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Discussion on Neurectomy Experiences
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Member:
Stevens
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Posted on Monday, Jun 12, 2006 - 4:59 pm:
Well, after finally having an abscess gravel in the left front and thinking I was home free after 2 years of on again off again lameness, my 14 year old quarter horse starting severe pointing of his right front.
I had already decided that enough was enough so hauled him to an equine diagnostic imaging center for a real diagnosis. He had been x-rayed at a local vet hospital 18 months ago where they found a small spur on his coffin bone that was determined to be a "likely" cause.
Long story relatively short; Standard lameness exam; horse moved off sound when his heels were blocked. Next more x-rays, the fancy digital kind: his navicular bones have minimal "changes", certainly nothing to explain the lameness. Absolutely no rotation of his coffin bones. Next we did MRI which showed damage to his deep digital flexor tendon and his impar ligament inside his feet along with his navicular bursa.
The only option at this point, he's already on 2 grams of bute/day, is neurectomy. I'm OK with nerving a horse that is basically retired already, but am concerned that since the fundamental cause of the pain remains that I may be increasing the likelihood of more serious damage. My priority is his quality of life and given his current level of discomfort I'm pretty much committed to the neurectomy.
Thought I'd throw this out while playing phone tag with my vet. Does anyone have any personal knowledge/experience, no urban legends please, of nerved horses later sustaining severe injury to the areas that were already damaged?
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Member:
Shirl
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Posted on Monday, Jun 12, 2006 - 5:19 pm:
Chris, Just my experience. My mare lived in relative comfort for 9 years after the neurectomy. She passed from Cushings/Laminitis at the age of 23. It takes patience, lots of rehab time, but in my case, was worth it for I had many a ride after.
Best of luck whatever your decision may be.
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Member:
Stevens
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Posted on Monday, Jun 12, 2006 - 5:34 pm:
Thanks for the kind words Shirley. He's worth the time and effort to me.
Chris
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Moderator:
DrO
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Posted on Monday, Jun 12, 2006 - 8:18 pm:
You really are in a new area here Chris. Prior to such detailed imaging of the soft tissue with MRI we would have said go ahead, and give you are blessing. There is a small chance of breakdown, usually DDF rupture. Why some did and some didn't was not information available unless there was remarkable changes in the flexor surface of the navicular bone that could abraide the DDF. No one has studied such changes and the long term results of neurectomy...yet. I would like to know what the MRI reader thinks but most important if this is the last chance for comfort during retirement and this is important to you, I would take it.
DrO
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Member:
Shirl
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Posted on Monday, Jun 12, 2006 - 8:44 pm:
Chris,
I apologize, but must add Sierra had a partial neurectomy, in other words, she had feeling in her toes yet, so could be ridden. However, even if she required the total, I'd have done it. She was my soul-mate and remained so until she crossed the bridge, and still 'visits' me. Any further questions feel free to contact me privately.
Again best of luck,
Shirl
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Member:
America
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Posted on Monday, Jun 12, 2006 - 11:33 pm:
Chris one of my brood mares I also had a neurectomy done on her, she had a bone cyst on her navicular bone and was lame no matter what we tried with fancy shoeing so had it done and she is a happy camper . I've taken her on lots of trail rides in the hills do and arena work with her and she has done well (no tripping )good luck .
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Member:
Stevens
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Posted on Tuesday, Jun 13, 2006 - 10:25 am:
Thanks to all for the words of support.
Dr. O, the MRI reader and the examining vet are in agreement that we're seeing damage that has occurred over a long time and the recent change is likely a result that the horse simply is no longer able to compensate on one foot or the other. You've pretty much echoed their words that some horses do break down, but others don't and nobody really knows why. I'll be getting the detailed written report later this week along with the bill 
We are all in agreement that the horse is sufficiently uncomfortable that something needs to be done and bute just isn't cutting it. I'm not willing to put him down at this point as his attitude is bright and he continues to be very interested in his food and anyone else's he get can get his teeth on. I have no intention of campaigning this horse again and frankly am just looking to get him comfortable enough that I can send him to a friend's for retirement. I can't in good conscience send him out until I have confidence that he is "good to go".
I'll be scheduling the surgery in the next couple of days and will keep you posted.
Thanks again to all.
Chris
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Member:
Stevens
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Posted on Wednesday, Jun 14, 2006 - 10:32 am:
MRI reading results, sounds pretty grim.
