Category: surgery

adventures with the vet · shoes · surgery · Uncategorized

Footgate 2018, the continuing saga

Amanda6 Comments

So. You probably forgot (I know I was trying to) among all the OTHER things that have gone on in the last three months that as of August, Tristan is back in shoes. Which is both budget- and soul-crushing for me.

The good news, I guess: they’ve worked exactly as they were supposed to. He’s clearly a touch more comfortable (not, like, dramatically, but he’s got a bit more float in his trot, and he’s a bit more willing to go forward). And his foot is clearly more stable.

When he was at the hospital, we had the surgeon (the same one who did his surgery 6 years ago) look closely at the foot with an eye to everything we’ve been talking about.

The surgeon’s takeaway was that he wasn’t surprised at all that the sole was growing back differently; that was just an inevitable consequence of surgery on the foot.

Interestingly, though, is that he was not nearly as concerned as the farrier was about the line of bacteria that was getting up into the foot. He felt that unless and until Tris was lame he would not worry about it.

img_4451

I’m not entirely comfortable with “horse goes lame” as an indicator of problems when we have visual evidence for impending problems, but it’s at least a useful thing to keep in mind for how far we have to go before we start to really freak out.

So we’re still on the wait and see path. Specifically, we’ll wait until the foot grows back down to the toe with decent sole again, filling in the hole that the farrier had to keep cutting back. Then, once it does so, we’re going to sale the toe with Hoof Armor.

Image result for hoof armor

Farrier is a touch skeptical. I did a fair amount of back-and-forth emailing with the company owners and some sleuthing in endurance forums (where this product is most frequently used) and I think in our conditions, for our application, it has a decent chance of success.

Though it’s intended to protect sensitive soles on tough terrain, we’d be using it to simply create a barrier between the ground (and bacteria) and the funky scar tissue spot on his sole. The hope is that re-applying it periodically will keep it refreshed. It’s supposed to last from trim to trim, but I’m not counting on anything. If need be, I can rasp it off and re-apply every two weeks or so.

We’ll see. I’ll definitely report back whenever it is we get to this point – it will most likely be later in the winter, as he’s got a decent amount of sole to regrow.

In other foot issues, his hind foot heel grab is healing up more or less fine. Some proud flesh, but the nascent infection has been kicked to the curb. I’m still re-wrapping every two days and swapping back and forth between the antibiotic cream and the steroid cream, like we did with the front foot. So far our theory of “it will heal better if we jump on it quickly and it’s not so damn hot and humid” has proved true. Like the front foot, he hasn’t taken a lame step on it. Except when I scrub it down before re-wrapping (which I’m sure stings) he doesn’t even know it’s there.

Bottom left is last Friday. These were taken roughly at each re-wrapping so represent about 10 days of healing. WAY faster than the stupid RF.

 

 

horse finances · lasik · surgery · Uncategorized

The Best Money I’ve Ever Spent

Amanda8 Comments

I had Lasik surgery about 10 days ago. I’m going to do a whole wrap-up post about it next week, after I’ve gotten a few rides in and can report reliably on that part (because when you google “Lasik + horseback riding” there basically crickets? which was not helpful for my brain?).

Lasik is not generally covered by insurance, which means that I paid for the surgery out of pocket. Or, more accurately, I arranged for financing through Care Credit, and will be paying for it for another ~18 months or so. I planned carefully, did my research, evaluated my budget, and felt comfortable taking on that amount of debt for that amount of time.

A lot of people have asked about the money part. Honestly, it’s pretty much in line with any other surgery. I didn’t find it agonizingly expensive, not for the return on investment. But the reactions veer between “that’s so expensive, I can’t believe anyone would spend that!” and “isn’t it the best money you’ve ever spent?”

I’ve thought a lot about that in the last few days, for some reason. Yeah, I’m happy with the money I spent! Seeing clearly for the first time in my life is pretty great!

But is it the best money I’ve ever spent? For some reason, that question – which was surely intended to be rhetorical! – has stuck in my brain.

