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We Are Flying Solo

May 31, 2012

Diagnostic Geek-Out Imminent

After I left Encore at the NCSU Equine Hospital on Wednesday night, things proceeded roughly like this (italics are me):

Wednesday night:

He's not lying in his stall, whinnying in anguish.  He is not lying in his stall, whinnying in anguish.  Dr. Newman said he would call on Thursday when Encore was going into his bone scan tomorrow, so I will just try and breathe deeply till then.

Thursday:

Did my phone ring?  How about now?  Now?  How about now?  Ahh, I have to pee, I'm taking my phone with me.  It still didn't ring.  How about now?  Well, I guess they would call me if he died.

Friday:

10:30 am; Dr. Newman calls with results of bone scan -

"Overall, he looks pretty good.  There are three hot areas, in his left stifle, left hock, and the spinous processes of his thoracic spine.  So I would like to do radiographs there, unless you prefer to try blocks first.  I'm not sure if it's just his back or if there are any surgical lesions on his hock or stifle"

When looking at bone scan images, darker areas indicate where there has been greater uptake of the radioactive isotope into the bony structures.  This can mean a potential problem area, but keep in mind, that it is only an indicator to help zero in on spots, because it will show you EVERYTHING.  Dr. Newman said almost all horses will show up hot in their sesamoids, withers, and some elbows.

A nice matched set of knees.
Pretty  matchy scan on the hind feet too.
 ZOMG, you said the "s" word.  No problem.  I'm totally not freaking out right now.  It's only $600 more, radiograph away, my friend!

11:00 am:  Dr. Newman informs me that Encore is going into radiology.  At this point I realize my horse has basically just gotten to be high for two days and I start to feel less bad for him.

11:30 am:  Dr. Newman calls with the results of radiographs -

"His hock and stifle are lovely and clean, so I suspect there is just some bone bruising there or bruising at tendon/ligament attachments.  His neck and cervical spine are beautiful and some of the cleanest we've ever seen.  What Dr. Redding and I feel is causing the problem are the arthritic changes between his vertebrae from about T15 to L1 and we'd like to inject those."

Look at that hock -- pretty darn clean, I can't ask for much more than that!

Left stifle.  Radiographs fascinate me.  But you can see the joint edges are pretty dang clean and smooth.

So no surgery?

"No, no surgery."

OMG, my horse and I are a perfectly matched pair.  This is the same procedure I got last year, only I didn't get to be doped out on xylazine.  Go get 'em, vet-man.

Shortly after that, I was able to pick Encore up and take him home for three days of pen rest, after which I am slowly bringing him back to work over the next 2-3 weeks.  If there are any lingering issues at that point, we can poke and block and see if we can chase them down.  Dr. Newman also sat down with me when I arrived to rescue the pony and went through the imagery with me.  It was easily apparent (if your entire career has been training to look for small differences in details) where the problem was.

Bone scan of happy withers.  Notice the spinous processes above the vertebrae are clearly defined.
Now compare that to his thoracic spine (back of the saddle) -- the processes are dark and indistinct.
Radiographs confirm -- see the nice spaces between the processes at his withers?  Happy withers.
Back to his thoracic spine and you can see the uneven edges of arthritic change and that the spaces between vertebral processes have shrunk.  Very common in riding horses, especially short-backed horses.
Four injection needles inserted and position checked prior to injection.  This one gave me shuddering flashbacks to the horrific pain of my own injections but Encore got sweet sweet drugs, so the vet said he didn't even flinch.

So, best case scenario, I bring him back in 3 weeks, he is fixed, I jump up and down and I never have to talk to you again?

Dr. Newman:  "LOL, yes, that is the most likely outcome."

Now, my goals are Training Level long format events, which are 3'3" jumps.  We're not asking for Rolex, but will he have a problem with this?

"No, he should do just fine."

If I didn't have massive personal space issues, I would hug you right now, but I do, so let's just pretend.

Is it just me, or did his laugh sound relieved?

20 comments:

  1. Fantastic news, and those detailed radiographs were super cool. Thanks for sharing!

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  2. What a relief! Super cool images...can't wait to see how he comes back :)

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  3. Wow! woohoo! Happy Happy Happy- thank you for the geekyness I enjoyed the detail! I am very happy for you both, A previous horse-vet/ Chiro I used to use discussed with me once about how he has seen animals and the people they are closest to -tend to mirror each other with physical issues - he had no explanation and wasn't a wacko, He was just saying what he has seen in his practice - I have seen it a couple times with different people. .food for thought . . .