Exam:
MRI, Right and Left Front Feet
GE 3D T1 Sagittal and Oblique Planes
GE 3D T2* Sagittal Plane
STIR Sagittal and Axial Planes
FSE T2-Weighted Oblique Plane
Exam Date: 06/07/06
Findings
Right Fore:
There is increased signal intensity in the medial and lateral lobes of the deep digital flexor tendon beginning at the mid aspect of the second phalanx continuing distally to the level of the navicular bone. This area of abnormality can be identified on T1-weighted images and identified only at the level of the second phalanx on T2-weighted and STIR images. The normal fluid space of the navicular bursa cannot be identified. There is low to intermediate signal intensity tissue occupying the normal space of the navicular bursa, extending from the deep digital flexor tendon to the palmar margin of the collateral ligament of the navicular bone. At this level, the dorsal margin of the deep digital flexor tendon is irregular. The medial lobe of the deep digital flexor tendon is enlarged. There are mildly enlarged synovial invaginations in the distal aspect of the navicular bone. There is diffusely marginated increased signal intensity in the palmar aspect of the navicular bone on STIR images.
Left Fore:
There is diffusely marginated increased signal intensity in the palmar aspect of the navicular bone on STIR images. There are mildly enlarged synovial invaginations in the distal aspect of the navicular bone. The deep digital flexor tendon has increased signal intensity on T1-weighted images and several dorsal margin defects beginning at the mid aspect of the second phalanx continuing distally to the navicular bone. Distal to the navicular bone, a focal area of increased signal intensity can be identified in the lateral lobe of the deep digital flexor tendon. There is not a concurrent signal increase on T2- weighted or STIR images. The normal fluid space of the navicular bursa cannot be identified. There is extensive low to intermediate signal tissue extending from the dorsal margin of the deep digital flexor tendon to the palmar margin of the collateral ligament of the navicular bone.
Impressions:
The findings present in the right fore deep digital flexor tendon indicate severe degenerative injury to the tendon with intra-substance tearing beginning at the level of the second phalanx and extending to the navicular bone. Throughout this level, there are extensive adhesions between the deep digital flexor tendon, navicular bursa and collateral ligament of the navicular bone. Similar adhesions are present in the left fore at the level of the proximal recess of the navicular bursa between the deep digital flexor tendon, collateral ligament of the navicular bone and navicular bursa. However, the tendon itself is less affected having focal areas of degenerative change identified on T1-weighted images that are not severe enough to be present on T2-weighted and STIR images. The mildly enlarged synovial invaginations in the navicular bone of the right and left fore may indicate degenerative change. The increased signal intensity in the palmar aspect of the navicular bone on STIR images in the right and left fore indicates mild stress-related edema or contusion.
Conclusions:
Mildly Enlarged Synovial Invaginations, Navicular Bone, Right and Left Fore
Severe Degenerative Injury, Deep Digital Flexor Tendon, Right Fore
Intra-Substance Tearing, Deep Digital Flexor Tendon, Right Fore
Extensive Adhesions, Deep Digital Flexor Tendon, Right and Left Fore
Extensive Adhesions, Navicular Bursa, Right and Left Fore
Extensive Adhesions, Collateral Ligament of the Navicular Bone, Right and Left Fore
Degenerative Injury, Deep Digital Flexor Tendon, Left Fore
Mild Stress-Related Edema or Contusion, Navicular Bone, Right and Left Fore
Neurectomy scheduled for this Friday.
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Moderator:
DrO
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Posted on Thursday, Jun 15, 2006 - 8:38 am:
It does sound a bit grim. However you wish to make the horse comfortable and without working him he may be quite happy at pasture for many years. It is quite a blessing you give this horse.
DrO
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Member:
Stevens
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Posted on Sunday, Jun 18, 2006 - 10:16 am:
Update: Successful neurectomy, and I was able to bring "86" home yesterday. He is visibly more comfortable and was happy to see me pull up with the trailer but not quite as happy as I was to arrive after almost 3 hours in So.Cal traffic. Fortunately, the traffic home was great and he didn't have to stand in the trailer that long.
Now we're at the beginning of a 6 week recovery time of stall confinement and hand walk to reduce the likelihood of neuroma formation. Then it's off to pasture to become a baby sitter.
Thanks again to everyone for the supportive comments.
