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  Discussion on Rehab Relapse
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Member:
9193

Posted on Tuesday, Sep 27, 2005 - 11:30 pm:

Hello All,

First of all, I want to say Thank you to Lynn, Aileen and Dr O for their good wishes and encouragment given to me at the end of Lynn's post in "Elusive Lameness". I very much appreciated the consideration.

Justin had his fourth recheck by Dr Gillis today in which I was hoping to find out why he presented with a subtle lameness a couple of days after we had worked up to the nine minute trot mark. We had his check ligaments examined by my vet which did not solicit any reaction from Justin at all. After two weeks of walking under saddle, we cautiously introduced trotting for two minutes in a 45 minute ride under saddle which he performed without any signs of discomfort at all. We were encouraged by all of this and were hoping that whatever was stressed was just needing more time to get stronger and that we just needed to introduce any additional trotting at a slower rate.

Last Friday,(AFTER we came back from riding Justin) my daughter and I were informed that Justin's stall door had been left open that morning during stall cleaning and that he had ambled out and proceeded to do what any red blooded horse who has been confined and restricted would do when finding oneself free and unfettered. He ran for about two or three minutes up an embankment and along a deep leaf littered bridle path to join the other horses in the turnout pastures

Today's ultrasound showed a rebowed superficial digital flexor tendon (above the just healed one) and re-injured medial and lateral branches of the suspensory ligament. The check ligaments look just fine, thank goodness!

We are back to handwalking for 30 minutes for the next three weeks and then can ride at the walk working up to 40 minutes by the next recheck in November..Flat surfaces only, bute and Surpass twice a day for the next two weeks.

I am finding it very hard to stay out of a big bag of chocolate chips. However, on the bright side, all this walking will keep me in pretty good shape for the holidays..I feel really bad for Justin getting restricted and confined to minimal exercise again. He was so enjoying being able to get out and move!

Anyway, this is our story thus far..I will keep periodic posts as they seem relevant..I know I am not the only person who has experienced these kinds of frustrations and fall backs..

Smiles,
Debra
Member:
Frances

Posted on Wednesday, Sep 28, 2005 - 9:22 am:

Oh Debra, I truly feel for you . This is the trouble with rehabbing - things happen which are outside your control. I'm sure you're furious as well as devastated - I would be.

Trying to look on the bright side, Dr Gillis has not started Justin back at the beginning with stall rest, so hopefully the degree of damage is not too bad??

I know from my own experience how depressing these setbacks are but, as some wise HA member remarked, we have to KBO.

Don't despair; you'll get back to where you were in no time, and then you'll be on the final stretch.

Hugs

Lynn
Moderator:
DrO

Posted on Wednesday, Sep 28, 2005 - 9:25 am:

I say attack that bag of chips, just once, I know I would feel better. Sorry to hear about the set back and still think with time you have a good chance of being back on Justin.
Smiles back at you,
DrO
Member:
Sunny66

Posted on Wednesday, Sep 28, 2005 - 10:34 am:

Oh NO! Debra, I'm so sorry...I too feel for you!

Perhaps a big sign on the door - REHAB - Please make sure door is CLOSED and LOCKED when entering or leaving. Thank you.

These silly lovable ponies sometimes make me want to pull my hair out... Hang in there. I agree with Dr. O, attack that bag :-)

Sending positive calming, healing thoughts to you and Justin.
Member:
Dres

Posted on Wednesday, Sep 28, 2005 - 10:37 am:

Debra / Dr. O... I have a question re this kind of injury and the rehab of it... is the whole leg / tendon weak on the effected leg..? why would another location tear above the ''old'' injury...? I always thought the ''old'' injury was the weakest part of the leg and was to always be careful cus of it... IS the whole tendon weakened becus of the original tear...

