Bailey’s Journal – Conquering High Ringbone

January 1, 2017 UPDATE- Bailey continues to be healthy, happy and ridden even through Syracuse winters on a regular basis.  She does show signs of general arthritis as she ages that is managed with bute when necessary.  I am very happy with her progress, and I love seeing her run pain free.

I am happy to report, that as of November 15, 2015, Bailey is a happy horse enjoying most of the things we love to do together, but to get her to this point has been a journey to say the least. 

It may take me time to describe the events that got us to the point we are now, but I hope the journal will encourage other owners that might be in a situation like I was, with a very special horse, to never stop researching for a solution, to take a chance and to always have hope.

THE DIAGNOSIS

July 20, 2010.  The beginning of my journey with Bailey.  This was going to be the fourth best day of my life after my wedding and birth of my two children.  This was also going to be the beginning of owning a horse for the first time and learning very quickly your perfect horse life is not always what you dreamed it would be. Bailey is a 15.2 hh, 10 year old tri colored pinto mare.  She was sold as a sound accomplished horse in hunter shows, hunter pace, fox hunting.

July 27, 2010.  I had accumulated the proper English riding tack to start riding Bailey in a lesson.  In the lesson I am asked to right lead canter Bailey.  Bailey stumbles very bad almost causing me to go over her head after turning right around the bend of the ring.  Both the instructor and I assume Bailey tripped and I continue to try to canter her, but the stumbling continues to the right, not to the left.  Since she was sold as a sound horse, we didn’t expect an issue.

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August 10, 2010. The barn I was boarding at was having their driveway paved so for a few days the horses were not being turned out since it would require walking and crossing the road construction to the pastures.  Bailey was in her stall or brought out for grooming and cleaning of her stall for a day and a half.

August 12, 2010.  The horses were all put out in the pasture in the evening after completion of the road.

August 13, 2010.  I receive a phone call first thing in the morning that Bailey is severely lame when they went to bring her back into the barn after being out in the pasture for the evening.  She cannot walk.  This is a phone call no horse owner wants to receive.  I have the barn vet come out that day and examine Bailey’s right foot.

EXAM-LAMENESS – (0.34) (0.34)Lame RF. Was noticed this morning when horse taken from stall. Grade 4/5 lame on turns, 3/5 lame at walk. Palpable heat medially in hoof. Pastern region slightly swollen, minimal reactivity to flexion of fetlock, no sensitivity to hoof testers. PD block partial improvement but still careful on turns. Abaxial sesmoid block abolishes lameness. Suspect foot bruise or abscess. Plan: Soak foot daily in Epsolm Salts then bandage in animalintex pad and diaper.

She advises me it might be an abscess and to treat for that.  I am told by fellow horse owners I should feel so lucky it is only an abscess.

Little did I know.

So it is day one of the first 5 days of making a duct tape wrap to fit around my horses hoof with a poultice pad stuck on the hoof bottom to draw out the possible infection.  This was my first medical task as a 23 day old new horse owner.  First you soak the foot for about 10 minutes in a bucket of Epson salt, then carefully without getting the hoof dirty, be ready to apply to the medicated pad, then put hoof in a small diaper pad, and finish up with a duct tape homemade square grid to wrap around and hold everything to the hoof.  Do this 2x a day for 5 days to a 1000 lb. horse you hardly know, plus be prepared to cut it off the hoof to repeat the process.  Luckily I did get help at the barn I was boarding at.  It was very much appreciated.

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August 18, 2010.  The veterinarian was called back to check on right hoof.

EXAM – Mare is comfortable on foot, turns with ease, negative to hoof testers. As per owner mare is running in pasture soundly. Plan: Dry wrap foot for 2 days then resume normal activity

August 24, 2010.  Bailey is severely lame again!  What could be going on?  It is now 6 days since the vet had examined Bailey and nothing was making sense.  I was beginning to get suspicious to the health of Bailey.  It was appearing to be the classic used car deal.  Salesman says the car is perfect, no issues, and 23 miles later the check engine light goes on.

August 25, 2010.  The vet at the barn I boarded at came out for a third time.  She determines Bailey is still not sound and we need to investigate more.  She advises me that x-rays will be needed at this point.  I authorize 2 x-rays on Baileys right leg.  The x-rays reveal probable high ringbone.  Since the vet had not planned to do x-rays and had a time restriction, Bailey was not properly washed down in the leg area for perfect x-rays, but it would give us some idea.  More x-rays would have to be done at a scheduled appointment.  I now had a new word to research- HIGH RINGBONE!

EXAM-LAMENESS – Horse appeared sound for several days while being turned out. Mare had a day and a half in stall due to weather conditions(8/22/10+8/23/10), and when brought back in after first day of turnout was grade 4/5 lame. Owner bandaged leg and kept inside for the remainder of the day and until seen 8/25/10. Today grade 1.5/5 lame RF on straight line. Grade 2/5 lame on turns to left. Horse is negative to hoof testers. Lower limb flexion horse becomes grade 4/5 lame. Small degree of swelling is still present on dorsal aspect of pastern. Discussed full evaluation including joint block and radiographs. Owner is undecided as to course of action to take and is considering returning horse to seller. 2 Radiographic views of the pastern were obtained. Lateral view shows small osteophyte on dorsal surface of P2 which may be the cause of underlying
lameness. Recommended pastern joint block as next step in lameness diagnosis. Owner needs to consider options before going further.

