Also, this is likely to be because the coffin bone sitting higher in the hoof would be a very recent development - and you just haven’t seen the flow-on effects of this yet.
Picked her up on Tuesday and took her straight to a rehab barn so that she could have daily Theraplate, cold laser, therapeutic ultrasound, and PEMF treatments. The barn is on the other side of the state, so I reached out to contacts in that area who gave approval/ good reviews. The facility and people are super nice but I’m concerned I made a mistake. She’s not been eating (not surprising after the stress and all the meds) and they “can’t” get the meds into her (just called today). I’m frustrated because their reason is she flings her head too high and allegedly reared in the cross ties (allegedly as of all the times in the 11 years I’ve owned her shes reared exactly twice and neither was on the ground). The hospital had no issues with meds and had students giving them daily. I’m half tempted to pick her up this weekend but I really do think the therapies would be beneficial (though not more so than the antibiotics she isn’t getting right now). They also requested daily sedation which I okayed but am not super comfortable with as she didn’t need it during her two weeks at the hospital and has never been sedated for anything outside of medical procedures. She is very calm and well behaved. Bringing her home would also mean our out of country trip planned for next week would be out as I have no one at home to do her daily care.
Excuse my ignorance-- what is a flip flop pad?
Are they giving meds in the cross ties and not the stall? That’s probably one large difference with what the hospital would have done. Ugh, I’m so sorry.
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They were, they since figured out she’s fine in the stall. However, now, they are going back on the agreed to treatments saying they never agreed to two of the 4 (so half) treatments and general being a PITA. If anyone has any recommendations for a GOOD rehab place that knows how to actually handle rehab cases please let me know. I’m in the Midwest.
Today was the last straw with this place. In addition to being baffled by medications and asking for her to be sedated, they are inadequately bandaging the surgical site which means shavings and manure are getting underneath the bandage as well as not keeping her stall clean. Absolutely ridiculous to spend this kind of money on care for it to be done SO poorly at the detriment of the animal, when this is supposedly their specialization. I’m angry that they would believe this to be adequate care for such a precarious situation and that while trying to do the best for my girl, I inadvertently put her in a shitty situation.
Can you ask the vet clinic to look after her a few more days, until she is further along or you can find a better place?
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Are you near Keswick in Ky? I think they are in Versailles.
You mean Kesmarc, I think -
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Geesh! 
Yes…thank you:grinning:.
A flip flop pad (and their shoe counterpart) is often used to help alleviate heel pain or pressure by removing constriction from the shoe around the heel, and lifting the heel off of the ground.There are all kinds of flip flop pads now but traditionally it was similar to an older snowpad except backwards. The thickest part of the pad went over the heels and frog, and was left open around the sole and toe. The shoes are usually cut halfway at the widest part of the hoof, and nailed in – leaving half of the wall and all of the heels “unshod”. This is done to relieve pain from navicular, sore soles, contracted and sore heels or crushed heels, and sore coffins. It’s usually a temporary therapeutic shoeing job to address pain in the hoof.
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What the heck!
Between the above and going backsies on the agreed upon treatments, I’d be pulling her out of there.
So sorry to hear of this set back.
Is this normal? That a specialized rehab place is unable to dose meds or adequately wrap a foot?
It sounds ridiculous they can’t even keep the foot wrapped
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Beowulf is spot on about the flip flop pad! Thank you for explaining.
Bluey - THANK YOU for that idea! I have no idea why it didn’t cross my mind, but I doubt I would have thought of it on my own. I am capable of caring for her at home, but we are leaving the country Saturday AM for a week and desperately needed to find a place for her. MU is happy to have her back and I am glad knowing that there won’t be ANY issues with meds, bandage changes or anything else while I’m gone so I can enjoy the trip. She’ll also get follow up X-rays while there since those were planned for 2 days after our return anyway.
I originally wanted to send her away to receive the extra therapies (namely the whole body vibration as it has been studied to increase hoof growth) as well as alleviating some of the “strain” on me. It isn’t difficult keeping her at home, but it is certainly time consuming which was what I was hoping to avoid by sending her away. But at least with her at home I know for certain everything is getting done and done correctly.
We are looking to rent or buy a vibe (EquiVibe specifically) plate and sell after we are through with this since I am thoroughly put off of sending her anywhere now. I know a lot have a negative opinion on the vibe plate (and other therapies) but honestly I’m willing to try anything that might maybe help so that in the event she doesn’t improve/ heal (as far as the soles are concerned) I can say that I truly tried everything and left no stone unturned.
I just realized I never posted a shot of the surgical site/ shoe setup we ended up with (rail shoes with a slight banana-esque bevel and heart bar on the RF, no heart bar on LF due to abscess at tip of frog when they shod her). The surgical sites were much smaller than I had anticipated, thankfully. They are both along the toe of the shoe (partly hidden by it).
