Heel pain / navicular diagnosis with pics - need to make decisions: (SEE POST #75) Update post #101

[LarkspurCO]

[QUOTE=Beethoven;8703063]
http://veterinarynews.dvm360.com/ups-and-downs-equine-mri-veterinary-medicine?id=&pageID=1&sk=&date=

Article comparing all the MRI…

No, actually, we find some horses being laid down and hoisted up by their legs is theraputic and the horses is sound after. Think about it, relaxed muscles and being hung upside down. It’s like the ultimate chiro adjustment…just kidding. We seriously do joke about the therapeutic CT scans that we have done.[/QUOTE]

You had me going for about two seconds there. Sort of like the inversion boots for people. :lol:

[Ganesha]

[QUOTE=Beethoven;8703063]

No, actually, we find some horses being laid down and hoisted up by their legs is theraputic and the horses is sound after. Think about it, relaxed muscles and being hung upside down. It’s like the ultimate chiro adjustment…just kidding. .[/QUOTE]

Ok, that makes sense! Thanks for quelling that fear.

[Ganesha]

I heard back from Rood and Riddle and, no surprise, I was strongly encouraged to get an MRI, especially since he was sensitive over the frog to hoof testers, which may indicate soft tissue injury of some type. We discussed some treatments, but in the end, the treatment will depend on the exact diagnosis.

If no MRI, I would have to proceed very slowly on a trial and error approach, and he was happy to advise on that approach, but I’ve decided to pursue the MRI and am working out trailering arrangements and schedules to get it done. I don’t think I can mentally and emotionally handle the uncertainty of trial and error.

I’ll post when I have the results from that - it should be some time in the next couple of weeks.

[Beethoven]

[QUOTE=Ganesha;8704341]
I heard back from Rood and Riddle and, no surprise, I was strongly encouraged to get an MRI, especially since he was sensitive over the frog to hoof testers, which may indicate soft tissue injury of some type. We discussed some treatments, but in the end, the treatment will depend on the exact diagnosis.

If no MRI, I would have to proceed very slowly on a trial and error approach, and he was happy to advise on that approach, but I’ve decided to pursue the MRI and am working out trailering arrangements and schedules to get it done. I don’t think I can mentally and emotionally handle the uncertainty of trial and error.

I’ll post when I have the results from that - it should be some time in the next couple of weeks.[/QUOTE]

Good decision and in the long run will likely save you lots of money.

[Beethoven]

[QUOTE=LarkspurCO;8703474]
You had me going for about two seconds there. Sort of like the inversion boots for people. :lol:[/QUOTE]

Seriously though, we have had some that we think we fixed part of the problem with just the anesthesia and being hoisted by their legs. I do think it can benefit them in some ways. I’m tempted to do it with my trainwreck of a mare that has been NQR since falling out of a horse box because she felt the ramp was optional about half way down. The chiro really helps her, but it would be interesting to see how she would be after anesthesia.

[Beethoven]

[QUOTE=Jungle Monkey;8703463]
While I was not a fan of the idea of my horse being hoisted up by his legs it was more the fear of what could happen when he was coming out of the general that made me go with the standing MRI.[/QUOTE]

Oh I understand. It all about the drugs you run during anesthesia that influence the recovery. Most of ours have an easy recovery and stand on the first try, but not always. It also has to do somewhat with the personality of the horse. I’m the anesthetist at our clinic, not boarded, but it one of my areas of interest and seems to be something that I’m naturally good at. I sit in the box with the horse until they can no longer be quietly “held down” in lateral.

[LarkspurCO]

[QUOTE=Beethoven;8704447]
Seriously though, we have had some that we think we fixed part of the problem with just the anesthesia and being hoisted by their legs. I do think it can benefit them in some ways. I’m tempted to do it with my trainwreck of a mare that has been NQR since falling out of a horse box because she felt the ramp was optional about half way down. The chiro really helps her, but it would be interesting to see how she would be after anesthesia.[/QUOTE]

Well, I can see how that might snap something into place.

Regarding MRI of a front limb, if a horse is wearing a non-metallic shoe such as a glue-on EasyShoe, I am assuming those would not need to be pulled. Correct?