No, it’s not the best money I’ve ever spent.

I have an easy answer for the best money I’ve ever spent: Tristan’s coffin bone surgery.

img_3394

almost exactly six (!) years post-surgery

If you tally up the actual procedure + hospital stay, it cost almost exactly the same as my Lasik surgery. If you include everything related to that injury it was 50% more, over the course of about nine months.

It was life-saving surgery. Not at the time – he wasn’t going to keel over – but surely it was a matter of time before the infection in the bone went septic and then systemic. Certainly he would never have been sound again if it had chewed away more of the coffin bone.

So, yeah. Easy call. Keeping him alive, sound, and happy was an easy call, financially. It certainly helped that I had an emergency fund that covered the surgery + vet bills, and steady employment that assured me of replenishing the emergency fund, but even if I’d had neither of those things, it still would have been an easy call.

But the average person who asks me that question does not want to hear about my horse, much less his surgery, so I usually just smile and say “it’s pretty great!”

abscess · blog hop · surgery

TOABH: Costly

Amanda4 Comments

What has been your horse’s most expensive injury to date? Let’s exclude maintenance things, like hock injections and the magical monthly package of MSM. What single episode blew your savings or left you boiling ramen? If you want to get technical about it, time is money, too.


hahahahahaha.
 
ha.
ha.
I’ve covered this at length in the blog, but for newcomers, here’s the short version. In August 2012, Tristan blew his first ever abscess. It was really bad. He blew at the coronet band, and then at the toe, and then a few weeks later midway down the hoof. Cue 6 months of NQR; he would almost come sound, and then he wouldn’t. On and on. In March, he had surgery to remove the cause of the abscess: a bone chip from his coffin bone that had become badly infected, as well as portions of his coffin bone that had died from infection. Upon recovery from that surgery, which took months (if we’re counting the time back to normal hoof status), he came sound and has been ever since, though I would not call him 100% recovered – he still has to wear front shoes to keep that foot stabilized, because it is still not growing evenly enough to stay balanced barefoot, 2.5 years later.
Here’s what I call the foot progression collage: photos taken at monthly intervals from initial abscess to final recovery.
And here’s the post where I broke down and tallied up every penny I spent on that injury and what it went towards (three sets of x-rays, supplies, surgery, umpteen vet visits, specialty shoeing, the whole nine yards). So, to answer the original question: $6,100.08, which does not include lost opportunity costs or even begin to approximate time.
If you’re really feeling in a reading mood, check out the abscess and surgery tags. Dozens and dozens of update posts there.
abscess · adventures with the vet · farrier · surgery

What the Vet Found

Amanda5 Comments

You may remember that about three weeks ago, my farrier raised some concerns about the way Tristan’s RF was growing out and healing. Based on his experience, he felt very strongly that Tristan had a keratoma growing within his hoof.

Yesterday, I arranged for my vet to meet my farrier at the barn, and we did a full workup on Tristan. I also had a list of other concerns; I was worried that his topline wasn’t building the way it should, and wanted to ask about supplementing with alfalfa cubes, and had a few other miscellaneous questions. (The most important answer: yes, you can add bute while a horse is on Pentosan.)

Waiting for the vet.

We started by longeing him, and I explained that I felt he was actually moving pretty well: lazy, but evenly and without obvious hitch. Slightly stiff, and tracking ever so slightly behind on the RH, but nothing that would even rise to the level of concern. We walked, trotted, and cantered, and then tested the trot/canter transitions. Then the vet took him in hand and spun his hind end to watch how he crossed over.

We did not flex. I can practically guarantee that Tristan would not flex clean, and to be strictly honest? I don’t need him to. He is functionally sound and comfortable in the level of work he does. I’m still not sure if he’ll jump again, and he certainly won’t ever get to the level of dressage work that would require the carrying and thrust that would start to trouble him.

The vet agreed with me that he looked pretty darn good in his movement. Certainly he was just fine on that RF.

