Let's Talk Stifles

Gogo's bone scan results came back Thursday. I actually called Tufts midday in a total panic, very nearly cancelling it and making the other vet very angry, but we decided that since she was already there and already injected with the isotope that we would just go ahead with it. I felt much better after telling him exactly how I felt about it though. He called me back later in the day to confirm that the effusion in her right stifle was indeed showing up on the bone scan, and she also had left SI pain, which didn't surprise me given her chiropractic history. They found the two SIs to be asymmetrical, which Dr. A had mentioned when he looked at her last. They blocked the stifle yesterday and she jogged sound. It appears that along with the tendon hyperextension she also jammed her stifle while sliding. As the other stifle was sparkling clean, this appears to definitely be an acute injury versus long-term degeneration, so we opted to treat the stifle with Vetalog and Polyglycan to get any last inflammation taken care of. That's of course not ideal in my mind, but I want to take care of this right now - long-term inflammation CAN lead to joint degeneration and that's the last thing I want. By taking care of it now, we can prevent that from happening, and it's likely that we've had to do this joint (and only the right one, I might mention) and then never have to think about it again. All in all, I am glad we ended up doing the bone scan, as it gave me peace of mind, like a few of my readers said.

As for the SI asymmetry, I am calling up Dr. A right away to have her adjusted. I knew for a fact that she needed one (he put his hands on her and told me so), so we are opting to treat the SI issued chiropractically for now. If we need to address them again in the future with antiinflammatories we will, but I hope not to do that. Dr. A is nothing short of a miracle worker in my mind so I expect he will be able to help greatly.

(For those of you unfamilar with nuclear scintigraphy, here is a little write-up of what it is. Essentially, the theory is that when bone is injured it repairs itself by adding more bone to an area and increasing its activity, a term called remodeling. The isotope injected into the horse is radioactive, and accumulates where there is a high level of bone activity. Essentially they measure the radioactivity of areas of the horse - the areas that accumulates the isotope in high levels is essentially measuring inflammation. It's useful over radiographs for things like joint degeneration because a horse might have clean x-rays but still have joint pain, or often times vice-versa. However, it doesn't do more than tell you which areas of bone are inflamed - it's up to the doctor to determine what exactly is causing the pain and why.)

Of particular note is the fact that her hocks were, and I quote, "pristine." Either they were not the trouble I thought they were, or injections greatly helped. Which is very comforting to hear. We ran the ultrasound over the fat hock and found nothing of particular importance, and when it showed up clean on the scan, we can only deduce that for whatever reason, she developed some mild cellulitis (bug bite? trama?), which may or may not go away. Seems to not be a problem, so we'll just wait to see what it does.

One last thing to note is that we no longer suspect this is an issue of Lyme. The other vet said that something about Lyme shows up in a certain way on the bone scan, and they didn't see that (he explained it to be but I couldn't make heads or tails of it). So at least there is that. Now we know she's just a nutty event mare on stall rest in December. Not surprising!



Here are a few of the images from the bone scan:






It's always very interesting to see because I dunno, those stifles look the same to me!


And a quick ultrasound image:



Coming along very nicely. I guess there are still small margins of where the lesion was but they are so unremarkable that they weren't even pointed out to me on ultrasound.



Gogo's rehab program continues as thus:

Dec 5: Strict stall rest (and grooming), 2g bute
Dec 6-11: Treadmill 25 minutes once a day, 2g bute daily for 3 days then 1g bute for 4 days
Dec 12-18: Tackwalking 30 minutes, treadmill 25 minutes
Dec 19-Jan 1: Tackwalking 30 minutes, trotting 5 minutes, treadmill 25 minutes
Jan 2-15: Tackwalking 30 minutes, trotting 10 minutes, treadmill 25 minutes
Jan 16-29: Tackwalking 30 minutes, trotting 15 minutes, treadmill 25 minutes
Jan 30-Feb 13: Tackwalking 30 minutes, trotting 20 minutes, treadmill 25 minutes
And then we can begin canterwork, if all is going well. We'll talk to Dr. Chope in 6 weeks to see about another ultrasound if we need it, but I'll probably just have Dr. C do it here.


Hooray!