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  4. rofl! I am laughing with and at you, because I would totally do the same thing, except probably be more frantic. Really, for someone who's horse was in the hospital, you were quite calm. Here's to hoping Encore doesn't get his own case study and all is well.

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  5. really cool images, thanks for sharing! I am so glad the problem was fixable! fingers crossed for a sound and happy pony from here on!

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  6. I am hoping hoping hoping the vets are right and all will be well soon. Encore is still sore from the injections, but I know for me, it took 7-10 days for the inflammation to settle and it hurt WORSE for 3-4 days after the injections.

    SB, I was at home where no one could see me, so no one will ever know my true level of calm. But Friday, I was on the phone with vet, realtor, lifeshighway, and other vet about 20 times from 10-2. Head insanity.

    Thanks all for the good wishes! It took me forever to pick out images to share because they are all really cool. The resolution in the NCSU rads is UH-MAZING.

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  7. Hooray! Great news all around. :-D Team Cripplebacks will be back in business in no time (sorry, couldn't resist--you two are certainly a matched pair)!

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  8. Well that's good news!! :)

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  9. Well, that is SUPER news indeed! And as a former pre-vet student/lover of all things animal-medical, I absorbed every detail. Yes, those rads ARE super-defined, best I've ever seen!

    Questions, questions, I have questions:
    1) My dog has the Exact Same Thing: arthritic changes in her thoracic vertebrae. We have treated her acute episodes of pain with two two-week courses of painkillers and muscle relaxants, and then most recently with a visit to the chiro. He wants to see her every 4-6 weeks.

    2) With what, exactly, was Encore injected? Why will the shots not have to be repeated?

    3) Why has no one suggested doing this for my dog if it's such a good long-term solution? Why have we mucked about with drugs and (expensive) ongoing chiro if she could be helped by one round of injections?

    4) Last but not least, how come YOU were not given a local before they did your shots? That seems really dumb!

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  10. I've thought about doing bone scans with Ozzy. It must be so nice to get conclusive results. Hooray for no surgery!

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  11. Awesome news for young master Encore! :) I'm so glad for you - I know you were a-fretting and a-worrying to the maximum levels.

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  12. Frizz, I love it, ROFL!

    RW: (1) Yeah, I got muscle relaxers and chiro at first. It wasn't enough. First orthopedist I went to told me there was nothing to be done and I should just give up oh well. Good thing I went to the second one.

    (2) The injections (horse and human) contain a mix of antibiotics (just in case needle introduces bacteria) and corticosteroids. I will write about it more in the next post, but basically the pain is due to inflammation. Once you get the inflammation down, it breaks the cycle and you get your life back.

    (3)Um, I can't answer that one. Get a second opinion? I had to PUSH hard to get my injections. But the vet school practically threw Encore's at me.

    (4) I did get an anesthetic injection in the joint before the steroid. THAT was the painful one and you can still feel the needles moving around after that in some surreal kind of spine/bone pain. Next time, I demand xylazine.

    Dom, I would LOVE to do it for Solo. Sadly, for the uninsured shiny one, it is not a financial option for me at this time.

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  13. Yay for science!

    Those radiographs do look really cool. The needle one kind of freaks me out though.

    Glad Encore is on the mend!

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  14. Thank you for answering my questions! :-) I'll tell you what, *if* Sunshine has another acute episode - and I'm hoping she doesn't, she acts 100% fine and dandy most of the time so when she's hurting my heart breaks - I will be on the phone immediately discussing injections with the vet. I'm really rather annoyed that this has not been mentioned. Maybe they don't do them to dogs? (Can't imagine why not, but who knows) Surgery was brought up, yes, but no spinal shots. I love my vet so I have no problem bringing this up! (I will be nice about it, I promise) I know better than to ask the chiropractor - they never want to use drugs... which is usually good.

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  15. I would at least ask. I honestly don't know about their application in dogs, since I no longer have one. But a mammal is a mammal -- so it's worth looking into!

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  16. YAY!!! Fantastic news!!!!!

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  17. Thanks, Nina! I hope he is right!

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  18. So happy to hear the news!!!

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