Monday, 15 March 2010

Kingsley: Vet + Physio Reassessment. The First Day Of The Last Go...

Above: Kingsley, still looking sleepy after sedation, in a pulsed electromagnetic rug

It's not good news for the little man. It looks like the rearing wasn't just him being naughty...He is in a lot of pain along entire topline, poll, neck, back and sacroiliac area. His back muscles are in spasms and he reacted badly to palpation. All this after basically being in the field for 3 weeks - I sat on him once on Friday for a short walk.
He is is bilaterally lame behind still and unlevel in front with some inconsistent near fore lameness. I had to ride him for the vet and physio in walk/trot/short canter and it felt awful.

Trot-Up/Lunge Assessment

He moved very short both front and behind on the hard surface on a circle. I asked the vet to test him for neurological deficit so we did but he didn't exhibit any behaviour that would suggest there is something neurologically wrong. Apparently, the level of pain present in his back, neck and SI causes the movement to be as it is and point towards neurological problem.
As the relapse in his progress started after the incident with the gate (in Feb he jumped over a 5 bar metal gate getting stuck on it, possibly also falling over) it seems he re-injured the SI that was in the process of healing.

What Now?

The question is, where do we go from here...we stood by him on the courtyard and believe me it is so hard to say 'that's it, let's just call it a day and put him down'...No matter how clear it is in your head when you think about it cold, it's not the same when the horse nuzzles you gently and cuddles his head under your arm.
Vet's opinion is that the only thing we haven't yet tried is injecting the poll (he looked at the X-rays again to re-assess the chipped bone that was spotted initially and decided it might be beneficial to inject the area with Cortisone to settle any possible inflammation).
As the injury seems to be chronic and present for a long time the prognosis is "guarded". What this means is that basically IF he gets "better" he will always be a high-maintenance horse needing physio and possibly regular injections. He MIGHT make a happy hacker. If we are lucky.

So where do we go from here...the vet and physio, although agreeing as to the complicated and basically no-go case of Kingsley are also keen on trying some aggressive therapy and see how it goes. It's understandable really and the final decision isn't really their responsibility.

Bone scan is an option but we are advised that all it will show is the areas of pain. This actually isn't that much of a secret with Kingsley as you can easily detect these via palpation.
We could send him to Liphook or Newmarket or Willesly clinics for tests but many thousands pounds later we might still be without answers.

The Vet says that his ridden behaviour and movement pattern is indicative of a classic, chronic sacro-iliac disease that hasn't been treated when necessary and developed into array of muscular and skeletal issues.

Next Steps

Considering there is a few option we haven't yet tried, after a rather depressing discussion, we decided to give him a last chance with an aggressive treatment plan and further investigation.
He is booked for nerve blocks to determine where is the primary source of pain. We know what's hurting but we don't know the root of the problem. He will see a specialist vet for that, a vet whose major interest lies in orthopedic problems in sports horses.
He will be given daily pulsed electromagnetic field therapy (via special rug - see photo above of Kingsley in his rug; he is still sleepy after sedation for physio treatment) to help with the healing process. More info: http://www.curavet.com/.
We will use TENS machine again to relieve muscle spasms and to help promote correct usage of the muscles.
He will have weekly physio sessions to stay on top of any muscle pain.
Here are a few photos from today's physio session under sedation to relieve poll and back pain.

Pauline and another physio pulling on the tail to stop Kingsley from falling over and to help with correct tucking in of the pelvis.

Anna manipulating the head and neck to help with poll, neck and back pain:


So this is it. We are giving this treatment/investigation plan up to 3 months to show SIGNIFICANT improvement. By that I mean we need to see if the improvement shown will give any hope of Kingsley ever being able to withstand ridden work of moderate intensity.

The detailed plan of action for the first month is as follows.

1 MONTH BOX REST PLUS CONTROLLED IN HAND AND RIDDEN EXERCISE

WEEK 1:
Pulsed Magnetic Rug: Set 5; 30 minutes
Walk in hand with tapes over SI: 30 minutes
Nerve Blocks and specialist vet assessment
Poll and SI Injections with rest afterwards

WEEK 2:
Pulsed Magnetic Rug: Set 5; 30 minutes
Walk in hand and ridden (hacking in walk) once given all clear after injections (with tapes over SI): 30 minutes

WEEK 3:
Anna back to review and treat
TENS machine
30-60 minutes walking on hacks (tape on)

WEEK 4:
TENS machine
30-60 minutes walking on hacks (tape on)

I must say that if he shows proper improvement in those 3 months I will be amazed. I don't have much belief left in him becoming sound, it seems almost impossible with all the problems he's got. But hey, if there is a chance to give him a happy, pain free life then this is the last go he deserves.
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