Good news for people who love bad news!
Wednesday afternoon was our appointment with Dr. C and Dr. G up at Tufts. Even though Gogo jogged out only mildly unsound the day after the incident, I hadn't jogged her since and wasn't sure of what we would find. I had thought maybe we'd have to try and induce the lameness again. I bathed her, clipped her, and trimmed her all up, plopped her on the treadmill, dried her off, and then tossed her on the trailer and left. When we arrived and unloaded, I was reminded of how much I completely adore my mare - as usual, she walked into the clinic like she owned the place, sniffed around at some extremely questionable looking things as if they were nothing, and stood there bright, calm, and interested, despite the chorus of screaming horses in all directions all around her. Love her.
When the vet showed up, we took her into Tufts' long aisleway, and had a tech jog her. And wow... she was a lot lamer than she has been the day after the incident. Quite a lot. Since she conveniently happened to be so lame on the day that we were there, we decided that we would start with blocks to see what we could isolate, and then go ahead and ultrasound the legs afterwards. I told them my concerns about her stifle, and when palpated we did find some mild effusion there, same as last time. (For the record, I think the injection didn't do much for her.) We also found effusion in both tendon sheaths in both hind legs, something I've been concerned about and unsure of what to really think - they fill at odd times and for odd reasons, which is why I've felt unable to wean the wraps off of her at this point despite my best efforts. We agreed to block the tendon sheath on the RH first and see what that gave us. Somewhat alarmingly, when the needle went in, a whole lot of fluid came shooting out, and left a fairly sideable puddle on the ground. The fluid was also more watery than it should have been. We blocked the area with 15ml of Carbocaine, and I took her for a little walk before we jogged. Not expecting to see much, I turned her over to the vet tech and watched her jog out for the second time with the vets at my side.
And... she was quite a lot better. And it continued to improve the more she moved.
Well, we weren't totally concerned at that point because the left hind had the original lesion in it, right? There was no structural damage to the right hind anywhere, aside from the inflammation in the tendon sheath and the jammed stifle. She was always lamer in the right hind originally, but honestly these past few jog outs prior have been great. There was nothing on ultrasound that was concerning. We clipped her up, pulled her up alongside the ultrasound machine, and looked at the RH.
There. An angry, fresh, little black hole. A brand new lesion on the other leg. My heart sank. It couldn't be.
We went back and forth for a long time about it. How could this have happened? Did she do something stupid? Was the canterwork just too much too soon? Was this a compensation issue? Did she have an adhesion that did in fact rupture but took part of the good tendon with it? We don't know. There was an area of very mild tendonitis on the left SDFT as well, despite the fact that the original injury is nearly invisible. At this point, it is impossible to say.
The official vet write-up:
"Upon presentation, Gogo Fatale was bright, alert, and in good body condition. Physical exam revealed mild right stifle effusion as well as effusion in the deep digital tendon sheaths, mild on the left hind and marked on the right hind. Lameness examination revealed a 2+ out of 5 lameness in her right hind limb at the trot. Upper and lower flexion tests resulted in mild t moderate and mild increases in lameness, respectively. The area of the skin over the right hind deep digital flexor tendon sheath was steriley prepped and 15ml of Carbocaine injected into the sheath. Upon repeat examination following local anesthetic injection, there was approximately a 75% reduction in lameness in the right hind at the trot.
Sonographic evaluation revealed a small local lesion in the superficial digital flexor tendon approximately 4cm proximal to the annular ligament of the fetlock joint, possibly resulting from a torn adhesion. The superficial and deep digital flexor tendons were noted to glide smoothly past one another. Additionally, an area of mild tendonitis was noted in the superficial digital flexor tendon just proximal to the annular ligament. As seen previously on sonographic examination, the area of previous tendonitis is improved however an area of mild tendonitis was noted in the left hind superficial digital flexor tendon distally, which is new as well.
As we discussed, due to its location, there is the possibility of the annular ligament of the fetlock putting pressure on the deep digital flexor tendon sheath and causing some discomfort. There is the possibility of surgically transecting this ligament to relieve this; we discussed this as an option for the future if needed. We agreed to treat conservatively and implement a controlled exercise program, allowing time for the tendon to heal."
We briefly discussed PRP with this particular lesion but shrugged it off pretty quickly, seeing as it is very close to the surface of the tendon. It is likely that everything would just leak back out into the tendon sheath versus stay put and do what it is intended to do. Given the location of the injury, we did discuss the possibility that the annular ligament around the back of her fetlock might be putting pressure on the tendon sheath and causing discomfort. They said maybe in the future if we needed to we could surgically transect it. I said no. I see no reason why we shouldn't be able to get the swelling down and gone with cold therapy and time.
And in the end, that is what we collectively agreed on. Time. We obviously need to immediately rest her and cool out the legs, but beyond that? Honestly, I've got all the time in the world. Maybe I'll take up my roommate's boss' offer to swap out horses and let her go live outside 24/7 for a few months while I take on a horse to see if we can get her sold. Maybe I'll just spend the summer lightly trail riding. Maybe I won't get on at all. Maybe I'll decide to teach her a bunch of dog-and-pony-show trick. Yeah, I think I'll do that.
Pick a trick, readers. I'll teach her how and get back to you once she knows it. That will be fun. Just don't suggest teaching her how to rear on command.
As for the next two weeks, we are on strict rest with 10 minutes of handwalking once a day, cold-tubbing twice a day, and icing twice a day as well. She is ticked about not going outside, but she has a nice big fluffy pile of hay in front of her, and she is still sparkling clean from her bath and has a freshly pulled mane. Maybe 2010 is our year to do silly things - explore, swim, trail ride, hang out - and then next year will be THE year. This year is also looking like the time to breed. So maybe, just maybe, this time next year we will have a bouncing, rearing bundle of love on the way to all ooh and aah over. I'd love that.
I am surprisingly not too bad about all this. Clearly, I'm not happy but at the same time my life isn't over. She's healthy, gorgeous and happy. She just has some funny legs right now, that's all.
Hey. I've got some funny legs too. We'll get through this. I know we will. It just takes time, and determination, and love. And time. Did I mention time?
Zac's 3 week update
18 hours ago