Monday, April 10, 2017

Vet Call Recap - Proximal Suspensory Ligament Injury

Casey is still injured. Sunday we stuck her on the lunge line and while she did look a lot better, she still wasn't sound. Today I took a personal day off of work and had the vet come to check her out.

When vet arrived he first did a cursory inspection of Casey, checking her heartbeat & lungs with a stethoscope. Then he gave her a little bit of tranquilizer (because on Sunday she was a nightmare to stick on the lunge line) and we stuck her on the lunge line again. She appeared to be sound at the trot, but had trouble at the canter, which is consistent with what Trainer and I have noticed. Vet then had Vet Tech hand jog Casey in a straight line away from him so he could look at the pattern of her hoof-fall. After that he did a flexion test and when Vet Tech trotted Casey away after he flexed her left hind, she was a lot worse. When he did the flexion test on the right hind, Casey still wasn't sound, but it wasn't as bad. At this point he agreed with us that it was her left hind, but wasn't sure if it was a muscle/tendon thing or if it was a bone (hock) issue. Since she had gotten injured on the take-off of a jump it seemed that a muscle/tendon injury was more likely so we decided to move on to ultrasounds.
I didn't actually take many photos when the vet was there, so enjoy Casey grazing

We brought Casey back into the barn, she got a bit more tranquilizer and then they prepared her for the ultrasound. This involved clipping her back legs, because apparently that is necessary to get a clear image on the ultrasound. It was really cool to watch how they ultrasound. Vet didn't know where exactly she was injured, but thought that it was around her hock area so that is where he started ultrasound-ing. It took longer that I expected for him to figure out where exactly the injury was, but he did find it!
Casey checking out the ultrasound machine

Casey has a proximal suspensory ligament injury. Basically the ligament that attaches to the hock has a slight tear in it. Essentially she overstretched that ligament and so it slightly tore away from the bone. The vet said that it was a super minor tear and that this type of injury is very common in sport horses, especially jumpers. He showed me the tear on the ultrasound. It basically looked like a slightly darker spot on her ligament. He had taken ultrasounds of both legs for a comparison and so it was really cool to see the images side-by-side. I wish I had taken a picture of it, but oh well... instead enjoy a picture from the internet that shows where exactly she is injured.
She injured the upper part

Now that we knew what exactly the injury was, we could talk about treatment. Vet said that normally he recommends time off, and since we gave her a full two weeks off, we did the right thing. He said that since she has improved a lot in those two weeks we could move on to the next step. This type of injury is prone to scarring, but we do not want a lot of scarring because that will impair the flex of the ligament, which would in turn lead to more injuries. Vet said that the best thing to reduce scarring is controlled work. His recommendation was to start her on very light exercise and slowly build the intensity of the work out as she improves. He said that for two weeks I should ride her at a walk for 20-30 minutes. The two weeks after that, I should do 10-5-10 (10 minutes walking, 5 minutes trotting, 10 minutes walking). He wants to come back after a month to recheck her and ultrasound again to see how it's healing and if all goes well then we can move on to 10-15-10 (adding in some canter here) and then 10-20-10. The goal is to get to 10-20-10 for a month without re-injury, and if we can achieve that, then she will be totally fine after that. All in all, the amount of time that we are looking at for recovery is about 3 months (we are already 2 weeks in). Trainer and Vet both pointed out that trying to ride Casey at only a walk might be hard (especially because right now she has pent-up crazy energy), so Vet gave me some Ace so that we can drug her for the first few rides. I suspect that she will only need it for the first 2-3 rides, because she really is a good horse and normally doesn't act too crazy, but I will concede that for the first few rides, drugs will probably be needed.

In a way this is sad, because it does stop our training in some ways, but overall things are looking pretty good. We knew that Casey was injured and this is the least bad of all of the potential bad things that could have happened. The vet even said himself that this is a really minor injury. We do want to take it slow though because a minor injury like this could turn into a major one if we try to rush the healing process. I'm just excited that I will be able to ride my horse, even if it is just at a walk. We can still work on things, like voice commands and leg yielding, so it's not like we can't still be training, it's just a different focus of training. I think that it will also be really good for Casey to go back to "work" 4-5 days a week because having time off is driving her bonkers. She is super bored and when she gets bored she gets destructive.

After figuring out the immediate treatment plan, Vet talked to me about some other options we could do. He talked about some type of plasma treatment and shock wave treatment, but both were crazy expensive and so I told him I wanted to wait for this first month and see how she is after that. Really what she needs is time and light exercise, and while those treatments might help speed things up, it's a lot of money for something that will heal on its own. Vet also talked to me about how her hocks might be bothering her which could cause her to be straining her muscles and ligaments more, so in a month we will be looking more closely at her hocks and we might want to consider getting hock injections. He isn't sure that they are causing her problems though, so it will really depend on what she looks like in a month.
Vet will check her again in a month

The last thing he recommended was to put her on some type of joint supplement, because that's more of a preventative thing to do for her hocks. He talked to me about all of my options, and they are all kinda spendy ($50-100 a month), but he said that doing this would help her hocks and other joints and that if I do this I might not have to do hock injections at all. My Trainer recommended Polyglycan and said that she had a couple of horses that do really well on it and so I agreed to that. It's the mid-priced option at $80ish a month, but it basically acts like two of the other ones combined (Legend + something else). It's not cheap, but is definitely cheaper than hock injections, plus I can buy it a month at a time so it's not a huge expense up front.
Now a horse who is on joint supplements

All in all, I'm really glad I had the vet look at Casey. Now we know exactly what it is and how to treat it and how long it will take to heal. I'm also relieved that it is not as bad as it could have been. She is injured, but it is a common injury and it will heal fairly easily (it just takes some time to do so). I'm scared to see the vet bill, but I know that I did the responsible horse owner thing, and now I get to ride my horse!
I get to ride her tomorrow!!!

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