Suspensory Injury now - please advise


lara.wear@...
 
Edited

Now Callisto has a suspensory injury on his left hind and 3/5 lameness. Diagnosed with xrays and blocking.

Vet says give bute 3-4 hours before riding and then to try light riding. If that does not work, we could consider surgery.
His advice is based on the following:
1) I rehabbed him with a small paddock and hand walking for what might have been the same injury 7 years ago and studies have shown that if I were to try that again there is only a 19% chance of recovery.  Shockwave therapy added in would increase chances of recovery to 44%. Surgery increases chances of recovery to ~80%. Read more:  https://www.dvm360.com/view/lameness-hind-limbs-caused-proximal-suspensory-desmitis-proceedings
2) He is IR and needs to be moving

He is currently barefoot and sore on all four heels.  I had him in plastic shoes for 5 weeks and he was the happiest he has been in a long time because it stopped his feet from hurting. However, I just pulled them off because of thrush (we are currently having very wet weather) and because the heels on his right hind collapsed. So he is now turned out during the day with front boots on. If you look at his xrays from January you will see super thin soles, low heel, and npa on his hinds.  

But the reality is, I cannot do this anymore.  I am exhausted from unsuccessful rehab.  I don't live at the barn and cannot go every morning before work to put boots on and go again at night to take them off. He lives at my mom's and she is 77 and I cannot ask her to do it.  Most of my decisions have been made based on advice from this group, but often restricted due to advice from my vet or farrier.  

Is it ok to put him on the bute the days I ride? 
Should I go back to shoes?
--
Lara W. in Victoria, BC 2021
Callisto Case History
Photo Album


Eleanor Kellon, VMD
 

Lara,

I personally wouldn't ride this horse. The negative palmar angle behind also strains the suspensory by resulting in greater drop of the fetlock. His fronts are only a hair away from being negative too so all four legs have extreme deep digital flexor strain as well as navicular bursa and bone. 99.9% chance that is where the pain is coming from. There is no evidence of laminitis. The distal descent is from shoes. I agree with surgery if this is truly a chronic suspensory injury.  He needs hoof rehab https://hoofrehab.com/DistalDescent.htm and should be in boots and pads  until his feet are corrected. You don't have to take his boots off at night. Just have a second pair to swap when they need cleaning.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


 
Edited

Hi Lara,
I wanted to ask about Callisto’s PPID because horses with uncontrolled PPID tend to have more issues with ligament and tendon injuries.  His ACTH has been pretty much in the mid point each time you’ve tested yet you have been increasing the pergolide dose.  Have you found that the added pergolide helps the issues you were trying to address?  There are some horses whose ACTH does not adequately reflect their PPID state.  I have one and need to increase his pergolide based on symptoms.  

I’m that 77 yo mom with her daughter’s horses here so I can relate.  If she’s capable of changing boots, can you do something else for her in exchange?  Could you pay someone to stop in and help out?
--

Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


Sue Ring
 

Hey Lara,

I rehabbed two rear suspensory injuries......and this may be along shot but do you know if there is an Aqua Tread facility near you?  I could not afford stem cell injections and formulated a rehab program with my vet at a facility with an Aqua Tread.  Over three months and, at that time, a relatively low cost per session, he came back better than new.  If Aqua Tread is even a remote possibility for you, with your vet's approval, I would recommend it for anyone looking to rehab from a serious injury as suspensory is!  Good luck and all the best wishes to you and Callisto!!!
--
Sue R in NC 2021

CASE HISTORY:  https://ecir.groups.io/g/CaseHistory/files/Sue%20and%20Shifty

PHOTO FILES: 


 


Kirsten Rasmussen
 

Hi Lara,

My horse was diagnosed with ligament degeneration in his hinds last summer by our vet because of exaggerated flexion during a lameness evaluation.  However, it was suggested here that the actual issue might be exaggerated flexion due to his ground parallel hind coffin bones and crushed/underrun heels, and it was suggested I try putting him in a wedge pad to reduce the stress on his ligaments.  I just mention that to you because if you are booting and padding, you might find Callisto is more comfortable with a wedged pad that elevates his heels a few degrees so that his coffin bones are not ground parallel or at a negative angle any more.

