Injectable

On Wednesday, I took Ashke out to see Dr D. This was a scheduled follow up on our last visit to see if the left SI had stayed in place and a final check prior to our A-Rated show at Expo. It felt to me like Ashke was a bit off at the canter but considering his self-destructive behavior and the fact he had hurt both legs on the left side while I was in Germany, I wasn’t surprised.  He felt hitchy and not as smooth as he had been, but it wasn't as bad as he has been in the past. I figured something was out, but nothing significant.

<I finally figured out how he managed to scrape up his front leg. There is a 4” PVC pipe that runs along the bottom of his northern fence line of his run, from the downspout to the outdoor water tank. He somehow managed to destroy the metal strapping holding it in place and snapped the pipe into two pieces, leaving a very sharp point at the end of the pipe still attached to the fence. He was pawing at the end of that pipe and cutting his front leg on the sharp point. There are at least four scrapes that I counted where he took off the hair, and cut himself in a couple of places. We used a sawsall to cut the broken end flat, added a coupler and a 10’ piece of pipe. We tied it in place with bailing twine, since he had broken all of the strapping. I figure he can’t cut his face open with bailing twine, although God knows he might try. >

Before our visit to see the Doc, I did my lesson with Amanda. I could feel a little bit of a hitch at the canter, but Ashke gave me so much try and a wonderful collected canter, that I left our lesson flying higher than a kite, because it was that kind of ride. One of the things I did feel, however, was his overcompensating for something and swinging his hip to the right. I think we've been so focused on him keeping his hips in at the canter, that he has started defaulting to that position. Overall, though, he felt incredible and I was so happy at the end of our lesson.

Dr D started her evaluation and said the only thing she could see was him swinging his right hind and dropping it short at the trot. This is the same issue we've dealt with since the first time she had evaluated him, and her assessment has always been the hamstring, although we’ve never ultrasounded it to see. As Ashke has developed muscle, it has gotten so much better, and it didn't feel like he was short striding in our ride, but I’m never surprised by that assessment. Inside, we started with the frogs, and they were all over the place, with each frog base at a different cm, indicating he wasn't landing evenly on any of his feet. Her next step is to go over the accupuncture points with a plastic needle cap and watch for his reaction. I always watch this part carefully to see what parts are reactive and it was obvious there was a rib out at the T18. (The good news is that there haven't been any reactive points related to saddle fit! FTW!!) After she checked the accupuncture points, I asked her about his left hind where I’ve been treating the scar tissue with Vitamin E (the degolving injury from April of 2016) in an attempt to soften the scar tissue and make it less itchy. That’s where the wheels fell off.

(Although I do have to acknowledge that Dr D suggested I try Preparation H on the scar tissue. The main ingredient in Prep H is a vasoconstrictor, which will help reduce scar tissue. It has helped a great deal, although it is oil based and attracts all of the dirt. Overall, the treatment on the scar tissue has made a huge difference in the size of the scar and the thickness in that fetlock.)

Dr D noticed that his left stifle seemed bigger than normal and stopped to check it. Her assessment was that his left stifle was significantly swollen. She checked his right stifle in comparison, and the left was definitely larger. I don’t know if she’s ever really checked his stifles before, but the left has always been a little bigger than the right, from the surgery, I think. On Wednesday, that stifle had a little more fluid on it than the right one, but there was no heat in that stifle, and he hadn’t shown any indication that it was bothering him. I don't know that she has ever really felt the stifle before, since she focuses on what the accu points tell her, but she kind of freaked out about it. She had me laser the area while she finished up with another horse, then came back to put the needles in for his treatment.

He wasn't out at the base of his neck, which he has been the past couple of visits (which is actually good news, since it hadn't traveled up his body). He was sore when she placed the SI needles in, especially on the right side. He kicked out when the needle on his right hip went in, and there was some blood in the left SI needle. She said the blood was due to inflammation in the SI joint and that he was a very stoic horse that was in a lot of pain. She told me Ashke needed to be on stall rest for 30 days due to the inflammation in the SI and the swelling in the left stifle.