Chris
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Member:
Paul303
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Posted on Monday, Jun 19, 2006 - 5:21 pm:
Thank you, Chris. Is there any chance that you could update a time or two more? I have a navicular mare ( 26 ) who has been treated/shod correctively since about 1986. If this is coming for me, all the experiences on this site that I've followed are informative and so helpful.
Sincere good wishes for a comfortable future for your boy.
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Member:
Shirl
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Posted on Monday, Jun 19, 2006 - 8:54 pm:
Chris,
It all sounds familiar and wishing you and your boy many Happy Trails, even if it's just walking around the pasture. You won't regret it.
Just don't let him over do. Boy, do I remember that hand walking with a horse that was minus pain for the first time in years! Good Luck,
Shirl
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Member:
Stevens
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Posted on Tuesday, Jun 20, 2006 - 9:46 am:
I'll keep you posted on his progress.
I changed his bandages last night for the first time and the incisions are healing nicely. Sutures come out in 7 more days, then reshod and more hand walking.
I'm fortunate in that I have three friends with horse retirement facilities. I just need to come to terms with not having him close and figure out which climate will be best for him. He's a California boy, but I'm thinking Oregon will be fine.
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Member:
Stevens
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Posted on Monday, Jun 26, 2006 - 8:43 am:
So far so good on the recovery. Sutures come out today or tomorrow. He initially was hesitant to walk, but is doing much better.
Now we just need to knock down the flu bug he picked up in the vet hospital
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Member:
Djws
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Posted on Monday, Jun 26, 2006 - 9:44 pm:
Chris-
My best to you and your buddy!
Oregon is a beautiful place.
He will always be close in your heart and mind...that's important. You love him enough to do what's best for him, and that speaks volumes.
Good luck!
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Member:
Stevens
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Posted on Monday, Jun 26, 2006 - 10:38 pm:
DJ,
Thanks for the kind words, even more meaningful since my really old guy, 31, died tonight. I was thinking of keeping this one close now, but your post has really helped me focus on what's best for him, and that's not standing in a stall in LA.
Thank you,
Chris
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Member:
Djws
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Posted on Monday, Jun 26, 2006 - 11:06 pm:
Oh, Chris...I am so sorry.
I sense that you were both fortunate to have one another.
He will always be a part of you, that will NEVER be gone.
I am sure that many a gallant steed came to carry him home...
I hope you will find peace and comfort in the memories of your dear, old friend.
My sincere condolences.
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Moderator:
DrO
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Posted on Tuesday, Jun 27, 2006 - 6:51 am:
Hello Chris,
Usually the surgery does not cause reluctance to walk but flu can make the muscles stiff, I wonder if that is what you were seeing.
DrO
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Member:
Stevens
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Posted on Tuesday, Jun 27, 2006 - 11:39 am:
Dr. O,
I hadn't made that connection, but now that you mention it, it was more of a general reluctance to move other than seeming sore on the front end. It was a bit disconcerting when a couple days after he was home he went off his feed, which of course made it difficult to get his prescribed bute into him. That's also coincident with his temperature spiking.
When I consulted with the operating vet, we speculated that he had developed an ulcer as a result of the stress. I was convinced of URT issues when he developed a deep cough and obvious congestion. Equi-tussin helped that but did in my dose syringe, any suggestions on re-lubricating the gasket would be appreciated.
On the up side, he was eating this morning.
Chris
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Moderator:
DrO
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Posted on Wednesday, Jun 28, 2006 - 6:28 am:
What is the syringe constructed of Chris?
DrO
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Member:
Stevens
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Posted on Wednesday, Jun 28, 2006 - 8:57 am:
Dr. O.
The syringe is plastic with a back rubber gasket thing on the plunger.
Chris
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Moderator:
DrO
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Posted on Thursday, Jun 29, 2006 - 6:44 am:
I don't often do this Chris so I am just guessing. I would try washing and drying thoroughly and then try a silicone based spray. While I lube my very large oral metal syringes with mineral oil, I have seen where some types of small syringes become stuck when oil was placed in them.
DrO
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Member:
Christos
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Posted on Thursday, Jun 29, 2006 - 7:09 am:
Chris, if there's a scuba diving shop near you, ask them for some silicone grease they use to lubricate o-rings.
It does not break down with time, it does not dry out and it will not attack the rubber.
