Two steps forward, one step back...

After a fairly good couple of weeks, with great comments from the insurance ombudsman and potentially promising developments on research here, I got an email this week that brought me back to reality.

I'd had a fairly typical enquiry from someone wanting to send their horse here. As usual, I need vet consent and the owner wanted me to talk to the vet about our rehab first.

That's always something I'm happy to do, so the owner passed my number to the vet.

I realised we might have an uphill struggle when it took the vet 2 weeks to call me. Fair enough - maybe he had more important things to do, but it was the owner who was paying his bills (and who had to chase him several times).  Eventually he did ring me and we were on the phone for a while; I sent him the research info, abstracts and detail on the horses who have been here previously.

I updated the owner and waited for him and the vet to speak.

10 days later (!) I had an email telling me that the vet wouldn't agree to the horse coming here because he wasn't convinced by the science behind our rehab!

I must admit, I have never had this sort of response from a vet before and I was pretty astonished. I don't think vets (or anyone else!) are entitled to pick and choose whether they want to be convinced by science - its either proven or its not!

Bear in mind that the vet's preferred line of treatment wasn't some fantastic new therapy but 6-9 months' box rest and remedial farriery (both of which the owner was understandably objecting to, both of which have a much lower success rate for returning horses to work than our rehab).

As the saying goes...

Late blog - here's why...

Late blog today 'cos it was a very long and busy day yesterday. We went up to the NW of England to pick up this gorgeous guy, who was being fostered thanks to the NW Vizsla rescue group.

We  couldn't resist him, because he is the spitting image of a rescue dog called Basil (below) we had years ago and he amazingly has the same incredible temperament.

Many thanks to Helga and Jo who have done such a fantastic job in first rescuing and then looking after him. He has settled in incredibly quickly, although he still has a lot to learn about horses, sheep and cattle. He is a very quick learner though and is very focussed on people so I have high expectations for him :-)

Roo's footage and a wake up call?

I was in the throes of a rant, but I will shelve that for now...though I will revisit it shortly...

More importantly, here is the footage for Roo, who has been here just over 6 weeks.

With all the usual warnings that our arena is a REALLY tough surface and she is on a 10m circle, I hope you will agree she isn't looking bad...Bear in mind she should improve over the next 3-4 months as well.


FWIW, this is a horse whose vet was suggesting a neurectomy - de-nerving the front feet - as the last ditch attempt to allow her to move properly. This is a 12 year old horse who has been competing in affiliated dressage competitions.

What do you think?

Is it  - perhaps - time for veterinary practices who are recommending nothing better than box rest, de-nerving, retirement or remedial farriery for horses like Roo to wake up and smell the coffee?

Its a start...I think...

Well, we've got ultrasound on M, Dali and Eva. I can't tell you a whole lot more, at the moment...

If that sounds odd, its only because we won't know - till we do repeat ultrasounds - whether we are able to identify any measurable changes. I'll tell you what I can so far...

First, the good points:

• Its relatively quick and inexpensive - 3 horses took us under 2 hours and our vets are going to work out a fixed fee basis so the cost is predictable - important because I'm funding it - at least until we know whether its worthwhile or not(!) 
• Its non-invasive and the horses are pretty relaxed with the procedure. Most won't need sedation and its not uncomfortable for them [but see also the bad points, below...]. 
• Its repeatable, so we can do horses at the start and end of rehab.
• I was really impressed with the level of interest shown by our vets. Since Anna and I spoke, she had been researching and trialling techniques and called me on Sunday to discuss them, and she turned up with not only a vet student but her colleague, Gordon Sidlow, which made testing the whole thing much more effective. 
• As a fringe benefit, we've agreed it would be sensible for Anna to do a quick lameness assessment (trot up on a hard surface) for each horse at the same time as the ultrasound. This means that effectively I will have a veterinary assessment which I can use for Project Dexter at the beginning and end of rehab, which will be beneficial.  

Now the imponderable:

Are the changes that are happening in these horses' feet measurable using ultrasound? This is the $64,000 question.

From what we saw today, its possible to identify calcification on the DDFT, holes in the tendon and distension in the navicular bursa.

That's great, but even when horses become sounder, 12 weeks may just not be long enough for the changes to be measurable using ultrasound. We just won't know - at least until we've done many more horses - whether its worthwhile.

And finally, the bad point:

Here is the irony - to get the best (the most credible, from a veterinary point of view) ultrasound images of the navicular bone and DDFT within the hoof capsule, you need to ultrasound through the frog.