September 8, 2010.  The vet comes back again and does 2 more clean x-rays on Bailey’s leg and confirms high ringbone is the reason for her lameness.

EXAM-LAMENESS – (0.34) Grade 2 lame RF at trot on lunge in both directions. To left horse tends to drift to outside of circle and to right horse prefers to drift to inside of circle. RF lower limb flexion mare becomes grade 3 lame. Injection of 4cc Carbocaine into distal phalangeal joint does not improve lameness. Injection of proximal interphalangeal joint was difficult and only 3cc could be deposited in joint abolished lameness in RF and horse was more relaxed in both directions. Two oblique views of RF pastern were then obtained. The DLPMO view shows a large irregular osteophyte on proximal P2 with lipping into joint surface.
DX: Osteoarthritis of proximal interphalangeal joint centered over dorsal medial aspect of joint (a.k.a. High Ringbone).

9-8-2010 x-ray

I will never forget the words the vet said to me.  She’s junk, get rid of her.  Those words have haunted me for 5 years.  I was obviously quite upset and concerned as I was now faced with owning a horse for a little over a month, that I hardly knew, had ridden about three times, and was now diagnosed with a pre-existing progressive condition with a very poor outlook.

WHAT IS HIGH RINGBONE

ringbone
noun ring•bone \-ˌbōn\
Definition of RINGBONE
: a bony outgrowth on or near the articulating surface of the pastern or coffin bone of a horse that typically results from injury and usually produces lameness.

pastern illustration

The pastern is a part of the leg of a horse between the fetlock and the top of the hoof.  The pastern consists of two bones, the uppermost called the “large pastern bone” or proximal phalanx, which begins just under the fetlock joint, and the lower called the “small pastern bone” or middle phalanx, located between the large pastern bone and the coffin bone.  The joint between these two bones is aptly called the “pastern joint”. This joint has limited movement, but does help to disperse the concussive forces of the horse’s step and also has some influence on the flexion or extension of the entire leg. The pastern is vital in shock absorption. When the horse’s front leg is grounded, the elbow and knee are locked. Therefore, the fetlock and pastern are responsible for all the absorption of concussive forces of a footfall. Together, they effectively distribute it among both the bones of the leg and the tendons and ligaments.

The veterinarian caring for Bailey concluded:  It is my medical opinion that the origin of lameness is directed at the proximal interphalangeal joint (diagnosed as osteoarthritis of the proximal interphalangeal joint). Osteoarthritis begins as inflammation within the synovium of the joint and is not evident on radiographs at this stage. As the disease progresses, the inflammatory mediators break down joint cartilage and synovial fluid. Bony changes are a later manifestation of the disease and represent irreversible pathology. It is my medical opinion that “Bailey’s” radiographic changes are chronic in nature, occurring well before the 26 days between initial examination and final diagnosis. Treatment of this condition can be unrewarding, and consists of systemic and local anti-inflammatory therapy (both topical and intra-articular). Additional treatment may consist of fusing the affected joint, but this is of last resort as the animal is not generally sound for riding.

STARTING MANAGEMENT

1st TREATMENT- BUTE

Dealing with ringbone is not a single treatment but rather a whole management scheme that is lifelong for the horse.

October 7, 2010.  The veterinarian come out for a re-check and treatment plan.  Bailey was treated prior to me owning her with Bute (phenylbutazone) and she seemed to respond to that drug as I bought her assuming she was sound.  Since it wasn’t till she didn’t have bute in her system that she became lame with me as her owner I was prescribed 1 gram of bute to give before a ride and after the ride.  I was also prescribed surpass cream to apply directly to the joint.   Bailey is currently a barefoot horse, and it is recommended to trim her short and roll the toe.  (It never was short enough through this whole process according to what the vet wanted)

I moved Bailey that day to another barn with more trail riding opportunities since the barn I was at was considered a hunter jumper barn and required lessons which Bailey would not be able to participate in.

Horses with ringbone do best with consistent low-level exercise. Horses that stand excessively all day long tend to get more inflammation in the joints and therefore more lame. Constant walking around all day on pasture helps stimulate circulation and decrease inflammation within the joint, therefore decreasing lameness.

October 7- December 7, 2010.  Bailey is ride-able at a walk with prescribed bute.  We participate in “Trail Trial rides” which are organized trail rides that includes obstacles and situations horse and rider might encounter on a trail ride. The ride is planned using the natural obstacles that already exist on a particular trail such as walking over logs, opening a gate, or maneuvering through a creek.  It is fun and new for both of us to do together.

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The barn she is at is under construction and her pasture time is greatly decreased while work in that area is being completed.  She is standing in her stall too long making her lame and anxious.  Her behavior is changing from being stalled for long periods.  It is reported she breaks through a fence while being led to pasture.  That same day she bucks violently when I first mount her in the riding ring.  I am concerned for her health and well being.  This has to change.

