abscess · farrier

Foot Update

Tristan saw the farrier yesterday. Originally, our plan was for him to lose the front shoes back in April: from the front, it looks like the abscess hole was all the way grown out, and he’s always been a barefoot horse before. I wasn’t there for that farrier appointment, but the farrier put front shoes back on. I was confused but didn’t have time and energy to follow up.

I asked the barn manager to check in with the farrier specifically yesterday and ask what was up, and chatted with her this morning.

The upshot: believe it or not, he’s still growing out the abscess hole/hoof damage. Remember, this is the abscess that blew on August 16, 2012. Yes, that’s right: this abscess hole has been growing out for 22 months now!

It’s barely detectable, but it is still there, and there’s bruising in the toe area leftover from the destabilized hoof. He was missing massive quantities of hoof wall for so long it’s just taking a while to grow a completely healthy hoof, top to bottom. Because the abscess blew at the coronet band, there’s still a lump in the hoof starting from that scarred area.

So he’s still in front shoes. He probably will be in front shoes until the end of the summer at least. Farrier thinks he’ll need some serious time to adjust to going barefoot in the front again, so I have to think about what would make sense as a timeframe for that, and what combination of toughening work & time off would help him out.

(I swear, I thought I was done with the abscess tag…)

abscess

Foot Progression Collage

I finally completed a project I’ve been wanting to do for some time: a complete collage of the progression of Tristan’s right front.

For those who haven’t heard this before, let me make a long story short: in August 2012, Tristan blew a massive abscess out his coronet band. Over the next few weeks, he blew it again halfway down the foot and at the toe. Eventually, we discovered that it was due to an infected stress fracture of the coffin bone, and in March 2013 had surgery to remove bone chips and dead bone.

(if you want the story in excruciating detail, check out the abscess and surgery tags)

Photos are as follows. The top left photo is from August 2012, the night I discovered the abscess. They follow through monthly, left to right, at roughly the same time each month. August and September 2013 were lost in a camera data card crash, and I don’t have a November 2013. The bottom right photo was taken on December 18, 2013 and still roughly represents where his foot is today.

For anyone who has ever wondered what a massive abscess hole looks like as it grows down from the coronet band to the toe, look no further.

This will, please God, be the last entry in the abscess tag set.

abscess · product review

Product Review: Davis Soaking Boot

In the bad old days when I was soaking Tristan’s foot every single day, trying desperately to draw out the abscess that we thought was just stubborn and/or trying to keep the abscess holes clean, soaking was a chore. I used the tried-and-true feed pan method. Result: guaranteed spillage, frustration, and possibly tears. (If you want the whole abscess drama in real time, follow the abscess tag and then the surgery tag.)

One day, I found myself at Smartpak to purchase more Betadine and epsom salts, and cleverly placed alongside those vital supplies was a Davis soaking boot. It was $32.95, and as we know that is pretty darn cheap for something connected to horses. So I bought it. And it changed my life.

Chillin’

I’m not trying to be dramatic, but wow. Why did it take me so long? Within two or three sessions, we went from frustration, anger, and lots of cleanup afterwards to uneventful, straightforward soaking. I would put his foot in the boot, pour the epsom salt/hot water/Betadine in, tighten the velcro, toss a flake of hay in front of him, and he would stand stock still for as long as there was hay on the ground. I didn’t even tie him. I often read a book. To this day, that training holds.

Some of the advertising for this boot seems to imply that you could, in theory, fill it and then turn your horse out in it. I believe that to be creativity bordering on bullshit. If you have a boot large enough to hold an appropriate amount of water, it’s too large to stay on your horse. Also, it would get trashed, durable as it is. So don’t do that. If you truly desperately want something to serve as a hoof dressing during turnout, do the old duct tape method and plan on replacing daily. But if you are looking for a way to make your life easier while soaking, buy one of these. It’s a game-changer, and no barn should be without one.

abscess

12 Months

This is to say that 12 months ago yesterday, I pulled Tristan up in his lesson because he wasn’t feeling quite right. The next day, he was quite unsound on the RF. The day after that, he blew out his abscess, one year ago tomorrow.

