The Five Stages of Lameness Rehab

Readers of Team Taco might be familiar with the Kübler-Ross model of five stages of grieving. Originally developed by sport horse veterinarians for helping their clients through the process of lameness rehab, the model was adopted by the psychology community to be applied to terminally ill human patients and grieving loved ones.

Here, however, I resurrect the theory as it was first designed.  It is important to remember that not all owners will experience all stages in the order in which they are presented.  Indeed, swings from anger to acceptance to denial are not at all uncommon.  All rehabbers, however, can expect to experience at least two of these stages.

1. Denial
Riders, upon hearing the news of a horse's season- but not career- ending injury, are often oddly cheerful.  This is temporary.  They may make comments such as, "it's only a 20% tear, thank goodness-- he'll get better in time for that fall destination event!" or "I'm really OK with this because I needed more time to take up scrapbooking/ knitting/ spelunking," or "think of all of the flatwork we can get done!" The horse's mane remains pulled and the tail clipped and banged.

2. Anger
As the reality of the horse's injury becomes evident, the formerly cheerful rider becomes rageful and bitter.  "But he was so fit-- how could he have pulled that?" "What on earth was he thinking, screaming around the corner of his pasture like that?" "Why do I get all the accident-prone ones?" This is the stage during which the rider or owner is less-than-perfect company, due to tiresome self-pitying and indignant tirades.  He or she might respond disproportionately to the slightest setback: for example, one particularly disturbed rider was reported to have lost most of her hair because she tore it out upon hearing that her rehabbing horse trotted two steps and then bucked in place-- twice-- in his tiny outdoor pen.

3. Bargaining
This stage seems entirely reasonable at first.  In exchange for money, the rehabber obtains a diagnosis and treatment plan from the veterinarian, stall toys for the horse, and extra services such as hand walking, wrapping, wound dressing, stall cleaning, and cold therapy.  As time goes on, the rider begins to believe that the more money that is thrown at the injury, the faster it will heal.  Expensive consulting veterinarians are brought in to perform expensive treatments.  Fancier toys are placed in the stall, and failed attempts are made to pay others to ride the pent-up mount on her rodeo sessions controlled exercise rides. Meanwhile, the horse heals at her own damn pace (see Anger, above).

4. Depression
Eventually our rehabber comes to the realization that the season is definitely over, the horse is bored out of his skull in the stall and there is nothing she can do about it, and she is broke.  She might observe friends driving off to competitions and returning with stories of adventure, or find herself obsessively checking the competition organization's website for next year's show dates, and find that both leave her numb and unfulfilled. Responses might include endless Facebook and horsey bulletin-board surfing, considerations of quitting riding, ice cream and cookie binges, or the refusal to get out of bed.  The horse's mane gets long and shaggy and her tack grows mold. It is important to treat the rehabber with sympathy and understanding at this time, and not try to talk her out of this difficult, but all-important stage.


5. Acceptance/ Resignation
This is the crucial stage in which the rehabber comes to the understanding that she must rehab the horse step-by-step, literally.  She purchases a new stick of Sadl-Tite, puts the horse on a calming supplement, and surrenders to the simultaneous boredom and excitement of thirty minutes of walking a fresh horse on straight lines in a lovely November cold wind breeze. When she is bucked off, she dusts herself off and catches the horse, carefully examines the injury for signs of relapse, then gets back on. Eventually, the horse returns to full work, and the rider's mental state begins to heal too.  Only residual effects remain, such as panic attacks over imagined swellings in the injury area, and a somewhat annoying habit of recounting the story of the injury and treatment for any hapless interlocutor. 

*With a nod to Not That Kind of Doctor!

Heal, Taco, Heal!

Last week Taco and I drove back to Lexington for his stem cell and platelet-rich plasma (PRP) injections.  His bone-marrow stem cells grew very well at the Cornell lab and he had them injected just 2 weeks and 6 days after they were extracted.

We had a somewhat adventurous trip up.  First, we hit traffic in the construction on I-65 in Kentucky.  NOTE: if you are traveling this route, I strongly recommend that you consider an alternate route-- either 31E or 31W-- between Horse Cave and Elizabethtown!  You can use the traffic function on this map (on a laptop, tablet, or smartphone) to help determine where the traffic is and where to start your detour.  I took 31W home this time between Upton and Munfordville, thus sparing Taco the experience of sweltering in the trailer as we inched along.  But on the way north, I ran smack into the delays.

