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In Loving Memory...
~ Gogo Fatale ~

6/2/01 - 10/11/11
~ Forever the Marest of Them All ~

Sunday, August 14, 2011

The Harsh Reality of Turnout

Gogo is, once again, pretty unsound. Not consistently, not horribly, but it's there. Going to the right on the lunge, she looks completely normal and fine... you wouldn't even know there was a problem unless you were truly looking for something, and hard. Going to the left, she has a consistent hitch in her right hind. I am grateful that whatever is going on still appears to be with the SDFT, and that this presentation of lameness has been positively associated with SDFT damage in the past, because this is a classic suspensory presentation. If she had a new suspensory injury on top of everything, I think I'd die. Thankfully, as far as I can tell it's just the same old thing, forever.

To play the complete pessimist, deep down in my heart I think I always knew this would happen when I put her on turnout. I said a year and a half ago that I felt that turnout was "archaic" for a horse with a tendon injury, and received quite a lot of commentary in response. 9 months ago, I retracted my statement and decided that I would turn her out 24/7 and see what kinds of healing powers nature had to offer my mare. Stall rest and controlled exercise brought her back magnificently, but she reinjured twice in the process. Something wasn't working, and so I tried the alternative.

But I had my doubts early on. I wrote here about the fact that turning out a fresh tendon injury is potentially asking for trouble, and wrestled with myself over the ethics of it all. Was it right to trap her in a stall and bubblewrap her in the hopes that her body would heal even though her mind would struggle? Or was it right to turn her out, allow her mind to be happy, and potentially cripple her in the process? The important excerpt is here:

November 26th, 2010: "I am at war with myself over the best course of action for Gogo right now. Every fiber of my being screams against turning her out with a fresh soft-tissue injury. It's simply a fact: she WILL get hurt. It WILL hurt her. It MAY permanently damage and deform her. It MAY offer perfect, miracle healing. It might completely ruin her, and cosmetically and structurally destroy her permanently. The last horse I saw that was turned out with a SDFT injury ended up literally so deformed and lame that she knuckled over at the knee in an effort to not use her painful limb, and was severely lame at the walk even after the tendon was declared set for life. THAT could be Gogo. OR, she could take good care of her body, build up scar tissue, and come back as a mildly useable animal someday. The fact of the matter is that the body compensates for whatever it needs to in order to make itself functional. Likely, she'll build up an ugly bundle of disorganized scar tissue and heal herself. She'll hurt herself out there, oh yes! She will. Which is why I am at horrible, stomach-turning odds with myself. It's the right thing to do, retire her and let her loose to be a horse and give up hope of her ever being really rideable again. If she ever IS rideable, great! If not, it's fine too, so long as eventually she turns out pain free. Understandably, this is completely killing me."

In my heart, I felt as though I just couldn't trap her in a stall any longer - what was I achieving if she was just going to reinjure in the end? And so, I turned her out.

At first, I believed in it. I believed that nature would take my sweet mare and heal her. I still believe that nature has healing powers that modern humans simply cannot replicate through our controlled settings and our medications. (Which is why I chose the barefoot thing as a career... I believe in the restorative powers of a body's natural process. Humans just can't do it better than nature can.) For a short while, a spark ignited in my heart - returning my horse to her naturalness would help her so much! That's the answer! She seemed pretty happy once she adjusted, and I settled in to allow nature do its thing.

She got sounder. She got lamer. She got sounder. She got fatter. She got lamer. She got sounder. She got fatter. Her feet changed. She got fatter. She got sounder. She got lamer.

Six months into it, I had hope. She wasn't fully sound but she looked pretty darn good to me. She hadn't come sound like she had during stall rest and controlled exercise (2 months into the first injury and again into the first reinjury, she was sound), but hey, nature takes time. Once at the clinic, however, she displayed pretty constant lameness on the right hind. Ultrasound showed that there was still tendon degeneration as well as a tendon sheath full of stringy, messy adhesions. It looked like a pot of spaghetti spilled inside of her tendon sheath. (Tasty, I know). There was also annular ligament involvement, more than ever before.

Her body was doing exactly what I had predicted it would do: "Likely, she'll build up an ugly bundle of disorganized scar tissue and heal herself." Heal, at this point, is a very subjective term. That's just what tendon injuries out in a field usually do.

We injected the tendon sheath with Kenalog and went on our way. The vet advised that we continue with turnout (as if I was considering anything else), since this was now considered a chronic injury, and that I sit on her and see what happened.

The leg went down after the injection. She blew an adhesion and went lame. The leg blew up again. She got sounder. Life went on.