That sounds OK, but to get a clear image the frog needs to be pared until it is relatively thin. You can imagine what this would do to the soundness of a rehab horse, who is depending on a healthy frog and correct frog stimulus to build a healthier caudal hoof. Anna and I discussed it, and I've vetoed it because it will adversely affect horses' soundness which to me is the holy grail. As Gordon said, it would set each rehab horse back by at least a week each time it was done, and that's just not acceptable.

How ironic that the "best" way of scanning with ultrasound to assess navicular and DDFT damage involves a procedure that will almost certainly lead to a horse landing toe first and stressing the DDFT - talk about a self-fulfilling prophecy!

Good news from old lags

Big congratulations to Hannah and Patsy who went jumping this weekend - I've posted updates on them before and they seem to just get better and better!  

Like most owners, Hannah keeps Patsy at a livery yard and like most owners she has had to work really hard, get creative about managing her grazing, have a bit of good luck and live with lots of ups and downs to achieve this level of barefoot performance. Rehab we can do here - ongoing improvement is down to the owner!

Patsy has overcome a host of problems, including not just foot problems but suspected kissing spine, so its even more impressive that she is now jumping so well and clearly loving it :-)

I also saw this great post from Flynn (aka the Original Flynn) on Facebook - I really think more rehab horses should get online and have their own pages...!

All together now: awwwwww!

Happy trails, Patsy and Flynn!

Horses never stop trying to grow the best possible hooves...

When I posted last week about Dali, one of the comments that struck me the most was from his owner, Rachael. When she saw the changes he had made in less than 3 weeks she said this:

"He's been lame for so long and has so much to repair - the odds were against any big changes really :)...there isn't a single person or professional that gave Dali any hope".

Dali is only 13, he has been lame a long time but even in 3 weeks he has made substantial improvements to his hooves and I see no reason to write him off just yet! 

So todays' post is for anyone whose horse has been given a poor prognosis, who has been long term lame or whose owner thought it was too late for any improvement. 

These aren't the best comparison shots, but they show Eva in her shoes and today. Many people would think that her feet were more symmetrical in shoes but I hope you can see that to judge whether a hoof capsule is well balanced you need to look a lot further than just the hoof. Incidentally, this is one reason why I never comment on hooves if all I can see are photos of the foot - you just can't tell anything without looking at the limb AND at the horse moving.

Compare her stance in the top photo and today and imagine which is more comfortable and more supportive of the body above. Her hoof capsule looks less "symmetric" today but is actually in a better place and allowing her to stand and move straighter. Eva had a severe DDFT tear and was given a poor prognosis for a return to work, yet here she is.

Lexus proved that even a 19 year old horse after years of poor shoeing would grow better feet. These photos are 5 months apart.

How many people would have written him off saying he was just too old?

Here's Abbey, proving that growing a better frog is the key to better medio-lateral balance...

 The photos are just 4 weeks apart...clever boy, Abbey!

Here's Roo, showing how much a frog and digital cushion can beef up in 4 weeks. She is doubly clever as she had a DDFT injury 4 years ago which (we assume) has recurred but she is still able to turn her hooves around. 

Roo is also happy to demonstrate how healthier hooves allow for better limb balance... 

Here she is on arrival, well shod with comparatively healthy hooves but with a niggling lameness and poor medio-lateral balance. Like Eva, looking at her hooves alone you would have said she had well balanced feet - but the overall balance is better now in front and hind feet. 

Comparison today - not perfect but better loading from limb to hoof. Horses are ALWAYS trying to have the best possible hoof balance with the most effective support for the limbs above. 

Whether they manage to grow it depends on how they are shod, how they are fed, how they are kept, how they move and how their feet grow. 

Even in 2 weeks, M is starting to make the changes that will lead to stronger hooves...

Horses NEVER stop trying to grow the best possible hooves. Whether they achieve that is a whole 'nother story.

 

M says its pretty tiring growing new hooves...I could do with 5 more minutes in bed...

The cheque is no longer in the post!

This is it - the cheque that NFU have sent Catherine - the full amount she was owed plus interest from the date they should have paid!

More good news, as well, that Buster's owners have also been paid and NFU confirmed last week that they will cover a new horse who is due to come here at the start of July!

Nice one, Catherine, and well done NFU for finally doing the right thing :-)

Also available in white...