Neither Ashke or I were real excited to hear that. In fact, when she reiterated that he should be on stall rest for 30 days, reevaluated and restarted slowly, Ashke pinned his ears and got pissed. (Yes, I do believe that my horse understood what she was saying). In the past, I’ve always treated what Dr D has said as truth, but this time I really felt like she missed the mark entirely. I know my horse and I can tell when something is bothering him. I just couldn’t imagine something requiring 30 days of stall rest would have slipped past me.

Needles in his haunches

Needles next to his poll. The top one was really twisted.

I was in shock and Ashke didn’t seem happy. He got really nippy and after he was put back in the stall, he spent the next five minutes rearing and protesting. We loaded up and headed home. I was still in shock that the left stifle, which felt the same way to me that it always feels, was so painful that my horse needed 30 days off.

I spent the next fifteen minutes thinking about our ride that morning, our rides in the past month, and the possibility that Ashke would have any legs left if he was put on a 30 day rest period. Amanda had told me that morning that he was beginning to develop a schooling canter, which is the step just before canter pirouettes. How could we possibly be developing that kind of canter if he was hurting bad enough to need a 30 day respite from riding? I was in shock and call it denial, if you want, I just didn't believe that's what my horse needed.

I called CS and talked to her. I called Amanda and talked to her. I frantically texted with Saiph, telling her what I was feeling, how he had been moving. They all thought Ashke would make a bad patient, and that no movement was the wrong choice if the issue was his stifle. They all supported my decision to get a second opinion, which J supported as well. I made an appointment for Dr S to come out to Morelli’s and do an evaluation. We set an appointment for the next Tuesday.

I don’t want you to think that I did this because I didn’t want to tank my show season, because honestly my pulse jumps with happiness a little bit at the idea of NOT showing. I would feel this way if the shows were off the table. EVERY fiber in my being tells me this is the wrong thing to do for my horse. I've been able to tell when he was off and needed an adjustment, and could feel the difference afterwards. I had no issue with taking most of 2016 off completely with his degloving injury, including trail riding. If Ashke really needed a rest, then rest he would have, however, it didn’t feel like that was what was going on. I knew there was a lot of diagnostic work we hadn’t done on Ashke yet - like a flexion test or x-rays - and some options beyond accupuncture - like joint injections - if he really was dealing with pain he wasn’t sharing with me. 

I rode him on Friday and he was comfortable and felt awesome at the canter. We didn't do a ton, but we did enough that I could tell the rib was no longer bothering him. I reverted back to the w-t-c progression of warming up, because if nothing else, changing our warm up program didn’t make things better and could have very easily made them worse. I did the clinic on Saturday and CS said that in the three or so hours I was there, she did not see a single misstep or short stride on Ashke’s part. Then on Sunday, we did 9+ miles at Chatfield and there were no symptoms of him not feeling great. We did a couple of fairly small hills, but up and down, and there was no issue or hitch in how he was going. He was eager with soft, if skeptical, ears.

Cute boy being cute.

Tuesday, Dr S came to the barn to look at a bunch of different horses, of which we were one. He started with evaluating him on flat ground and once we got him to stand up on his feet, he showed me the asymmetry of his haunches (his right side is not as developed as the left, by almost 30%). His next step was to run his hands all over Ashke's legs, pointing out that although Ashke's left stifle was a touch bigger than the right and had a little more fluid than the other, it was not unexpected based on the surgical history, there was no heat, and size alone was not enough to get excited about. The next thing he had me do was trot him out, up and down the arena, which led to me having an asthma attack. Running in sand in 30 degree temps with Ashke trotting next to me is not my forte. I was gasping so hard at the end of that, Dr S offered me some albuterol. (I hadn't had an asthma attack in four months and I've had three in the past week.) 