Hell of a year.
Tonight we had what might be called our first really solid schooling session since that day. We warmed up, we worked on lesson homework, we worked through rough spots, we improved from start to finish, we took a break, and we picked the work back up and cemented it. He felt fit throughout and tired in a muscle building way at the end – it was the most time he had spent bending and forward and stepping under since last year. SO glad we are on the path forward!
abscess · chores · farrier · surgery

Whew

On the one hand: I helped out with chores again today, and there were only two of us, and it was a completely packed and busy six hours. I was too tired to ride and came home and have been mostly flopped on the couch re-reading Pride and Prejudice.
On the other hand:
– all those calories burned!
– I have my first 30 minute lesson on Tuesday! I am incredibly excited to get back on track. It will be almost 11 months to the day since my last lesson on Tris.
– last night, we cantered all the way around the ring, once on each lead. I could’ve kept going forever.
In state of the foot news, farrier will trim him in the next few days, cutting off the plastic shoes with clippers, dremeling out the epoxy, and then we’ll see what’s left. He could go back in another round of glue-ons, back to regular shoes, or back to barefoot. It depends on how much foot is left after the trim and what quality it is. Here are pictures from this morning.

abscess · adventures with the vet · budget · surgery

Doing the Math

If you follow the COTH forums long enough, you’ll see multiple threads about horse budgeting – and in every single thread, at least one person says that he/she never actually looks at how much it costs to keep a horse.

I don’t understand that attitude at all. When I first got Tristan, I was making just under $20,000 a year. I knew where every single penny went – most of them into him. I am doing better now, but I work in nonprofits. I’ll never make so much that I don’t know how much I spend on him.

With that in mind, here is the end result on a project I’ve had in my head for a little while: start to finish, how much Tristan’s coffin bone chip cost. The period in question is June 8, 2012 through May 16, 2013, when he got his fancy glue-on shoes. I’ve broken it down by categories:

Veterinary Care – vet calls and treatment (hands on care)
Farrier Care – shoeing, which he would not have had had he not gone off
Diagnostics – x-rays, mostly
Medications – bute, antibiotics, sedatives, specific supplements
Supplies – epsom salt, vet wrap, duct tape, and the like

I could also do a category called opportunity costs – for the scratched Valinor and King Oak entries, for the 7-8 lessons I pre-paid and left behind when I moved to Vermont, and I’m sure for other things if I thought about it. Easily around $500 or so.

So:

  • Veterinary Care – $2,037.59
  • Farrier Care – $990
  • Diagnostics – $1,070.75
  • Medications – $1,313.70
  • Supplies – $688.05
Total: $6,100.08
Some of my separations were silly; I split the surgery up several ways (vet care, board, diagnostics, medication) when the two days of hospital care, surgery, and drugs cost $2,189.20, which is DIRT CHEAP if you ask me. I am also certain that I missed a few epsom salt and duct tape purchases in reviewing my budget numbers, so that category may be off by $50 or so.
The medications column ended up being the longest, and it was mostly sedatives for his farrier issues. The big ticket items under supplies were his EasyBoots, the two regular sizes and then the third larger size he had to get at the vet clinic. The diagnostics were entirely x-rays, four different sets of them and the one radiologist consult.
Out of all the vet visits, if you look at each visit as a cohesive cost unit, the surgery cost the most, obviously, but after that it was that first visit, the one on June 8 for the first abscess diagnosis that was the most costly. (In more ways than one, since that was the one that sent us down the wrong track!)
In conclusion, this seems astoundingly low to me. In my head it was closer to $10k. Paying for it has still emptied three savings accounts (Tristan’s, my farm down payment, and my tax return) and put a serious dent in my emergency fund. Still, it’s a testament to those early days living on noodles and sleeping in all my winter gear on the couch in front of the wood stove because I couldn’t afford to turn the heat up that I was able to cover it all and that I could pursue the problem to its final solution.
abscess · surgery

8 Weeks!

Yesterday morning was Tristan’s 8 week check, and it went spectacularly all around. Vet was thrilled with his foot, with the care, and really with everything. She was not terribly worried about the crack in his foot.

The farrier is on his way back from Florida right now, and as soon as he arrives back in Vermont he will trim down Tristan’s front feet, put his shoes back on, and then Tris is cleared to go back under saddle!

Possibly just as exciting, no more wrapping! I will spray some AluShield on the hole to form a barrier, and flush it regularly to clean it out and keep it pretty good, but at this point it can grow down and heal on its own.

I’m excited to ride again, and I’m excited to start getting the sole of that foot in better shape. It’s really bad right now – crumbly and soft and just gross. I’ve ordered some Durasole to use on it to start toughening it up, and I’ll probably also do some thrush treatment on it. The LF foot responded quickly once I started treatment; I expect the RF will as well.

Here’s a comparison shot to show how far the original abscess hole has grown down, and to show the nasty crack:

And here’s the bottom of his foot. You can see some of what I’m talking about with the sole!

abscess · pedal fracture · surgery

Sea Change

Wow. I’m not even sure how to start this post. Begin at the beginning I guess?

Before I do, here’s the very short version: Tristan has a pedal fracture of the coffin bone that is badly infected and likely has been for some months. He will have surgery for it on March 4, a week from Monday, and if that goes well he has a very good chance of returning to riding sound.

Long version.

