Back to Work!

Tony came to ultrasound Taco this week.

He also palpated and flexed the leg.  All looked good!  Taco jogged very energetically, so to speak-- there was plenty of mane-tossing and strutting.

We sent the images and exam results up to Duncan Peters, who gave the OK to start legging up.  Starting this coming week, we will walk 30-40 minutes a day and trot 5 minutes.  After that we will start increasing the trotting.  If all goes well, we can maybe canter in 8 weeks.

Doc is still being his lovely little self.

I was laid up for January myself, and I have been riding again since the end of the month.  But all three of us-- Taco, Doc, and me-- are back in action now.  We are ready for 2012!

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!!

Taco's Treatment... and mine (thanks Doc!)

I've covered many miles since my last blog post: a conference and visit with family in New England, a trip to Lexington with Taco and Carol, and most recently a trip to Atlanta to pick up a temporary addition to the Team Taco family.

I hated to leave town while Taco was in the acute stage of his injury, but I had committed to a conference for work nearly a year earlier.  So off I went, leaving Taco in the capable hands of Amy, Kate, and Terri.  Amy iced his leg twice a day with a cold pack that we kept in the fridge that Terri generously brought to the barn.  She kept the leg wrapped when it wasn't being iced, and also did (and continues to do!) Taco's extra stall cleanings.  She also met Dr. Tammy Perkins, our rehab specialist who came to treat the tendon with a laser while I was away.  Terri brought an extra little fridge (with a freezer!) for the ice pack, and took Taco on what she calls his "walking picnics" (hand grazing with a good bit of walking) each day.  Kate took him on short hand walks at feeding time late in the day, and also does some of the extra stall cleanings when Amy is away.  It truly takes a village and I was lucky to have these three devoted friends helping us out!

Immediately after I returned last week, Taco, Carol, the dogs, and I climbed into my rig and made the 4.5-hour trip up to Lexington, Kentucky, to the Sport Horse program at Hagyard Equine Medical Institute.  We went for a consultation with Dr. Duncan Peters, the same vet who volunteered at last fall's Midsouth T3D.  Dr. Peters did a brief lameness exam (news flash: Taco was still lame) and then brought him into the climate-controlled procedure room for an ultrasound.  To my dismay, the lesion in Taco's superficial digital flexor tendon was even bigger: almost 30% as opposed to the 5% that it was on Dr. Tony's ultrasound ten days earlier.  Dr. Peters explained that it is quite common for tendon injuries to grow as damage continues after the first insult.  I am very grateful to Amy for icing that tendon twice a day! In better news, he confirmed that there is no damage to the suspensory in that leg, putting my mind to rest.

Dr. Peters then outlined our options, and we decided to treat the tendon in two ways: with Platelet-Rich Plasma and stem cell therapy that will be grown from his bone marrow.  Both of these are in addition to the rest, non-steroidal anti-inflammatory medications,  and controlled exercise that are part of the traditional treatment for a tendon injury.  Dr. Peters extracted some bone marrow from Taco's sternum, a process for which Taco was sedated and given local anaesthetic, and it has been sent off to the laboratory at Cornell to grow the culture.  It will be sent back after a total of 3-4 weeks, and then we will all make the trek back up to Hagyard again so that the treatments can be injected into the injured tendon.  Taco's prognosis is good, according to Dr. Peters, but it will not be until the end of this year or the beginning of 2012 than he will be back in full work. 

Feeling verrrry sleepy for his procedure...

So, in the meantime, Taco is still hand-grazing.  I bought him an Uncle Jimmy's Hangin' Ball, which he consumed in less than a week, and I am trying to keep him to a routine of grooming and walking.  Amy has put up a small pen for him that has grass for now and allows him to spend time outside without being able to run. 

This view is becoming extremely familiar to me

Unfortunately, during the time that I have been working on this blog post, we have encountered a few potholes in to the road to recovery.  First, the skin just above the tendon injury blistered and developed a sore.  It's needed careful wrapping that doesn't put too much pressure on that spot but keeps it protected.  Next, he stepped on a nest of yellowjackets at the end of our evening grazing session yesterday.  He was grazing happily, and then started frantically stomping that left hind... the one with the injury.  I saw an insect flying around that leg and thought it was a bot fly at first.  But then a yellowjacket landed on my arm and I realized what had happened.  We beat a hasty retreat back to the barn, where he stood on three legs and dangled the left hind miserably, barely allowing me to touch it.  And the front of his leg, the side with the three-year-old scarring on it, had a pink raw spot where one of the scars was.  Oy, vey.  Icing and wound cream and oral tri-dex ensued... and several hours later it was clear from the swelling that he'd been stung on the inside of his ankle and possibly on the front of the cannon bone.

We hit the third pothole this morning.  The sting swelling seemed to have gone down, so I was feeling better. We grazed and then I groomed him and led him into his stall.  Now, every pony clubber knows to turn around once she's led a horse into a stall, so that the horse's head points toward the door.  I did not do this.  As is my habit, I led Taco over to his hay corner and removed his halter there.  He then spooked at a white milk jug that I'd placed in his stall as a toy, wheeled, and clattered down the barn aisle and outside.  I had a brief, cruel moment of hope that he would let me catch him when he paused to greet some pastured horses.  But it was not to be, and soon he zoomed to the top of the largest pasture on the farm.  I followed, swearing copiously.  I got within 15-20 feet of him and off he went again, back to the bottom of the field, where I'd had the presence of mind to latch the gate.  One more brief run and then I caught him, to my relief. 

Is the tendon damaged even more than before?  I don't know.  I did not see any additional swelling or feel additional heat.  I did a couple of icings, and Surpassed the whole thing, and wrapped it.  We'll see what we have tomorrow morning, and I will call our vets to let them know about this development and ask whether I should do anything else.  And does anyone have ideas for alleviating stall rest boredom?

All of this has been admittedly stressful, and my usual way of handling stress is to ride.  Since Taco will not be able to be ridden at all for much of this summer, and when he does return to work, he will only be able to walk for at least the first month, I was horseless.  Fortunately, my friends have come to the rescue again with offers of horses to ride.  Eventually it worked out for me to borrow another horse from Annika, Taco's past owner.

Meet Doc.

(sorry about the dust on the lens)

He's a plain bay, ten-year old OTTB (off track Thoroughbred) who is the sweetest soul.  He was temporarily down in Atlanta with Team Taco friend Lynda, and he needed to get back to Michigan, and we all thought it would be wonderful if he stopped off in Tennessee to keep me company for a little while.  He arrived on Wednesday, and so far we've done some easy flatwork and hacking with Terri and Truman.  He is lots of fun.  I'm so grateful to Annika for lending him to me-- he is a bright spot of fun in what have been a few weeks of roller-coaster riding.

The bay boys together again