Flexion test with Dr. Tolley Tolley and Rudy serving as handler.
Thankfully, it seems as though the answer to that question is "not much."
This whole thing started last winter when Speedy went through a month of lame for a few days, sound for a few days, lame for a few days. I took him over to Alamo Pintado, a premier equine medical center here in Central California. The diagnosis was a possible collateral ligament injury with a recommendation for six weeks of hand walking and a slow return to regular work.
Speedy ended up super sound after the rehab period and went on to have a great show season without a single moment of lameness - until a month ago. It's funny that this new lameness appeared at roughly the same time as last year's.
A month ago, Speedy came out of his stall lame at the walk for no apparent reason - just like last winter. My heart sank as I was positive that the lameness had presented itself in exactly the same way as it had the year before - sound one day and completely lame the next with no sign of trauma or heat or swelling.
I hand walked him for a week and felt encouraged when he returned to soundness. I called my vet, and with his encouragement, took Speedy to the most recent Christian Schacht clinic. Two days after the clinic, he was lame again. I called Dr. Tolley and scheduled an appointment.
This whole thing started last winter when Speedy went through a month of lame for a few days, sound for a few days, lame for a few days. I took him over to Alamo Pintado, a premier equine medical center here in Central California. The diagnosis was a possible collateral ligament injury with a recommendation for six weeks of hand walking and a slow return to regular work.
Speedy ended up super sound after the rehab period and went on to have a great show season without a single moment of lameness - until a month ago. It's funny that this new lameness appeared at roughly the same time as last year's.
A month ago, Speedy came out of his stall lame at the walk for no apparent reason - just like last winter. My heart sank as I was positive that the lameness had presented itself in exactly the same way as it had the year before - sound one day and completely lame the next with no sign of trauma or heat or swelling.
I hand walked him for a week and felt encouraged when he returned to soundness. I called my vet, and with his encouragement, took Speedy to the most recent Christian Schacht clinic. Two days after the clinic, he was lame again. I called Dr. Tolley and scheduled an appointment.
Photo courtesy of Cecile
I've been using Bakersfield Vet Hospital for nearly twenty years, and Dr. Tolley has been on my team from the very beginning. The equine athletes may have changed over the years, but Dr. Tolley and I have developed a very good working relationship through his care of each horse.
I brought my calendar with me, which has detailed records of each day's barn visit. I shared Speedy's on again, off again lameness story. Last year while at Alamo Pintado, I had a full set of radiographs done for Speedy's right front foot - the one that he was so lame on at the time. The truth though is that I never was sure which foot was the culprit as it seemed to change from day to day.
So when I told Dr. Tolley it was the right front with which I was concerned, we were both a bit surprised when we saw Speedy trot out lame on the left front.
I brought my calendar with me, which has detailed records of each day's barn visit. I shared Speedy's on again, off again lameness story. Last year while at Alamo Pintado, I had a full set of radiographs done for Speedy's right front foot - the one that he was so lame on at the time. The truth though is that I never was sure which foot was the culprit as it seemed to change from day to day.
So when I told Dr. Tolley it was the right front with which I was concerned, we were both a bit surprised when we saw Speedy trot out lame on the left front.
Dr. Tolley examning Speedy while on the lunge line.
I am definitely not a vet, and I don't even try to pretend that I am great at diagnosing lamenesses, but my jaw hit the ground when I saw that Speedy was lame on the left front. Seriously. What. The. Hell.
Dr. Tolley noted my confusion and was quick to reassure me that I wasn't an idiot. He stated, quite firmly, that if I saw it on the right, he didn't doubt for one instant that it was to the right. Today however, he was seeing it on the left side, but it was only presenting itself as a grade one out of five. That means that it was pretty slight. A long conversation ensued.