At the new farm, I tried to sit on her again, and again, she went quite lame. The leg blew up again, in a very grotesque kind of way, and this time it stayed. The leg as of today:

It's probable that she has reinjured, or done a new injury, or keeps blowing continual adhesions, or something. There is lameness and swelling and there is no end in sight to this whole vicious cycle. If she stays in turnout, she continues to walk around on an injured limb, possibly injuring it further or causing strain to other parts of her body. But at this point, if she gets stalled, it will kill her. It didn't do her any favors before, and it's not going to do her any favors now.

This all basically boils down to this: I don't think I did her any favors physically when I turned her out. In fact, I may have completely doomed her soundness forever. Maybe that's being a little dramatic, but honestly, she's lamer now than she was before I turned her out 24/7, and the leg is now ugly and fat and full of adhesions when before it didn't have any. Before turnout, she was trim and muscular. Now, she is morbidly obese, and it is going to be next to impossible to get the weight off of her while she is unridable. (And the weight adds to her lameness, so it's a vicious circle). Before turnout, she has gorgeous, picture-perfect hooves. Now, I'm doing constant damage control due to all the changes they have gone through.

It's too late for stall rest now, and it would mentally wreck her. There's nothing I can do anymore except just keep her turned out and hope that she remains happy and relatively comfortable. At this point, I don't really have any hope that she'll return to any level of functional soundness. Trail pony someday, if I'm lucky. Maybe. We also have the option of cutting her annular ligament, which has been discussed all along and which I violently opposed up until now. That could possibly be a helpful last resort. Or, it could be a total disaster. Who knows?

It feels like Metro all over again. When he first went lame, I said to myself, "Well, he'll just max out at Training level in eventing, and that's ok." When his lameness progressed, it became, "Well, he'll make a super dressage horse." When he worsened, it became, "Well, he'll be a great trail horse." It wasn't long before it became, "Well, he'll be really nice to look at in a field." At the end of it all, when it was clear he wouldn't even be comfortable enough to hobble around in the pasture, it became, "Well.... this is the end."

I hope it doesn't come down to that. As long as she is walking around in comfort and is happy, we'll keep trying. But I'll do the right thing by my horse, if she tells me so. It's cruel to make a horse hobble around in a field in constant pain just for an owner's selfish emotional needs. I'm not that person and I'll never do that to her.

It's obviously not NEARLY that bad at this point. But honestly, having previously lost one in a similar slow downward spiral, I can't help but worry about it.

Oh, Gogo.


Val said...

What type of activity caused the leg to blow up? I know that you are very careful with her. Just curious.

I hope her situation is not as grave as Metro's was. You deserve a break at this point. I wonder if there could be a horse professional besides a vet who could be of help to you. There are people with some incredible abilities out there.

What would cutting the ligament do?

Melissa said...

*Big hugs* Hang in there. It must be terrifying to watch that leg refuse to heal up, but we can all see that you're doing the very best you possibly can for her. Maybe her body will cooperate, maybe it won't. I'm confident you'll make the best decisions for Gogo's well being that can be made.

Jenny said...

Sorry to hear the news.... I still think you have done everything right that you possible could, including turn-out. As you said.... despite stall-rest and religiously sticking to her rehab plan, she still re-injured. At least with turn-out you have a happy horse! Best of luck! Have you tried infrared light therapy?

pony said...

You might think this is a ridiculous idea, but have you considered switching her between pasture and a stall? That way you could gradually wean her off of pasture and get her used to being in a stall again for longer and longer periods of time and maybe that way she wouldn't go completely bananas in a stall.

My best friend's mare was a complete nightmare when kept in a stall 24/7, so she kept her out on pasture all day and ran into the same problems you have - mainly the hoof and obesity issues. We decided to work as a team to get her mare to stop freaking out in the stall, and with patience and time, worked up to keeping her in a box stall 34/7 over a couple of months and her mare has adjusted well to it.

She started putting her in a box stall for one hour a day and moved up hourly from there. She spent a week straight at 8, 12, 16 and 20 hours, and her mare is much more content to be inside than she used to be. I know it sounds ridiculous but we are fortunate to board at an awesome barn where we have extra stalls and elementary school and middle school volunteer kids who are around all the time and who are super excited to spend time with any horse they are allowed to play with. The slow adjustment period totally worked for her mare, and maybe it could work for you and Gogo. Her mare doesn't freak out when she is stalled all day and all night and is a lot less obese than she used to be.