With closed boots, if you put a sock over the hoof and use liberal foot powder plus feed a mineral balanced diet you should not have any problems with thrush.  But boots and socks need to be changed once they are damp, so 1-2x a day, depending.

I'm sorry to hear you are exhausted.  Most of us have been there, too.  Hang in there for Callisto's sake.

In looking through your Case History again, I read the comments about the hay testing being expensive and the corer unaffordable.  You mentioned Nutrilytical in Calgary but reported an unusually high price for their hay testing.  Prices are definitely higher here in Canada.  You can request that Nutrilytical do an initial NIR test (26 Can$) to screen your hays if you have multiple hays and want to identify the ones most likely to be lower in ESC and starch, or you can request the 644 Carb pack (49 Can$).  Ask them to hold the samples for additional testing.  If you decide to do the full wet chem test on the hay(s) that looked good in the initial screening, Nutrilytical will do it and only charge you for the more expensive test.  So if you test first by NIR or the 644 Carb Pack, they will upgrade you to the 603 Trainer without charging for the initial testing on that sample.  The 603 Trainer covers everything you need, and I add Chloride to it for a total of about 100 Can$ (it is 87 Can$ without the chloride add-on).  I know its expensive, especially if your hay changes frequently, but I just wanted to update you on the pricing, etc.  Nutrilytical will also mail you a hay probe for 26$ (cost of their shipping) if you return it to them with your hay samples.  You will need to provide the drill but you can probably rent one.  I recommend using a corded drill because the cordless ones don't seem to have enough power.

--
Kirsten and Shaku (IR + PPID) - 2019
Kitimat, BC, Canada
ECIR Group Moderator
 
Shaku's Case History
Shaku's Photo Album


lara.wear@...
 

HI Dr. Kellon, thank-you for your response.  I took the shoes off in August 2020 thinking I would be able to correct the long toe, underrun heels, thin sole and distal descent.  We started out in boots with a barefoot farrier. In that time, we discovered he was PPID, and IR.  By July 2021, his feet has not improved so I started trimming him myself, weekly, by bevelling the toe as recommended in the Distal Descent link, as I read all of Pete Ramey's stuff in the past.  By January 2022, even though his feet looked better from the outside, the xrays showed little or no improvement, and possibly things got worse, especially the NPA and he was in pain everyday, even with boots and pads (I did try).  And I gave up, which is why my farrier suggested plastic shoes.  So for a glorious 5 weeks he was not in pain, and we both enjoyed life a little more.  I now realize that with a metabolic horse, you can only achieve so much with the trim, and in this case, we have not been successful.

So perhaps I should increase his prascend...this might help with the poor feet.  Do you think Metformin might decrease the heel pain?

I cannot do another 1.5 years of barefoot, hoping that maybe his heels will grow and his sole depth will increase and watching him be in pain.  Some people say that some horses just cannot go without shoes.  Might this be the case for Callisto?

I appreciate your insights.
--
Lara W. in Victoria, BC 2021
Callisto Case History
Photo Album


lara.wear@...
 

Hi Martha,
Thank-you for your response.  Yes, after the diagnosis, I read about weak tendon/ligament issue in PPID horses.  and thought to myself "of course it's related."  I have increased the prascend against my vet's advice in an effort to try and minimize his symptoms. The problem is, it takes months to figure out if it's helping or not with long coat, late shedding, better laminar connection, and the other symptoms of mouth ulcers and weak tendons...well I simply did not know these were symptoms even with the hours and months of reading I've done.  

I stuck with 1.5 mg for 13 months because my vet said to lower it and people on this forum said to try raising it and I got stuck between conflicting advice. Now that this has happened, and a different vet agreed with me that raising the prascend might be worth a try, I am going to try.  But then, how long do I wait to know if it's working?  It's a year to determine by the coat.  It's months for the feet. 

When you increase, how long to you need to tell if it's making a positive difference?


--
Lara W. in Victoria, BC 2021
Callisto Case History
Photo Album


lara.wear@...
 

