Proximal Suspensory Surgery Advice - Updates at end

[quietann]

Tranquilizers are your friend. Use them.

Oddly enough, in the mare’s very, very long rehab, those moments of electricity that I thought would set us back – the times she reared and spooked while I was handwalking her and came down limping or went absolutely ape**it in her tiny turnout and started bucking/farting/carrying on – never did. Compared to a lot of horses, she is very good on the lead and never tries to get loose… except maybe to get to that bit of tasty grass just out of reach The worst she did was canter a tiny circle around me, stop, and snort a bit.

The vet’s response to my question about moving her to a barn with more turnout was “yes, Yes, YES!” He says, barring craziness in T/O, it can do nothing but help. She’s generally well-behaved and quiet in T/O, though I do have a photo of her galloping straight down the steepest hill to get to her buddies, when she lived at this barn before. BO says we can keep her out of the really steep paddocks. This barn is out of the vet’s normal area, but he says there’s a barn about 10 miles away he goes to, and I could probably haul her there for lameness exams.

[quietann]

[QUOTE=vicarious;5713469]
Quietanne, I think going the dressage route could be very productive for your mare. Done with strong attention to the “classical” progression, it can be strengthening and straightening. Which can be helpful with soundness issues.

Your area should have a number of dressage instructors. Although I know you are happy with those you have. Are you a NEDA member? I think a full day, or even as we do overnight, turnout is wonderful in situations such as yours. So you may be scrambling for a new instructor, vet, and probably farrier. I don’t envy you that.

…
For you though, it is the endless trudge of the hand walk. Enjoy your togetherness time.:D:[/QUOTE]

vicarious, I’m actually one of those people who wanted to event really badly, just got started, and then had a bad fall three weeks after my first competition (off a different horse) and can’t jump anymore. (My orthopedist wanted me to stop riding entirely, but I refused.) So we’re sort of “wanna be” eventers but the eventing community in my area has been very tolerant of me I volunteer some, and sometimes am a groom for friends when they event. And now the maresy, who had evented before I bought her, can’t jump either, so we can enjoy our middle-age decrepitude together

We’ve been a dressage team ever since. We even had a year+ of full training. Mare was trained through Second Level before I bought her, and can, when she’s in the right mood, be a very, very fancy dressage pony. She knows far more than I do :lol:

My vet may be able to keep following us for lameness stuff, and the farrier I currently use already does a few horses at the potential new barn. My dressage instructor is on the fence about whether she’d travel there, but if I could get one other person interested she might do it.

The closer-to-Boston parts of the NEDA territory are just tough for the combination of good turnout and an indoor for the winter (and summer to some degree), because land is just so (^%&( expensive. The barn I am looking at has both.

For Napoles: the months and months of handwalking did a lot for how the mare and I relate. It’s long and often boring but does have its benefits.

[merrygoround]

Napoles-I had never been a big “quiet-downer” believer. It was always a case of just hike up your breeches , tighten your girth and deal with it. But with this post-op rehab there is so much riding on good behavior from a known quick stormer, that I asked the surgeon about reserpine, and started a 1500# horse out at 2.5mg/day orally. It has been upped to 2.5mg/ twice a day, and peace reigns. The only side effect that has been a concern is diarrhea. When that occurs, it is time to back the dose down.
Some people have had other side effects, but to me the advantage is the low level steady reaction, where with Ace, it wears off so darn fast, and seems to have a different effect on their perception and balance.

[Samantha37]

I’ve actually been really lucky and haven’t had to do much in terms of sedation. He’s only had a couple of freak outs but I’m constantly prepared for them so it’s easier to stay on then I thought it would be! He was getting extremely spooky though… I got the OK to turn him out overnight a few days ago!! It has made a huge difference in his demeanor… he is so much happier. My barn owner lets him out around 9:30-10pm and then he comes in with the rest of the horses at 5AM. He’s tired but sound (hopefully he stays that way!)

I think we are mainly battling the hock arthritis now but with the turnout some of the stiffness should go away. He is very sound at the trot and we are up to about 10 minutes maybe slightly more. He’s going in for a recheck next Monday and I’m so excited!!!

Napoles- I’m so sorry you have to join the club

[Napoles]

[QUOTE=Samantha37;5713876]

Napoles- I’m so sorry you have to join the club :([/QUOTE]

Aw thanks Samantha. It is a very welcoming club though I have to say!
Comiserations and sympathies to everyone else who is in it too.

