Update: Not Lame

Sunny had his vet appointment yesterday.  Since Fort Valley he had been confined in a small paddock and received a dose of Equioxx on Friday and Saturday.  By Tuesday he looked great, which unfortunately makes it challenging to diagnose what is going on.   Had this been his initial onset of lameness in that hoof I would not have been so concerned.  However he was lame on the right front on September 15, from a what I had assumed was a mild abscess but it never ruptured and he wasn't 'abcsess lame'.  That history made me very concerned for a mild tendon or suspensory pull as those horses can have mild intermittent lameness, especially with the amount of downhill trotting (and even slow cantering) we have done in the past few months.  The downhill forces at even moderate speeds can really stress the suspensory apparatus.  Also, when I palpated his tendons I found he consistently reacted more to the right front suspensory than the left.

Sunny saw Dr. Davis at Piedmont Equine for his lameness workup and I was very pleased with Dr. Davis's thorough, detailed, and knowledgeable exam. I would be more than happy to use him (hopefully not needed!) in the future.  I chose Piedmont, as my normal vet (Dr. Ann Marie Hancock), didn't have any availability in the near future, and the other recommend endurance vets also didn't have any opening's that worked with my schedule.  I have also been impressed with Piedmont for other veterinary workup's in the past (EPM in Rogan and an injury to my neighbor's horse).  Piedmont is a referral level hospital and they have great lameness evaluation facilities including an asphalt trot-out lane, a soft footing round pen, a firm footing riding/longeing area, and a regular arena.

Sunny was completely sound for his examination.  During flexions he did show a slight positive to flexion of his right hind hock/stifle according to Dr. Davis (it was slight enough that I couldn't really see it!), but completely negative on the other 4 limbs.  The veterinary technician longed Sunny (so I could watch) on the different surfaces, and then I even rode him in the arena -- he was sound the entire time! Dr. Davis explained how to properly palpate the tendons, during my palpation of the suspensory I was likely causing a cutaenous (skin) reaction, not eliciting true pain in the suspensory.  Instead of running my fingers down the ligament continuously I should apply pressure in each location separately.  Sunny certainly didn't react at all to his palpation! (And this is why my horse sees an Equine Vet- while I certainly know the basics, I see small animals all day and don't have the daily practice with horse injury)

I elected to proceed with imaging (xray and ultrasound).  I have big goals and demands for Sunny's future athletic career (would like to try a 100 mile ride and definitely would like to have a decade team horse!). I need to know if Sunny has a problem that could cause reevaluation of my goals, or if he needs a year of rest and rehabilitation.  It is not fair to push a horse that could have a problem -- you could cause a major problem or a lot of pain for your horse unknowingly.  I need to feel confident that my athletic demands are fair to my horse and not causing him pain.  He is my beloved partner, not my ATV!

The technician and I went into the radiology suite and she quickly took the views needed, Sunny was great, obediently standing on the blocks; only pooping out of nerves when another horse left his direct sight.  The xrays looked great- no signs of osteoarthritis in either front hoof or the fetlocks!  The only finding was what appeared to be a flat, 0 degree, angle of the solar plane. To explain, that is comparing the bottom flat surface of the coffin bon/P3 to a flat line. Ideally, while standing the bottom of the coffin bone/P3 (solar plane) would be about 3-5 degrees up from a flat line, this would allow 3 degrees for the bone to sink to level (0 degrees) into the digital cushion during maximum weight bearing.  When the hoof sinks below level (a negative solar plane) the horse is more prone to heel pain and tendon tears.  To fix this problem Sunny needs either higher heels or a lower toe.  His heels were lowered for the recent shoeing (to provide a flat surface for the shoe) so I suspect I just need to let them grow out a little but I will have my wonderful barefoot trimmer, Patrice Sager, evaluate his hoof and let me know for sure what the correct course of action is for this.  The xray also showed the defect the abscess left in his hoof wall (so, yes, it likely was an abscess making him lame in September).  However, after measuring his hoof on the xray and calculating the angles I consistently get between a 2.4 and 2.8 degree positive solar plane, not quite the 3-5 degrees of ideal, but better than 0 degrees!

Image courtesy of  http://www.thelaminitissite.org 

We then proceeded with an ultrasound of his flexor tendons and suspensory to check for common problems in seen in athletic horses.  I have to say Sunny was a champ for all of this, no sedation required.  He was a little unsure of going into the ultrasound/wash stall area, but trusted me that he wasn't going to fall into a black hole, then stood quietly for the exam (he did receive regular carrots for his exemplary patience).  The ultrasound showed some mild changes in his distal suspensory branches, but it was explained that those minor changes could be from anytime -- once they happen they generally don't heal ultrasonographically, but he should still be lame/ouchy if they were acutely injured.  The only concerning abnormality was at the origin of his proximal suspensory.  Sunny has a slightly abnormal anatomy with a more prominent bony ridge separating the medial (inside) and lateral (outside) of the lobes of proximal than expected.  This was symmetrical in both legs so that tells us it is likely just him; if these changes were just present in 1 leg then injury would be a major concern.  The biggest concern of the entire exam was irregular bone surface (instead of a smooth bone surface) at the origin of the suspensory in both front legs, this indicates some chronic inflammation/changes or stress to the area.  This could be an area of pain or just changes that indicate use and are not an issue.

So the plan is to enjoy Sunny as a light riding pleasure horse through the winter, essentially with easy rides and time off.  This may give any minor injury sustained during the season time to heal and bone to remodel. I will start conditioning him in the late winter/early spring for next season's rides and hope he doesn't have any more lameness.  If he does come up lame again (without an obvious cause) the next step is to get him to the vet while he is still lame and then block (numb) the proximal suspensory.  I am also going to be more aware of stressing his suspensory area and avoid high jumping (LOL), racehorse style-gallops (LOL-- the fastest we have ever gone is about 15 mph!) and for what really affects us - go slower on the downhills.   My favorite theory for the whole episode is that Sunny banged his lower pastern on a rock, causing swelling above the coronet band, which mimicked coffin joint effusion, which explains what the ride vets saw and also would explain the quick resolution. And that means he would be essentially fine. 

So really good news overall!!!