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December 7, 2010.  Bailey is relocated to a private barn where I am hoping for more cooperation in my goal to manage her ringbone.  It is a snowy day when we transport her.  This is the start of the winter from hell.  It didn’t stop snowing from that day till spring 2011!  The barn was consistent in pasture time even through winter, and that was just what Bailey needed.

So far so good…

EMERGENCY CALL- non ringbone related

This is off the path of high ringbone, but  the major event added to my determination to do everything I could for Bailey who was such a fighter.

February 26, 2011.   It’s happening again, that 8 am morning phone call every horse owner fears.  The caller says “Your horse is down and another is gone”.  What does that mean!  I immediately head to the barn to find my precious Bailey on the verge of death, and another horse is dead.  I had just left her the previous night and she was fine.

Now in a series of unfortunate events that seem to keep following us, my vet has decided to sell her practice but not tell any patients yet, so when I make an emergency phone call she tells me she is moving that day!  The barn owner and I are desperately making phone calls to every vet in the area for emergency service.  In the mean time a handful of people are trying to walk Bailey who is stiff as a board in movement and has gums the color of a gray whale.  It was not looking good at all and time was against us.  We administer upon recommendation of an on-call vet from Cornell to give her Banamine.  That seems to bring some relief until a vet out of Ithaca, New York reaches us at 1pm in the afternoon.

No one at the barn knows what has happened to Bailey.  The mares were being put outside and within 5 minutes one horse staggered a few steps and died.  Bailey was laying down in a snowbank, and the barn owners got her up.

The vet after performing a colic exam, immediately started saline fluids, lactated ringers.  Blood was drawn to be sent to the lab and the vet suspected severe tying up. We have heaters brought in to warm her up as it 10 degrees out.  Bailey is blanketed for more warmth.  The fluid process takes about four hours.  I spend the very cold night with Bailey.  She is responding to treatment.

I get the toxicology report back and it confirms tying up with severely deficient blood selenium recorded at 4.21 ug.  (range is 17.0 – 25.0 ug/dl.) and creatine kinase 3239 (range 142-548).  Selenium injections would be immediately started to get her levels in the correct range.

It is discovered no selenium is in the feed being supplied to her at the barn she is boarded at.  They are not using a commercial feed, rather a bulk feed distributor where the owner selects what is added to the feed.  The common addition of selenium to commercial grain mixes has decreased the percentage of selenium-induced tying-up drastically.  I start adding to her new special feed which does already include selenium an additional scoop of selenium and vitamin E powder to boost her levels per the veterinarian.

Since no autopsy was done on the horse that died, we do not know what happened that triggered Bailey to severely ty up.  It is speculated from the toxology lab that a traumatic episode happened to Bailey that could have been her witnessing the death of the mare.  We will never know.  There were no marks on Bailey to indicate a collision with the other horse, which was first suspected.
March 3, 2011. Vet out for selenium injection

March 11, 2011. Vet out for selenium injection

March 18, 2011. Vet out for selenium injection

Bailey has lost a lot of muscle from tying up, and a rehabilitation program is prescribed.  On top of that, her high ringbone is progressing and she is limping most of the time.

This event was a turning point in my mission with Bailey’s general care. 

I would be supplying special food that had the adequate vitamins, minerals and extra selenium needed for a horse in Central New York.  Also, I would be personally giving her bute tablet according to the schedule devised by my managing veterinarian.  This was important for me to handle now as barn help had their own opinions on what amount of bute Bailey should receive rather than what plan was developed by the treating veterinarian.

2nd TREATMENT- EQUIOXX / 24 HOUR TURNOUT / BUTE

May 3, 2011.  Vet is called out again to take blood for comparison and to discuss another treatment plan for high ringbone.  It is recommended I try Equioxx for two weeks instead of bute.  Equioxx provides consistent pain relief for 24 hours with just one daily dose.  Both bute and equioxx are Non-Steroidal Anti-Inflammatory Drugs (NSAID). I find no improvement in Bailey’s lameness and in fact she seems worse without bute on a daily basis.  The vet prescribes going back to 1 gram bute tablet on a maintenance schedule of 5 days on, 2 days off.

BAILEY MOVES HOME!

P1070573(1)IMG_0043(1)Winter Dec. 2013 004

July 21, 2011.  Bailey moved home 1 year and 1 day since buying her. After staying at a few barns and seeing what she needed most, the best thing for Bailey was to come home where I could be sure she had 24 hour turnout, medicine distributed correctly and high quality feed and hay.  The barn at my home had existed on the property, but it did require some structural reinforcement and a stall area constructed, as well as some initial fencing.  All that was accomplished in three days with some very hard working friends and hired help.  Now Bailey would be free to move about and not be in a stall even for a short amount of time.  She is never locked in a stall even in rain, snow, sleet, wind, anything.   Bailey has free choice to come into the barn stall area or not, and for the most part, she prefers being outside.

July 27, 2011.  We meet our new veterinarian! Alfredo Romero, DVM, DACVS  Dr. Romero will handle Bailey from this point.

