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Fred's Blog - Page 3
22nd November 2007
Well the main abscess(es) seem to have healed and stopped issuing pus. He's been out of the boots again but is a tiny bit sore on it this morning (probably as a result of the hard ground from the frost last night) so I've put a boot back on the left fore again just in case. Meanwhile the wall growth coming down from the coronary band seems to be staying reasonably tight to the pedal bone despite all the mechanical forces from the damage below which I'm taking to mean that the laminae are healing well. This is a good sign as it means that I've got the underlying laminitis reasonably under control.
I'm still soaking the left fore with epsom salts because I'm worried about re-infection. The old sole from before the July laminitis attack is now starting to peel off (it's taken longer than I'd expected). There's a small hole appeared in it and underneath is creamy coloured horn that I'm assuming was produced immediately after the attack by the inflammed corium. It's interesting that this horn appears to be unpigmented whereas the sole is normally black. On the other side of the toe, there's more new sole being exposed but this is pigmented. The unpigmented bit is where I think the most damage was done, but why this results in a loss of pigmentation I'm not sure. It will be interesting to see if the loss of pigment in this area is permanent or not.
Here's a photo of the whole sole and a closeup of the hole. I'm hoping that as the rest of the old sole comes away it won't reveal too many horrors.
The abscess on the left fore had been healing nicely, but today he's 'broken leg' lame on the left fore again - clearly another abscess, probably in the same place under the sole. He's looking really uncomfortable - the only way he can walk is to rock right back onto his hinds with each step so that he doesn't put any weight on the left fore. I hate watching this kind of severe abscess, he's obviously in a lot of pain.
It's proving very difficult to manage these abscesses in the field because of all the mud (it's done nothing but rain for weeks now), so I've decided to bring him back in for a while. He and Olly are now back in the stable with access into the small sand school. I'm hot poulticing the sole and soaking in epsom salts daily in the hope of moving things along as fast as possible. I've also put him back on the Bute-X temporarily for the pain.
It only took two days for the abscess to blow and sure enough, it came out in the same place under the tip of the pedal bone (where the hole is in the photo above). This time the stuff that came out was jet black and absolutely stank. There was a lot of it too. After one final soak in epsom salts, I've switched to wrapping the foot in a disposable nappy and then putting the boot back over the top (he looks rather cute with the Winnie-the-Poo characters poking out of the top of the boot). Nappies are brilliant at soaking up moisture and work well for drawing out infection (and they're also cheaper than lintex poultices). The first day, the nappy came away with a very large patch of black slime on it. Today there's just a small spot so the abscess seems to be drying up well.
I'm guessing it'll take quite a while for this abscess to dry up completely, so I'll likely have to continue with the nappies for a while. The nappies also have the advantage of drying the horn to it's optimum moisture content which tends to leave it harder and less flexible than when the hoof is constantly emersed in mud. That in turn should help what sole there is to protect the damaged corium underneath. Meanwhile, he's much more comfortable today and is starting to weight bear again on the affected foot, so I'll start phasing out the Bute-X.
I'm still very worried about why he keeps abscessing. It suggests that there's a lot of damage under the tip of the pedal bone. I just hope that it's still capable of healing.
Well I wasn't wrong when I said "I'm guessing it'll take quite a while for this abscess to dry up completely". It's still occasionally leaving a small yellow mark on the nappy and it's now 16 days since it blew. I'm planning to keep using the nappies for a while yet as it's certainly helping him be more comfortable.
The constant rain is starting to annoy me. The original idea of bringing him and Olly in was to get Fred out of the mud. Now our little sand school is turning to mud itself which is making keeping the affected foot clean more difficult. I may have to start putting a plastic bag between the nappy and the boot to keep the mud out.
Fred has revealed a new side of himself. We'd always thought of him as 'nice but dim', but today he worked out how to open the gate out of the yard - something which our other 4 horses have never managed. He led a boys escape committee... the first we realised there was something going on was when Esme and Zafirah started shouting (the gate had swung shut in front of them so they'd clearly decided to spoil the boys' party if they couldn't join in). We rushed out with head collars to see the three boys disappearing into our neighbour's yard... in the direction of his hay barn! Luckily we managed to redirect them into another yard (with no hay) where they spent a good ten minutes showing off how sound they all were on gravel. Jazz was cantering around, Olly was doing a rather nice medium trot... and Fred (admitedly with a boot on his left fore) was doing a beautiful floaty extended trot. So Fred's clearly feeling a lot better!