Thank-you Sue for your response.  We have no aqua tread facility here.  I do have a few questions about your rehabs:
1) Was the horse turned out with room to move? Was he turned out with other horses? Or was he in tiny paddock jail?
2) Did you hand walk or ride the horse during this time?
3) Did you use bute or another anti-inflammatory?
4) Was he barefoot or shod? And if he was shod, did you do any corrective shoeing?
--
Lara W. in Victoria, BC 2021
Callisto Case History
Photo Album


lara.wear@...
 

Hi Kirsten, I did finally cave and get his main hay tested wet chem at Nutrilytical and it was about $92 CDN.  It confirmed that the two non wet chem tests that had been done on the hay by the supplier were accurate and his diet balanced well with the supplements he is on.  

My exhaustion is from 1.5 years of trying to improve his feet and getting no success, with things just going downhill. I thought going barefoot was going to improve his quality of life, but instead it's destroyed his and mine.
--
Lara W. in Victoria, BC 2021
Callisto Case History
Photo Album


Eleanor Kellon, VMD
 

There are some things I would suggest with the trim but since it doesn't sound like you are willing to go that route I won't. Not having the diet mineral balanced may also be a big factor in why you are having issues. Neither Prascend nor Metformin will help this.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001


Sherry Morse
 

Hi Lara,

Were this my horse I would not ride him and I would concentrate on getting his trim in better order as that's probably where a large part of his pain is coming from.  I would also keep him in boots 24/7 if he's more comfortable that way as he has no sole to speak of.  

As far as giving up - that's ultimately your decision.  We've seen horses with feet in worse shape than Callisto's come back to soundness but it does take a year to grow out a new hoof and the trimming while that is happening needs to be done more frequently than can happen while wearing shoes.  




 
Edited

Hi Lara,
I’m not sure there’s a simple answer to your question about ‘how long’.  Many of the PPID symptoms I noted were only in retrospect.  I increased for one reason and noted improvement in other areas.  With skin issues, the improvement was quite quick.  You might never know if it helps his ligaments and tendons.  I just mentioned that because it’s of interest to me but getting his trim in order is what needs your attention the most.  More pergolide won’t help with that.

When I get totally frustrated, it’s usually because I can’t see the next step.  That might be alleviated by taking his trim on as a learning project.  Those people who follow Lavinia’s advice to the letter seem to do really well but I think you have to touch base with her very frequently as things can quickly get out of hand.  I learn a lot from just following her advice to others.  She did mark ups for you a little over a year ago but checking in with her after your first trim would have been ideal to make sure it happened as Lavinia intended.  His X-rays are fairly consistent from one set to the next, which is not what you’d hope to see.
--
Martha in Vermont
ECIR Group Primary Response
July 2012 
 
Logo (dec. 7/20/19), Tobit(EC) and Pumpkin, Handy and Silver (EC/IR)

Martha and Logo


 
 


Sue Ring
 

Hey Lara,

1.)  Horse was initially confined to stall rest with 3X daily hand walking for 15-20 min as tolerated.....this lasted for approx 4 weeks.
2.)  After stall rest period, Aqua Tread was started at 1 x weekly working up to 3 x weekly for 1 month, then tapering back down to 1 x weekly, over a period of about 3 months.  "Turn out" was limited to 12' x 36' paddock run attached to stall, and hand walking, given as tolerated and to help eliminate any confinement anxiety.  Horse was never medicated (sedated) during confinement.  No riding for about three months and when I did start back up it was long walks on level terrain for a while.  Renewed riding activity was planned with my vet and eased into based upon check ups.....but he REALLY improved/strengthened after the Aqua Tread.  Horse was strictly a pleasure horse.  Never did any explosive movements, jumping, etc.  He actually wrecked himself playing in the pasture.
3.)  Tapering dose of bute was given early on, bute was discontinued halfway through the stall rest period and given again only if soreness/heat was indicated.  I pretty much stopped it a week or two before he started Aqua Tread and then watched him closely for any signs of pain, but he remained pretty comfortable.
4.)  He was shod with corrective trailer support behind, but after Aqua Tread therapy, shoes were removed and he was transitioned to barefoot.  Horse had been barefoot off and on, but at the time of his injury, he had been shod, but not therapeutically.  Horse is now barefoot and has been for many years.
I should add that I do have him at my own farm and I have my own trailer so the transport to Aqua Tread was convenient for me.  I also have Stable Comfort flooring in the stalls in my barn, which is VERY comfortable for them and conducive to comfort for horses with injuries such as suspensory.  He also had other familiar, friendly horses to smooze with over his paddock fencing during confinement and horses to see, at all times, in the pastures.

