Liphook visit 15-05-13

So, vet's view on his feet was good - he liked what the farrier had done with them.  His idea was to bring the breakover point back further but explained farrier felt he didn't want to make too many changes at once but was aiming to do that eventually.  Not sure how much will be possible though as he's already starting to wear his toe slightly.  He's happy with the wedged pad and the frog support and thinks it's likely he will need to stay in these shoes and pads or something similar permanently.  Currently they're still looking very good after 3wks.  He liked the fact they had the Magic Cushion under the pads too.

So we trotted him up and he looked sound (if anything he said his eye was drawn slightly to the RH but that's a whole other can of worms we're not opening right now - he said possibly he has mild spavin but it's not enough to investigate right now)

He asked me what my aims were for the year and I said anything (I had lost all faith he'd ever be ok to do anything) - he laughed and asked again.  I said well I'd like to make it to the Regionals in Sept/Oct.  So he asked again and I said I'd love to get to some events in June so we could try and get another Regionals qualification - he said that was more like it.  No reason not to.

Lunged him on the hard circle and he was 1/10 lame LF on left rein and 1/10 lame RF on right rein which he always has been since I've had him and if anything that would be better than he has been at times in the past 2.5yrs.  At this stage vet was happy to send him home but we put him on the lunge in the school and he was surprised that he still looked lame to the same degree and if anything the more we did with him the more noticeable it became.

So, we had a discussion about what to block as the problem was quite mild and might not be very easy to interpret.  Decided to block the right fore as this was the one I had felt was possibly causing a problem.  He blocked the coffin joint with 5ml intra-epicaine.  When he inserted the needle, the joint fluid ran very freely out of the needle - it looked quite watery.  Normal joint fluid should be more gloopy (viscous) than that.  We reassessed him after 5mins - he was still sound in a straight line.  On the lunge on the hard surface he appeared slightly worse on the left fore on the left rein and slightly better on the right fore on the right rein.  Similar effect on the lunge in the school.

Put him in the stable for 10mins then repeated.  Still sound in a straight line.  Lunging on the left rein on the hard he looked possibly slightly lamer LF.  On the right rein he also looked slightly lame LF so bigger improvement to the extent it had made him look lame on the LF on the right rein.  I went to get his tack after that while vet repeated lunging on the soft then the hard again and his summary was that he continued to look like the LF was more of a problem now.

Then I rode him.  Picking him up and riding in an outline I could hide the lameness completely but letting him have his head he was clearly lame on his LF on the left rein, felt ok on the right rein.  Left canter felt harder than usual for him and right canter was nice.  Clearly blocking his RF coffin joint made a considerable difference to him.  Vet said he looked like a different horse under saddle.  Complete dope on a rope around the yard, lazy on the lunge and yet comes alive under saddle - he said he can see him working over his back, coming through from behind and he looks very nice.  Think he might have been wondering what planet I was on telling him about my aims for him before then!

So, we popped a little dressing over his injection site and he is to have a bute daily for next 3days then he will try and come back either Sat or Mon to inject both his coffin joints with a combo of triamcinolone (steroid), HA and precautionary antibiotic.  He didn't want to do it today as he'd already put 5ml local in there and distending the joint too much is painful, plus injecting it twice in one day increases the risk of infection.  He will have a day off and another 3days of one bute daily and then need to crack on and get him fit.  He was happy for him to start eventing once he's lost his flab which I reckon I can get off him with a couple of weeks of intense work.  He will test positive for the next couple of weeks due to the steroids in his joint getting into his bloodstream so will be lots of schooling trips and no competing, but then all go for eventing - yay!

Blocking the coffin joint will eventually diffuse to the navicular bursa but he feels that because he showed such a noticeable improvement almost immediately it is most likely that the pain is coming from his coffin joint rather than too much associated with the navicular.  This is most likely due to chronic foot imbalance.  He felt that one lot of joint injections and continued effort with his foot balance should be enough to make a difference for a long time.  He didn't feel that this was likely to be something we should need to do regularly at this stage as he shows no signs of arthritis in his coffin joint currently.  He also recommended injecting him with cartrophen - 1 bottle once weekly IM for 4weeks then monthly for maintenance - this should help with the quality of his joint fluid.  And he needs to lose weight - he is so fat at the moment!