Just wondering because my horse has an appointment next week, MRI may be recommended, and he needs to be shod in the meantime.

[Ganesha]

[QUOTE=Beethoven;8704447]
Seriously though, we have had some that we think we fixed part of the problem with just the anesthesia and being hoisted by their legs. [/QUOTE]

OK ever since you mentioned this, not only do I feel better about my horse being hoisted, I’m now seriously craving hanging upside down myself. My family had an inversion machine back in the 80s and I remember how good it felt, even though I was still young and frisky back in those days, and had no real mileage or issues yet.

[StormyDay]

Let us know what the diagnosis is when the MRI is done

[Comegaitby]

Glad to hear you are getting the MRI done. Then you know exactly what you are dealing with. In my case it was a very mild strain to the medial collateral ligament and a bit of joint effusion likely due to him trying to compensate. We shod him in a shoe that was wider on the side of the injury to take pressure of it for 6 months and did a round of IRAP. He’s been back in regular shoes and in full work for two years now (knock on wood!!)

[Ganesha]

[QUOTE=StormyDay;8704653]
Let us know what the diagnosis is when the MRI is done :)[/QUOTE]

Thank you StormyDay, I certainly will. Sometime in the next 2 weeks probably since I have to coordinate schedules and time off from work with someone who has a trailer.

[Ganesha]

[QUOTE=Comegaitby;8704673]
Glad to hear you are getting the MRI done. Then you know exactly what you are dealing with. In my case it was a very mild strain to the medial collateral ligament and a bit of joint effusion likely due to him trying to compensate. We shod him in a shoe that was wider on the side of the injury to take pressure of it for 6 months and did a round of IRAP. He’s been back in regular shoes and in full work for two years now (knock on wood!!)[/QUOTE]

Thanks for sharing and I’m glad it turned out well! Did you have to do any stall rest during that time? What kind of turnout or exercise were you able to give him?

[stb]

Your problem is your trim - not the shoes. The horse still has long toes with underrun heels, just now sitting on wedge shoes. You need to find a farrier to fix the trim. Not easy to do, I know, but that is what is needed here.

[TBFAN]

If the problem is caused or exacerbated by the shoeing, maybe hold off on the MRI until that is corrected?
Just thinking of cost savings here - I have sunk a ton of money in the past into diagnostics and injections, just to have the real issue being a trim and balance one.

[Ganesha]

[QUOTE=stb;8704880]
Your problem is your trim - not the shoes. The horse still has long toes with underrun heels, just now sitting on wedge shoes. You need to find a farrier to fix the trim. Not easy to do, I know, but that is what is needed here.[/QUOTE]
Definitely the hard part is finding the right farrier! I’ve had a lot of suggestions, including someone on COTH who PMd me a very useful reference. It is hard to know who is really good (and really STILL good). Everyone seems to love their current farrier (until they don’t…).

One challenge is professionals who have a great reputation on what they did a long time ago (lameness vets, farriers, etc). They have the skills, experience and intuition to do great work, and have done great work in the past, but something happens (health or life issues) and they just cannot either show up, focus, or deliver the same level of service. Life is hard and can beat people up.

Hoping that with references, etc, I can find someone who not only has the skills, but is still fully “in the game” and up to doing the job.

[Comegaitby]

[QUOTE=Ganesha;8704737]
Thanks for sharing and I’m glad it turned out well! Did you have to do any stall rest during that time? What kind of turnout or exercise were you able to give him?[/QUOTE]

I did not have to do any stall rest. He was turned out individually in a smaller paddock but not medical size, just small enough to keep him from really being able to get up speed and go flying around. Once we got him shod correctly I rode him at the walk for about a month while we were doing IRAP. I was very mindful of footing and lots of straight lines and no lateral work. He was sound and flexed fine after we finished the IRAP so we slowly introduced trot and canter work, more circles and lateral work. By three months in we were doing our regular flat work, although I continued to be mindful of footing for about a year and did not jump him for 7 months (until he was back in regular shoes for a month). My vet thought it would have been okay to do more quicker but I tend to be anxious and cautious.