July 21, 2011 – April 15, 2012. We continue with the bute program, 5 days 1 gram bute, 2 days off.  I also add topical surpass, although I am not seeing any benefit.  It is a cream that is rubbed directly at the joint.  It is pretty hard to tell if you are actually getting through the hair to the skin properly.  It is a very mild winter, and I ride Bailey a few times a week through winter keeping her moving and in a non strenuous trail riding program of walk only.

EasyTrail0photo

April 16, 2012 – May 5, 2013.  Trail riding access to my paths change forcing me to have to hand walk Bailey a half a mile down a paved road, then onto a pebble road.  This change is extremely painful for Bailey even given bute prior to the ride.  My farrier is rolling both Bailey’s front toes, cutting them very short so they leave the ground as soon as possible.  I purchase EasyBoot Trail boots with pads inserted in them for protection when walking on the road.  Again, as terrific as the boots were, the hard surfaces are her enemy with high ringbone, and she has minimal comfort from the boots.  I do use them as they are better than nothing.

3rd TREATMENT- SHOES & PADS / JOINT INJECTIONS

May 6, 2013.  My vet and farrier discuss with me putting shoes with pads on Bailey for the first time as she currently was a barefoot horse.  We put on lightweight aluminum shoes with a pad and set the shoe back on the hoof to encourage a dramatic rollover effect.  This with the bute schedule did show improvement.  She is still lame on roads, hard ground, down slopes at a walk.  We discuss doing cortisone injections.

photo shoephoto(1)

May 23, 2013.  Bailey gets first joint injection of corticosteroids Depo-Medrol into her right pastern joint.  After waiting the 10 day period, I saw great results for 2 months.  Bailey was sound on all ground surfaces.  I am hopeful the injection will provide comfort for possibly 4-6 months, through the riding season.  X-rays are not taken, so it is hard to determine if the injection is getting into the joint with all the ringbone around the joint.

EXAM-LAMENESS – Shortened stride on R front at walk. Right front DJD in the
PIP. Last x-ray was taken 3 years ago. Administered .5cc torb/.5cc dorm. ABSES block was placed in right front. Pastern was sterilly prepped in standard fashion. PIP was injected with 60mg depomedrol and 250 mg Amikacin.

August 6, 2013. Bailey’s lameness has deteriorated in the last 2 weeks since the injection 2 months ago.  The vet comes out to give Bailey her 2nd joint injection.

EXAM-LAMENESS – Lameness is moderate in severity. apparent at the walk.
Owner said that the last injection worked well but horse’s lameness has come back over the last two weeks.  Discussed the possibility of surgery or ethyl alcohol injections in the future. Today: ab ses block w carbocaine, rf. sterile prep of dorsal pastern rf. sedated with .5 dorm and .5 torb IV. injected rf pastern jt with 6 mg triamcinolone, 250 mg amikacin, and 2 cc hayaluronic acid.

September 14, 2013. Bailey is barefoot again.  The shoes are pulled off for winter and her upcoming procedures.  It is becoming clear to me I need to do something drastic if I was going to have a horse to ride in the future.  The injection was pretty much useless.  After waiting 10 days to ride her and hope she is sound, she was just as lame, the injection did nothing.  I schedule an appointment to have Bailey’s pastern joint injected with ethyl alcohol in a last desperate effort to make her comfortable and hopefully be able to be ridden some day.

4th TREATMENT- ETHYL ALCOHOL INJECTION FUSION !!!

After 3 years of managing Bailey’s high ringbone with 24 hour pasture opportunity, a maintenance exercise program, bute, equioxx, shoes, pads, barefoot, cortisone injections, I have come to my last chance to make her comfortable and hopefully able to be ridden, even at a walk.

Any lameness can be tough for a veterinarian to treat and resolve, but pastern joint lameness caused by osteoarthritis can be especially problematic. Stephanie Caston, DVM, Dipl. ACVS, discussed possible options for managing pastern osteoarthritis at the 2010 American Association of Equine Practitioners Convention, held Dec. 4-8 in Baltimore, Md.  Chemical joint fusion using ethyl alcohol was one treatment she and colleagues examined in a recent study.  In low-motion joints, sometimes the solution to lameness troubles is physiologic fusion (fixation of the joint so it can’t move) called ankylosis, to relieve pain and discomfort. Ankylosis occurs naturally in some joints, but Caston noted that ongoing joint disease in itself is unlikely to result in complete ankylosis. Typically, veterinarians manage such low-motion joints using arthrodesis (surgical fusion) with a variety of approaches ranging from lag screws and plates to drilling away the cartilage to laser surgery or chemical injections with irritating substances (to induce fusion). Many of these orthopedic solutions are expensive and fraught with long recovery periods.  Caston presented an alternative chemical approach to surgical arthrodesis, injecting sterilized 75% ethyl alcohol (Everclear grain alcohol) into an osteoarthritis-affected pastern joint.  Nancy S. Loving, DVM

I discuss this option with my veterinarian, Dr. Alfredo Romero who is a lameness expert.  He is aware of this relatively new and barely documented procedure, and has preformed a similar procedure on the hock joint, but never with the pastern joint.  He discusses with me the pros and cons.  I call around the area for input from Cornell and other well respected veterinarians who assure me I am in the best hands with Dr. Romero, although they will not do the procedure.