They've had a lot of rain in Suffolk...especially for the time of year...Debbie sent me this pic of Paddy, taken on his birthday...  :-0

Nicely done, Padster!  Still, he's enjoying himself which is the main thing - its not even a year since he had his colic surgery and its not even 6 months since he went home, so on the whole he should be pretty pleased with himself on his birthday :-)

Many happy returns, Paddy!

Dali - 2 and a half weeks

Sorry about the late blog - the internet was down yesterday so I am behind on stuff! I thought Rachael could do with a Dali update - there is not an enormous amount of change yet in his hooves as he has only been here 2 and a half weeks but at least he is starting to head in the right direction!

Looking at the obvious event line, you can see the its already moving down his hoof so even in this short time there is some good growth happening.

Some improvement in the frog and the foot is starting to develop at the back.

This is the sort of thing we need more of, to stop his toe first landing and the stress on his DDFT...

A year ago it was all about wedges!

Believe it or not, its a year since the arrival of Dillon - who of course came to be known to everyone as Dillon-with-the-wedges!

There is lots more about him on his first day here and you can search the blog for news about his progress during and after rehab but, as Nicky has said before: "Much as I want to shout from the rooftops about how fab he is, I am worried about jinxing him"! I am delighted to say, though, that she sent me an update to celebrate his anniversary.

"Exactly a year ago you took off Dillon's monstrous wedges and he started his barefoot rehab...

I am pleased to report that despite the recent grass and trim related blip [a trimmer misread his hooves,  decided to address some supposed "flare" and made him temporarily less capable on uneven ground...] he is much better. Much as I wanted a glorious sunny ride to take some pics, it was very windy and miserable and Dillon is doing a good impression of a skewbald currently so I decided the photos could wait! 

Today [about a week or so after his trim] he is pretty much back to normal on our stony drive and fine out on the road, even the new gritted bit. Even the YM has ridden him and is telling me not to worry he is fine.

Hopefully we can keep on top of things now and then there won't be a need for me to let anyone else to help him trim his feet. "

Potentially VERY exciting...

Lots of you have followed the ups and downs as I've tried (with lots of help from others, especially vets Peter Clegg and Jeremy Hyde) to put together some solid research into the rehab we do here.

Of course, Project Dexter, which records the results from horses with navicular and DDFT-type diagnoses, is ongoing and I will continue to add to that (**we are at 50 horses, by the way - surely that's a milestone, and I reckon there will be a big Project Dexter blog before too long!!!**).

HOWEVER, this is something different - and it has great potential - though I won't know till next week if its really going to work...

To give you a bit of background, there are 2 ways of assessing damage to tendons and ligaments (ie the stuff which won't show up on x-ray) - either ultrasound or MRI.  

MRI is fantastic, incredibly detailed (images above courtesy of Hallmarq) and extremely expensive (it runs at £1000-1800 currently); it can also only be done at specific veterinary centres which have the right facilities.

Ultrasound is much cheaper and is portable - most veterinary practices have ultrasound machines which can be transported in the back of a car. Its often used to scan leg injuries but its much more difficult to get images of damage within the hoof capsule. Although I've heard eminent French vet Prof Jean-Marie Denoix describe obtaining ultround images of the DDFT within the hoof till now I've not come across a vet in England who thought it was do-able.

But step in Anna Ehrle, a fantastic German vet who joined our local practice last year. She's been to Rockley a couple of times and I've been extremely impressed with her but it was only in the last few weeks that I discovered she was a bit of an ultrasound specialist.

When she was last up here I asked her about scanning within the hoof and she was confident that we could get images of the DDFT and navicular bursa and that damage would show up provided it wasn't too deep. I mulled it over and realised that ultrasound would give me a way of looking at DDFT damage before and after rehab, and although it wouldn't be cheap, it would be a hell of a lot more practical than repeat MRIs.

It seemed mad not to give it a try so, after talking to M, Dali and Eva's owners, next week we are taking the plunge and Anna will come up here and scan all 3 horses. The advantage is that we already have MRI for Eva and Dali, which will give us a control for what we are looking for in the DDFT. Even better, Dali and M have been here only a short time, so if the scans are useful we can re-scan them at the end of their rehab.

I'll let you know next week what the scans are showing us, but I have high hopes - keep everything crossed...  :-)

M: the one you've been waiting for...!

Finally, a chance to post M's pics - they should have been up last week but with all the excitement of HandH, NFU and the monster grass post, I ran out of room for him...

M is of course our scholarship boy and he arrived 10 days ago from Derbyshire. He is an 8 year old ex racehorse who came out of shoes one by one earlier this year essentially because his feet were no longer able to keep them on. 