Having finally gotten free of the traffic, I was merrily motoring along when I heard a WHOOMPH! noise from behind me, and looked in my mirror in time to see my trailer's fender spinning through the air.  I didn't register what it was at first, but as I continued to look in my side mirror I realized that I could a) see the tires and b) one of the tires was completely shredded.  This was the bad news.  The good news was that it hadn't caused an accident and I was half a mile from an exit-- an exit that had a truck repair shop, as it turned out.  First I pulled into the lot of the shop and changed the tire.  But then, when I asked the shop if I could air up my spare, they said that they actually had an identical tire to the other three on the trailer.  So I had them take the spare back off and give me a brand new one.  Taco was very, very patient through this whole ordeal.  Aside from pointedly ignoring the attentions of the nice repairman, he was a perfect gentleman.

 

 

That is one jacked up trailer.

We got back on the road and reached our destination, our friend Sarah's farm, a couple of hours later than intended but safely.  Taco enjoyed a night of luxury in her beautiful barn.

Taco to his host Tristan: "nah nah, I got to stay in your stall last night!"

Then we headed over to Hagyard.  Dr. Peters drew some blood, which he then sent to the lab to be spun down into the PRP. Then Taco was brought to the treatment room, sedated, and re-scanned with the ultrasound.  To my relief, no additional damage seemed to have occurred from the unauthorized self-turnout of the previous week. Dr. Peters carefully chose several injection sites and clipped the hair off the leg, and then Bree, his skilled technician, scrubbed Taco's leg for a very long time.

Then Dr. Peters injected some local anesthetic (as with the local for his bone marrow extraction, Taco did not like this at all).  In both cases, however, he didn't seem to notice the extraction/injections themselves.

Stem cells on the left, PRP on the right

By this point, the PRP was ready and it, plus the stem cells, were combined together in five syringes, ready to be injected.  Bree held the ultrasound probe so that Dr. Peters could see exactly where he injected the stem cell-PRP concoction. 

He explained that research seems to indicate the two types of treatments work synergistically, with the PRP providing growth factors and "scaffolding" and the stem cells providing healthy new cells.  He was very pleased with how the procedure went, and after the injections were complete, he showed me on the ultrasound how the concoction had distributed itself all along the tendon.  Taco's leg was wrapped up and he went back to Barn 2 to wake up from his sedation.

I'm awake-- can we go home now?

We loaded up and headed home that night (making the aforementioned detour around the construction).  Taco will be on 60 more days of stall rest, with an ultrasound recheck in 45.  Hopefully, at the end of those 60 days he will be able to begin some controlled exercise. In the meantime, he's continuing his hand grazing routine.  He's not thrilled about it, but he is remarkably patient.  I, on the other hand, find that patience is very difficult. C'mon Taco, heal!!

Cross Country School with Doc

Last week I had my first lesson and first cross country school on Doc.  I'd already been enjoying him because of his willing and fun attitude, and both Amy and I were very pleased by how capable he was in the lesson and at the schooling.  Annika has a great eye for a horse and Doc is a great testament to that fact.  I'm thanking the universe for bringing his and my paths together at this point in time.

In my lesson last Friday, Amy and I were very encouraged by his willingness on the flat and over some low jumps.  We worked on lengthening his stride and his neck, as I found that it's easy to shorten both.  He can almost canter in place-- it's truly amazing!  But he also has a lovely long TB stride, we discovered.  These things make him very adjustable, which is pretty cool.

Then we went to Colonial Hill Farm in Pulaski for a little cross country school. 

The owner, Eleanor Parkes, has dozens of well-built fences from knee-high to training, which was perfect for our initial xc experience together.  Doc stepped off the trailer and looked around with calm curiosity.  I tacked up and hopped on-- and he remained calm, willing, and interested in what we were doing.  And his jump!  He thought that the BN-N-level fences that we were doing were quite easy, and just skipped over them in a lovely, balanced gallop.  I had a ball!  Here is a video of him in action (thanks Carol!):



I felt so lucky to be enjoying cross country on a lovely horse just one month after Taco's injury-- I had thought that it might be up to a year until I next had the privilege. 

Isn't this fun?

Taco himself is still recovering.  There was no new heat or swelling after his unauthorized "self turnout" episode last weekend, and the swelling from the yellowjacket went away in a few days.  The sore over the tendon remains, but has gotten much smaller.  We got word that his cells are ready to be shipped back to the clinic this week, so we are planning a trip back to Hagyard to get them injected.  The only problem is that the sore must be healed in order for the injection to be safe.  I'll find out more in the next 24 hours about when we might be able to go-- it could be as soon as Wednesday, but might be later.

Today Carol grazed Taco while I rode Doc.  It was a very lovely Fourth of July morning at the barn. How I wish that Taco was his usual healthy self, but how fortunate I am to have him and my supportive family-- and that includes my horsey family too.