Kathryn Papp, DVM

1008 Piketown Rd.  Harrisburg, PA 17112

Phone: 802-238-0094 - kpapp@... – Fax: 717-307-3304 

Post-Racing/Newly Adopted OTTB Exam Report for Marcy Dalton

Charlie’s Quest - 7 yo, Dk Bay, OTTB, Gelding

Date: Arrival 8/5/2016 from PID, Initial In Depth Exam 8/11/2016

General Examination and History:  

Charlie was recently retired from training and competing as a claiming-level thoroughbred racehorse.  His last reported race was July 10, 2016.  He was retired and purchased privately as a companion and possibly for light riding use.

Charlie had not hit the board (1^st-4^th) racing since September of 2015.  His racing career originated in 2012 when he was a 3 year old.  He alternated between racing in claiming and allowance races on the dirt over the next couple of years and changed trainers/owners 7 times throughout his career.  He ran his best races around two turns and usually closed for most of his wins.   Almost every racing chart reflected that the horse preferred to run very wide across the racetrack and often drifted out.  He was an inconsistent finisher and dropped in ranks over time.  He has only ever had one period of time where he had a significant break from racing, which was from 11/2015 to 6/2016.  He never ran well again after his return.  

Charlie came directly from PID to my rehab and medical boarding facility in Harrisburg, PA on 8/5/2016. He is a large horse and arrived with a BCS (Body Condition Score) of 4/9, a healthy looking coat and appropriate muscling.  He was quite exuberant and slightly pushy to work with.  He had aluminum race plates on up front and was barefoot behind.  His hooves were in decent condition. The gelding exhibited mild reactivity when hoof tested across each of his four feet. Charlie’s heart, lungs and GI system all ausculted normally, both at rest and after exertion.  The heart rate and rhythm were all within normal ranges and he appears to be in good cardiovascular health.  A brief ophthalmic exam revealed no abnormalities.  A brief neurologic exam, as well, did not show any definitive abnormalities.  Some responses that looked possibly neurologic could most likely be attributed to underlying soundness issues.  Dentition appears appropriate and though teeth could use a floating in the near future. 

An upper airway endoscopic evaluation identified asymmetric abduction of arytenoid cartilages and vocal folds with the left vocal fold classified as having a 2b paresis.

Soundness Evaluation:

Charlie’s most obvious limb abnormality is a very enlarged and firm fluid filled distended RF flexor tendon sheath just above his RF fetlock.  His range of motion in the RF fetlock region is limited and deep palpation of the area causes the horse to try and withdraw his leg in discomfort.   Also noted were his relatively long pasterns all around.  No additional heat or sensitivity was detected during palpation of other structures, but static flexion of all fetlocks as well as hocks did result in an attempt to withdraw the limb.  He had an acceptable range of motion in his neck and back.  

The horse initially appears sound at both at the walk and trot in a straight line, but when turning it was obvious that there was some pain on both forelimbs as he tried quickly to unload the weight off of each before returning to straight traveling.  When traveling on a circle in both directions and on different ground surfaces (soft & hard) he was extremely playful and not very adept at lunging appropriately in a controlled circle.  He showed decreased anterior phase of stride in his right hind limb as well as a hip drop (lameness of 2/5), especially when traveling to the left.  It was difficult to discern whether or not the right forelimb lesions were contributing to this behavior.   He also showed a left forelimb lameness 2/5 traveling on the circles in both directions.  An intermittent, though not consistent, right forelimb lameness was noted.  He did exhibit normal upward and downward gait transitions, but would bunny hop and counter or cross canter frequently when traveling in either direction at the canter.   His cardiovascular status post-exercise was within normal range and he recovered to resting status quickly.  No abnormal respiratory noise was noted.  

Active Flexion Testing Results were as follows (scale Neg-+5):

RF – +2             LF – +1

RH – +2             LH – +1.5

Charlie’s previous racing charts were reviewed and his conformation, soundness, as well as expectations for his potential as an athlete or long-term companion, were taken into significant consideration when examining this horse. 

After reviewing the numerous diagnostic images obtained, including digital radiography and ultrasound, my recommendation was to refer to surgeon for further work-up and likely RF annular ligament desmotomy/tendon sheath tenoscopy to help relieve adhesions and/or decreased range of motion and damage in that limb. 

Initial radiographs of the entire horse including feet, fetlocks, knees, hocks, stifles, tibias and dorsal spines were taken and reviewed.  The RF medial sesamoid was basically destroyed with multiple fragments identified and disruption of suspensory branch attachments.  Floating calcifications were seen within the flexor tendon sheath, which was distended with a large amount of effusion as well as fibrous thickening.