[Ganesha]

Ok, we have a diagnosis and MRI result. Both feet were imaged in TAMUs 3 Tesla MRI under general anesthesia. The whole experience was amazing and I am very grateful to TAMU vet school for the way they treated me and my horse. So - in his right front foot only, he has Navicular Bursitis with Fibrotic lesions. Treatment is surgery to remove and clean out the lesions, and TPA (Tissue Plasminogen Activator) to prevent further fibrosis/lesions. Then 2 weeks stall rest with 4x daily hand walking, moving to 24 hr turnout in a small area with progressive exercise over 2/3 months. And correct trimming and shoeing to get and keep his feet in shape.

The intake process at TAMU was so cool. Everyone was incredibly kind and careful and thorough. My horse stood quietly and was at ease with them. We had vet techs, vet students, at least two vets, and a farrier observing/checking/palpating/testing my horse from head to toe, taking his history, etc. When the moment came to say “goodbye” and leave my horse in their hands (his MRI was the following morning) one of the vets was so reassuring and confidence-inspiring that I had no trouble leaving (once I got home was another story But that’s what large bottles of wine are for, right?)

They called me at work the next day when he came out of anesthesia - I was so worried I remember just sitting at my desk trying to hold it together. Seriously, when they said “he’s up and hanging out in his recovery stall and did great” I almost stood on my desk and held my phone in the air and yelled “HE SURVIVED!!!” I got two more long calls later that day to talk about the results and treatment options. Some if it is a blur as I was super emotional and worn out (partly from relief). I took lots of notes on about 7 scraps of paper - mostly illegible, but I’ll get full formal report Monday. They emailed me the link to his MRI images.

So, his other structures in the hoof look fine. They said the navicular bursitis is a fairly common problem, but the fibrous material is more rare. They say it is a reaction to inflammation, and once it starts up, it tends to be self-perpetuating until the lesions are removed and cleaned up. They mentioned there may be a hereditary component to this type of reaction to inflammation, but they are not sure. It is definitely a reaction to trauma of some sort - could be hoof balance issues, or could be one time trauma (which they suspect, given the other foot looks fine). All we can do is treat, and then address all known issues (like getting his feet trimmed correctly).

The treatment is arthroscopic surgery to remove and clean up the lesions - and during surgery, he’ll receive Tissue Plasminogen Activator (TPA) in the foot to discourage more fibrosis or adhesion formation. They will treat him again in 3 days with the TPA. Total stay at TAMU is about a week from the surgery date - then he can come home for a short period of stall rest with hand walking 4x a day, followed by 24 hour turnout in a small area (30 x 30ish) and we can start a schedule of very slow progressive exercise for approximately 2/3 months to bring him back into work. The turnout and careful movement is important to prevent adhesions during healing.

They said that we caught this early - they usually see horses that have had this “brewing” a year or two (while other treatments were tried). By then, the fibrous tissue is a solid hard mass, and prognosis is poor. They mentioned several times that we are lucky it was caught early.

TAMU is a couple of hours away. I woke up early and drove out to visit him today. It was so good to see his beautiful face. He was happy to see me - he is a goofy horse and I swear he was trying to be extra cute and funny today. Took him out to walk him and hand graze him about an hour. I will go back in the morning to spend time with him. It was such a relief to see him. I feel a little crazy right now. I wish he weren’t so “real” to me as a thinking, feeling creature who has been dropped off in a strange place with none of his horse friends, or barn people he knows, or me.
However, he is being very well cared for and is in a safe place - they constantly check on him, groom him once a day, he gets a little turnout time, etc.

So, he has a diagnosis and a treatment plan. I also have a new farrier who is on board with working to get his feet sorted out once he’s home. There is risk to the surgery and treatments, and there’s risk something will go wrong in rehab, or that his body won’t respond properly, but I feel hugely relieved.

I’ll check back in to let you know how things go!

[StormyDay]

Wow, so glad to hear the results. While surgery is never fun, at least you know now the problem is treatable. Also, unless I am mistaken, horses can return to full work after the rehab is over.

[LarkspurCO]

I’m sorry to hear this isn’t going to be an easy fix with shoeing but glad to hear you have a diagnosis and a plan. Best of luck with the surgery, recovery and rehab. I hope you will have good news to share soon.

[Palm_Beach]

Thanks, Ganesha. Would love to hear updates on how he does.