Dr. Tolley noted my confusion and was quick to reassure me that I wasn't an idiot. He stated, quite firmly, that if I saw it on the right, he didn't doubt for one instant that it was to the right. Today however, he was seeing it on the left side, but it was only presenting itself as a grade one out of five. That means that it was pretty slight. A long conversation ensued.
Rudy is a great handler.
We studied my calendar and compared it to notes that Dr. Tolley had taken last year when I brought Speedy to him for a recheck in April. At that appointment, he had taken detailed notes about Dr. Carter Judy's thoughts (the vet from Alamo Pintado), as related by me. It became clear through our conversation that the lameness was pretty erratic and quick to resolve itself. Dr. Tolley started to have doubts that last year's lameness was due to the collateral ligament.
Last year, I felt certain that it was in the foot, but since I am not a vet, I didn't know what structures in the foot might be affected, nor did I know how they might present themselves. Dr. Judy had offered me three likely diagnoses: an abscess, a bone bruise, or a collateral ligament injury. Without knowing for sure, I took his advice and treated it like a ligament injury, the worst case scenario.
Dr. Tolley started to think it might be something altogether more benign. As Dr. Judy did the year before, Dr. Tolley recommend that we start with nerve blocks to be sure that Speedy's lameness was indeed in the foot. He spent a lot of time explaining how the nerve blocks work and which structures of the hoof and leg are affected.
Last year, I felt certain that it was in the foot, but since I am not a vet, I didn't know what structures in the foot might be affected, nor did I know how they might present themselves. Dr. Judy had offered me three likely diagnoses: an abscess, a bone bruise, or a collateral ligament injury. Without knowing for sure, I took his advice and treated it like a ligament injury, the worst case scenario.
Dr. Tolley started to think it might be something altogether more benign. As Dr. Judy did the year before, Dr. Tolley recommend that we start with nerve blocks to be sure that Speedy's lameness was indeed in the foot. He spent a lot of time explaining how the nerve blocks work and which structures of the hoof and leg are affected.
Dr. Tolley is administering the second side of the lowest nerve block.
In the most layman of explanations, the lowest set of nerve blocks (inside and outside) "numb" only the bottom portion of the hoof. This nerve block is for the lowest structures of the hoof. If the horse trots out sound after this injection, the vet knows that the pain is coming from the coffin bone or nearby structures.
If the horse does not trot off sound, or trots off only marginally improved, a second nerve block higher up is necessary. The next injection would come just above the fetlock. Dr. Tolley explained that even if he is sure the lameness is coming from the knee, he always starts the nerve block at the bottom because most lamenesses come from there. And often, while a horse might be sore in the knee, the real cause of the lameness is usually down lower.
Speedy did trot off more sound after the nerve block of the lowest portion of his foot. Dr. Tolley was sure that the pain was emanating from somewhere low. The trick was now to figure out why. We went inside and studied Speedy's radiographs from the previous year. While there were a few little things here and there on the right front, Dr. Tolley felt certain that a radiograph of the left front would reveal a bony structure that was as clean as the right side from last year. He didn't think the cost of a second full set of radiographs was warranted. Thank you, sir!
Given that there were no red flags in Speedy's skeletal structure, Dr. Tolley began looking at how Speedy was moving. After a careful study of Speedy walking and trotting, he noticed that Speedy was landing on the outside of his hoof wall first and then "slapping" the inside heel down. He also noticed that Speedy was forging, a lot. In fact, we could hear the tell-tale click, click, click with almost every stride. Dr. Tolley began to form a hypothesis.
If the horse does not trot off sound, or trots off only marginally improved, a second nerve block higher up is necessary. The next injection would come just above the fetlock. Dr. Tolley explained that even if he is sure the lameness is coming from the knee, he always starts the nerve block at the bottom because most lamenesses come from there. And often, while a horse might be sore in the knee, the real cause of the lameness is usually down lower.