Radiographic Imaging Findings:

FRONT:

Right Front

RF foot:  navicular appropriate, nearly flat coffin bone, disrupted hoof pastern angle, long toe (bull-nosed appearance), decent sole depth and medial to lateral balance

RF pastern:  large linear proximo-palmar calcification/enthesiophyte associated with palmar P2, mild pastern joint OA and spurring 

RF fetlock:  major demineralization, degeneration and fragmentation of both sesamoids, apical and basilar fragments small and large close and far from parent bones, jagged and irregular palmar fragments intra and extra-articular, remodeled dorso-proximal P1, fetlock OA with decreased joint space and flattened palmar distal condyle, flexed DP view shows condylar sclerosis as well as a lucent line in sagittal ridge, decreased width of distal MC3 neck

RF canon/MC3:  thickened dorsal cortex consistent with previous bucked shins and race related bone remodeling, calcifications and fragmentations coming from sesamoids are visible within distended and thickened digital tendon sheath at this level

RF knee:  3^rd carpal bone decreased cortical medullary definition and sclerosis, prominent but clinically irrelevant distal radial epiphysis

Left Front

LF foot:  mild navicular changes and sclerosis, flat coffin bone (almost negative palmar angle), broken hoof pastern angle, long toe, medial to lateral imbalance with medial heel higher and causing pinching in joints along the column, sole depth ok

LF fetlock:  palmar condylar flattening and obvious lucency/bruising with associated surrounding sclerosis, moderate joint OA with spurring and decreased joint space, decreased sesamoid density, flexed DP view shows OCLL/subchondral bone bruising with discrete circular lucency

LF shin/MT3:  thickened dorsal cortex consistent with previous bucked shins and race related remodeling

LF knee:  3^rd carpal bone decreased cortico-medullary definition, medial proximal splint old and quiet, small lower knee joint spur and prominent but clinically irrelevant radial distal epiphysis

HIND:

Right Hind

RH fetlock:  Significant dorso-proximal P1 remodeling, moderate OA with spurring and decreased joint space, lateral sesamoid small basilar fragment, plantar condylar flattening with medial OCLL and deep bone bruising evident

RH hock:  pea-sized OCD lesion dorsal talus surrounded by sclerotic ring, decreased lower hock joint spaces  

RH tibia:  plantar cortical remodeling (possible previous or current early stress fracture)

RH stifle:  distal medial femoral condylar flattening, corresponding lipping of the proximo-medial tibial plateau

Left Hind

LH fetlock:  Dorso-proximal P1 remodeling, P1-P2 pastern joint dorsal spur, moderate OA with decreased joint space, medial apical sesamoid is irregular, distal plantar condylar bruising, both sesamoids irregular apical margins

LH hock:  moderately decreased lower hock joint spaces

LH tibia:  island-like medullary lucencies and calcifications proximally of unknown significance, proximal plantar tibia cortical remodeling and thickening (possible callus)

LH stifle:  distal medial femoral condylar flattening, corresponding lipping of the proximo-medial tibial plateau

Other

Withers:  WNL (within normal limits)

Thoracic/lumbar spinous processes:  2-3 overriding spinous processes near the thoraco-lumbar junction with some associated boney erosion and reaction (ie. Mild-moderate kissing spines)

Ultrasound Imaging Findings:

RF distal limb:  Thickened digital flexor tendon sheath with multiple adhered and floating calcifications present, sheath lining is also thickened with normal to sometimes fibrinous fluid effusion and fibrin adhesions in the distal MC3 region, significantly thickened annular ligament and decreased transmission of synovial fluid through the sheath proximally and distally to the fetlock, majorly disrupted (barely recognizable) sesamoid bone architecture and concurrent disruption of and damage to suspensory branch attachments both medially and laterally  

Bloodwork Results:

CBC: Mostly within normal limits excepting mild dehydration and blood transport artifact

Drug Screen:  Negative for all substances included in Cornell CVM PPE drug screen testing

Lyme Multiplex:  Negative for all OSPs

In my professional opinion, and based on the provided surgeon’s report and evaluation, Charlie has quadrilateral lameness, some of which is very severe, progressive, degenerative and likely painful.  Many changes identified are chronic, with no acute lesions noted on exams.  It is my opinion that the reason for this horse’s poor racing performance and continued drop in class was directly related to these limiting lameness factors.  It is hard even to believe that this horse was even completing races and daily training, nonetheless, passing consistent racing veterinary inspections.   While he does appear to be a very stoic and strong patient and quadrilateral or even bilateral lameness can be more difficult to detect, it still seems unreasonable that a horse that is mainly unfit for even moderate riding sport was recently subjected to high speed racing competition. 

It is very unfortunate that Charlie’s Quest is most likely going to be unusable as a companion riding horse or low-level competition partner.  Even with a pampered life as a pasture companion he will continue to have degenerative changes that will worsen over time due to the initial injuries and wear and tear that he has previously incurred.  

I hope that we have helped to guide you for the future care of this horse and given you the needed information to maintain his comfort and welfare for the years to come.  It is amazing and incredibly lucky that a caring adopter has agreed to take on Charlie even with all of his issues and give him the life a horse who has worked hard for his people deserves.  I believe, as a veterinarian, that all animal lives have inherent value whether or not they provide us humans with a particular self-serving use.  Their lives have value for the sake of living peacefully and comfortably even if nothing more.  I applaud your thorough approach to the homing of Charlie’s Quest and wish you both all the best.

Kind Regards,

Kathryn Papp, DVM