As the day went on it was like the horses knew Dr. Landes was coming, so they decided to pile on to the impromptu appointment. I rode Walsh, who came up lame on his right front leg when going in a circle to the right on the harder footing in the arena. I also rode Dewey, who incessantly flipped his head in an earnest effort to tell me his teeth were bothering him. By the time Dr. Landes and his technician arrived, the top of Highboy's front legs had begun swelling.
First we looked at Highboy. I had to take him out of his paddock so that his roommate wouldn't assist too much with the exam since Dewey is sure that he is quite helpful. We asked Highboy to walk, lift his head up and down, and turn it left and right. Dr. Landes palpated Highboy's chest, shoulders, and front legs, finding swelling and heat on the grumpy painful horse. We determined Highboy had sustained some sort of trauma to his chest, shoulder blades, and front legs, or in more basic terminology, he had gotten clobbered. My best guess is that he either slammed himself into the fence trying to play with friends on the other side, or he harassed Dewey one too many times and Dewey double-barreled him, kicking with both hind legs. Because Highboy was wearing a blanket there were no marks on his skin from the impact, but clearly he was sore. The treatment for Highboy is to put him on topical and oral anti-inflammatories, and keep him moving to help the swelling resolve.
Then I cautiously asked how open the vet's afternoon was. When I worked for veterinarians one of the worst things we could hear a client say was, "Hey, Doc, since you're here..." because it always meant havoc with the rest of the day's schedule. Luckily their afternoon was actually available, so Dr. Landes had time to work on Walsh.
We started with a basic lameness exam for Walsh, which included watching him walk and trot on a straight line as well as on a circle, and then flexion tests. We did indeed note that he was sore on the designated leg. Best case scenario he had a stone bruise of some kind on the bottom of his foot, and it would resolve itself in a couple weeks. However, since this had lasted at least a week already, I decided I wanted to pursue the issue to see if I could get a more definitive answer.
We proceeded to do nerve blocks on that limb. These work by injecting a temporary anesthetic under the skin, close to the nerves very low down on the leg. We started by injecting just above the hoof wall. We waited for about ten minutes while the numbing agent took effect, then gently poked his foot with a pen to see if he could feel it. When he was sufficiently numb we repeated the flexion test with a mild improvement. If the problem had been in the foot, the injection would have temporarily numbed everything below the injection site and he would have trotted off comfortably, telling us that the foot was the problem. However, since he was improved but not completely better that told us the problem was slightly higher up in the leg.
We repeated the process, this time injecting the anesthetic slightly higher on the leg which would numb the next highest area. This picture shows approximately where the injections went so you can see that everything below the injection area becomes numb.
The second injection worked great, Walsh trotted off much more comfortably after having his pastern numbed. If it hadn't worked we would have continued blocking up the leg until we found the area that hurt him because the lameness would greatly diminish once he couldn't feel the painful area. These injections wear off after a while, so no permanent nerve damage is done, but it's a great diagnostic so that we knew exactly where the problem was and what to radiograph. Otherwise we would have been completely guessing about where to take pictures. It wouldn't make sense to x-ray his knee if the problem was in his fetlock. This process told us the area where we needed a visual.
First order of business for x-rays was to put on our party dresses. The lead gowns keep our important organs from getting the radiation from the machine. Once all the equipment was set up in the tack room Dr. Landes and his tech, Erin, set up the cassettes containing the film in the cassette holder.
We did a few shots to make sure we were seeing all the important parts from all the pertinent angles, and Walsh was a perfect gentleman. He loves cookies and to earn them he was willing to stand quietly for all his pictures without sedation, even when we needed him to stand on blocks so we could get a slightly different angled picture of his pastern. He really is a great pony and such a well mannered guy.
Next was "developing" the films. Since Dr. Landes has a digital x-ray set up I don't have to wait three days for films to be chemically developed and then read. We had instant answers! The film is taken out of the cassette, placed in this grey cylinder, and run through the machine. The radiograph then appears on the laptop screen.
On the images we found Walsh recently had a small bone chip break off the side of his short pastern bone. It probably is lodged in or near the joint capsule, but not in a position to interfere with the joint itself. It's not career limiting or very serious, his long-term prognosis depends on how he responds to the treatment. Because he did have a digital pulse and was sore on it we decided to inject the joint to quiet the inflammation and just leave the bone chip alone. Walsh is seventeen years old, and it makes sense that a horse his age would have some bony changes in his pasterns, especially considering his pigeon-toed conformation (his toes angle towards each other instead of facing straight). Overall this is a good outcome for these diagnostics. Not the ideal of simply a bruised sole, but really the second best result.
We injected the joint with a steroid to quiet the inflammation and hopefully make Walsh more comfortable. He's also on stall rest with oral anti-inflammatories for a few days while everything quiets down. Walsh has decided he likes the special treatment and the unlimited small mesh hay net. Evening mash is nice, too, even if it does have medications in it.
This last photo shows the horse's thoracic, or front leg, skeleton superimposed on a photo of a front limb. Walsh's bone chip was between the second and third lowest bones, which matches where he was sore on palpation and where the nerve blocks indicated the issue was located.
Lastly Dewey had a dental, and the veterinary afternoon was finally done. I'm so grateful to have a veterinarian who is willing to be so thorough for me when I need specific diagnostics done on a horse with lameness, as well as willing to do dentals every six months on poor Dewey with his myriad of crooked teeth, not to mention looking at Highboy for me on such short notice!
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