Debra you are doing such a great job keeping the faith... I think a chip or three is in order too...
On the first day God created horses, on the second day he painted them with SPOTS..
Member:
9193

Posted on Wednesday, Sep 28, 2005 - 3:46 pm:

Oh my, I was moved to tears this morning when I saw your quick and empathetic responses to my post. It does help take the sting out a bit to know that there are other people out there who care and understand how it feels to have the wind knocked out of your sails temporarily.

Lynn, you are right, we are not at square one. Estimated time loss is about eight weeks. We will go slow and easy. I am still optimistic that we can have Justin sound by next June. I would love to have a summer with him sound! How are things coming along with your mare??

Aileen, What a great suggestion! I made a sign with BIG red letters on it before I left for the barn this morning and showed it to the barn manager. He explained in Spanish what the sign was to the workers that clean the stalls, so hopefully we are all on the same page now. Thanks again for the suggestion.

Ann-I have that question too.. I am happy to hear Dr O's thoughts as to why he would develop a new injury above the "old" bowed tendon. I was not in a frame of mind yesterday to ask a lot of "whys"..

Dr.O Thanks for your encouragement..Between the support I may get from you, the members of HA and chocolate, I feel able to take a deep breath, put this in perspective and carry on.

With Gratitude,
Debra
Member:
Canter

Posted on Friday, Sep 30, 2005 - 8:30 pm:

Debra,
I've followed your posts since the start, and just want to wish you the best with Justin. What a shame that he got out and suffered a setback. I can feel your frustration and completely empathise: My mare suffered a minor injury about 7 weeks ago and required some stall rest and hand walking. It was nothing severe but I tend to be VERY conservative with her. Well, 1 week into the stall rest, she got goofy as we were walking, pulled away from me and of course , got out of an open gate (my fault - the ONE time I forgot to close the #$@& thing). She took a tour of the entire farm at full gallop, including down a paved driveway, back up & across the driveway, down again, until she finally settled down for some grazing. I was sick with worry and furious at myself for leaving the gate open. Fortunately, nothing came of her little adventure and she is fine now.

So, all that being said...I'd sprinkle those chocolate chips on a BIG bowl of icecream and ENJOY! With your patience & dedication, you more than deserve it.

Fran
Member:
9193

Posted on Monday, Dec 5, 2005 - 12:17 pm:

Hello All,

I wanted to reply to Shari's kind inquiry regarding Justin's progress in her post of last week, so decided to put it here for ease of continuity.

Four weeks of handwalking and four weeks of walking under saddle have passed.. On December 1st, we started adding one minute of trot in a 40-45 minute outing. Next week we will add another minute of trot and if all is going well, then we are to add two minutes of trot per week till we have another checkup toward the end of January.

It has been somewhat amusing watching him respond when we ask him to trot... His ears flick back and forth like his mind is rolodexing thru the info that is stored and he seems to be asking "Are you sure I can go faster?" "Is this what you are wanting me to do?" "This is REALLY OK?"

Yesterday when I picked my daughter up at the barn, the first thing I saw was her face all lit up and even before I asked, she burst out with "Mom, Justy was so good today and he gave me his big, floaty trot!!!" Only other horse lovers could appreciate what a sweet moment that was.

She is competing with the warmblood that we are sponsoring, so she has not been completly grounded by this problem with Justin. She enjoys her riding and barn buddies, but her heart belongs to Justin.

Thank you all again for your comments and support. As I read posts that are placed here daily on HA, I am constantly amazed and moved by the knowlege and compassion that is shared from so many places and so many people.

My New Years resolution is to increase my computer skills to include posting photos! I just love seeing the pictures that folks send in and have a few that I would like to share also!

Smiles and Appreciation,
Debra
Member:
Mrose

Posted on Monday, Dec 5, 2005 - 1:38 pm:

So good to hear of Justin's progress! And, yes...I can appreciate that big floaty trot!

