Consult with the Surgeon and Lexi

December 2012
I trailered Lexi to the surgeon's office where he carefully examined her right hind fetlock and did a lameness exam to see if she would be a candidate for surgery.  He had me walk and trot her in hand on the asphalt driveway so he could see how she was moving and stepping on that leg.  He also did a flexion test by holding the leg up and putting pressure on the fetlock for a minute or so, then had me trot her down the driveway again.  I could tell that she really limped after the flexion test.

The last thing that he wanted to do to make sure that it was only the bone chips bothering her was a fetlock block.  This is where the vet does a hock injection that makes the horse's fetlock numb, then determines whether or not there is any improvement in their way of going while the pain from that specific area is temporarily eliminated.  The criteria is that the horse must show at least 60% improvement in soundness while the effects of the bone chips are "blocked".

After the injection, we had to wait for 30 minutes for her hock to get numb.  We walked around a little bit and I let her eat some grass to pass the time.  The surgeon examined her again and we did the same tests as before; walking, trotting and another flexion test.  She did show a lot of improvement and the surgeon was satisfied.

We talked about the surgery, recovery time, and whether he thought it was the right thing to do.  I know that it is.  I know that without surgery her condition will only get worse, and she'll have a poor quality of life.  He agreed, and I scheduled the surgery that day for January 28.

In a nutshell, this surgeon charges a flat rate for everything.  $1800 for the surgery, anesthesia, medication, and an overnight stay.

Recovery time would be two months, best case scenario.  Four months, worst case.  Lexi has a stall with paddock, so we will have to block off the paddock and keep her in her stall for the next few months to avoid injuring the fetlock.  During the first two weeks, she will be able to come out briefly to get brushed or graze a little, but that's it.  After the stitches come out, I believe we can start hand-walking, but I'll get full post-op instructions after the surgery.  It will be a minimally invasive arthroscopic surgery, and the surgeon said it will take about an hour and a half.

January 2013
So we have been waiting patiently for surgery day ever since.  I am not doing a lot with her, and her condition has gotten worse just in the last two weeks.  She doesn't want to flex the ankle, and at times she'll even try to walk on her toe to avoid putting weight on her foot.  A few weeks back I started her on some Smart Tendon and Smart Calm Ultra supplements, along with her regular Sho-Flex Vitamins, just to pump her up before the surgery.

She was becoming grouchy and fearful from not feeling well.  The Smart Calm Ultra really took the edge off, and it should help her deal with her recovery.  My mom gave her a jolly ball with an attached lick-it for Christmas, and I plan on hanging that up in her stall to give her something to play with and lick while recovering.  I hope it will help her pass the time.  I will be out at the ranch every day for quite some time to make sure she is ok and to get her through her recovery time.  I'm hoping for the quickest possible recovery time, and that we will be riding and showing again by May.

Stay tuned for pictures on surgery day January 28, and when I bring her home the following day.

Introduction

I am starting this journal in hopes that I can help other horse owners with bone chip symptoms, diagnosis, treatment and recovery.

A life-long equestrian and amateur owner, I have been riding and showing horses for 40+ years.  I have competed in western and english pleasure, equitation, trail and halter classes, and I've been an AQHA Member for 20+ years and an APHA Member for 3 years.

I will be writing about my beautiful paint mare Lexi, aka Exclusive Style.  She is an 11 year old, 15.3 hand chestnut overo mare.  I have owned Lexi for 3 years.

October 2012
After lunging Lexi for about 20 minutes, I noticed some swelling on her right hind leg that looked like small, egg-shaped lumps on either side of the fetlock.  The swelling was hard to the touch, and somewhat hot as well, so I cold-water washed it for about 10 minutes then put an ice boot (that I keep in the freezer out at the stable) over the fetlock, and had her wear it for about 20 minutes.

Hoping that it was something fairly minor that would go away with some rest and anti-inflammatory medication, I decided to just let her rest for a while and assess the situation.

I hand-walked her for three days, continuing the cold water washes, ice boot treatments and anti-inflammatory medication.  The swelling did go down somewhat, so I started letting her jog on the line for about five minutes, just for her own peace of mind.