[colliemom]

Can I join?

(Not that I really want to, but …)

I found this thread this morning, and have been reading it with interest. Asterix (if you’re still reading!) was this your big boy you rode at the ES clinic??

Mr. Colliemom’s youngster (6 year old OTTB) just had the fasciotomy surgery by Dr. White on both hind legs June 28th. He has been an ANGEL in the barn, which surprises the heck out of all of us, knowing what a big, powerful, active horse he is! He left his bandages alone, he hasn’t fidgeted more than usual in the aisle (something on this horse is ALWAYS moving!) He has killed a double lick-it spinner toy that we put on his wall, and he totally flattened his jolly ball :eek: , so we’re looking for more toys! He’s getting a bit mouthier than usual but I suspected that would happen. He was allowed to mouth everyting at the track – they would let him chew on the leather leadshank to keep him from chewing on them, I suspect! He was getting really good about that, but his frustration now seems to be showing itself there. I can live with that!

We could never see the incision site – almost wondering if they just took our money and didn’t do any surgery! No swelling, no scurf, just switched to standing wraps Wednesday.

We are on the same protocol as described before – 30 days total stall rest, then gradual handwalking (starting at 5 minutes only per day), then re-check at 60 days for decision about the platelette treatment (can’t remember the full term.) He has a shockwave treatment a week prior to surgery. We were told that he could probably be back to full work in 6 months, assuming all goes well, but I have already cautioned for hubby to be as conservative as possible, and not rush anything. Especially considering taht 6 months puts us in the absolute worst part of winter in Eastern PA, and who wants to be doing much riding then anyway? :winkgrin:

I am vastly encouraged by the success stories I’ve read here, and keeping fingers crossed! This guy was going Novice, and we have had several people tell us he has 4* potential, so we’re hoping this is just a temporary set-back.

Does anyone have any good images/pictures of the anatomy of the hind leg, clearly showing the relationship between the suspensory ligament, the canon bone, and the split bone? I am using a therapeutic laser (with vet’s permission) and want to make sure I’m aiming it as accurately as possible for best effect. Thanks!

[asterix]

Hi colliemom! No, that was my other (smaller!) horse in the clinic.

My big horse (see pics below) had the surgery in '08, Dr. White, etc etc. Shockwave after. I took his wraps off the day after surgery as he had destroyed them, and I too could barely find any evidence of the surgery!

His suspensory rehab was straightforward and by the book. He was NOT jumping etc at 6 months out but was sound W-T-C. He went back out in the hay field (so, rolling terrain, hunt coming through, etc etc) full time in month 7.

We then had 2.5 years of completely unrelated issues, including getting kicked, slipping on ice, and most recently getting his hock wrapped in high tensile wire. So I’ve managed 2 horse trials in 3 years on him, hoping we are now on the road to a fall season and Prelim again at last.

But he has NEVER been lame on those suspensories again. We never looked back from about 60 days out of surgery. He has gone Training since so essentially back to the work he was doing before.

I am SO glad I had the surgery done, and done quickly.

Good luck and hang in there. I was given very high percentage “back to Prelim” by both Dr. Allen and Dr. White and neither is prone to throwing around overly rosy scenarios…

[colliemom]

Thanks, Asterix! Yes, that’s the same pair we are working with (4 single day round trip drives from Bucks County PA to Middleburg/Leesburg VA in 8 days – ugh!!) so we are very hopeful.

You do like large beasts, don’t you? :winkgrin:

[asterix]

It’s worth it to do it right, but I hear you!

(the chestnut is the SMALLEST one I’ve ever owned – you should have seen my dearly departed Irish horse, 18 hands and cocky…:D)

By the time I went shopping for the munchkin, I had given in to my destiny and wouldn’t even sit on anything under 16.3. I can’t help it!

[quietann]

colliemom,

welcome to the club Not a happy reason to join a club, but this thread has been great for me and the maresy. It sounds like you have a great vet and the right idea about how to do rehab – slowly. Best of luck!

[asterix]

oh, hey, speaking of rehab, I will say that Dr. Allen and Dr. White gave me slightly different protocols. A friend of mine had her horse in for the same surgery within a week of mine.
She followed Dr. White’s protocol, and I followed Dr. Allen’s.

Both horses came sound and returned to work with no problems. She was out and about sooner than I was, but we had several NON related issues and my horse was both bigger and older than hers.