To say he has a good range of hoof issues would be an understatement (the uneven hairlines are a good clue that these feet have been unbalanced for a while), but his feet in some ways look better now than they have done in the past. This shot below came with his scholarship application and shows his RH in 2011 following a resection for a severe crack (he also had a crack in his LF).

The lower photo is the same hoof today. The crack has effectively healed with coming out of shoes and stopping the peripheral loading which was over-stressing his hoof wall. Of course his feet have other issues now, not least having weak, collapsed, under-run heels and long toes, so that's what we have to try and improve during his rehab. 

Like many ex-racehorses, M also has thin soles and is very prone to bruising. These sole shots confirm the weakness at the back of his hooves but what you can't see is that his soles are so vulnerable at the moment that they flex on thumb pressure. Often this is due to dietary or metabolic problems, but M has been tested and come back clear, so its possible that they are the result of shoeing or the soles being mechanically thinned in the past in preparation for shoeing.

The dark shadow in these photos is bruising and its this which is going to give us a real balancing act to deal with during rehab. His hooves desperately need work and stimulus to improve but bruising and damage is a real risk. Fortunately the tracks here are a god-send for horses like him, as he can get the stimulus he needs without being on surfaces which are too challenging.   

The only problem is that - as an 8 year old TB - he isn't always convinced that going slowly and quietly is a good idea and he is rather revelling in his new-found social skills so I just hope he doesn't over-do it!

Finally, shots of the back of his foot for completeness. RF, as you can see, has the weaker frog but they are more or less as you'd expect for a horse just out of shoes and certainly aren't as bad as some. 

The heels are higher than the frog but - as with most horses with similar diagnoses to M - its not the heels that need to come down, its the frogs and digital cushion which need to become stronger. His heels also need to move back to be able better to support his limb, but that should come with time, movement and a better hoof capsule.

Bizarre feet of Legend

This week I thought I'd start the blog with some bizarre looking feet. These belong to Legend, who has been here 8 weeks now. He came here because of a long term navicular lameness but had also suffered from mechanical laminitis while in remedial shoes. 

When he arrived here he had very distorted hooves. He had been out of shoes for about 6 weeks but the nail holes are still visible. He'd just started to grow a better connected hoof capsule but it was clear he had massive changes to make. 

Here he is 8 weeks later, with a reasonable amount of new hoof capsule grown in. The problem is, though, that he has a double whammy of issues: weak heels, frogs and digital cushion and related soft tissue injuries (a safe assumption) from the navicular PLUS thin soles, long toes and solar and laminar pain from the laminitis. 

In practice, this means rehab is a slow, difficult process - even more than usual - because while his weak palmar hoof needs movement to strengthen it, the work has to be done in a way that doesn't damage his thin soles. 

However, despite having restrictions as to what we can let him do in the way of exercise, he is making some good changes to his feet. You can see in these photos that his heels are becoming more supportive and - although his toes are shockingly long still in the lateral shots - the foot is becoming more balanced. 

Here is his foot from the front, day one versus today.  The new hoof capsule growth is clear in the lower shot and I hope you can see that the medio-lateral balance is better too. 

There is always a danger in posting photos of really odd-looking hooves. 

I suspect that a lot of you will be thinking that he would be far better off if his feet were trimmed and particularly if the toe was taken back. 

Believe me, I would like nothing better (cosmetically) than to take a pair of nippers and a rasp to these feet and make them look pretty......BUT feet that look prettier in photos on the blog are no good to me or - especially - to Legend or to his owners unless he is also sounder on them and moving more freely. 

Of course, in one way it would help his biomechanics if he had a shorter toe...BUT if you whack off the toe in a trim that will immediately overload the palmar area, not good for a DDFT and collateral ligaments which are already under strain and which are in the early stages of becoming stronger. 

Also, if you look again at the solar view you can see that there really isn't that much which you could trim without being invasive - its not that his white line has stretched, its his whole hoof capsule which distorted with the remedial farriery - so again, although the appearance of the hoof from above tells you to trim, everything else is telling you to leave well alone. 

Legend is doing a great job of changing his feet and improving them as fast as he possibly can, but if we try to accelerate that by "rebalancing" his feet today then all we will do is put the tendons and ligaments within his hoof under even more strain than they are already - and he will be less sound not more sound - though his feet will appear "prettier" and may look less bizarre on the internet - but (for me) that's not a good enough reason to trim!