Speedy did trot off more sound after the nerve block of the lowest portion of his foot. Dr. Tolley was sure that the pain was emanating from somewhere low. The trick was now to figure out why. We went inside and studied Speedy's radiographs from the previous year. While there were a few little things here and there on the right front, Dr. Tolley felt certain that a radiograph of the left front would reveal a bony structure that was as clean as the right side from last year. He didn't think the cost of a second full set of radiographs was warranted. Thank you, sir!
Given that there were no red flags in Speedy's skeletal structure, Dr. Tolley began looking at how Speedy was moving. After a careful study of Speedy walking and trotting, he noticed that Speedy was landing on the outside of his hoof wall first and then "slapping" the inside heel down. He also noticed that Speedy was forging, a lot. In fact, we could hear the tell-tale click, click, click with almost every stride. Dr. Tolley began to form a hypothesis.
This photo clearly shows that he is going to land outside to inside heel.
Given that Speedy seems to recover quickly after only a few days of rest, combined with the fact that he trots out better on softer surfaces, Dr. Tolley believes that Speedy is bruising the inside quarter of his heels. Each time he lands, he falls in on the inside quarter. Exacerbating the whole problem is the forging. With each stride, his hind foot comes up and slaps the bottom of his front foot.
One of my favorite things about Dr. Tolley is that he has a deep respect for what I do. It never mattered that I wasn’t a top ten endurance rider. He knew that my endurance horses still needed to be in tip-top shape. And now that I no longer race, he still respects what I am doing. He knows that dressage horses must be well balanced in order to do their jobs well. And while I am sure that he treats all of his equine patients with great care, I know that he spent an extra amount of time working on a diagnosis that other vets might have just chalked up to “the horse having an off day.”
One of my favorite things about Dr. Tolley is that he has a deep respect for what I do. It never mattered that I wasn’t a top ten endurance rider. He knew that my endurance horses still needed to be in tip-top shape. And now that I no longer race, he still respects what I am doing. He knows that dressage horses must be well balanced in order to do their jobs well. And while I am sure that he treats all of his equine patients with great care, I know that he spent an extra amount of time working on a diagnosis that other vets might have just chalked up to “the horse having an off day.”
Dr. Tolley did a fair amount of lunging to really get a good sense of how Speedy was moving.
We have a plan for addressing Speedy’s small imbalance. Dr. Tolley called and made an appointment with the farrier that the hospital uses for corrective shoeing (he’s not on-site). He discussed Speedy’s case with the farrier while I listened in. Dr. Tolley also spoke with my regular farrier over the phone to let him know what change he thought needed to be implemented.
In a perfect world, Dr. Tolley would have liked for both farriers and himself to be present for the adjustment, but my farrier just can’t change his schedule that quickly. And of course, having Dr. Tolley present carries a pretty stiff fee. Dr. Tolley did say that if he isn’t too busy, he will try to be around for the shoeing as he would like to see his theory put into action.
My regular shoeing appointment is scheduled for two weeks later so Dr. Tolley is hopeful my farrier can check out the changes and try to maintain them.
While this isn’t great news, I am very relieved that Speedy doesn’t seem to have a joint or ligament injury. In fact, once his feet have been re-balanced, I should be able to bring him back to work without a lengthy rehab period.
Our appointment with the farrier is tomorrow. We shall see how it all goes.
In a perfect world, Dr. Tolley would have liked for both farriers and himself to be present for the adjustment, but my farrier just can’t change his schedule that quickly. And of course, having Dr. Tolley present carries a pretty stiff fee. Dr. Tolley did say that if he isn’t too busy, he will try to be around for the shoeing as he would like to see his theory put into action.
My regular shoeing appointment is scheduled for two weeks later so Dr. Tolley is hopeful my farrier can check out the changes and try to maintain them.
While this isn’t great news, I am very relieved that Speedy doesn’t seem to have a joint or ligament injury. In fact, once his feet have been re-balanced, I should be able to bring him back to work without a lengthy rehab period.
Our appointment with the farrier is tomorrow. We shall see how it all goes.