Having a veterinarian specialists that is forward thinking in treatment and compassionate about my horse, my goals, and me was key to moving forward with this procedure.

September 19, 2013.  I have built this procedure date up in my mind for a few weeks since I discovered the process written above while googling any hope for high ringbone and contacting my veterinarian Dr. Alfredo Romero, DVM, Dipl. ACVS, Diplomate American College of Veterinary Surgeons, in regards to having this done to Bailey.  Today was the day that she would be cured in my mind!  Dr. Romero came to my barn for the procedure.  This became in the end a wrong choice by me, as he had suggested I bring Bailey to his state of the art surgical facility.  Dr. Romero sedated Bailey and the goal was to inject somewhere between 6-10cc ethyl alcohol into her pastern joint.

9-19-2013 front

9-19-2013 side

The process to to get the ethyl alcohol into the joint space goes basically  like this:

-first numb the area,

-then place a needle into the joint,

-then take a radiograph to be sure it is in the correct position,

-then IF it is in the correct position, dye is injected to be sure it goes in the joint and not outside the joint,

-then if all that is correct, the ethyl alcohol is injected. 

These multiple steps prior to injection are crucial because if the ethyl alcohol gets out of the joint it can damage ligaments permanently.

This was done many many many many many many times that day without success.  Dr. Romero went above and beyond in his determination to get into Bailey’s joint, but she had so much deterioration around the joint, he could not manipulate her joint enough for a safe injection.  It wasn’t going to happen at my barn today.  I was completely devastated, and honestly, I think Dr. Romero felt my pain too.  He left saying he could try again at his facility where he felt he would have a sterile safe environment for Bailey’s joint to be manipulated and hopefully injected.  After my initial pity party, I scheduled an appointment to have the procedure re-tried on September 30, 2013.  Fingers Crossed till then.

I contact Dr. Romero as I am concerned what the outcome will be if he cannot get at least 6cc into Bailey next week.  He tells me that is not a major problem.  It just means that the joint space has started to fuse and so space is reduced.

The difference between choosing the ethyl alcohol fusion compared to the surgical fusion was huge for me- both financially and physically.  With the ethyl alcohol fusion, other than the needle injected, there is nothing else that effects the outside of the horse for this procedure.  There is no exterior first aid through recovery.  There is no specific stall rest.  Life for the recovering horse, according to what little I could find about this procedure, can be uncomplicated.  With the surgical procedure, there is months of stall rest.  There is cutting through skin, drilling, inserting screws, plates, stitching and exterior wounds which can lead to infection.  There is always the chance the horse won’t even make it through the surgery.  Casts are put on and need to be changed.  It is quite an ordeal for an average horse owner, although it can have a high success rate.  It was certainly not something I could tackle at my barn for her lengthy recovery period from that procedure.  Bailey also was a horse who had not been locked in a stall for three years now, and I couldn’t see doing that mentally to her, let alone physically.
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September 30, 2013.  We are off to Syracuse Equine Veterinary Specialists facility in Manlius, NY.  With the help of a good friend and her trailer, we load Bailey up for what I hope is going to be a successful day.  Dr. Romero knowing how emotional I am over this, politely suggests I leave for about an hour and let him work on Bailey.  As hard as it was to leave her, I wanted my doctor to have the privacy and concentration to get this done.  About an hour later I receive a call that is has been a success, and 8cc of ethyl alcohol was injected into her joint.  I am able to load Bailey back onto the trailer and bring her home that day.  Now only time will tell her outcome.

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Bailey is comfortable and not in pain the first 48 hours since she is still numb from the procedure.  She gets around fine.  Since this is uncharted waters, everyday is a new day with no real guidelines as what to expect.  I am told she will go through many stages of in and out of pain.  As the nerve endings die off she will not feel pain, as the joint fuses together like a broken bone would heal, she may feel pain.  Since Bailey is the only horse at the barn, my hope is she will fuse beautifully since she will not be frolicking with other horses.  Also, I had selected this time of year knowing winter was coming and she will by choice spend more time standing around in the stall eating hay and allowing the joint to fuse from less movement.

October 1, 2013.  Bailey is fine

October 2, 2013.  Bailey very sore, won’t put any weight on foot.  Administer 2 grams of bute in the am and pm.

October 3, 2013. Bailey very sore, won’t put any weight on foot.  Administer 2 grams of bute in the am and pm.

October 4, 2013. Bailey very sore, won’t put any weight on foot.  Administer 2 grams of bute in the am and pm.

October 5, 2013.  Bailey very sore, won’t put any weight on foot. Barely walking, doing a three legged hop.   Administer 2 grams of bute in the am and pm.

October 6, 2013.  Some improvement.  Administer 2 grams of bute in the am and pm.  She is a remarkable horse with such a big heart.

October 8, 2013.  Bailey is walking better.  I have a previous planned trip to California and leave boarding the plane relieved that Bailey is getting better.  I would be gone for 5 days and Dave was here to feed her and keep me posted on how she was doing.

