Some Very Good News, and Good Times

Well I have some very good news! After reviewing the ultrasounds taken two weeks ago, and the ultrasounds taken three days ago, the vets have concluded that the lesion in her LH is resolving so well on its own that they felt the PRP was unnecessary - she is rapidly healing on her own! Sweet!

On Monday, I tidied Gogo all up (it was too cold for a bath, but she got a serious grooming and her face all clipped so as to not look too skanky for the vet... I believe I am the only one in the world who makes my horse look nearly show-presentable for the vet), and I packed all my stuff in order to head right from Tufts up to New Hampshire, where Daun and a fantastic foxhunt awaited me. Early Tuesday, I cleaned her up, threw on her nice sheet, put her shipping boots on over her bandages (this is a nifty little trick I just figured out... thin no-bows and bandages apparently fit nicely under shipping boots, which is great because she pulls down bandages in the trailer unless you offer some other kind of protection), and off we went by 7am in order to make it in time for our 9am appointment. We were a little early, so Gogo had to hang out in the little holding stall for awhile:



She was like ummmmm what's this about? But of course, she's perfect for things like this, so she stood quietly and peed a lot when another gelding came in (perpetually in heat, of course).
Dr. Provost and Dr. Chope came in to meet me after a well meaning but sort of confused 4th year vet student took our info (although I admit, the story is pretty complicated), and we did a lameness evaluation after discussing the case. She trotted out still fairly lame in both hinds, moreso in the left (they gave it a 1.5 to 2 at the trot on a straight line, and didn't rate the right hind), but it's a definite improvement. We moved on into the room with the treadmill and ultrasound, and Dr. Chope ultrasounded both hinds extremely thoroughly - we did both hinds pretty much from right below the point of the hock all the way down to her hooves, and it took at least an hour. Again, nothing of interest was found on the RH, except for some tenosynovitis in the digital shealth of the superficial digital flexor tendon (SDFT). Essentially, she has some inflammation of the tendon sheath, which is filled with synovial fluid (which is really fascinating... the body is so efficient and fabulous when it works normally!). On the LH, she still has the small lesion in her SFDT, and some tendonitis and tenosynovitis, same as the RH, except the RH has a little more swelling than the LH. However, the lesion looked remarkably improved for just a week and a half out from the previous ultrasound - essentially, it's healing itself quite rapidly. We scanned the entirety of both legs, and it really is just localized to that one little area, which is great. The vets expect it to resolve itself just fine, and for the tendonitis/tenosynovitis to resolve with some more anti-inflammatories (namely Surpass). When flexed, her fetlock on the LH was painful, which was a little weird. We took some x-rays of it just to be safe, and found nothing remarkable, so it's possible that she either strained the fetlock, or that the way the leg was being tweaked was painful due to the ouchy tendon. The last thing of concern was her back. They were a little worried that her lameness level was a little more than it should have been for this type of injury, but it's possible that the tendons just hurt like hell, which wouldn't surprise me, but the other thing it could be is her back. She was pretty sore, not in a muscular way though... right over her spine, mid-back. It's possible that she either was overcompensating for the legs and stressed it, or perhaps torqued it while out on XC... or maybe she was sore from her recent vaccine reaction? Who knows. We didn't explore it further at this time, but I will have Dr. A the chiropractor look at her on Tuesday and see what he thinks about it. Whatever it is, it's pretty much a given that it's probably going to require stall rest, and we're already on stall rest, so there you are. We're going to put her on some methocarbamol and see if that helps.


This was the basic write-up:

