Improvement!

I was pretty dismayed yesterday after visiting Penny at the vet's and seeing how much pain she was in. However, today when we went, Penny felt much better! She wasn't quite as "dazed" with pain - her ears moved to watch Sammie and I as we groomed her, and she was putting more weight on her LF - even put it down to shift her RF around. The difference was the addition of "Previcox" - a drug prescribed for canine arthritis, but has recently been put in a paste form for horses called "Equioxx". Interestingly, the total dose that would treat a small dog would also treat a 1000 pound horse with the same efficacy, so the small dog pills are often used instead as they are 1/10th the cost (yay!) (<$1 a day vs. $12/day)

Here is Penny yesterday:


You can see her pointing the LF - owwie! She shifted it around a lot and seemed overall very uncomfortable. The nerve block from Sat. had worn off, and the banamine was obviously not doing a good job with the pain.

Here is Penny today:


She is holding her weight more evenly between her front feet, and much more relaxed. You can also see that she is not clenching her stomach muscles like she was yesterday. Her heart rate was down to 36, but I could feel the pulses in her RF had increased. Hopefully, the Soft Ride boot will support her and keep her comfortable to prevent any laminitis issues.

Other things that helped me relax a bit is to hear that the procedure to drill into the hoof to remove any dead bone is relatively simple, and cheap (considering! $1-200 instead of the $1-2K I thought it could be) They do it while the horse is standing, but sedated, so it would not involve major anesthesia to do it. The senior vets do believe it is probable that it will happen, and we will see it on the followup radiographs in 4-6 weeks. Or maybe after that. Because the fracture is completely across and already appears separated, it is likely, but she could yet surprise us.

It was nice to hear that the prognosis was better than I was feeling yesterday, and that this certainly should be something we can make it through with proper care (my specialty!). The key will be managing her pain so that she does not get laminitis in her good foot. If we can do that, then I think we're going to be okay!

Radiographs

Here are radiographs of Penny's LF. You can see the fracture(s) towards the toe - the dark areas are where there is a fracture. It looks like a severe concussion/crushing force hit from the bottom. Some of the vertical lines are blood vessels - I think even a lay person can see the disorderly lines of the fracture.





Looking at the lateral view- the force seems to have gone all the way through the bone to the front of the coffin bone - notice the separation there.



I've never seen anything like it. I doubt others have as well. Usually it is one of the "wings" that fracture slightly and can be corrected - this one is pretty unusual.

Still praying...

Penny's Fractured Coffin Bone

When I first looked out the window this morning and saw Penny lying down in the hay remnants by the barn, I thought she must be enjoying the warm sunny morning with a nice nap. The rest of the herd wasn't too far away, and she was laying flat out like possibly in a deep sleep and hadn't noticed when they began to meander away from the barn. But after I had put out grain & hay and let the horses in, I looked out the end of the barn to see Penny still laying there, on her belly, not even trying to get up. She was looking at me, but not getting up. She wasn't struggling, wasn't rolling, just looked comfortable where she was. I walked out to where she was laying and could see that her breathing was elevated, but she started nibbling on some old hay remnants. I leaned over her and laid my head to her belly and listened for gut sounds, and there were plenty! Lots of gurgles and pings, plenty of noise. Which was good news - probably not a colic - but left me confused. So I ran 20 yards back to the barn and grabbed her halter and came back and put it on. I clucked gently and Penny looked at me, but didn't offer to get up. So I twirled the end of the lead rope and tapped it on the ground behind her, and she stood up. I didn't notice that she did the whole dance without putting her left front hoof down, but as she stood, she held her left leg off the ground and would not put it down. I gently lifted it up to look at her hoof and I could immediately see drops of blood slowly oozing from the middle of the bottom of her hoof - about a centimeter away from the point of her frog. There was no obvious culprit - no foreign body sticking out to give me more information, but Penny was clearly in a lot of pain.