After about two weeks of this regimen I got the lumps to reduce in size, but they were still hard.  I could tell that she had some excess fluid in the fetlock joint.  Still hoping it was a strain or a sprain, as she wasn't too lame on that leg, I decided to give her until November to see if I could get any more improvement out of her.

I continued with the hand-walking, some jogging on the line, cold-water rinsing and ice boot treatments, but after 30 days there was no improvement.

First Diagnosis

November 2012

A vet showed up at the stable one day so I showed her the swelling on the fetlock, and also had her look at Lexi's lip.  Lexi had developed a big, angry-looking raspberry on the side of her lip that appeared to be infected.  The vet sedated her, lanced and cleaned the sore, then cauterized it so it would form a scab.  Lexi had to eat some antibiotic powder for a week and the sore healed nicely.

This sore seemed to have gotten infected because it was so close to her mouth and couldn't stay clean.  I have never had this happen before, but it was an easy fix.

Regarding the fetlock, the vet did not like what she saw.  She asked me to make an appointment to have her co-vet, who was more experienced with legs and joints, take a look at it.

November 6th, 2012.

It was a very stormy day but the vet and I managed to complete a lameness exam and take X-rays of the right hind leg, as well as a couple of extras of the other legs just to make sure everything was ok with them.  The vet studied the X-rays and saw what he said was something very interesting going on with the right hind fetlock.

Something I had never dreamed of; bone chips!  My heart sank as I knew this was not going to be easy.  The vet said that Lexi had a lot of fluid not only in the fetlock, but in both upper hocks as well, probably as a result of shifting her weight onto the left leg for relief.  He suggested some joint injections to relieve the inflammation, and said that he would refer us to a surgeon for a consultation on the bone chips.

What next?

November 8, 2012

The vet came back and gave Lexi three injections in each upper hock and one injection in the right hind fetlock.  The injection consisted of hyaluronic acid, a steroid and an antibiotic.  Recovery from the injections was hand-walking for a few days followed by light exercise.

The injections provided a lot of relief for her, but I knew it was just a temporary fix.

The vets that I had used up to this point were excellent, but unable to quickly refer me to a surgeon so I decided to find one on my own.  I knew a surgeon that I had used in the past, and that I really liked, so I called him and made an appointment for a consult with just me and the X-rays.

December 2012

Went to my vet/surgeon consult December 11 and the surgeon was great.  He spent over an hour with me looking at all the X-rays and pictures of the swelling.  Not only did he see the main chip, he also saw some chip flakes above the main one that I didn't see.  He said that the location of the chips and the hard swelling weren't "textbook", and that he wanted to see Lexi in person before committing to surgery on her.  I agreed, and made another appointment to bring her in.

In the meantime, I researched bone chips in horses and how they occur.  One thing that the surgeon asked me was how this had happened?  I told him that I did not notice anything wrong until the day that I saw the swelling, and that there was never anything obvious like a cut, blood, bruising or any kind of trauma at all.  I have no idea how she developed bone chips in her fetlock.

Bone chips or chip fractures of horse's joints are properly termed "osteochondral fragments".  Osteo (Latin for bone) and chondral (Latin for cartilage) describe the make-up of the fragments that can cause irritation and lameness in a horse's joint.  In horses, the major component of the fragment is normally bone.  Fragments (chips) occur for two main reasons:

1) Defective development of the bone (sometimes called osteochondrosis) where the bone fragments under normal loads; or

2) Uneven loading or trauma to normal bone, where the bone fragments are under uneven pressure.

The chip fractures that cause problems are those that cause debris to be shed within a joint and irritate the joint.  Debris causes acute painful inflammation.  If the debris shedding stops, the joint can heal.  If the the debris shedding is chronic, then arthritis results.  The size of chip can range from small to large, but the size does not matter.  It is the amount of debris that is shed that matters.

Lexi's chip fractures are definitely shedding debris, hence the excess fluid and swelling.  I know in my heart that there is no other option but surgery for her to have a normal and productive life.

To be continued...