We put the three escapees back where they belonged and shut the gate. We walked back into the house and looked out of the kitchen window to see Fred opening the gate again. Luckily this time I got to the gate before he actually managed to get through it. He then opened it again three more times while I watched - but had got bored with the concept by the time I'd got back with a video camera... typical! Anyway, the gate is now roped and tied with a complex knot. It has to be complex because Jazz is an ace at untying things and I really don't want them clubbing together to solve the gate thing. Assuming I've outwitted them, I'm hoping for a quiet night in.
10th January 2008
There've been no more attempts on the gate, and Fred seems to be improving well. He's reasonably comfortable in walk on concrete without boots, but I'm keeping the front boots on for the moment to protect the new sole growth while it toughens up. The right fore is looking reasonably good and I'm pretty happy with the balance. The left fore is quite high in the heels (not to mention low in the toe) so now that the abscess seems under control I'm going to start gradually reducing the heel height a bit every few days to try to move him towards a more correct balance.
Here's a photo of him with his rug off showing how much better condition he's in (albeit rather lacking in muscle).
11th January 2008
Did a more thorough trim today, the first time he's been comfortable enough for me to do so for quite a while. The right fore is pretty stable now, I've dropped the heels a touch more and brought the toe back a bit but that's about it. The left fore however is changing quite a bit. The false sole towards the heels is starting to exfoliate off as a thick layer of powder and the excess height in the frog is also powdering off nicely. That's allowed me to take more off the heel height than I'd expected to be able to today and even with such a dramatic change in balance, he's still really comfy. I've also been able to get the left fore onto a hoof stand at last which meant I could bring the toes back a bit more thoroughly.
Here's photos of the left fore before and after the trim. You can see the change of angle about half way down the foot that dates back to the July laminitis attack. You can also see two further changes towards the top of the hoof that appeared when each of the recent abscesses happened. Comparing the before and after photos you can see very clearly how much heel height I've been able to take off today (look at the angle of the hairline in the side-on shots).
Fred had a visit from the osteopath this evening. He coped remarkeably well with all the manipulations and seemed to actually enjoy most of it. Having lost so much weight and only recently regained it he has very little muscle - which made him interesting to work with as you can currently feel a lot of internal structures that would normally be buried under large muscles.
He had all the usual muscle problems you'd expect for a laminitic - mainly tension in the gluteals, the hamstrings and the lumbar spine. There was also some lack of mobility in the coffin joint on the right hind - possibly from taking a lot of weight on that foot while he had the abscesses on the left fore. The only other significant thing that came up was a misalignment of the first and second cervical vertebrae (just behind the poll). Our osteopath thinks this is likely to have happened at the same time as his jaw got broken - effectively a whiplash injury. While it looks like there's some permanent damage there, she thinks that once he's built up muscle around the joint it shouldn't bother him too much. If I ever get as far as riding Fred, it will be interesting to see if this causes problems.
I've replaced the pads in both boots - they were starting to disintegrate and weren't providing as much supports as they had. The new pads are pretty much the same as the previous ones except without the wedges. They're essentially plain pads with a cut out under the tip of the pedal bone. I'm still using nappies on the left fore, the right fore is just in a sock and this seems to be paying off. The false sole on the left fore is starting to exfoliate - a large chunk came off from beside the apex of the frog today revealing a nicely concave sole underneath. I'm guessing it might take a week or few for the rest to come off, but it's nice to see the process starting. Once the false sole's exfoliated, he'll need time for the sole to toughen up, so I'll probably keep him in pads for a while after that - I'll have to make the call on how to proceed based on his ongoing comfort levels. He's not had raised pulses in either front foot for quite a while now and is looking really comfortable in the boots and pads. His hind feet are also looking really nice despite being on concrete 24/7 - which encourages me that there's no significant underlying laminitis problems, just the old damage to heal out.