Maybe that's not for you, but it seems like you are totally beating yourself up for making a decision that you thought would benefit Gogo, and I think you shouldn't. This one isn't your fault. If you thought she would be bored and potentially harmful to herself in a stall, and also thought she would hurt herself in the pasture, you really didn't have a stellar choice to make. You just made a choice that a lot of compassionate horse owners would - the one that preserved her brain so she wouldn't lose her shit and go bananas. You thought it was totally risky, but you also thought stall rest was, and you should remember that and maybe feel less bad because clearly you are awesome to your horse and her injury (for better or worse) isn't your fault. It's like reaching your hand into a mystery bag and pull out something you can't see. It could be a giant scary spider or it could be some delicious candy, but you won't know unless you put your hand in there. I would absolutely chance bumping my hand on a creepy spider for some delicious candy but maybe that's just me...

Anyway, what I'm trying to say is that I certainly don't judge you or your decisions regarding Gogo and hope you don't blame yourself for that because it's not your fault that her lameness is not improving.

Maybe things aren't just black and white, lame or not, stall or no stall. Does your barn have double wide stalls? Do they have box stalls with a run or a very small paddock that she could toodle around in but not walk as much as she does in a larger pasture? At this point, you've done stall rest and put her out on pasture, so you really have nothing to lose if you try any and all of your available options, and even if you have to try ridiculous things, maybe something will work.

Whoa, that was a novel. I have been reading your blog for years and feel horrible that you have worked so hard and feel like you're at a road block. It'll be okay! You aren't alone in your struggle! You've got all of your readers for support and encouragement, and I think most everyone respects and supports your decisions. Keep brainstorming, lady!

pony said...

Oh yes, didn't you know there are 34 hours in a day?! I meant 24/7 haha.

Lisa said...

I remember you saying that you were going to turn out for 12 months and then see what you have at the other end of it. I think this should still be your plan.

Also, fat horse with no rug in winter = trim horse come spring. Probably the only way you will get the weight off, but an easy way. Plus I imagine that the weather where you are doesn't get dangerously cold, so it should be doable for you.

buymeaclue said...

You know – as much as it sucks, it’s maybe possible that Gogo was never going to properly come sound. That is. These are big powerful incredible creatures that regularly withstand tremendous forces without batting an eye…but they’re also intensely fragile, some more so than others, and sometimes they ruin themselves over some teeny-tiny little thing that never should have been a problem…except that it was.

Who knows why Gogo injured in the first place? We can guess and analyze and ponder all day long – and I know you have some theories, and they seem as likely as anything else – but at the end of the day it’s hard to be definitive. Some horses come back; some horses don’t. Sometimes one rehab plan works out, and sometimes another, and sometimes none at all. There’s a lot of science to this stuff, but none of it’s exact. It’s possible that there is and was no right answer here, no one set of circumstances and schedules that, if only you had found it, would have brought Gogo back sound. It’s possible that there’s just something going on in/with that leg that meant it was never going to hold up and/or heal itself as well as we all would have liked.

I like results and reasoning as much as the next person, and more than most! I like to control every variable that I can, because frankly the alternative is just Too Much for me. But there are other variables, too, and there is only so much responsibility that one person can be, y’know, responsible for.

I’m sorry it hasn’t gone better thus far, and hope it goes better in future.

smarty9930 said...

Andrea, I dont think you can compare whether her healing would have been better if she were stall-rested vs. turned out. I agree with the post above, with such a drastic injury, she may never have come sound no matter what you did or how careful you were.

I know a horse with the same injury - he injured himself in turnout, was stall-rested, stem-celled, reconditioned slowly, made it to showing level soundess and then reinjured 2 more times. Same injury, same leg, same reconditioning process... I can't help but feel that the poor owner is fighting a losing battle.

He is currently in his 3rd bout of stall rest, nothing has been spared in the efforts to bring him sound enough to have a decent quality of life. A recent ultrasound for the (3rd injury) shows no improvement of the tendon after stem cell treatment and 3 mos in a stall. So 3 more mos it is.

The horse has not been out of his stall in 3 months and has to be sedated to keep from bouncing of the walls when the farrier comes...

If he ever heals enough this time, his owner has had a special paddock made that is 8 x 12, it is attached to his stall...where she plans to keep him for the rest of his days. Knowing what I know of the horse and his owner, without turnout and a decent work load, he will never be calm enough for her to ride again. So it will be life in his box. What kind of quality of life is that...?

I personalyy think you did right by Gogo - at least she was able to be a hrose.

Good luck!

Emily M. said...

Well I suppose you are constrained by finances right now so there are limited options, but you probably need to dry lot although I have heard most pastures in TX are dry lots right now. When my horse injured himself, I put him in a 40x60' turnout for a month and actively managed any swelling. After 2 weeks the swelling was under control, another 2 weeks by himself and then I turned him back out with his buddy, however it is only a 120x200' dry lot paddock. They also have a 1 acre pasture, but they are too busy stuffing themselves to get into trouble when they are out. This was rehab plan because that's what I have available and it seemed to work. Anyway I think you should always agressively treat any swelling because my impression is that when the tendon is hot and swollen this is when the most damage is happening and it needs to be brought back to normal temperature asap. I don't know if you have been doing this all along, but I think it's an integral part of the turnout for a year rehab plan. Anyway I hope that you can get things turned around.

