Tuesday, June 21, 2016

Sweet Relief

Saturday morning was the vet appointment at Dr. C's clinic, to look into Boca's mystery lameness. I could have waited until Monday to have Dr. C come out to our farm, but to be honest, my mental state wasn't the best, and trailering down to the clinic on Saturday would save me a farm call fee. I didn't sleep very well Friday night, and I woke up Saturday morning groggy and nervous, with my stomach in knots, relieved the day had finally arrived.

I got to the barn at 7 am, with the plan to be on the road by 7:45. I brushed Boca, put on his bell boots and fly spray, hooked up the trailer and we were ready to go. The morning was beautiful - sunny and breezy, with little humidity. Just the kind of morning to remind me why I love New England. The drive to the clinic was down many winding side streets, with charming old farmhouses and beautiful yards. In spite of myself, my spirits began to lift, and I had a funny feeling we were going to be ok. Of course, Boca was his perfect self, loaded quietly, and rode the entire way there without a peep, happily munching hay.

The vet clinic was on a busy 2-lane highway in Rhode Island, without a lot of room to park and unload. It was a mostly dirt, gravel and tarmac parking lot, with little area to graze and not another horse in sight. I was grateful to have such a compliant horse, and thought that a tense or reactive horse would have a tough time with the set up.

We are here... But where is everyone else?
I left Boca in the trailer and went to find the office to check in. We were a little early for our appointment, and I could see the vet techs setting up in the small clinic exam area. Boca unloaded like a pro, and though a little wide-eyed, happily picked at what grass there was to be found.

Dr. C came into the clinic, the vet techs introduced themselves, and we got started. First, I gave them a thorough history of the issue - that Boca had been coming out slightly off in his RF front for 3-4 weeks, that it was slight, and that he worked out of it as we went along. That it was worse recently, seemed more obvious on hard footing, and when circling to the right. In softer footing, and while circling left or on a straightaway, it all but disappeared. It was most evident at the trot, and was unnoticeable at the walk or canter.
Dr. C began the exam by running his hands down Boca's legs, feeling for any swelling, heat or irregularities. He did note that Boca had a very slight digital pulse in his RF, but there was nothing else that stood out.

I think next came flexions. I hope I am remembering the diagnostics in the correct order, but like I said, I was overtired and anxious, so it does have a bit of a fugue state quality.

Flexion on the RF
During the flexion tests, the vet techs were exclaiming what a sweet boy Boca was and what a cute face he had. It is always nice to hear other people think your horse is a good boy. I like to think I have a small part to play in that. He is a pretty good guy overall, but I do make sure his manners stay intact, and I think we have a pretty deep bond of trust. He takes good care of me, but I take pretty good care of him, too. 

Boca's flexions were negative. He flexed and jogged sound on all joints, but I really didn't expect otherwise. He passed his pre-exam flexions with flying colors as well.

We went to the (really) small lunging ring, next to the highway (!)
The vet tech asked Boca to trot right, and Dr. C said 'Ah, there's our lameness'.
And, indeed there it was. The vet tech had Boca do a short trot and canter session in each direction, then we brought him in for the next round of diagnostics, which was nerve blocks.

Local to the LF, before nerve block to the Navicular Bursa
We blocked the RF to the coffin joint, took Boca out to lunge in a really tight circle on the pavement, and he immediately came sound. The really interesting thing is that he was then absolutely crippled on the LF. I was not terribly surprised, as I had read this is not uncommon (I guess interwebz school of veterinary knowledge FTW?)

Dr. C then blocked his RF to the Navicular Bursa. He warned me that this could be pretty painful if there was an issue with the Navicular Bursa, as it only holds a small amount of fluid, and the added pressure of injecting the nerve block could be really painful for the horse. Luckily, Boca didn't flinch, and he was still very lame on the LF, which was actually a good sign. The reason being, the pain did not originate from the Navicular Bursa.

Now that we had a better idea of the area that was causing the lameness, it was time to move on to the x-ray portion of the exam.

