The Shadow in the Bone

Edit: this has been reposted as my original post was not allowing comments for some reason.

Yesterday was Leo's big vet visit at the University hospital.

En Route

I was a bit nervous about taking him off property; he hasn't exactly been on his best behavior during our previous field trips, and he's been hanging out in the pasture for the last two months, so I was expecting the day to involve a fair amount of drama.  Thankfully, that assumption turned out to be mostly incorrect.

He loaded like a champ and we made the 15 minute drive to the University at 9:30 this morning - we'd given ourselves extra time to load because he has been...difficult in the past, but thankfully we didn't need it and were able to check in early.  Barn BFF E then said goodbye and left to go not spend the next six hours at the vet clinic.

Leo unloaded well, and after a couple of minutes of saddlebredding around, he reverted to his normal state of being - something that mostly resembles a sleepy puppy.  The vet wasn't ready to see us yet, so he got to hang out in a stall while I went to sit in the lobby.  As soon as I was out of sight, he started screaming for me, and continued to do so for a while before settling down.

After about an hour of waiting, the initial lameness exam began.  There was a new rotation of vet students today, which meant that they were all busy doing orientation things, so the clinic itself was actually a little understaffed.  Because of this, I got to actively participate in the exam, which was pretty cool; I got to do all of the in-hand stuff, lunge him, and held him for pretty much everything that they did.  Leo got several compliments on how well-mannered and calm he was throughout the entire day.

Little hat!

The first part of the exam was the Digital Lameness Locator.  ((Fun fact - our vet (Dr. K) was actually one of the primary people who invented it.))  Leo got to wear his little hat, and then sensors were placed on his front right and on his back, just above the SI joint.  Dr K had me walk Leo up and down a hard aisleway, trot up and down, then lunge in both directions at the walk and trot.  He then was able to use the output from the locator to show me exactly where Leo's lameness was coming from, and how the rest of his limbs were moving differently from normal in order to compensate for the pain.  He walked me through all of the graphs, and I think that they'll be sending me a copy at some point.

Leg sensor + grass stains.  Please ignore how crappy his feet look.

  The Locator showed that the issues were, 100%, coming from the lower RF.  They also showed that the soreness in his back/hind legs was coming from moving in a compensatory manner - not from arthritis.  The exam then became physical as Dr. K tried to determine which part of the lower leg was injured.  He did say that this pattern of lameness was consistent with an abscess, and that he definitely would have suspected that initially as being the cause.  Unfortunately, as we all know, that is not the case.

Tiny butt sensor

 After a very thorough examination of the legs, he determined that the fetlock area was the source of Leo's pain.  He wanted to start with x-rays, because the blocks had been unsuccessful before, and with the hope that he would be able to find the issue without having to do any blocks.  The x-ray tech was busy with another horse, so Leo went back to his stall and I went back to the lobby to wait.  At this point, they did the x-rays without me, and Leo had his one lapse in calmness; they wanted to sedate him for the x-rays and he apparently flipped out...and then when they went to do them without sedation he just chilled like nothing was an issue.  Homeboy HATES needles, and has just gotten to a point where Trainer K or his regular vet can approach him with a syringe and not have a meltdown.   Once the x-rays were taken, Dr. K came up to get me and took me back to a consultation room so that we could look at them on the fancy computer setup.

The in-depth x-rays showed what the initial image taken by Dr. G had not.  The bone chip was just another symptom - it wasn't the cause.  There was a shadow on the lower part of the cannon bone, just above the fetlock joint - so faint that I honestly would never have noticed it if Dr. K hadn't pointed it out.  Leo has a subchondral cystic lesion - a bone cyst.  It is not in a location optimal for surgery.  It has most likely been there for some time, and has just recently degraded to the point where it has become painful.  It has the potential to be career-ending.  It has the potential to heal.  It is not at all what I expected.

More of this, please

What happens next?

Leo received a sterile injection of Hyvisc (hyaluronic acid) and betamethasone (a steroid) directly into the joint.  In theory, it will provide therapeutic benefits to the bone cyst; he mentioned that it is possible that it could begin to heal, although the existing damage has already been done.  He's on stall rest for a few days, and then he'll be able to go back to turnout and light (read: walking) work.  Improvement should begin to show in 4-6 days, and in 4-6 weeks he will need to go back for a recheck.  At that point, more x-rays will be taken and it will be determined whether or not he needs a second injection, or if the treatment isn't working at all.

If the treatment works, he should be able to return to his life as a jumper. If it does not, he may have to be retired.  Everything is up in the air.

We're playing a waiting game, now.