I look forward to seeing some of your pictures. It really isn't all that hard~
Member:
Frances

Posted on Monday, Dec 5, 2005 - 1:41 pm:

So glad to hear of your solid progress, Debra, and especially of the "big, floaty trot"! That says it all!

Best wishes for more of the same ,

Lynn
Member:
Srobert

Posted on Monday, Dec 5, 2005 - 3:48 pm:

Oh - wonderful news! I was watching Rajah float himself across the field this morning and thinking the same thing. It looks SO WONDERFUL to see him in the pasture again and just being a horse. I'm so glad, glad, glad for you and Justin and your daughter.

BTW, chocolate is also for celebrations!!

Shari
Member:
Brandi

Posted on Monday, Dec 5, 2005 - 4:00 pm:

Debra, I feel for you and your daughter...that is WONderful! I wish you the best, very best success as you move Justin forward. After 17 months of rehab and relapses, and a complete rehab re-tooling , and shoeing changes, I too had a wonderful and sailing 4 minutes of trot just last week! And yesterday my good friend and excellent riding companion moved him through nearly 10 minutes of what looked like perfection in my eyes (we've been working since September to get him to be able to do 10 minutes of trotting, so this is BIG!).

I'm as happy for you as I am for me and Apache. I know the pain and frustration of the setbacks and now the joy of the payoff. Good luck and keep up the good work.
Member:
9193

Posted on Wednesday, Dec 7, 2005 - 1:05 pm:

Thank you Ladies, for your support and understanding.. It gives a warm feeling to read your responses.

Lynn, How is your mare coming along these days? Is she still kicking the wall of her stall?

Brandi- 17 months!! 10 minutes is HUGE!! I'd be jumping up and down like a crazy woman!! Thank you for sharing.. I've have since met two new boarders at our barn who have sucessfully rehabbed their horses thru serious tendon/ligament issues and each horse needed one to almost two years to come back to soundness and competition. Good Luck and continued soundness to you and Apache!

Shari- Justin would so love to be turned out to be free in pasture.. I hope I can do that by summer.. Right now the rains are coming on and I have to really be careful of how slick it gets with all this clay, so no turnouts for the winter. And you are right.. The versatility of chocolate is legend!! No horse owner should be without it!!

Smiles,
Debra
Member:
Frances

Posted on Thursday, Dec 8, 2005 - 6:53 am:

Hi Debra,

So far so good with my mare (phtu phtu of course). I've had thick carpeting fixed onto the stall walls for good cushioning if she DOES kick. I think it also yields a less satisfying kick (no real contact, and no loud slamming noise - no fun at all really!)

She seems pretty sound at the back end too these days, was shod today, and I have the vet coming on Mon or Tues of next week to see if we can progress to a little canter work. (That should be interesting! She's really hyper when I ride her nowadays. Not that I blame her after about a year of no turnout, no canter and continual restraint - well, you know what it's like.)

Her left knee is quite large, I have to say, i.e. the actual knee joint is big, and I hope she's not going to need another injection.

Anyway, I feel I've sort of got my horse back, although a somewhat wilder version of her! Keeping my fingers crossed for the vet's visit. Thanks for asking, and good luck!

Lynn
Member:
9193

Posted on Friday, Mar 10, 2006 - 4:30 pm:

Hi All,

Am singing the same song, but second verse of another relapse of some degree.. January's ultrasound showed that enough solid healing from the first relapse had occured to warrant permission to continue adding 2 minute trot blocks.

Bad weather, a closed covered arena for new footing repair and my tendency to go very s l o w l y this time around allowed us to build up to six minutes of trot (in two minute increments) until we got to the 8th of February when the last 30 seconds of the trot block for the day Justin looked and moved like he was off. The next day confirmed a very slight short striding on the LF. We handwalked him for a week per vet's instructions. I need to mention that we ice his leg daily after every workout and apply Surpass after every trot day. He also gets Adequan every two weeks and 99% glucosamine HCL every day. This has been the routine for the past 11 months.