Then we did the flexion tests on both hind legs. When he lifted the left leg, I really expected Ashke to protest, pin his ears, tighten his nostrils, but instead I got floppy ears and a bored look. I was still expecting it to be the left stifle. During the trot out, which my friend Kat did, he looked pretty normal to me. Then we did the right leg and it was pretty obvious to me that it was not as flexible when Dr S lifted the leg. Tight eyes and tight nostrils, plus a bit of a bite on my shoulder (little shit) told me he wasn't so happy about that leg. On the trot out, Dr S could see something. I just saw Ashke and what is normal movement for him. Dr S diagnosed 2/5 lameness after flexion.

Guess what showed up?

Right hock. Lower joint, where the hock was visibly bigger than the left.

Saiph guessed it two years ago, which she pointed out (gently and with humor). I told her to smack me upside my head with a skillet next time.

We took x-rays the old fashioned way to see what was going on in that hock, and set up another visit.

Visual proof X-rays were taken.

We were looking at them via the fog lights on Dr S’s truck.

Dr S started off by showing me an X-ray of a “Normal” 14 year old hock. You could see the lines between the bones in the joint. There were three lines we could see. In Ashke’s X-ray those lines are gone. The hock has begun to fuse, but is not fused completely, and there is no way to know how long it might take for the joint to fuse. He was also concerned by a white fleck he thought might be a bone chip, but upon taking a second set of X-rays, determined that it was dirt/foriegn material on the outside of the leg, most likely. There is also a small bone spur where Ashke is still laying down bone to finish fusing that hock. Dr S believes he damaged that hock at some point in his life prior to my getting him and it has slowly been healing for the past six years.

The hamstring issue and all of the SI joint issues we’ve been seeing in his body have probably stemmed from this issue. I could kick myself for not having that joint x-rayed five years ago. Or at the least two years ago when Saiph suggested it might be his right hock. Funny how what we WANT to believe can lead us down the wrong path. 

Friday evening we did injections in the lower joint. 

Dr S drugged Ashke and then spent fifteen minutes scrubbing the site with betadyne and wiping it clean with alcohol.

After the vigorous scrubbing, he soaks the area with betadyne and left it to soak.

Very drugged poneh.

He was so very good. He didn’t even flinch.

Putting the needle in for the second injection.

He had a bit of an issue with the one on the outside of the joint. He had a hard time finding the space to place the needle (#22) and it actually took two tries to get the needle in the correct space.

During this time, I was pushing on his left hip to get him to weight the right leg.

You can’t see it cuz the phone slipped, but the needle was in place and then he did the injection.

Before we did the injections, Dr S gave him another dose of drugs to make him even more sleepy (he is not a cheap date) and a huge dose of Bute (IV). After the injections, I had to wait almost two hours for him to wake up. One moment he is dosing next to me with his mouth resting on the Belle the Cat, and the next moment we are staggering to his stall so he could pee. Once he had peed, we wandered around the barn some, with him becoming more and more alert. Once he was awake, I tucked him in the stall with his mash and took my emotionally exhausted self home. 

Saturday he was restricted to his stall and I hand walked him twice (morning and evening). Sunday, I hand walked him and I had a fire eating dragon on my hands. Amanda (who has watched him move more than anyone in our life) said today that he is already straightening out how he swings that leg and that there is less rotation to the hock. After twenty minutes of walking, socializing with other people and horses, I opened his stall run door and let him outside. Tomorrow he can return to turn out and Tuesday night I will see how he feels under saddle. I have a lesson planned on Wednesday and in ten days we have our first show of the season. 

I am still processing all of this new to me information and what it means in relationship to the past six years. I am thankful for the events that have led to me taking the steps to have flexion tests and x-rays. I am thankful that the hock is fusing, although there is no tried and true timeline for the fusion to be finalized. And I am more than thankful that there was no heat, swelling or stiffness on his part after the injections. I am thankful that it seems to have worked in the sense that Amanda believes his stride is straightening out. I watched him today, walking in a slow circle around me, and he was finally dropping his right hind into the hoofprint of his right front, instead of just to the outside, which tells me that what Amanda was seeing is correct.