[colliemom]

quietann, thanks! I’ve learned a lot from all of you already

asterix, I hear you. Hubby likes them tall, too. The one rehabbing is 17+, his other is 17.1 both TB’s. I think he thinks Owen is a pony! (Love your pics, btw!!)

[kiwifruit]

I guess I better get my membership card ready! After returning from the vet for a routine exam, he says I might have proximal suspensory issues. Horse is lame 1.5 at the trot. Lame leg is evident on the outside of the circle. Like previous post, I always thought it was hocks and the injections worked for awhile but now he is really off. Blocked below the suspensory, was still lame. Did some ultrasounds since he said you can’t block the suspensory and do ultrasound at the same time. Ultrasound showed some thickening on that leg but it was pretty much the same look on the other leg. Vet said that when I return for more diagnostics next Thursday he is pretty sure that once he blocks the left leg suspensory he will go off on the right. Anyway a lot of terms were mentioned like injections, shock wave or faciotomy surgery. I guess I want to do this right the first time so after reading the posts I’m wondering if I should just consider surgery and get on with it. The horse is 11 and we just moved up to training level after a huge setback two years ago with his front feet. Just when I feel we are on the right track, I get a huge sideline and it is really taking its toll on me mentally. I know that horses do get hurt but mine always tends to take the 1 year plus route. Couple of questions for the wisdom of this thread: is the surgery covered by insurance? Just curious, what is the cost? It seems Dr. White is the one I need to see in Leesburg once I get a clear diagnosis from my primary vet. Do they offer self medication in the form of wine for the owner going through this surgery/rehab

[quietann]

Hi and welcome. I guess I should add a sad face because while we’re a friendly lot, it’s not like any of us wanted to join the club.

Feronia’s surgery (March 2010) was covered 100% by her insurance, as well as all vet care from when she first went lame and I got the vet involved (January 2010) for the next 6 months. Most insurance policies do have a time limit for an “incident” and hers was 6 months. So everything through July 2010 (approximately $6500, minus the $500 deductible) was covered. Unfortunately, her recovery was slow and complicated so I’ve put in another $3500 or so since then, for ultrasounds, injections, lameness exams etc. (Please note: I am using a good – expensive – vet, so YMMV on costs.)

It’s hard to say whether your horse needs one or both legs done. From this thread, both seems more common, unless (as was the case with Feronia) there is a conformational issue causing one leg to go off.

I’d count on a year to recover, again based on experiences described on this thread. This means if all goes well, you could be doing Novice at the end of next season and prepping for Training.

---

As for the mare, she’s better. I actually put off this month’s lameness exam because other than the occasional tripping behind, and the slightest shortness in her LH (which she usually works out of), she’s been quite sound. I also decided not to move her; my BO has increased her turnout in both size and hours out, and that’s made a huge difference. (BO and I completely miscommunicated about what the horse needed, d’oh.) Bigger TO also means she can now reach over the fence and get nose to nose with her buddies… There has been a certain amount of squealing (she is a she after all), but it’s good for her brain.

video from Tuesday:
http://www.youtube.com/watch?v=4ll3Jzn8a3s
http://www.youtube.com/watch?v=LWe3s9vekkg

[kiwifruit]

Thanks Quietann

I’ve enjoyed reading your progress and hope you have continued success making strides towards a sound horse. I head back to the vet clinic Monday to get a final block on that suspensory and a plan. Looking back, he was problably in pain for a long time. He was never lame but had difficulties collecting and using his hindend. I always thought it was the hock and after he got injected, he was fine. Problably because some of the medication from the injection leaked into that area and helped quiet it down. Glad to know that insurance will cover it. My vet before mentioned several things about treatment but of course, this will change with the visit on Monday. 1. Rest. 2. Rest and shock wave 3. injections 4. PRP 5. the surgery. He is 11 and been eventing much of his life. So I guess I need to make some decisions since once I phone in the claim, I have 120 days to treat it.

[kiwifruit]

One more thing. Does it matter if the injuries are chronic whether or not a horse is a candidate for surgery? I’m pretty sure that my guy has been dealing with this issue for 3 plus years but we always thought it was hocks.

[asterix]

kiwifruit, welcome to our sad club! I don’t know about the chronic thing per se, but what Dr White told me (when I said, how could this have happened bilaterally, horse was SOUND, as in, always in the top 3 after Dressage and S at Prelim SOUND) that he saw that all the time…sound horse is suddenly not sound, and it turns out to be bilateral and chronic (as opposed to one catastrophic bad step, “acute”)…

he thinks it is “strain one side” – you do not notice anything, horse compensates, thus straining…the other side…still no obvious lameness…and then one day both sides decompensate and horse is lame.