His "offness" at the trot under saddle never did resolve thru the month of February. He does not show gimpyness when trotted in hand as long as the footing is firm.

March 7th ultrasound showed that the LF check ligament is 85% healed but the size increased 14% since last January's ultrasound.

The lateral suspensory has improved since January, but the medial suspensory size has increased 8% since the January ultrasound.

The LF SDF has improved since January and is 80% healed.

The thought is "something" is overloading the check ligament and medial suspensory. Next week my regular vet and farrier are meeting on the same day to start literally from the ground up to try to figure out if there is something going on with the other three legs and hooves. I am sure there will be discussion regarding flexion tests and the state of his hocks. Also, his saddle will be evaluated to insure proper fit (Have I left any thing out??)

This continues to be a learning experience. Am leaving now to stock up on good chocolate and an excellent Pinot Noir...

Smiles,
Debra
Member:
Sunny66

Posted on Saturday, Mar 11, 2006 - 12:29 pm:

I'm so sorry Debra...this is an incredible lesson in patience!! I don't think you've left anything out... but just in case I can't remember, have you done a farrier series of xrays? Just a thought.

Good luck to you...
Member:
Mrose

Posted on Saturday, Mar 11, 2006 - 2:07 pm:

This has been a really long haul for you, Debra; and for Justin!

And, I was just reading an article about how good chocolate and wine were for you. Just add a cup or two of green tea, and an raw oyster and an apple a day and you'll be able to face anything!

Seriously, I'll be interested in hearing what Justin's next appointment reveals. It's a learning experience for us all.
Moderator:
DrO

Posted on Sunday, Mar 12, 2006 - 11:00 am:

You seem to cover it all: reevaluate. I am a bit confused, on your first post you state the check ligament was fine and above you talk about healing of the CL is there some post I missed?

Your history seems clear Debra, considering the multiple injuries to the supporting structures of the leg that you will need to go much slower with the rehab and it you should discuss with your vet alternative treatments like shockwave.
DrO
Member:
9193

Posted on Sunday, Mar 12, 2006 - 1:43 pm:

Thank you all for your thoughts and encouragment.

Aileen, Have not ever had xrays done of the feet. That is a question that may need to be asked if anything seems suspecious upon hoof evaluation.

DrO- In my first post I was referring to the fact that the check ligament was the one structure that did not reflect any re-injury during his "freedom run" in August. Since then, the CL has been healing well, but upon this last ultrasound even tho the fiber patterns and echogenicities look good, the size increased 14% from January's ultrasound. The biggest mystery is why we can't seem to get past six minutes of trot time for the last four months without gimpyness occuring.

I am curious about the shockwave thought... I was under the impression that shockwave therapy had a better healing record if it was used when the injury was new. Would you consider shockwave therapy on this kind of an injury one year later?

Would shockwave therapy be better for one structure over the other? ie; CL vs medial suspensory (the medial suspensory is his weakest link)

I am figuring that this rehab is going to take us another 6-9-12 months barring reinjury..Four structures IS alot. Patience and time... We got this horse for my daughter, but I have gotten so very fond of him because of the time spent with the handwalking and leg care.. I really enjoy getting my daily "horse fix". I really missed horses these last 30 years and I am grateful to have this opportunity to reconnect with a long shelved passion.

Sara-I will be happy to report next Tuesday's evaluation. Thank you again for your suggestions and good thoughts. I absolutely adore oysters on the half shell!)

Smiles,
Debra
Member:
Sunny66

Posted on Sunday, Mar 12, 2006 - 3:08 pm:

Debra, my farrier loves that I have xrays as there is no question on what she needs to do. It makes her job much easier without the guessing game.