The false sole is really exfoliating well now. The only area where there's a significant amount left is the toe area that corresponds with the cutouts in the pads. I think now he's ready to go into plain pads without the cutouts and that should encourage the last bits of false sole to come out (although it looks like they may not need much encouragement now). I'll probably sort the plain pads in the next few days. He's looking really comfortable now in the boots and pads, striding out with real purpose.
Here's the left fore as usual. I've included a shot looking across the sole at an angle, which helps to show the concavity that's starting to appear. You can also see the remains of where the abscess damaged the sole at the toe.
This morning I removed the pads from both front boots. So now he's in plain boots (with socks still to prevent rubbing) in front and, as before, nothing behind. I've been watching him closely today to see how he's coping without the pads, and he looks really, really comfortable. To be honest, he's pretty comfy without the boots too, but given that he's on concrete a lot of the time, I don't want to risk bruising. His soles are still not fully toughened up yet. Hopefully a period in boots without pads will start toughening up his sole so that eventually I can wean him off the boots.
Fred's looking very comfortable around the yard with just the boots on so I thought I'd try an experiment today - I lunged him in the sand school without boots. The result was pretty good. He's very slightly lame still on the left fore in trot, but otherwise looked very happy. He showed off a nice forward walk and a reasonably big trot and he even offered canter (which I didn't encourage). I think the remaining subtle lameness on the left fore is most likely the result of the dramatic abscess he had at the toe. It's only really around 6 weeks since that stopped pumping out pus, so I wasn't really expecting him to be as sound as he is. I'm really pleased with his progress and will probably try the experiment again in a couple of weeks or so.
I trimmed Fred again today. The hinds just needed a quick roll around the walls to remove sharp edges - other than that they're a tiny bit short from being on concrete so much, but otherwise looking reasonably good.
The fronts are coming on very nicely. I've been able to bring back the wall at the toe a lot more today, although he's still a real fidget when it comes to standing on the hoof stand (I don't think it's particularly uncomfortable any more, but I suspect he remembers when it was). Lots more false sole has now exfoliated out, revealing what I think is likely to be the last of the abscess tracks on both front feet (under the tips of the pedal bones, into the seat of corn and under one of the bars). Where the worst of the abscessing was, the soles are still moderately thin (especially on the left fore), but they're looking a lot more healthy now with some degree of concavity.
Looking at the growth rings, it's clear that the heels were still growing faster than the toes up until around 5-6 weeks ago - which fits with when he last had significant amounts of toe pain from the various abscesses. Since then, heel and toe growth has been more even (although still a bit biased towards the heels as I'd expect at this stage). Now that the growth rings are coming down more parallel, that should reduce a lot of the forces that were pushing the toes forwards - so I'm hoping to see the rotation damage gradually grow out. I'm increasingly convinced that with these serious cases, the key to success is getting the sole to heal (even if that has to be at the expense of the wall), and that the wall rotation will not start properly to recover until the sole is reasonably comfortable. The outlines of the soles are coming back nicely to being circular rather than elliptical, which is a good sign that the soles are healing well.
As usual, here's the left fore:
I lunged Fred again in the sand school without boots today. He's almost, but not quite fully sound. He's just limping very slightly on the left fore in trot, otherwise he looks great. He was very keen to move, flying around on the lunge.The sole on the left fore still gives a little to thumb pressure, but a lot less than it did - I think he's finally putting some sole thickness down.
I think I'll start doing some groundwork with him - he needs to learn to back (haven't worked on this yet because he found backing hard with the laminitis) and he needs to learn to lower his head. That way, if he comes fully sound in another few weeks, I'll be ready to start doing some proper training on the lunge - he really needs to learn to be calm on the lunge and I'm also going to have to work on getting him to work more long and low (he's currently completely hollow and head in the air). I'm trying very hard not to get excited - he's still got a long way to go yet.
It's quite a while since I lasted updated this blog. Fred's out in the field now with the other horses, but I'm keeping him on a pretty poor pasture. He's still a tiny bit underweight but for now I'd rather keep him that way as it should reduce the risk of a relapse at this delicate stage. He's gradually getting more and more sound, although it seems a painfully slow process. To the casual observer, he's now 100% sound on soft ground, although I'm aware that there's still very subtle signs of lameness on the left fore. To give an idea of how he's getting on, here's a brief video of him and the others in the field. The nice bits about this footage are seeing him choose to pick up the left lead even though it was the left fore that he's been lame on for so long and the really nice sharp turn he does towards the end.