October 15, 2013.  It is now 2 weeks since Bailey was injected with ethyl alcohol and she is not doing good at all.  I was returning from California to Syracuse. Dave had said Bailey was not getting up in her stall the last day.  It is not the recovery I had read about when I was deciding to do this.  With so little follow up on the recovery everyday was pretty much unknown.  That was the hardest for me as an owner.  I never knew what is normal for the recovery.   Thankfully I did have the best veterinarian taking care of Bailey and me!  Every time I contacted him, and it was pretty much daily for the first month, he was always helpful since he had a calming effect in assuring me to be patient and continue to contact him if I was concerned.  Since Bailey looks worse than ever, I call Dr. Romero to come out and examine Bailey.

EXAM – Post alcohol injection of the pastern 2 wks ago. Bailey is increasingly
uncomfortable. On exam today, Bailey is 4/5 lame, with sensitivity to palpation of the pastern joint, no sensitivity to hoof testers. Recommendations: continue observation and increase bute to 3g/day, consider adding gabapentin if lameness persists. Will call on thursday with update.

October 16, 2013.  Slight improvement.  Administer 2 grams of bute in the am and pm.

October 17, 2013.  Not much difference.  Continue 2 grams of bute in the am and pm.

October 24, 2013.  Pretty bad again.  Left legs seems to be getting worn out.  Leg wrap on left leg is suggested.

October 28, 2013.  It has been 28 days since the procedure.  Bailey is having a good day.  Walking pretty good.  Still giving bute but I have cut back to 1 gram in the am, and 1 gram in the pm.

There are now questions I need to ask Dr. Romero.  Do we inject Bailey again?  I have read that the clinical studies all did another injection of ethyl alcohol after one month.  I also talk to a veterinarian at Equine Affaire that has done the procedure and he says he injects after a month.  Dr. Romero is not suggesting another injection.  He assures me that a month ago he got all he could possibly inject into the joint, and further injection was not necessary.  I am satisfied with the decision not to do another injection, plus quite frankly, I was seeing some level of comfort return to Bailey and did not want to go through this past month again.  I still didn’t know what to expect for the next 6 or more months until we x-ray again.

November 12, 2013.  42 days after injection, Bailey walking pretty good on the soft coating of snow.  Her left leg is still wearing the neoprene wrap for strength.

From this point on, Dr. Romero nicely suggests I close the curtains and let Bailey recover.  Unfortunately I tell him I have no curtains on the back of the house, so I do see everything going on, but I follow the doctors orders and let nature do its part both on Bailey’s recovery through the winter months.

THE RECOVERY – Part 1- ETHYL ALCOHOL FUSION OF THE PASTERN JOINT

Winter 2013-2014 in Syracuse, New York behaved as it was supposed to.  Very cold and very snowy.  Perfect conditions for Bailey to want to stand in her stall and eat hay all day and let her pastern joint fuse together.  I still was giving her 1 gram of bute 5 days on, 2 days off.  All was going fine for about 4 months.  I was getting pretty optimistic that I would have a horse to ride in the summer.  That all changed on April fools day 2014.  Could this lameness be starting all over again?

April 2, 2014.  6 months since the ethyl alcohol injection.  Bailey can’t walk at all.  She won’t put the foot down at all.  What is going on?  Is this the final stage of fusion?

4-7-2014 90% fusion

4-7-201490% fused

April 7, 2014.  Dr. Romero is called to examine Bailey and take an x-ray as to what is going on with the severe lameness.  The x-rays reveal 90% fusion.  I guess I am happy, although Bailey seems terrible.

Patience is a familiar word in this procedure I am learning.

EXAM – Diagnosis: Osteoarthritis right front pastern joint.
History: Degenerative arthritis of the right front pastern joint, previously injected with
alcohol 5 months ago. Owner reports increased degree of lameness over the past week but
has been improving slowly. Owner also reports increased coughing spells which also
started about a week ago. Coughing doesn’t seem productive and may be associated with
the new use of wood pellets for bedding.
Exam: BAR. T 99.7, P 44, R 16. BCS: 6/9. Increased effort and lung sounds. Small
whistle on the right side on exhalation. 4/5 grade lameness on the right front, sensitivity
to palpation of the pastern. No sensitivity to hoof testers. Small sore on right hind
calcaneous. 1cmx 3cm non haired plaque of skin, raised, and pigmented on the right neck.
Radiographs reveal 90% ablation of the PIP.
Reccomendations:
1) Use anti inflammatories and pain killers for one month.
2) Recheck in 1 month. (Alfredo Romero, DVM, DACVS)

April 8, 2014.  Bailey out and about walking in pasture.  Still favoring right leg, but definitely getting around better than last week.

April 16, 2014.  Bailey with a bit of spirit in her walk.

April 20, 2014.  Almost 7 months from the Ethyl Alcohol injection.  Bailey walking around pretty good.

April 27, 2014.  Slow progress.  Hoping slow and steady wins the race.

May 7, 2014.  Dr. Romero checks Bailey again.  He suggests again putting her on Gabapentin for a two week trial to see if that helps her since her lameness is so intermittent.  One day good, one day bad.  Nothing seems to matter.