Lainey said...

Hun, you have done the best for Gogo, what decisions you made at the time were the right ones at that time, and that is all that matters. Can you not put her in foal? sorry if you have already answered this somewhere else. At the end of the day she is one luck lady to have you. Big hugs you must be hurting so bad inside.xxxxxxxxxxxxxxxxxxxxxxxxxxxxx

SprinklerBandit said...

You just can't get a break lately. Hugs.

DressageIsToDance said...

I still vouch for controlled turnout.

While turnout IS good for injuries, the other effects it's having on her heath may be doing some collateral damage to the leg. Definitely not the whole reason for the off/on lameness I'm sure, but perhaps a "contributing factor".

I think 12hrs in, 12hrs out would do what you're looking to do for her.

She wouldn't mentally suffer, but she'd lose weight, her feet would stabilize, and her leg would have "rest" time.

A lot of her weight is a grass belly though. I have pictures of Amber when she was at her old owner's, when she was on that roundbale 24/7, and she had the biggest hay belly you've ever seen. She looked obese and deformed. She's doesn't weigh *that* much less now, but it LOOKS like she's lost much more weight.



thistimedressage said...

You've made the best decisions with the hand you've been dealt. Period.

All you can do is keep giving it time and not dwell on it so much. A watched pot never boils, nor does a watched tendon ever heal...

I know that sounds crazy, but you aren't really in control of the outcome (and probably never really were). So the best thing to do--if Gogo is happy and healthy otherwise--is to put your mind and energies elsewhere. If finding a project horse doesn't appeal to you, use this time to pursue other hobbies, things you've been putting off, etc.

Also, is there great harm in riding her (at a walk, for fitness purposes) even if she is a bit gimpy? Maybe try it for a week or so and see if it makes her way worse. If not, so what if she is hitchy at the trot? At least you could work on breaking the one part of the cycle you might be able to control--the weight.

HammersArk said...

I sincerely hope Gogo goes sound for you, soon! If not, I know you've thought about it before, but what about breeding her? She is a lovely mare and then all of her fat would turn into lovely baby making power. I know a mare personally who if she is not bred yearly will founder on air. So her owner breeds her and has never had her founder while preggo. She also then gets to remain with her herd out on pasture, and is ridden lightly by beginners for about 6 months of the year, and loves her life. Gogo would have mucho magnifico babies! Many a good sporthorse mare was retired to become a baby maker after injuries, and many stallion owners give nice discounts to proven show mares.

Just a thought!

Trini said...

Andrea, don't you DARE beat yourself up about making the choices you have made. Remember this is Nature we are dealing with, and she holds all the cards. She showed you a couple, and you made the BEST choice you could have based on the information you had at the time.
Things could have easily gone just as bad had you stall rested her again and she exploded out one day (as she has in the past).
It may very well be that Gogo will not ever be sound enough to ride again. This is NOT YOUR FAULT.
Please, please don't beat yourself up for wanting the best for your girl and doing everything in your power to help her heal.

*hugs from Trinidad*

Bif said...

My first eventer had a suspensory tear just below the hock on his left hind. Couple of factors led into it, but it happened. He had careful rehab of stall rest and handwalking for months, months, months, careful rebuilding in walk work for months... and a year and a half after the original injury, even though we'd done two novice events, the fact that he was still an inch or two shorter strided on the leg drove me nuts. I ended up giving him to my vet. He was on 24/7 turnout before his injury, and again about a year after the injury.

After a few months of riding, then about a year and a half of just sitting in the field (24/7 the whole time he was there), I got him back. He sat at a friend's house for almost another full year. Started him back in work then,(on turnout 24/7, although most of the time was a pretty small area) sound and even, taking 2 months of walk before we even trotted A STEP, kept building him up.
Stayed sound through preparing for an event, when I sold him for work and personal reasons. He did multiple events at novice and A level junior jumpers and stayed sound. He had had EPM a year before the suspensory injury, so the fact that he was sound and capable was pretty rockin'.

If you want to give turnout a chance, you have to stay off them AND not lunge for at least a year. Just my personal opinion. If she's fat, she needs more active turnout buddies or less food (I know, you've said her pasture is poor... maybe add some worms ;-) or a muzzle.

I hope it all works out for you both, whether that means you find a new one to work with, and low and behold she comes sound two years down the road, or you can find the magic balance of turnout and light work that brings her back, or just you enjoy having her for her and use the non-riding time to advance your personal career to open up more opportunities later for your riding career.