"Upon presentation, Gogo was bright and alter. A physical examination was preformed and revealed that her vital signs were all within normal limits. A lamaness examination was performed which showed a 1.5 out of 5 lamaness (0=sound and 5=non weight bearing lameness) in her left hind and a 1.5 to 2 out of 5 lameness when she was trotted on a straight line. She was sensitive to palmation of the superficial digital flexor tendon distrally and resented fetlock flexion in the left hind. Digital tendon shealth effusuion was palpated in both distal hind limbs, with more effusion in the right limb than the left limb (you report this is an abnormal amount for her). She was also sensitive to back palpation in the caudal thoracis region.
Ultrasound of both hind metacarpal and pastern regions revealed a local lesion in the lateral aspect of the left hinmd superficial digital flexor tendon, between 38 to 41 cm from the point of the hock (proximal extent of the digital sheath). Enlargement was present. The margins of the tendon appear intact. Increased fluid and synovial thickening was observed in the digital tendon shealth in both hinds legs, indicating tenosynovitis of the tendon shealth bilaterally. All other structures were within normal limits. Her deep digital flexor tendons were measured and evaluated bilaterally and were nonremarkable at this time. Thus, Gogo has a focal subacute superficial digital flexor tendonitis and digital sheath tenosynovitis. In compasion to her previous ultrasounds, her superficial flexor tendon appears improved. The treatment for tendon injuries is rest and constrolled exercise, followed by a gradual increasing return to work with periodic sonographic monitering. Other therapies such as intralesional medication (PRP, stem cell, etc) or shock wave therapy may be beneficial. At this time, however, with the focal nature of the lesion and its apparent improvement, we do not feel that intralesional injection is likely to significantlyimrpove her prognosis over rest and controlled exercise. Accordingly a program is outlined below. Her digital shealth tenosynovitis is likely due to her tendon lesion in the left hind and/or strain. It should refuce with anti-inflammatory therapy. Radiographs of her left hind metacarpal phalangeal joint (fetlock) were taken and were nonremarkable.
Her degree of lameness is of some concern, as it is bilateral and possibly more severe than one mightg expet for her tendon lesion. However, as discussed she may also have a component of muscle or back soreless due to her slipping/competing/shipping and more recent possible vaccine reaction. Local nerve block may help rule oin or out a lower limb versus upper limb component. We recommend that we rest her for the tendon lesion and re-evaluate her lameness (possibly with nerve blocks) and tendon in 6-8 weeks. Additionally, re-evaluation by her regular chiropractor to assess her back comfort is recommended."


The program from here? Two more weeks of handwalking, 10 minutes twice daily, and ice boots for 30 minutes a day (this last part is just because I can, mostly). She'll also have 10 days of Surpass, followed by a week within, then possibly more Surpass depending on the swelling. She'll increase by 5 minutes a week for the following two weeks, getting 15 minutes of handwalking twice daily and then moving up to 20 twice daily. Then, I can sit on her again (yay!!), walking slowly for 15 minutes daily, and eventually building to 30 minutes daily over the course of four weeks. About two weeks into that, I can start to put her together again, and do some minor stuff at a medium walk. So in about 8 weeks, we'll re-evaluate her sonographically to see where she is. If she's looking like it's healing appropriately, she can start to trot for 5 minutes a day, and building by 5 minutes every two weeks until we reach 20 minutes. Then we can add canter in 5 minute increments. We'll recheck her regularly via ultrasound during her re-legging up. And this is all very tentative, of course, and it just depends on her, so it might change.


And the rest of my two-day adventure was AWESOME! Not only did I get to see my fabulous friend Ali, who is my very good friend from college and who is currently attending Tufts for vet school, but I also went from Tufts up to visit Daun and see the big Brego, and go on what we expected to be a totally fantastic foxhunt. Well, of course it being the perfect New England fall, the hunt got called because of rain. D'oh! However, that evening she and I took Brego and her mare Hobby over to the gallop track in the woods, and let them rip. Or well, we let Brego rip! Daun had me get on him (that's so freaking sweet!) and take him for a spin around the track. He tested me a little bit ("now do we REALLY need to go faster than a canter? I'd really rather not leave the mare thanks") but after some encouragement (whack whack!) he really opened up for me. Man that dude can FLY! I really would have NEVER expected such a big guy to be capable of speeds like that, but it's clear he's no ordinary Perch. It was getting dark so I didn't get the chance to take him over any jumps, but perhaps that day will come! He looks so cute and fuzzy from the outside, but he's got a big ego and an attitude to match. He is a seriously cool horse. It was pouring the next day, as expected, but she and I still got to squeak in a ride at the fairgrounds, which was great fun. Plus, they stuffed me full of super delicious farm food, what could be better? Daun has been a fantastic big sister-type to me all this past spring and summer, really and truly. She encourages me, challenges me to think outside the box, gives me fantastic advice, and cheers me on through thick and thin. Daun, you're awesome. AWESOME. Seriously awesome. And thank you.


And now, it's back to the grindstone of daily work, until it all ends on the 15th. Now that I've realized I really AM leaving, suddenly I'm very sad about it. I mean, this place has been my life and home for the past 10 months, and these people my family. I know I can't even begin to afford to stay at a low-salary position like this any more, but moving on is always sad. I actually already have a potential job lined up in Michigan, one that sort of fell into my lap and might turn into something special, but then again it might turn into nothing at all at this point. We'll play it by ear, and I'll have some more details about it when I know them. We shall see.


Good news, good news, good news.