Item #1 on my to do list came back quickly. My vet heard from the consulting radiologist first thing in the morning on Thursday and called me at around 10:30. She told me his findings: pedal fracture, with infection and bone loss. Tris would need to start on antibiotics ASAP, and would get a hospital plate put on in the next few days while we tried to decide – with more consultants’ help – if he would need surgery.

Here’s what the radiologist report actually says:

Along the dorsolateral solar margin, there is a triangular, moderate sized fracture fragment. The margins of the distal distal phalanx are moderately irregular. A focal area of osteolysis is present, medial to the osseous fragment. Smaller rounded osseous fragments are present along the lateral solar margins  A long toe conformation is present that is slightly concave along the distal dorsal aspect.  There is a small amount of gas tracking between the sensitive and insensitive laminae.  

The navicular bone is within normal limits.  The remaining osseous and soft tissue structures are radiographically normal. 

Here’s the view that made him say that. You can see the triangular fracture fragment pretty easily in this picture, as well as the irregular margins. Osteolysis is a fancy word for bony changes, which you can see between the fragment and the rest of the coffin bone. The “smaller rounded osseous fragments” are bone chips.

Long toe and concavity is something we knew we had, and that’s been present practically since day one of the abscess. The gas tracking is also due, presumably, to the massive hole of the abscess. You can see both in this side view. This view was taken before a second, more aggressive trim of the toe that we did based on the x-ray, so the long toe was corrected.

Finally: hip hooray for everything else looking ok!

I sent off the x-rays from June and September and the radiologist saw the pedal fracture on both. He also guessed that the infection in the coffin bone has been going on for some time, based on the amount of bone loss. Which leads to the chicken or the egg question: did he abscess because of the fracture & infection, or did the infection come only with the abscess, or was the abscess incidental and confusing?

I drove out to the vet’s house Thursday night and picked up the antibiotics – enrofloxacin, trade name Baytril, which seemed a good combination of easy to dose, easy on his body, and broad-spectrum enough to fight the infection and get down into his foot. I stopped by the barn afterward to leave the drugs, dosing instructions, etc., and to cry all over him.

Friday afternoon I heard back from the vet, who had a long talk with the surgeon at the Vermont Large Animal Clinic in Milton, VT. They recommended surgery without question, and offered to take him the next day – Saturday morning. The vet was headed out of town the following week but would be back and take him first thing the day he got back, Monday, March 4.

My vet said she felt comfortable with his diagnosis, liked him enormously as a surgeon, and sent me the original files of everything so I could send them down to Tufts to get a second opinion, just to be neurotic. I trust her enough that I have made the appointment at VLAC and spent about half an hour talking to the surgeon’s intern (who has discussed the case with the surgeon, who was not available at that moment), who was extremely nice and able to answer all my questions.

VLAC wants him to go home in a boot, so I called the EasyCare company and they recommended their EasyBoot Rx. I’ll measure him tomorrow and order them first thing Monday morning. I did email VLAC back to gently question the boot v.  hospital plate aftercare, as everything I’m reading (I know, I know, armchair owner) recommends immobilizing the foot with a hospital plate instead.

He’ll go in at 1pm on Monday, and stay overnight. I’ll bring him home on Tuesday. He’ll have a minimum of 6 to 8 weeks stall rest while he heals. The good news is that he has a decent chance of coming sound enough for riding if the surgery is successful, and they’ve done this surgery before and are confident in it.

So…here we go.

abscess

To Do List

I do best with lists. Ideally, lists full of action-y things that I can do. So here’s my list:

1. Vet has sent Tristan’s radiographs out for consult, with comparatives from past views. We should have an opinion within 48 hours.

2. I will call our vet from MA and lay out what’s happened since we left and see if he has any ideas based on what he saw of Tris initially.

3. Vet will look at Tristan tomorrow, Thursday, and block his foot to make 100% sure where the lameness is coming from.

4. I’ll talk to her at that time. I’ll get her ideas on what she sees, and float the following ideas by her:
a) should we cut his grain and/or switch to a low-carb grain just in case he is having laminitic flareups? (absolutely no other indicators that this is the case, but I can’t think of anything else that would be causing periodic heat + lameness)
b) should we call in another Vermont vet who has ultrasound equipment and take a look at the foot? (said vet also specializes more in sporthorse lameness)
c) should we alter his turnout schedule in any way? (stall rest or 24/7 – the latter of which would theoretically be possible at our current place, but not without some negotiation.)

5. I will sit down probably Thursday night or Friday night and make a detailed, blow-by-blow chronology of everything that has happened. Luckily, I keep really good records, so this should be nothing more than a research exercise, rather than a reconstruction. I’ll email that to the vet so she has the full copy, keep it updated in case we go to the other vet.