Tuesday, September 17, 2013

Injected.


I had the vet (lameness specialist) out to check on Gussie on Friday and decided that while she was there I'd have her take a peek at Prair since we've not been able to resolve her dislike for R to L lead changes and S and I both have a sense that something is just not quite "right."  Part of me gets apprehensive about hunting for issues because I am certain that you can always find something wrong with a horse if you take enough pictures or poke enough places.  However, in my gut I knew Prair has been avoiding aspects of her work (however subtlety) and not exploring that gut feeling is not a very proactive method of fixing anything...

Gus, bless his little heart got a green light to return to turnout and also start back up in his lesson routine.  We are going to put him on some Previcox to help with the inflammation and play with what level and frequency of dosage keeps him happiest and sane.  We'll ramp his workload back up slowly and if he can't be used as often so be it.  But he seems happy and eager to do something.

Anyway, yay for Gus.  But onto the more interesting bit....

Prair was her normal self, a bit ouchie in her back, but otherwise happy and bright and in search of treats.  S and I gave a long, (not very well organized) account of our struggles and triumphs since we brought her home in April 2012.  This varied from more tangible information like which direction she is stiffer in lateral work to more squishy info like "her right hind just doesn't scoop up as much as her left."  I also discussed her tendency to hold tension in her neck (on the right side.. near her shoulder) and how she has twice been somewhat lame from the self-induced charlie horse. We talked about her history, her fitness, her willingness, etc, etc and then we got to jogging and flexing.

Prair hasn't really had serious flexions since I bought her and her PPE showed a nice, happy row of zeros across the board.  I held my breath a bit - only slightly terrified that something scary would have mysteriously crept into a joint over the last 18 months, but things looked good.  Prair maintained her zeros except for a mild 1 on her left front and a mild 1 for the right hind hock and a smidge on the stifle. 

Not perfect, but not horrid... and at least it was a matched diagonal set? I don't know.. The vet made noise that based on Prair's conformation and way of going on the lunge she was fairly certain the primary diagnosis was Kissing Spine, and that the low grade response on the flexions was most likely a result of her compensating and trying to work around the pain in her back.  Though she couldn't know for sure.

Fabulous.

So we stopped and looked at her back and my heart crept into my throat a bit as I stared at her (still moderately) dropped back.  Significantly more lifted than when I got her, but still a bit of a sway to it and rarely do I feel her really round up into it under any circumstance.  Everything the vet was explaining and demonstrating was making sense. 

The exaggerated curve of her spine behind the with meant that the dorsal spines were likely compressed and rubbing at the ends where they were most crowded.  Additionally arthritic change in the vertebras themselves was subsequently likely as was damage to the big fat ligament that runs across the top of the dorsal spines. 
yellow line where Prair is affected

conformation shot from May, showing the dreaded curve...
I okayed the next step of taking some x-rays to confirm what the hell was going on and we headed back to the barn aisle.  While I was sitting there I was filtering my rides and experience on Prair through a "kissing spine" window. 

- She tends to jump flat, though I have always attributed that to the fact that we jump low for her and she doesn't have to try very hard.

- She has always preferred a long spot to the short distance... but I always attributed that to not knowing how to jump, not to pain from having to get up underneath herself.

- When stressed out, she tends to motorcycle around turns with a short, choppy stride, instead of reaching underneath her. (again, avoiding use of her back).

- Especially early in her jump career she tended to land and freak out.  I thought she was being a nitwit, but maybe it was in anticipation of pain?

I snapped out of my recollections in order to watch the x-rays and hear feedback.

The first few pictures showed normal bone structure and spacing behind the wither, but then as we crept backwards, there was indication of some remodeling - though there was a big sigh of relief when we saw that none of the bones were actually touching. 

Huge.  Win. 

From the full set of x-rays I learned that we're still going to call it "kissing spine" even though the bones are really just air-kissing (think uppity socialites saying hello at brunch and not mashing into each other like middle schoolers on ski bus). 

So, the increased curve of Prair's back is stressing her spinal structure, that stress is causing damage to the attachments from the ligament to the bones.. causing some remodeling, but nothing horrid... yet. 

Vet explained that the increased stress made it very uncomfortable for Prairie to articulate her back normally which meant she spent lots of effort trying to keep it flat and immobilized (this fits with our training struggles).  Consequently, the muscles in that area have atrophied and increased the workload of the ligament holding everything together.

The next questions to explore were whether or not that stress had started to cause changes in the vertebrae themselves and what sort of damage the ligament had sustained from being overworked.