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I honestly don’t want to be a naysayer here, but I want to provide some realistic perspective. More than likely you are simply dealing with a “flare” of bacteria that was never eradicated in 2016.
I have two clinical studies going on about spine infection in humans. Sadly, one thing is definite, once bacteria (regardless of species) has become entrenched in bone, there is no way to remove the infection other than amputation(even debridement can’t always remove the organisms) or living on antibiotics for the rest of the patient’s life. This is especially true when osteolysis is occurring. Once the bacteria are in the bone they are isolated from the immune system and can “hide” there, undetected for as long as the patient is alive.
The best thing here is to seek local control of the infection via definitive identification of the pathogen (using culture methods). Then treat using the correct antibiotic with the expectation that the infection will never really clear. Surgical intervention where the wound is washed and an appropriate antibiotic powder is packed in can also work, if the exudate from the wound is monitored for pathogens.
I am sorry you are in this situation.
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What would cause it to “flare”? Any specific factors or just time?
I was with you until your third paragraph, you lost me a bit. They didn’t culture last time, but supposedly cultured this time when they went in for the surgery. I’m not sure what they found via the culture and FWIW she’s on Sulfa Trim again, although at a much higher dose than I remember ever giving her (17pills 2x daily).
Would life long antibiotics really be an option? I want to say no, but I’m no vet/ scientist. What you say about the infection being separate from the blood system once it’s in the bone makes sense but simultaneously makes me wonder how they (g) could ever treat any bone infection.
Bone infections are hard. A family member shattered a lower leg in a wooded area and who knows what got in there. Multiple surgeries, cultures, really strong antibiotics. (I never want to deal with a PICC line again.) And yes they said it might reoccur.
So what RAyers said makes sense. Hopefully they did culture it and can figure out exactly what you are dealing with to know how best to try to eradicate it.
Sadly, in humans, the simple answer is to amputate the limb. This is why I’m fascinated by spine infection. We can’t amputate a spine.
Currently patients are forever on antibiotics to maintain control over the bacteria. When the infection becomes acute, then we surgically go in, debride whatever we can, wash out the entire region, place drains and monitor drainage until evidence of the bacteria is minimal. After each procedure they will implant thousands of plastic antibiotic eluting beads or literally pour powder antibiotics into the wounds.
Some poor patients have a spine surgery every few weeks for months on end until we get control.
Continuing to update for anyones future reference and to chronicle how our recovery is going.
She is doing great for the most part - happy, feeling full of it with the fall air but content to much hay and snooze, sound without bute, etc just lacking in the hoof growth dept but that is nothing new. They remarked on her checkup last week that she doesn’t have enough sole, which I could have told you (g) that.
I’ve been debating demanding we go the hoof boot route for a while. The shoes they put on either suck, were put on poorly, or both IMO. We were also making really good progress prior to putting shoes back on (again IMO).
I decided, starting today, to get her out and walk as long as it’s dry enough. It’s hard to keep in mind this isn’t a soft tissue injury which makes recovery different (if she loses it for a minute it’s no big deal really). This is one of the many things we’re doing different this round in an attempt for a quicker recovery (last time was about 8-9 months until given the okay time turnout and begun ridden work).
We got our first load of sawdust yesterday which was exciting. I forgot how much drier the stall stays with sawdust (when deep enough). Normally I use bags since we don’t really have storage, but with this being a long haul thing sawdust is much cheaper.
I also ordered an EquiVibe last week that I am excited to use. She’s been getting PEMF, both on her front legs and on her hocks occasionally to help with all the compensating she’s been doing, wearing BOT quick wraps on front + a Smart Scrim from Benefab to sleep in (she seems to love that sheet). I don’t think any of that will help her heal better or quicker but like to think it keeps her more comfortable with being cooped up and again the compensation.
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Best of luck to you! She couldn’t have wished for a better mum. 
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Forever thankful for my Saint of a farrier who came out yesterday evening straight after a 20 hour drive back from Colorado to pull her shoes. She was quickly getting more and more uncomfortable due to being past due (IMO) and despite my alerting them of this issue, MIZZOU was insistent that she needed to wait 2 more weeks.
After hours and hours of research and going back and forth, I decided boots and barefoot is the way to go for now. This lets me access more of the surgical site, keep it cleaner (so far), and slowly address her forward foot again. So far she is super comfortable in the boots (Cavallo) which is encouraging. Her hooves are pretty thrushy and overall are a bit sad.
The EquiVibe arrived but I have yet to get it set up and in use due to our not so level barn floor. Hopefully it will be done tomorrow.