I'm not gonna lie, it was a long, drawn out process, frustrating at times, for sure, but I was committed to it and the results were well worth it.  If you are boarding, you may want to talk to some of the younger barn helpers who could help you out on certain legs of your rehab program, without breaking the bank.  It many times, works out well as they make money yet you are not having to pay a traveling rehab/veterinary professional.  There are many facets of a rehab program that willing friends and barn workers can help out with!

Again, good luck, Lara and Callisto.  It seems like years ago, but as I look back, it went by pretty fast and I went to bed each night very tired, praying for strength for the next day!  And my horse is 21 years young now, has some other age-related issues such as PPID, but through it all, has been a trooper!!!
--
Sue R in NC 2021

CASE HISTORY:  https://ecir.groups.io/g/CaseHistory/files/Sue%20and%20Shifty

PHOTO FILES: 


 


lara.wear@...
 

Thank you for your words of encouragement. I really need that right now.
--
Lara W. in Victoria, BC 2021
Callisto Case History
Photo Album


lara.wear@...
 

Hi Dr. Kellon,


Actually I would greatly appreciate any advice you can provide on trim. Sorry if my previous note implied I will not do what needs to be done to provide the best case for Callisto. Of course I will. Rehab in our situation, and with our the wet session is challenging, and I was just expressing that, probably not useful.


Regarding diet, I am confident that his diet has been mineral balanced for the past year now. I feel my next steps are to continue to treat PPID with Prascend based on symptoms and work with my farrier on trim. Again, I would appreciate any advice on trim and thank you for all the advice to date.

 
--
Lara W. in Victoria, BC 2021
Callisto Case History
Photo Album


Sherry Morse
 

Hi Lara,

If you would like trim advice you can post a note for Lavinia that says "Lavinia, trim markups needed" - not sure if you've had your first set (which is free) or not but they do need to be followed.  Looking at Callisto's feet there's not a whole lot of difference from his 2020 trim to now so you may need to do some trimming on your own in addition to what your trimmer does if they're not able to completely follow the mark ups.




Nancy C
 

Hi Lara

You've gotten a lot of input on this issue. At the risk of piling on, I wanted to share my experience with zero coffin bone plane in a now 22 y/o PPID QH.

My rads look similar to yours. We did not have the issue of suspensory injury but it appeared he was getting arthritis in his knees. We tried shoes.
We tried barefoot. We tried boots. We tried elevating the heels. We used various means of pain relief, mostly herbal. Nothing worked to significantly help him until we trimmed the foot to function as it should internally, giving him time to rehab his internal structures. 

The trim brings the toes back to within the white line, and the heels back so the bone structure is where is should be, underneath him. For the record, we did not do the heel ramping that Pete suggests. Just bring the toes and heels back slow and steady, with frequently touch up multiple times a week to start, monitoring the placement of the frog and central sulcus, and the lack of curvature of the coronet band at the heels.

This may cause discomfort while the tissues within the hoof develop correctly. He had been walking this way 20 years.  Using pads, boots, massage and hand walking, are how we moved forward. Importantly, it was not long before he was doing this work himself, moving out more and more because he felt better. Through all of this, he never needed supportive devices for long periods.

I now can go four weeks in between trims.

Regarding balancing your diet.  The good news is that if he stopped eating the magnesium as outlined in your CH, that appears to be okay, because your last two tests show your major minerals are already balanced in the forage. You do not appear however, to have enough info on your tests to know whether or not your trace minerals are in fact balanced. Making that so -- balancing the traces -- will have a huge impact on soft tissue healing .
--
Nancy C in NH
ECIR Moderator 2003
ECIR Group Inc. President/Treasurer  2021-2022



Eleanor Kellon, VMD
 

What are your mineral ratios and total intakes?  Protein and sulfur?  Any amino acid supplementation?

I would use this trim https://hoofrehab.com/DistalDescent.htm with heat fitted boots and pads with a slight wedge until the negative palmar angle starts to resolve.
--
Eleanor in PA

www.drkellon.com 
EC Owner 2001