June 5-22, 2014.  I decide to try as a last resort Gabapentin.  Gabapentin is a nerve pain medication and anticonvulsant.  Gabapentin is a structural analogue of GABA, an inhibitory neurotransmitter.  I complete 2-1/2 weeks of Gabapentin on Bailey.  Her lameness reacted the way it has all along.  One day good, then bad, then terrible, then better.  Dr. Romero said if she was going to respond to it, she would have by now so we stop the medication.  Plus the drug is really expensive and it really effected her mentally.  She was a zombie horse, even after we adjusted her dosage.  I did not like that drug on her at all.

I am exhausted from watching Bailey deal with high ringbone for 4 years, and especially the last 8 months not being successful in this treatment.  I am discouraged that after all Bailey has gone through, she is no better, and maybe worse than before the injection.  I make a decision to look for another horse that I can ride and if Bailey continues so poorly, I will do the humane thing and put her down before winter. 

THE RECOVERY – Part 2- ETHYL ALCOHOL FUSION OF THE PASTERN JOINT

There were four factors that made Bailey’s procedure and recovery a success.  First, the toughness of my mare Bailey.  Second, Dr. Al Romero, a compassionate veterinarian who is an expert in lameness.  Third, a very determined and patient owner.  The fourth factor is probably the biggest shock of all…Cheyenne, the new mare that I bought.

June 28, 2014.  The farrier has just left my barn after trimming Bailey’s hooves.  She is still limping around.  Dr. Romero and I are pretty much out of options.  He is thinking it could be scar tissue that is causing her pain again in that area, but we would need to start x-rays and lameness examine all over.  He is suggesting trying to get her to move more, but to do that I would have to be very forceful with her and that seems cruel at this point.  She just doesn’t want to move much.  I have decided to just let her enjoy the summer.  I go later in the morning to look at a horse that needs to be sold and relocated ASAP.  I am aware of the horse’s personality issues.  I really didn’t think I would buy her right then, but sure enough, about a half hour later I am bringing Cheyenne home.

bailey and cheyenne 8-20-2014(1)

June 29, 2014.  It didn’t take long for Bailey to claim her turf to Cheyenne as the alpha horse.  Bailey was now moving a lot with the addition of Cheyenne in the pasture, even though she was still limping.

July 2014. Bailey’s mind was distracted of her pain with the presence of Cheyenne.  Anytime I took Cheyenne out of the pasture to trail ride, Bailey would run the fence line.  This movement is just what the doctor ordered, only she was doing it herself!

August 2014-March 2015.  Bailey is enjoying life.  She is limping less and less, and moving more and more.  There is hope again that the fusion has been successful.  We decide to wait through the winter and re evaluate her condition.

P1120892 Jan 14 2015 2-15-2015

March 18, 2015.  Dr. Al Romero comes for the horses vaccinations and to discuss a riding rehabilitation plan for Bailey as she is walking great.  He advises 5 minutes a day for a week, and increase 5 minutes every week starting in the spring.

I always hoped I would ride Bailey again.  It was a dream come true.

April 2015.  The snow has finally melted and I begin Bailey’s rehabilitation program.  I stick very strictly to the guideline set by Dr. Romero.  Sorry that the video shows me without a helmet, no excuse, but it was my first time on Bailey in 19 months and I was pretty excited and forgot when we shot this video.  I am lucky to have the help of an experience riding neighbor and as the time increases in her program we bring both horses out together for little trail rides in the woods.

June 2015 – current.  I continue to ride Bailey regularly in a conservative matter.  I am still very cautious that the ground conditions be perfect for.  She does very well on my trails that are relatively soft ground with no rocks.  She enjoys trails rides and has participated in rides an hour long at a walk, except when she wants to rush through the mud!  She is very forward moving on the trails, and thoroughly enjoys being out with Cheyenne and friends.  I am enjoying the ability to use both horses and allow others to enjoy riding my horses with me.  I rarely ask her to trot with a rider on her.  We are still taking baby steps in her progress, but there have been a few times she has trotted, cantered and even gone over a cross rail for fun- her choice!  Bailey still gets 1 gram bute 5 days a week, 2 days off.

iphone transfer 11-2015 a 1418 betty photo(1) emily and kathy

Horse Owner Q & A – Ethyl Alcohol Fusion

There are always questions after a procedure has been done.  Below are some questions and my answers regarding the recovery of Ethyl Alcohol Fusion of the pastern joint on my mare Bailey.  If you have any questions, please send me a message with the question so I can incorporated it into this section.

Q. Was the procedure successful?
A. Success is an interesting word. What one person thinks is success, may be different to another. I wanted to be able to ride Bailey again even at a walk and have her not be in pain or limping. This procedure has been successful for that goal.

Q. After all Bailey went through- the ups and the downs, would you do it again?
A. Yes, because I have a horse that I love that I am riding again.

Q. Would you do the procedure again with her other leg if necessary?
A. Yes. I now know what to expect. I now know it is very possible for a positive outcome. It is unlikely that it will need to be done as it usually only affects one leg. I have an x-ray on her left leg and appears to be ok at this point, and Bailey is not being used at a level that could accelerate that in her other leg.

