What's Wrong With Speedy G? (part 2)

part 1

When Dr. Judy found us at the trailer, Speedy was his usual curious self, although he was cranky; chronic pain will do that to a guy. Dr. Judy listened thoughtfully as I shared the story of Speedy's on again, off again lameness. I document every barn visit on a calendar; I had brought it with me so the vet could get a good picture of what was going on. After listening to our tale of woe, he asked for a trot out.

Alamo's trot out area. It's a long, sloping driveway covered with a thick layer of smooth pea gravel.

Thankfully (?), Speedy trotted out lame. Nothing is worse than going in for a lameness exam with a sound horse. And even better, Speedy actually showed which leg was lame, right front. All along, it's been really hard to tell because he also acts like the left hurts. 

After watching him trot out, I asked the vet if he had any suspicions, given that the lameness kept coming and going. He admitted that it was possible Speedy had a fracture in the hoof. Without diagnostic work, I knew that was only a theory so I kept my OH MY GOD to myself. To narrow down from where the pain was coming vet, the suggested we begin with nerve blocks. I readily agreed; I've been down this road before.

If you've never had the need to use nerve blocks on a horse, here is a brief, but excellent description of the process. Basically, the vet "numbs" the lowest area possible searching for the point where the horse becomes "numb" to pain. Sometimes it is necessary to go higher and higher up the limb to reach this point. In Speedy's case, the vet first blocked the heel area. This brought him to about 65% soundness which told the vet we were probably dealing with a foot injury as opposed to a fetlock issue, but to be sure, he blocked the rest of the foot as well.

Waiting for the nerve blocks to do their thing. Speedy got much perkier as his foot started to feel better.

After giving the nerve blocks some time to work, Speedy came up more than 90% sound. The vet was certain the injury was within the hoof itself. While there aren't that many structures within the hoof, diagnosing foot problems in a horse can be difficult as it is hard to feel and see what is happening beneath the hoof wall. Dr. Judy suggested we begin with the most obvious diagnostic tool; radiographs.

Alamo has a great radiograph bay (entrance on the left side of the building) with an attached office that holds a large computer monitor for client consultations.

Of course radiographs of the foot meant that Speedy's week old shoes needed to be pulled. Fortunately, Alamo had a farrier on site who pulled the shoe and then re-tacked it on later. 

But we just put them on!

The radiographs revealed some good news and some not so good news. To both the vet's and my relief, there were no fractures. In fact, other than some expected wear and tear, Speedy's radiographs came back quite clean. The coffin bone was right where it was supposed to be, and there were no abnormalities. The bad news was that Speedy's lameness couldn't be diagnosed based on the radiographs.

Since the hoof wall is solid, we hit a brick wall of sorts. Ultrasound can't be done on a hoof. This created a problem because I wanted to know what is wrong with Speedy and more importantly, what I can do to help him get better. Since an ultrasound was not useful, Dr. Judy laid out my options: a standing MRI ($1,800) or a full MRI with anesthesia ($2,800).

Dr. Judy was very nonjudgmental as he presented my options. He made it clear that he wasn't recommending the MRI, only letting me know what the next diagnostic tool would be. After careful consideration, I asked him what he thought might be wrong. In other words, what did he think the MRI would reveal?

Dr. Judy's response was that there were three likely diagnoses. The first was that Speedy had an abscess, although three weeks would be a long time for it to brew. The second possible scenario was that Speedy has a deep bone bruise. Finally, Speedy might have suffered a soft tissue injury, most likely to the lateral collateral ligament of the coffin joint.

The CL is in the bottom third of the picture.

In the first case, an abscess will usually just blow out on its own if given the opportunity. For the other two diagnoses, the treatment was virtually the same, time off. The only difference is that a bone bruise/contusion will be solidly healed in two months while damage to the collateral ligament requires a period of rest followed by rehab; a six month process. In addition, damage to the collateral ligament may reappear in the future, as scar tissue is usually formed.

Deep sigh … continued tomorrow.