The x-rays were more good news, with no deterioration of the Navicular bone, no fractures, or any other areas of concern. One thing I was really happy about was that the x-rays confirmed my farrier is doing a good job with Boca's feet. The alignment and angles were all correct, and overall Dr. C was very pleased with the job that my farrier is doing.
We did find two areas of interest on the x-rays, in regard to Boca's lameness issues. Boca does not have a much of a digital cushion, so it isn't a great 'shock absorber' for the concussive force created when his hoof lands. Also, although his LF has remained about the same, there is some significant arthritic changes to his RF coffin joint, from his pre-purchase x-rays in 2014.
In case you don't know what arthritis looks like on an x-ray (I didn't), I circled the area in red on his x-ray below. That bumpy stuff on the front of his coffin joint is arthritis.
So, what does all this mean, and how do we address it?
To reduce the inflammation, Dr. C recommended we inject both the RF and LF coffin joints and make some minor shoeing changes, to provide extra support and cushion to the area.
When Dr. C inserted the needle to do the injection, there was so much pressure from the inflammation in his coffin joint, that fluid spurted a good 2-3 feet across the room. How I managed to snap a pic at that exact moment, I'll never know!
Look! My horse's joints are peeing!
Boca was a star, and tolerated all the poking and prodding without any fuss. Injections completed, we wrapped him up for the ride home, with instructions to leave him in for the remainder of the day.
Orange travel booties
The farrier is coming out tomorrow to add pads and Equi-Pak to Boca's front shoes.
He'll have until Friday off, then he can go back to work. We'll also start him on Pentosan IM, to help manage/repair/prevent his joint arthritis.
Hopefully, all of these measures will resolve Boca's lameness issues. The only possibility would be, if he does not come sound, there is an existing soft tissue injury in the hoof, which we would not be able to confirm without an MRI... which I cannot afford.
So I am crossing all fingers and toes that this will give me my fully functional pony back, so we can go on to have many fun adventures this summer.
Because, y'know, I need this pony in my life!


  1. This is exactly what I thought it would be, so go me? I'm glad that you have an answer and a very treatable one at that!

    1. Go you! I'm so glad you were right. I know I over-reacted, but it just seemed like there were so many scary/bad things it could be, and few good ones.

  2. Yah! That sounds like great news. You two are adorable.

  3. Sounds like you have an awesome game plan headed forward! Hopefully you guys can get back to work in no time!

  4. Glad you found an answer and a good plan to deal with it. Hopefully he's back into work in no time!

  5. Yay that you have an answer and a plan. Boca is worth his weight in gold.

  6. Good news indeed! Here's hoping the injections and shoeing changes do their job and you're able to ride again soon!

  7. I love a solid plan!! It's gotta feel good to have such a competent and effective vet too. Fingers crossed Boca is as good as new asap!

  8. Yay for a diagnosis & treatment plan. I too will keep everything crossed for full recovery!

  9. Fingers crossed, sounds like he'll be feeling good again soon! That hoof peeing pic is crazy!

  10. So good to have a plan, sounds very manageable! Cheering for you and Boca :)

  11. New here, just wanted to wish you luck before catching up on your guys' story!

    Just a quick question - How come he's quarter clipped in front? :)

    1. Thanks for reading Christle! I think it is just a trick of the light - he isn't clipped. It's just his summer coat.

    2. Whoops sorry - was referring to the shoes! Though he totally has a gorgeous coat that's nice enough to be a clip ;).
      I only ask because the quarter clips (maybe double clips?- in the US?) stabilise the hoof. And it sounds like that's not something you'd want to do intentionally given that he has poor shock absorption already? Giving the front feet a bit more room for expansion and contraction is going to increase his shock absorbing capability, and 'may' avoid going down that long and expensive equi-pak route.

      In saying all that, I get really uncomfortable when people question what my farrier/vet/trainer has me doing, and my question is purely out of interest. Your farrier probably has a great reason for doing so - maybe he pulls shoes, or the actual hoof structure is not that great/intact? A lot of people in NZ do it for fashion - a lot of our really good show jumpers went through a stage of all wearing double clipped shoes in front and next thing all the ammy's were doing it too haha! Similar story with bar shoes and all the dressage queens wanting bar shoes after Totilas!

      Anyway, your farrier sounds like he's doing an excellent job what with having everything aligned as it should be and the angles correct, which is why I'm curious as to why he's opting to use double/quarter clips. If you do ask about them - it is just interest and not questioning his capability or anything. I can imagine what my farrier would say if I said "someone on my blog said you should be shoeing my horse differently" hahahaha.