What’s the catch? Well, when I asked about his topline, and we brought him out into the sunlight, the vet was immediately concerned. Keep in mind she saw him in March for spring shots, and before that in the fall, and then the previous summer and spring every 2-3 weeks for surgery follow up. She knows him pretty darn well, and she’s a brilliant vet with an excellent diagnostic eye.

She didn’t even hesitate. “I’m pulling blood right now, and we’re going to test for Cushings. Even if he doesn’t test positive, I’d like to start him on Pergolide. He looks terrible.”

Keeping in mind that my vet is very blunt! Tris does not look like the picture of your typical Cushings horse, but he is 19 and he has a distinct lack of muscling on the topline. When we tossed the idea back and forth, other things fit with the picture. He’s been urinating much more than usual over the last 6 months. He’s been coughing more often in warmup over the last 2 months.

It’s very early days yet, and Cushings is a very manageable condition. We should have results back next week. If his levels come back totally normal, the vet wants to pull more blood for general CBC panel and make sure everything else is adding up for him.

PSA moment: yesterday was a perfect example of why you should have a vet take a look at your horse once or even twice a year. I had a vague, pit-of-my-stomach feeling that things were not trending well with Tristan, but it took the vet who hadn’t seen him in 4 months to immediately recognize the changes that had occurred in those 4 months. She had passed him with flying colors in March – even making a point of saying he looked terrific – and was able to clearly compare the horse in front of her with Tristan from March.

I admit, I was reeling a bit from her immediate diagnosis and all the research I was going to have to do to start managing him, and then we moved into part 2 of the day’s fun and games.

The farrier and vet first conferred about why the farrier suspected a keratoma: the bulge in Tristan’s hoof, and drainage holes at the toe. Farrier pulled the shoe, and we set down to work to take some x-rays.

Farrier had these super-nifty lifts rather than the vet’s blocks!
We spent a good 20-30 minutes taking shots, looking at them closely, and then taking more shots from different angles. Vet needs to take a good long look at the x-rays at home, but on initial examination, everything looks clean.
Here’s the neat thing: the farrier was 100% correct in what he detected. What he did not realize (or did not remember – since I had sent him the surgery x-rays before) was that Tristan’s coffin bone was already compromised, that it had been carved up quite a bit during the surgery. The farrier was absolutely spot on in recognizing the subtle changes that came in Tristan’s hoof once he was missing a piece of his coffin bone. I already knew I really liked the farrier, but I am HUGELY impressed.
What we’ll have to do is compare the x-rays the vet took with the immediate post-surgery x-rays to make sure there is no additional bone resorption or remodeling. Vet and farrier both agreed, however, that if a keratoma really had formed at the coronet band and traveled down to the dark spot on the x-ray, Tristan would be very lame, and he’s just not. 
VERY good pony getting his shoe back on.
The one remaining question mark is the drainage holes in Tristan’s toe. They definitely shouldn’t be there. They are tiny, but they are there. I offered to soak, and vet and farrier thought that wouldn’t do much good. The farrier ended up packing the toe with Magic Cushion and putting the shoe back on. Vet said that if Tristan does come back positive for Cushings, that would explain why the drainage holes aren’t closing – his immune system is compromised. 
So here’s the takeaway:
  • his foot is almost certainly fine, whew
  • he almost certainly has Cushings, in the very early stages
    • bloodwork will come back next week, and then we will start him on a low dose of pergolide
    • I’ll take an in-depth look at his diet and most likely switch his grain. Right now he’s on Blue Seal Sentinel Senior, which I mostly like – but which according to some internet sources is fairly high in NSC, which he’ll have to stay away from. Look for research posts about this in the future.
farrier · shoes · surgery

Feet Update – 1 year post-surgery

Amanda4 Comments

I missed an important milestone last week: one year since Tristan’s surgery. One year ago today, he was on stall rest in recovery, and now he is back in full work. I am amazed and indescribably grateful that everything worked out so well.

Here’s a front foot comparison, for the record.

1 week post-surgery. The chip out of the front separated during surgery;
there were additional abscess holes at the top of it and the hoof wall
was just that weak.