I also lunged him again today. As in the field, I can tell he's still not 100%, but I have to look pretty hard. Again, here's a brief video (my video camera was playing up, so apolgies for the quality):
What pleased me more than anything else was when I walked him down to the school to lunge him. The approach to the school is made of slate waste, a pretty sharp and aggressive surface for a horse to walk on. I've seen supposedly sound horses take more care over that surface than Fred did - he wasn't 100% unaware of it, but he also didn't look that bothered.
He's about due a trim again, so I'll try to get some more photos of his feet for here.
I trimmed Fred again today. As usual, here are the photos of the left fore:
This foot is starting to look a lot more 'normal' to the casual glance, but there are still a couple of issues. The first is the soft spots on the sole that I've been fighting ever since the last abscess. The most dramatic one has now gone, but I'm left with one small area that gives to thumb pressure - it doesn't look much in the photo, but it's still an issue:
The other issue (the real biggie) is that while the heel height is pretty much spot on, the sole thickness at the toe is way too thin. This has the effect of tipping the foot forwards, bringing the pedal bone into a more rotated position. Here's a diagram that shows very roughly where I think the pedal bone is sitting in this foot:
This leaves the pedal bone still tipped forwards too much - it should be tipped forwards a little, but only about half as much as this. In this next diagram, I've rotated the foot (and hence also the pedal bone inside it) to where I'd like it to be in relation to the ground and sketched on in red where I'd like the hoof capsule outline to be:
Clearly, I need to build more toe height. The problem is that, while he's out in the field, the sole is wearing away as fast as it's growing (which is probably still a little slower than I'd like). Normally, the wall would help by providing more material to wear away and hence making the hoof better able to resist wear. Sadly, all the wall in the front half of the foot had rotated away from the pedal bone dramatically (normally this happens mostly at the toe, but with the high degree of sink Fred suffered, the quarters had gone the same way). If I'd left this wall on the ground, it would have provided sufficient leverage to cause more flaring and potentially increase the risk of abscessing, so I've had to rasp that away. The new wall is gradually growing down better aligned to the pedal bone, but it will be a few more months before it's sufficiently grown down to be helping with the wear.
So I'm probably going to have to put him back in boots (and possibly pads) again, at least some of the time - just to prevent wear until some more wall has grown down. One other option would be to shoe him - which would be difficult because there's very little wall to nail to. Or I could put him in some kind of glue on technology - either a glue on shoe, or something like Equicast. The problem there is that there's still a very significant amount of rotten laminar wedge which, given the anaerobic conditions that such approaches create, would be likely to rot badly and cause a lot more problems. So on balance, I think boots are likely to be the best option so that I can regularly treat with disinfectant if needed.
Things are never simple with Fred. I've been putting him in boots and pads one week on, one week off. The idea is to reduce the wear and help the soles thicken up while also giving the feet a chance to breath and for any rubbing to recover (I'm not using socks this time). This was working well until today (he's currently in the 'no boots' period) when he came in looking very lame on the right fore. I'm pretty certain this is just a toe abscess (the pulses are up on that foot but it really doesn't look like laminitis), but it's a bit frustrating when he was doing so well. So after a quick soak in Epsom Salts, he's back in the boots and pads (and looking a lot more comfy that way) to see if that will bring matters to a head.
Three days ago he was hopping lame on the right fore. Today I had to look twice to realise he wasn't fully sound again (admitedly still in the boots and pads). I can't make up my mind whether the abscess has re-aborbed, or whether it's blown out through the laminar wedge and I've missed it. Either way, I've soaked in Epsom Salts again and turned him back out in the boots. Hopefully this is just a minor glitch and he'll be back to his usual sound self again in a few more days... but then again, this is Fred, so I'm not holding my breath!
Well the abscess on the right fore seems to have been something and nothing. I never really found a proper abscess exit hole (although I thought there might be something in the laminar wedge at the toe), but the lameness was so typical of an abscess that it couldn't really have been anything else. He's back out of the boots again and looking pretty sound. I haven't yet had a chance to lunge him again, but will do so as soon as I get a few minutes spare.Next Page
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