Boy, with horses, you never stop learning. And with Forrest, that has been an excellent thing as we now, finally, have a confirmed diagnosis, thanks to Dr Carol Gillis DVM, considered to be the top of her field in ultrasound examinations and consultations. Her resume would take up this entire blog, but one of its highlights is that Dr. Gillis obtained a PhD in equine tendon and ligament pathophysiology and established the equine ultrasound service at UC Davis, pioneering ultrasound of the musculoskeletal system at the University. So safe to say this is THE go-to vet, highly recommended by my vet, Dr. Bibi Freer, for Forrest. We are so lucky she moved to our area from CA (equineultrasound.com).
Dr. Gillis was kind enough to drive up from Aiken to beautiful Spiegel Farms, where a half dozen of us were scheduled during the day. Forrest arrived for his 2:30 appointment, believing he was in horse Nirvana. He took in the fountain, the baroque-inspired barn and spooked at a garden figurine, landing squarely on my right foot.
In my previous blog I shared that it seemed, after a clean stifle X-ray, and unchanged hocks and injecting all three, that further chiropractic consultation drew us to the right side of his sacrum/pelvic area. So the suspicion grew that that may be the root of the problem and the short left hind was compensating for it all. I have to tell you, I was simply blown away when Dr. Gillis requested that I walk Forrest from a standstill inside the barn, up just one step. And then once more. "I just want to see how he sets that foot down," she said, then added, "Did you see that?"
Um, no. And people, this is my horse. I know him well. I had no idea what she was looking at as he simply stepped forward. It looked totally normal to me. "From the video you've sent me and from what I just saw, I believe it's this stifle." Forrest, a bit on edge, was sedated, his hair shaved, gel applied and the examination began.
Let's have a little lesson here about the stifle, shall we? As dressage riders, we know it's hugely important. We know it's complex. And we know a stifle injury can be career ending. Why? Could be the three communicating joint compartments composed of bone and cartilage, as well as several ligaments, the joint synovial linings, the joint fibrous capsules and, oh yeah, that pesky menisci? In Dr. Gillis' 'Stifle Newsletter,' she writes, 'Often a combination of these structures is damaged, and a multi-faceted approach to treatment is needed for recovery to athletic soundness.' And as I stood, peering over her shoulder at the monitor, as if I had a clue to what I was looking at, this is exactly what had happened to Forrest as Dr. Gillis pointed out, "See this thickening here? That bit of scar tissue, there?" It sounded like a laundry list: femoral tibial joint medial synovitis, left medial collateral ligament desmitis, left medial patellar ligament desmitis- and all chronic, all going back to his racing days and I stood there, both dejected and angry at myself for writing off that ever so slight toe drag that arrived with Forrest, fresh from his last race, and was still there, after nearly 6 months of 'let down time,' that I had written off as simply the weaker of the two hind legs. He had flexed sound, he did have a small spur in each hock (the smaller of the spur being in the left hock) and we had injected both hocks, the left stifle and had done a course of Adequan, all in the last 6 months, when the left hind began to grow shorter, along with, I thought, a hip hike.
But Dr. Gillis wasn't finished and as I had mentioned what had been felt by the chiropractor, she went to ultrasound his sacrum and I was shocked to hear her pronounce that his sacrum and pelvis looked absolutely fine but she found an acute, small lesion in his glut. No surprise from his violent, twisting spooks and bucks. And frankly, I was very relieved to hear about his back as Forrest has always felt so loose, so swinging, always ready to work over his back without a hint of resistance that I couldn't understand how he could offer that if compromised in his sacrum/pelvis.
Had you been in my shoes, hearing the several findings that had appeared, you might have nodded along in agreement when I said resignedly, "OK, well, I am emotionally prepared to retire him." Dr. Gillis looked away from the monitor and over her shoulder at me with a raised brow. "Oh, no," she said, "If you follow my protocol of six months stall rest and careful rehab, he should be just fine. He's young and you've got that going for you."
Child, you could have knocked me down with a hoof pick!
Dr. Gillis went on to share with me that her practice, particularly in California, had focused on race horses, she had had her own Sport Horse business, had personally successfully rehabbed seven Thoroughbreds and had seen far worse than Forrest. I went from feeling hopeless to sort of numb- I couldn't quite believe that my horse had a good chance of a complete recovery. And I will state right here that I loathe stall rest: the potential for emotional stress, ulcers, the nutty behavior once hand walking. But as Dr. Gillis points out in her literature, 'a large study of equine athletes showed that 90 days of stall rest followed by 9 to 12 months of pasture turn out resulted in only 22-26% of horses returning to work for one year without re-injury." Why? Because our babies are goofy and as soon as the pain and inflammation subsides, they start leaping about, galloping, bucking and farting, and they might not look lame, but the injury gets tweaked, over and over and never fully heals until the horse goes back into work. So what I will do with Forrest is what I do each morning: he will get turned out, like everyone else, so that I can muck stalls, but instead of going into the field, he will go out into the front paddock, which is tiny: a small square in which can fit maybe a 10 meter circle? He can have his gorgeous Timothy/Orchard/Alfalfa in there as he dines next to Olsa, in the adjoining paddock, nap in the weak, winter sun and look out over the fence into the field. And from there, I can watch him like a hawk for the hour and a half it takes me to do my barn chores, ready to bring him in if I see him start to get wound up. When finished, he will come in for more hay, grooming, and following careful protocol, hand walking and hand grazing through the day.
It's going to be a long six months, but what a gift that there is such hope (a minimum of 85%!) that, come summer, I'll be back in the irons of a sound and talented horse.