Q. Would you do it with another horse?
A. I have thought about that, especially since I own a second horse with a completely different personality, but I think I would still do the procedure if that was my last hope for the horse to be comfortable and usable to the level I was hoping for.

Q. What was the worst part?
A. The worst part was having no post procedure information on expectations on a daily or even weekly basis. It was hard to see Bailey limp and hold her leg up. It broke my heart. That is where having a supportive veterinarian that responds to your call was crucial. There are always doubters, and you need a good support system from family and your vet.

Q. What would you have done different?
A. I would have taken Bailey to Dr. Romero’s veterinary facility to have the procedure done there rather than first trying at my barn. I might also not have done the cortisone shots. Since Bailey’s high ringbone was so developed that didn’t really seem worth it for the cost and the limited amount of comfort it brought on my horse.

Q. How much did this cost?
A. The procedure is very affordable. To have Bailey done at the veterinary hospital, with sedation, and approximately 7 radiographs and veterinary surgical time you can estimate $475. That price does not include veterinary calls before or after.

Q. Do you think you will canter her in the future?
A. I don’t know what the future will bring. Every day I enjoy the fact that when I get on my beautiful mare, she can enjoy life with a good walk through the woods and not be limping in pain. We have cantered a few brief times, and trotted a little, but I don’t ask for that. That was never my goal for her in this procedure.

Q. Do you think any horse can have this done?
A. I am not a veterinarian. I do not know your horse. I think the procedure is affordable to try on any horse that a vet thinks is a candidate. To me it was worth trying as I had exhausted all other options except surgical fusion.

Q. What was the most important thing in her recovery?
A. Time! Patience is a virtue. There were many times I questioned the length of recovery. It just seemed to be taking too long. Now it doesn’t seem like it was that long.

Q. What could have gone wrong?
A. If the injection of ethyl alcohol hit a ligament it would damage the ligament and that I was told would be very bad.  That is avoided by being extremely careful in the process of the procedure- first the needle, x-ray, dye, then if correct position, injection of ethyl alcohol.  Although my veterinarian had not done this particular procedure on the pastern joint, he had done it on hocks and he was a board certified surgeon and lameness expert.  I also felt I had nothing to lose at that point.  Other than that, there were no real risks.

Q. Would you buy a horse if you knew it had high ringbone?
A. No, I would not because I am a trail rider and the ground is inconsistent.  Going downhill was hard on her with high ringbone.  For someone who needs a horse in a ring with proper footing, maybe they could use the horse for a while without many problems. I am a little obsessive, and I thought about Bailey’s condition 24 hours a day for 5 years. I wanted to help her so much. It can be exhausting and not always productive.

Q. Why didn’t you just do the ethyl alcohol injection and skip all the other stuff?
A. It wasn’t until a few years later that I discovered this procedure and inquired about it to my vet. Surgical Fusion was always an option presented to me, but was never going to be a reality because of the recovery and financial aspect of it. This is relatively new and undocumented which is why I am sharing my story of Bailey.

Q. Did people think Bailey was suffering because of this?
A. People thought she was suffering before this.  Anyone who knows me knows that I do everything possible to ensure the best care for all my pets. I did get a lot of opinions and advice both from horse owners and friends that was inaccurate to her diagnosis and recovery. That is why a trusted veterinarian is so vital to the success. The horse owner has to be able to call the vet when questioning the progress and have the expertise of the vet assure you that the best interest is being done in the care of the horse. Her painful periods did not stop her ever from eating, enjoying treats, enjoying grooming and love. When I look back they were inconvenience pain periods that lead to healing. Just like a human having to go through rehabilitation and it being painful sometimes to reach the goal.

Q. Do you notice any difference in her walk or trot or canter?

A.  I do not notice any difference with the joint fused.

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4 Comments

4 thoughts on “Bailey’s Journal – Conquering High Ringbone

  1. Barb

    Love the site Kathy — great job!

    Like

  2. Nikki Benner

    Fantastic. So happy you stuck with it. I just had my saved from slaughter gelding injected. First round went well. Second, I am not sure. He is very swollen and miserable tonight. I am hoping the vet got the injection in the correct area. Agggh

    Liked by 1 person

    • Thank you for finding my journal. I’d be happy to talk to you anytime. I am very passionate and knowledgeable about how the process went for my horse. My vet only injected once successfully. I discussed with many vets after the first injection was needed and got mixed opinions, but ultimately went with my vets judgement that one was only needed. If all the area was injected correctly, there is no need for a second injection. If you vet did the dye first, I am sure the vet got it correct. That is whole reason for doing the dye injection test first. Feel free to update me. My mare is great. Is she perfect, no. But I ride her in-between this wet spring raindrops out on trails and she has a blast! Good luck to you. It will take a good year ! BE PATIENT!

      Like

    • Also, from my experience, there were good days, then bad days, then very bad days, then ok days, then good day. It varies for a long time. Again, patience is the most important advice I can give you. And have faith and hope, and don’t doubt the healing process.

      Like

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