Do keep us posted and good luck!
Moderator:
DrO

Posted on Monday, Mar 13, 2006 - 7:54 am:

Your setback could be considered an acute injury of a chronic lesion. There are many questions about shockwave: does it work, how it works, if it works when is best? It is new technology in its infancy but everytime I turn around there is a new report where improved outcomes appear to be happening with its use.
DrO
Member:
Frances

Posted on Monday, Mar 13, 2006 - 2:36 pm:

Hi Debra,

I'm just back after a week away, and am really sorry to read that you've had a setback. Good luck this week (tomorrow is it?) with your vet and farrier. Let us know.

Lynn (with fingers crossed)
Member:
9193

Posted on Thursday, Mar 16, 2006 - 12:38 am:

Well, Tuesday's exam revealed some issues to deal with that may explain the gimpyness and front end problems.

My vet is great at explaining what,where, how and why. My daughter had a short school day, so I allowed her to play hooky and be part of this learning process. It was educational and enlightning..

Palpation of the healing tendons on the LF showed no reaction or sensitivity. Palpation of the RF tendons generated a positive reaction on the main body of the suspensory (definite flinching)

Testing of the hooves with the hoof tester showed no reaction to the LF hoof. RF hoof showed a definite reaction back toward the heel.

Our vet then noted that the LF fetlock joint does not bend as far as the RF fetlock joint.

Flexion test on the RF (with the reactive suspensory) When asked to trot, Justin trotted off happy, happy and looked sound as a dollar.

Flexion test on LF (with less bendable fetlock joint) When asked to trot..Justin hobbled and bobbled like a cork in the water. We stopped him after six or seven strides and he just stood there with his leg in the air. Poor Guy...

Our vet suspects there is something problematic in/with the LF fetlock. (osteoarthritis, bone chip, ect.) We are having digital radiographs done next week of the fetlocks and hocks (for an updated comparison) to confirm a diagnosis.

We are giving 1Gm Bute per day for the fetlock and applying the Surpass to both the LF fetlock and RF suspensory. We will continue the twice monthly Adequan, ice therapy after workouts and daily glucosamine.

The theory at this time is that perhaps the trotting aggravates the fetlock, which flares up as we try to increase our trotting times. I am not sure what to think of the RF suspensory reaction. I think I am still in denial.... I will be talking to Dr Gillis to let her know what we found and I suspect there will be another ultrasound to the RF this time.

This sounds like it will be a managment situation where I will need to learn how much exercise Justin can tolerate that keeps his joints moving, but doesn't overly stress his tendons as they heal.

My daughter and I felt the exam was good to do even tho some of the reactions have us concerned. I prefer knowing what the problem could be than just guessing and conjecture..

I haven't gotten around to discussing any treatments like shockwave..I'll probably get to that when we see what the xrays and ultrasound show.

That's pretty much it for now..

Smiles,
Debra
Moderator:
DrO

Posted on Thursday, Mar 16, 2006 - 7:59 am:

Thanks for the update Debra, I think the only thing else I would like to have seen is the lameness blocked out at the suspected area but if the exam was clear cut perhaps this is not needed.
DrO
Member:
9193

Posted on Thursday, Mar 16, 2006 - 3:02 pm:

Dr O, Thank you for your quick response..

Does a flexion test focus on the joints( (ie fetlock, knee)or could the flexion test have stressed any of the healing structures like the medial and lateral suspensories which would have contributed to the hobbling/bobbling?

Is that what you are referring to when you suggest blocking may differentiate between a joint problem vs a soft tissue involvment?

I forgot to mention that about 15 minutes later, we had Justin trot just to see what he looked like and he trotted off looking quite happy and sound, so that's why the focus on the fetlock joint.

My learning curve is including a sherpa and a bottle of oxygen at this point....

Smiles,
Debra
Moderator:
DrO

Posted on Friday, Mar 17, 2006 - 9:40 am:

Flexion tests are pretty non-specific I am afraid. Yes selective blocking will certainly better localize the source of the pain, see Equine Diseases » Lameness » Localizing Lameness in the Horse.
DrO
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