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Member:
Stevens
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Posted on Thursday, Jun 29, 2006 - 8:41 am:
Thanks Dr. O and Christos for the advice. I knew not to use a petroleum-based product, but couldn't think of anything else.
Unfortunately, it's pretty much a moot point. It appears that whatever bug my horse picked up got into his nervous system and he died Tuesday night in the trailer on the way to the clinic. It's especially distressing as I had checked on him that morning on the way to work and he was up and eating.
Not a good week.
Chris
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Member:
Sunny66
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Posted on Thursday, Jun 29, 2006 - 10:39 am:
Chris, I am so very sorry. You did all you could and more. ((Hugs)) to you
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Member:
Christos
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Posted on Thursday, Jun 29, 2006 - 11:05 am:
My condolences, Chris, such a sudden end to such an honest effort!
You did all you could, got him some hope for a few days. Big Boss up there reckoned rest with his friend is more appropriate, and he's probably right.
His old friend was there first, so he'll have no problem adjusting to the shiny pasture. I am sure they're galloping and bucking up there, free of age and pain, remembering you, the love and the care you provided.
Take care of yourself.
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Member:
Hwood
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Posted on Thursday, Jun 29, 2006 - 11:08 am:
Chris, what a tough time you've had . . . losing both of your horses so close together. Gosh . . . that's a double whammy that really hurts . . . I've had to put two down at a time, and three down at a time . . . so I understand the sense of emptiness that follows. Be good to yourself. You are very compassionate and courageous.
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Member:
Quatro
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Posted on Thursday, Jun 29, 2006 - 11:09 am:
My deepest condolences Chris, You have been through so much! So very sorry for your losses. Sometimes it seems a heart can only take so much. May time and the support of all who care, help you through this difficult time.
suz
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Member:
Shirl
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Posted on Thursday, Jun 29, 2006 - 11:48 am:
Dear Chris,
I add my condolences to all the above. It's heart breaking after going through so much. They are happy and now you know you gave it your all. Take care of you, allow yourself to grieve. Their spirits hover over you.
Best, Shirl
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Member:
Djws
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Posted on Thursday, Jun 29, 2006 - 12:23 pm:
Chris-
Two more stars are in the heavens shining down on us.
Remember all the happy times with your two buddies...maybe that will ease your aching heart.
You did everything possible...and you loved them beyond measure, THEY will remember that.
dj
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Member:
Stevens
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Posted on Thursday, Jun 29, 2006 - 1:49 pm:
Thank you all for the kind thoughts. I am amazed and truly grateful for the outpouring of sympathy and support from all of the wonderful folks at HA and my resident barn. It is a tremendous comfort to me.
Friends have been taking care of my remaining boy as I'm taking some time off from the barn for a couple of days.
I feel very fortunate to have so many caring and generous friends.
Best Regards to you all,
Chris
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Member:
Dres
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Posted on Thursday, Jun 29, 2006 - 4:18 pm:
You are being smart again now Chris.. Take care of yourself for a while.. Time does heal...
On the first day God created horses, on the second day he painted them with spots..
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Member:
Paul303
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Posted on Friday, Jun 30, 2006 - 12:06 am:
Aaahhhh, Chris. It's so upsetting to read words like yours. It seems as though every case we follow here on HA, takes a piece of our hearts. Why is that? Probably because we all share a common bond, and at times like this, we all look at our own part of that bond - so big, powerful and muscular, yet...oh, so very delicate....and dependent...and we feel your sadness touch our souls.
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Moderator:
DrO
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Posted on Friday, Jun 30, 2006 - 7:38 am:
My condolences Chris boy it just won't stop will it. I do recommend you get a necropsy done so that you can resolve the cause of the death. Neurological conditions following a bout of flu is not unknown but more common following herpes virus infections. On the other hand acute death is often clostridial colitis, a common complication of a trip to the hospital.
DrO
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Member:
Lilo
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Posted on Friday, Jun 30, 2006 - 9:38 am:
My condolences, Chris. You did everything you could.
Take care of yourself,
Lilo
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Member:
Frances
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Posted on Friday, Jun 30, 2006 - 10:53 am:
Oh Chris, I am so very sorry - what a hard time you've had. As others have said, at least you know you went the whole way for him. There's no more you could have done.
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Member:
Canter
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Posted on Friday, Jun 30, 2006 - 7:41 pm:
Chris,
I too am so sorry to hear of your loss. I hope you will find peace knowing you did everything you could.
Fran
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