20 yards does not seem far, but for a horse to hobble on 3 legs, it seems like forever. We took it slowly and stopped several times as she hobbled into her stall - not once letting her hoof touch the ground. She was happy to nibble on some hay when she got there, (I took her handful of grain away just in case) and I ran inside to call the vet.

I didn't want to haul her anywhere in her condition, but the mobile vet I knew did not have access to an x-ray machine this week, and after telling her about the location of the injury, she urged me to take her to Elgin Vet so they could treat her right away. I knew that she needed to be seen right away, but hated to trailer her. By the time I had the trailer hooked up and backed up right to the barn, Penny was already laying down in her stall, still breathing heavily.

By the grace of God, Penny hobbled down the aisleway and into the trailer without incident or hesitation. I drove slowly and carefully to the vet, and to my amazement, she was still stand ing up after the 20 minute ride to the vet clinic. She had put her hoof down flat for balance, but when we unloaded her, she again would not let the hoof touch the ground. We got her as close as we could to the barn, and slowly walked to a stall bedded deeply in soft shavings.

Within two minutes, Penny laid down in the stall to rest, and she spent most of the next hour or more laying down while we waited for the vet seeing other emergencies. Even after resting for that time, her heart rate was still elevated at 60bpm, and her respiration rate was 40. Those numbers to me were typical of a surgery-bound colic.

Penny hobbled to the x-ray room, and within minutes after some pain medication and sedation and x-rays, it was obvious that she had fractured her coffin bone. There seems to be a "track" that goes nearly if not all the way to the bone, and you can clearly see where the bone has cracked all the way through - with more than one possible fragment. The good news is that if your horse is going to break a bone, this is the one to do as it heals eventually on its own. But there are many possible complications.

The first and most serious is she might get laminitis in her good, supporting leg (like Barbaro did) and the pain and bone rotation from founder after laminitis (pain in the hoof) sets in would probably mean the most humane thing at that point would be to euthanize her. The good news is that Penny has been very smart about laying down - she knows she's hurt and she's smart enough to take care of herself - and she needs to lay down as much as possible. The bad news is that Penny already has a small amount of rotation in her "good" hoof, and thus will be more prone to laminitis than a horse who has never experienced it before. Other things in her favor are that she is muscular ("stocky") and small-framed.

Another complication would be if one of the bone fragments "dies" and causes an infection deep inside the hoof. The vets can surgically go in and remove the dead piece of bone, but infections inside the bone like that can be difficult to cure. Or even just having the tiniest of openings (like the one that she has) that goes all the way into the hoof to the bone could lead to an infection. Cleanliness is of highest importance.

So, the vets have started by soaking the hoof with a betadine solution to kill the bacteria, and wrapping the hoof until a hoof specialist farrier can come out (Monday, we hope) and put a special shoe on her hoof - that will have a plate at the bottom of it that you can unscrew to treat the area, and otherwise will support the hoof and stabilize it. It will have a rim that goes all the way around the hoof to keep it from the constant expansion/contraction that the hoof normally goes through with every step. Stabilizing the hoof will be key to helping the bone heal, and making Penny feel more comfortable. The shoe will have to be reset every 3-4 weeks for the first month or two to keep it fitting well and secure. Oh, and it will cost more than any pair of shoes I have ever owned (hiking boots included).

The other key is pain management - to keep Penny happy, and eating/drinking normally so that she doesn't have digestive issues as well, and also so she doesn't break down on her good hoof. They have a special boot with pads in the bottom to support her good hoof, and hopefully prevent the dreaded laminitis from occurring. When she comes home, it will be my job to monitor her carefully for any change in pain levels, as the sooner we catch issues, the less severe they become.

She will be confined to a stall for at least 6 weeks. But for now, I've got to take it one day at a time. Sammie and I will be going for a visit tomorrow morning to groom her and give here lots of carrots. So please, say a prayer for Penny, for we have a long road ahead of us.