Friday, September 6, 2013

Here we are again

Sinwaan watching neighboring cows. 
When his mane is at this angle he always reminds me of the Breyer Indian Pony

Monday Chad was able to come out and pull Sinwaan's shoes and give him a trim. I had leveled out an area by his water tank the day before and flooded it so his hooves would not be so hard. Chad said it worked perfectly, and I was glad when the improvement also meant he could remove that last nail still in the hoof without a shoe.

I figured this past week would drag by, but with school starting up again and all the other things that happen in our daily lives, it actually wasn't too bad. Before I knew it Friday rolled around and it was time to take Sinwaan back in for some more evaluations, and hopefully answers. 

The night before we had a wicked storm pass through, leaving many without power. Sinwaan's barn was one of the unlucky ones, so we hauled some water out to them on our way to pick him up.

Dr Pritchett and her tech, I believe Linda was her name, started out with a lameness exam in-hand. Using some of the same tests as last time, but taking it a step farther. I am not a Hollywood pro focus-puller so apparently it is impossible for me to get clear in-focus videos from this fancy camera, therefore I am only posting one from that session.

Video #1 - Flexion test. This one I could see he looked a little off.

Guess who took their saddle pad home to wash it, and forgot to bring it today? 
Thankfully Matt was able to deliver in record time.

After those tests it was time to saddle up so she could observe him under a load. At the walk there was no sign of toe drag, but at the trot it became obvious. I didn't get to do much riding, as it didn't take long to see the issue. 

Video #2 - Riding, about 3 minutes long. It was a little stressful riding him there after not having ridden for 2 weeks, with the highway next-door, but he was quite good. I felt like a dummy when I un-tacked and noticed I had never clipped the top portion of his breastcollar. Oh well!

After  un-tacking they did more evaluations. 

Video #3 - Trotting, circles. More focus issues, sorry!

Video #4 - Flexion test, trying to aim higher up in the leg/hip area I believe (and a video capture below to show what he thinks of this)

Then another flexion test aiming lower in the leg, but that video is not worthy of posting as the trotting away portion is nowhere near being in focus.

After that she performed the same tests on the opposite side.

There was mention of sedating him, not for x-rays this time, but for palpating his hip from the inside (lucky for all involved that was never needed). First, however, she wanted to do some more research. So after a quick trip inside the building she came out with a couple more ideas. More palpating, flexing, extending his hind leg...trying to locate the issue.

Video #5 - Palpations and a reaction on the left

In the midst of this Ellie told me she had to use the restroom, so I took her in. I came out to find Dr. Pritchett with a look of triumph on her face. "I found it." Confused, I asked her what she found. She showed me that when she palpated his stifle, right over the peroneal nerve, he would move away, lift his leg, and just generally looked uncomfortable. She did the same thing on the opposite side with no response. Palpating other neighboring areas on either leg, also no response. Definitely an issue in that one spot.

Later, when we were inside the building, Dr Pritchett brought out her anatomy book to show me what everything looked like in his leg where he is having that issue. Quite kind of her, and fascinating!

Palpation of the right stifle joint over the peroneal nerve caused no reaction, 
compared to the left side. 

Dr Pritchett has an equine sports medicine specialist colleague (Dora Ferris DVM) whom their clinic plans to work with, who just so happens will be in town next week with her own ultrasound equipment. Dr Pritchett said she would like to talk with Dr Ferris more about this case and perhaps she could offer an additional diagnosis or treatment plan. She plans to get back in touch with me next week after they have a conversation.

(Sidenote: because I am curious, and the internet is so powerful, I Googled Dr Ferris and found the following...she is also the daughter of two local vets;)

We also talked about how after some rest and anti-inflammatories we should be able to develop a conditioning plan for Sinwaan to help build up his muscles to get him back on track for distance riding. (For example, lounging work with ground poles to start with, not riding) She sent me home with some bute to be given 2x a day. The barn owners volunteered to give that, to save me all that driving. Thank you!

So although I didn't get a complete answer about what caused this, or how exactly we will fix it, or how long he will be on vacation, it does sound like there is hope, and it is better than the alternatives. Here's hoping Sinwaan is back to normal soon.

However, no October ride for him. And since so much of the ride is about the bond that we share, I am not sure I want to do it without him on another horse, even though I have already had a very kind offer. I should probably volunteer, and crew, and see it all from the other side.

* * *

Later that afternoon I called back to the clinic to ask about that nerve, because I had already forgotten the name of it, and couldn't seem to figure it out doing basic Google searches for "stifle nerve." The gal who answered the phone said she could email me the notes from the visit, which I thought was really awesome. You can see them below.

Using this basic format—Subjective and Objective observation, Assessment and Plan, the vet notes on Sinwaan from today's visit are as follows:

Lameness Exam
S: Sinwaan is here for re-evaluation of the left hind limb. His feet have been trimmed. He has not been ridden.

O: No obvious lameness at the walk or trot on the pavement. Circumducts hind limbs well when turned to the left. He is more hesitant when turned to the right (left hind leg on the outside)
When ridden no lameness or dragging of the toe noted at the walk. When ridden at the trot - drags the left hind toe.
Flexion test of the left hind tarsus and stifle w/o rider - no change in gait
Flexion test of the left coxofemoral joint with the tarsus and stifle in extension - lameness noted and a few strides of toe dragging at the trot.
Subsequent to these observations - deep palpation of the lateral aspect of the stifle joint (area over the peroneal nerve) caused consistent pain reaction (moves away from me, lifts hind leg, switches tail). Palpation of the same area on the right hind leg did not cause any reaction.

A: Grade I/IV lameness of the left hind at the trot. Painful on deep palpation of the lateral aspect of the left stifle joint. Potential injury to the peroneal nerve.

P: Advised rest and anti-inflammatory. Consult with orthopedic specialist in additional diagnostics and rehabilitation. Lori C. Pritchett, DVM)

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