Yesterday! The bit of white is the absolute last remaining sign of the surgery/abscess.
You can still see/feel a sliiiiiight bulge but it is continuing to fade, ie far less
noticeable at the coronet than at the toe.

 Also! Remember last summer how worried I was about white line in his hind feet? I could carve out chunks of his quarters and his white line with the hoof pick, it was that mushy. Check out his hind feet today. Gorgeous.

In late April, the shoes come off the front feet and we are back to all-barefoot, all the time. FINALLY.

product review · surgery

Product Review: Easy Boots Rx

Amanda3 Comments

EasyBoot Rx

After Tristan had his surgery, the debate was between hospital plate and hoof boot. Hospital plates are a special kind of shoe that supports a flat piece of metal that covers the bottom of the hoof. They’re protective and supportive.

However, in those days, Tristan’s hoof was actually open on the front as well (see the foot progression collage for an example of what I mean) and needed protection all around.

The vet clinic recommended these EasyBoots, so I measured away and ordered them. He wore them 24/7 for 8 weeks on both front feet – both shoes were pulled and we wanted to keep them even so there was no compensatory lameness. The first 5 weeks or so were entirely on stall rest, and the remaining three were on limited turnout in a small gravelly area. His RF (the surgery foot) was wrapped 24/7 under the boots.

I ordered two size 4 boots, which were the correct size for him, but had to buy a size 6 from the vet clinic – in the first early weeks, we were wrapping his foot with multiple layers of gauze, vet wrap, and then Elastikon on top of that. Eventually we transitioned down to the 4 on both fronts.

Pros: they were really easy to use, opening up in the right way and sliding on. Sometimes it wouldn’t settle 100% on the hoof but usually asking him to pick his foot up and put it down again fitted the hoof right in. They do exactly what they are advertised to do, and it was rare for me to find even a shaving down inside. He only pulled them off once or twice. They function very much like the SoftRides and are a much better price (usually running about $75 per boot, as opposed to $200 per pair). They are also sturdier than the SoftRides and can be used for limited turnout.

Cons: they are not really for turnout. Wear & tear accelerated significantly when Tris started going out a little bit. The elastic that tightens the top of the boot wore out relatively quickly, but I was pulling it extra tight to try and keep more of an antiseptic environment. The boots weren’t exactly going to fall off, but there was noticeable stretching. The fabric tore a bit in the area where the two pieces come together – you can see it in the bottom left of the photo above. They MUST be worn barefoot – a shoe would have shredded the inside of the boot in short order.

My biggest complaint: those air holes? Did not work AT ALL. His feet were constantly damp. I tried shaking in talc powder to soak it up and that mostly created a paste inside the boots. His soles and frogs were a wreck after 8 weeks, because they were constantly steaming. Thrushy and mushy. I had to do a fair bit of remedial treatment to get them back online after he came out of the boots. He was just standing around his relatively clean stall, too – at no point did these boots EVER come in contact with serious moisture. If he could have spent even a few hours out of them I think that would’ve allowed everything to dry out, but he couldn’t. Better than the alternative of re-infecting the surgical wound, but the moisture was a constant battle.

In conclusion: these do what they say they do, and for a decent price. They are useful if you find yourself in a situation that requires therapeutic booting.

abscess · chores · farrier · surgery

Whew

AmandaLeave a comment
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

Amanda5 Comments

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.
farrier · rehab · surgery

The State of the Foot

Amanda1 Comment

I’m not saying I won’t be checking back in with pictures of Tristan’s foot as the last of the awfulness grows out, but these are the last for a little whole. Here’s what his right front currently looks like, after the farrier worked his magic.

HOW AWESOME IS THAT?
We had our fourth ride tonight, circles and one or two lateral steps in the ring then a walk up the hill and around the dressage ring, back down the hill and a few more minutes in the ring. He will get tomorrow night off, as he was a bit tired tonight, and on Saturday we bump up to 30 minutes.
Here’s my view these days.