He did assure me that my horse’s presentation of “sound until suddenly not, yet you say lesions are chronic” was quite typical in his experience. My horse was also hocky and I suspect we sometimes treated the hocks and got spillover onto the suspensory, just as you say.

My advice? IF you decide to do the surgery, yes, try and get Dr. White if you can.

The surgery is minimally invasive and a month later it’s just a memory. I don’t know how to stack it up against PRP but if you and your vet do not feel confident about rest or rest + shockwave I would give it strong consideration if Dr. White can review and give you a good prognosis.

[kiwifruit]

Thanks Asterix

I’m working with Kevin Keane at the moment and I head back to the clinic shortly to get more diagnostics and my options. I did hear him say that he just referred a horse down to Leesburg for a similar situation so I’m assuming that he is familiar with Dr. White and his work.

Interesting that your horse sounds very similar to mine. Sound and doing his job although dressage judges would always say my horse was not pushing from behind. Fantastic jumping. Never, ever said no even though I would drop him, push him to uber short distance, long distance. Makes me feel bad that if he does have chronic issues with his suspensories all this time, he pushed through it.

Interesting thing on the ultrasound that the leg in question showed some wear and tear. Nothing unusual for a horse in constant work. Had a few spots that showed chronic tearing/repairing but it was the same thing on the opposite leg! The doctor running the ultrasound said the block to the suspensory will be the most telling in what is really going on in the leg. Said his suspensories might be totally normal for this horse. Frustrating!

Could you clarify a few things for me? A faciotomy is actually several things, correct? It could be relieving the facial membrane to allow the suspensory to glide back and forth, and/or splitting the ligament to promote healing and/or removing the small nerve near the suspensory? Or are all of them different? So much info out there and I’m glad to say that at least there is hope for horses suffering from this.

Thanks guys!

[Cody]

Well I need to throw my hat in this ring too. Except my suspensory is the front. Any of ya’ll have any thoughts on that? It’s the distal suspensory that runs from the pastern/ankle down to the bulb of the foot. It has a significant tear in it. The vet has said he won’t be anything but a pasture ornament without doing something for me, such as prp, shock wave or stem cell. I’m on the fence as to which one. Vet says even with one of those, the best we can hope for is trail ridable sound.

Heck me and this pony hadn’t even gotten a good start yet. Fortunately he’s on stall rest and is a saint.

[asterix]

kiwi, Kevin is an awesome diagnostician and I’m SURE he is familiar with what’s available at Leesburg. Make sure if you go the surgery route that you tell them who is referring you, and don’t be shy about asking for Dr. White. It’s my understanding that he was one of the pioneers of this surgery, and, like any uncommon surgery, having an experienced surgeon can have a significant impact on outcomes (this is well established in human medicine. I can probably find you some PubMed citations if you like).

I have read on this board some other descriptions of “fasciotomy” that include additional procedures. The version I discussed with Dr. Allen at VEI and then with Dr. White, and which we did on my horse, was very, very simple. It was literally scalpel slits into the fascia over top the suspensory to relieve the swelling and facilitate healing. Although they send you home with the horse wrapped “for several days” my horse came home in a summer heat wave and within hours was having a total meltdown about the Elastikon. He gnawed, pawed, and kicked his way through the entire sterile bandage while I was parking the trailer.

So…we had to rewrap him a little more than 24 hours after surgery. There were no stitches; I could barely even see the slits that were made. It is very minimally invasive.

I would talk to Kevin and/or to Dr. White about whether there are additional components to the surgery that might be recommended. THe basic procedure is just a split of the fascia.

My horse had just carted me around our 3rd prelim (so, it was definitely a joint effort, and no walk in the park) before he was diagnosed. He jumped clean around a big course. His dressage was not spectacular, but…it was in our final conditioning trot and then coming out to jump the following day the week before prelim 4 that we noticed something wrong. He’s not very stoic AT ALL so I really don’t think it was bothering him significantly until it fell apart.

Don’t beat yourself up.You are at one of the best vets there is, and being proactive. Chin up! Good chance for a successful outcome. It’s a long haul but by the time we have proper winter you’ll be most of the way through the worst of the rehab. Seriously!