have thought. And although the front limb involvement being first is odd, it is not unreported.
DrO
|
|
|