The vertebrae (god bless them) still looked normal so that was one more complication we crossed off the list. 

The ligament wasn't... horrible.  But there were definite signs of stress and fatigue and even a few spots of scar tissue that were visible.  (Oh did I mention we moved onto the ultrasound machine? For anyone who's tracking the vet-taxi-meter, it was running along at full speed...ka-ching, ka-ching, ka-ching...). 

Feeling slightly more optimistic than I had been, we started talking about what all this meant for Prairie getting/staying comfortable and what it meant for her career.

I think (knock on all the wood) that the prognosis is fairly good. 

The silver lining is that we decided to explore the issue now instead of waiting until Prairie refused to pick up the canter or started slamming on the brakes at small fences.  Right now her back hurts, but she's figured out how to work around it and it's only an obvious issue when I'm being picky about her form/self-carriage/whatever. 

The prescription was to inject the spine along the vertebrae that are most affected.  The ultrasound showed several spots with some serious edema and general inflammation from the stress of the curvature.  The hope is that the injections will alleviate the inflammation (and pain) enough that Prair will start using her back a bit more again.  In two weeks we'll start some shockwave to aid some of the healing in the ligament as well as for additional pain relief and we'll keep riding normally.  After we finish the shockwave (ka-ching, ka-ching, ka-ching) we'll put her on Previcox to really keep inflammation at bay and really allow Prair strengthen that part of her back and build up more muscle which will in turn hopefully support the ligament, prevent additional damage and make everything come up roses. whew.

We could have injected, done the shockwave and started the Previcox all at once, but I think there's information to be gained from each step along the way - and I like to isolate my variables...

So injections went in, Prair was told to take 4 days off (though turnout was ok) and we are to check back in with the vet at the end of the week.

I had to leave the barn and head straight for the airport to go visit a very pregnant friend in a very soggy Denver for the weekend.  Thankfully both the impending baby and the state of emergency were fabulous distractions from worrying about Prair, but now that I'm home I'm back to obsessing a bit. 

This afternoon we'll get on, and see what we feel.  The vet's prediction is she'll feel better than she ever has.  I'm dubious, but also hopeful.  I'd love if we can get the mare comfy enough to use her back and really work those muscles well.  Sounds like the perfect project for the off-season. 

I did have an interesting follow-up with the vet in talking about what sort of frequency she sees this condition and the varying outcomes... and it was pretty interesting.  I am slightly cynical and think that Kissing Spine has spiked in popularity recently, but I suppose x-rays don't really lie...   The vet had some interesting comments on how it's significantly more common than most people think and that a good number of successful Eq horses actually perform functionally with varying degrees of the condition.  She started talking about how a flat jumping style might not win in the Hunter Ring, but it is a hell of a lot easier to ride (attractively) in the Eq ring. 

Something I hadn't really thought about but did make me smile...

Anyway.  Climbing back on the mare this afternoon... more to come after we see where we are.






7 comments:

  1. Glad all of this is getting found and taken care of early, and its true, flat jumping horses are easier to ride in the Eq ring (I suspect that my horse Carlos jumped flat due to a combo hock/nav issue which made him the best equitation horse ever..) that being said though we all want our ponies to be happy and sound.

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  2. Very interesting. That is the same ligament that Lucy damaged when she fell last November. She needed six months off, so you're lucky you can get on after just four days. I'm actually kind of surprised the vet didn't want her to get more time off, if the ligament is showing signs of stress and wear like that. Whatever the rehab looks like, I really hope she feels better and her longevity/soundness is helped :)

    As her back heals and theoretically strengthens, don't forget to have your saddle fit checked :)

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  3. My mare was having some back pain problems (I am currently thinking they are due to overcompensation due to her needing chiropractor work) but at first I was looking into all things that would cause back pain (uhm, like seven million options) and I ran across kissing spine. What I read was that a lot of horses actually have it when x-rayed but show no indication of that, which leads me to assume that it probably feels different for different horses, and it doesn't bother some at all.

    Glad you figured it out early!! That makes such a huge difference.

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  4. Maybe kissing spine is the new ulcers. Funny how they go in fads. Regardless, I'm glad you've got a plan going forward and it sounds positive for both of you. :)

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  5. Interesting. Ill be intrigued to read along with you guys through these stages!

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  6. Here's to hoping that miss mare feels better soon! Your ponies are so lucky to have you! You always make sure they have THE BEST care :)

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  7. Glad that bones aren't touching!! Yay for Gus too.

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