Mochi Update: Lameness Re-Evaluation

All bandaged up and ready to head home.

Ever since I got home from Florida, in the beginning of November, Mochs has been intermittently lame in her Navicular foot (right front).  Disappointing, yes.  Especially after this spring/summer where I was able to get her sound after two rounds of Osphos and some front shoes, and have her back in regular work for a while.  There have been no changes in anything in her management, so I'm not sure why this has started to be an issue again.  She's been front shod for about six months now and I'm wondering if there wasn't some type of adaptation to the shoes where at first they gave her some relief.  I also wondered if something had changed in that foot.

I decided to take her to New Jersey Equine because I was not happy with the suggestions made by our primary practice here.  I had them just start from square one.  They are a hospital with some outstanding staff.  I had sent the doctor we were seeing an email prior to our appointment with the images that were taken when we first arrived in NJ, as well as the history of this issue.  I missed a call from her after she read that email, and she left a voicemail.  That voicemail had more information in it that I have EVER heard concerning Mochs and her Navicular foot.  To say I was excited for this appointment would be an understatement.

They started with a gait analysis where sensors were placed all over her body to evaluate the lameness.  From there, three blocks were conducted.  As you can guess, each block went a little further up the leg to just narrow down exactly where the issue is.

When this all first started a few weeks before we moved from Georgia, I had our vet there, who I very much miss and I think needs a NJ vacation, come out and she blocked her as well.  She went sound on the right front at that time.  Unfortunately that was not the case this time.  She went about 85% sound.

After that they took some new images.  This confirmed that nothing had changed in that foot.  Why the different response to the block then?  Well, the first time she was blocked was a week after she initially went lame.  At this point it has been two years from that appointment.  What is going on is that she is experiencing some DDFT pain caused by the affected part of the Navicular bone in that foot.  So the last little bit of lameness is coming from the tendinitis.

Right front.

Left front.

See the problem?  

How about now?  Now go back up and look at the left where there is a strong white outline on the left and then there is that cloudy area in the right.

At this point I had a couple of options.  One would be Navicular bursa injections and a change in shoeing.  She also said that de-nerving her is an option though it most likely will not take care of the entire lameness due to that tendinitis.  She said if that was not present de-nerving her would be a great option for her, if that is something I wanted to do, due to the fact that we have tried other things and been dealing with her being on and off lame for two years now.  She said with de-nerving, Mochs would most likely be 70% sound, though there is a chance that it could make her 100% she didn't want to give me any false hope when the 100% was not the more likely of the two.

De-nerving, now I know some people are against it, and I know some people are for it.  I have been reading about it and keeping it in the back of my head for the past year.  I have known people that have done it with great success and I have heard horror stories, which are two ends of the spectrum that you can experience with just about anything.  I know that it would be likely the procedure would have to be repeated again after a few years as well since there is a chance the nerves would grow back.  I have went back and forth on it myself, but I am to the point of if she had went sound after the blocks I would have made the appointment that day.

Why?  Because Mochs is not a quiet pony.  I see all four of her feet come off the ground at least once a day.  If she's not running around, she's hopping around, just being goofy.  She is just goofy like that.  Right now she has good days, and she has bad days.  I'm tired of seeing her bad days, which mean she's in pain.  Yeah, she's not super lame, but any amount is not acceptable.  We are going on two years of this.  She also loves to have a job.  Enough is enough and if we could 100% end the lameness with that procedure, I would do it.

Mochs has never had the bursa injections so I decided that was worth a try combined with raising her heels 1 to 2 degrees through shoeing.  The doc was transparent with me concerning the injections as well.  It is clear that they care very much for their patients and they are trying to find the best option for them and not just trying to run your bill up.  She told me that the first round will most likely wear off in less than two months and recommended doing just the steroids, not the hyaluronic acid because I would be wasting my money since the effects will be short lived with the first round.  We will add that in the second round.

They did the injections and the doc said that they found what they expected to find when she put the needle in.  The bad foot was slightly tougher due to the thickening of the bursa because of its condition.  The good foot was no problem.  I had her do both feet because why just do one when she was showing a bit of soreness on the other foot, most likely due to compensation.  Images were taken of her left as well and she does not have any issues in that one.  Also, to keep the treatment balanced. 

Mochs was her usual star self the entire day.  She is always a model citizen for any type of medical procedure, or anything with her feet, and all without drugs.  She stands like a statue and only wants to do what you want her to do.  I cannot say it enough times, she is honestly the sweetest little horse in the entire world.  She does get nervous about things, but she internalizes it instead of acting out against the people around her.  How does this manifest?  Her hindquarters will start to tremble like she is shivering. 

Remember when I talked about her trailering anxiety earlier this year and how it manifests the first month of regular travel after she has had a break?  Same thing.  It has happened in the dead of summer in South Georgia and had me wondering if she was having an episode of Thumps.  She wasn't.  She does it if it is hot, or if it is cold.  People have asked me if she is cold in cold weather when they see it, she's not.  That's just how she handles things.  She would rather hold it in than take it out on people, other horses, or inanimate objects like the walls of my trailer, when so many other horses would want to take your head off or kick a hole in the side of your trailer. 

The doc and her staff were just so gentle and caring with her.  I can't thank them enough for being like that with her, that is what she needs, she doesn't need someone yanking on her, or putting a stud chain on her or some other ridiculousness (and no that is not what the primary practice did here, that was not my issue with them, those are solely examples of things I'd flip out over if any healthcare or hoofcare professional tried to do with Mochs).  They spoke quietly to her and loved on her, distracting her from the activity.  They kept a steady stream of treats going that day too, which is always a more than welcome distraction for Mochs.

 

Injection prep.

I stepped out while they were doing the injections since they're x-ray guided and I could hear them from around the corner saying "You're just a little saint."  The doc came to get me and said she was a perfect patient.  I paid our bill while they finished her bandages.  I went to get her and the doc walked her on the trailer for me and asked where her granola bar was.  I'm telling you...these people are awesome.  They care, they listen, they genuinely want the best course of action, even if it won't make them the most money.  I can't thank them enough for everything that day.  I wish they did regular, routine care.

She had to be stalled for two days following the injections.  So, we had her all set up with her Christmas lights and she had Christmas music playing.  The way our place is set up Klein and Wes could also hang out with her, and they would.  They would come and stand in front of her stall like they were the guards.

Mochs with her Christmas lights and Christmas music.

The Other Half taking Mochs for a little hand walk for some good grass the next evening.

My farrier was out ASAP as well and got her shod with pads on the front to raise her heels.  I have also heard stories of Navicular horses trotting off sound with no issues for years with the right shoeing set up.  And by right, I mean something individual that just happens to work for them.  That seems to be a common thing with Navicular.  There is just no black and white treatment.  Every horse is an individual case and what works for one may never work for another.  It is all about finding the right combination, and that is what we are doing. 

Her magic shoes.

I have not trotted her yet since the injections and pads.  I want to giver her a couple weeks to get adjusted to the shoeing change first, then we will see what we've got.

I feel like we are on a much better, concrete, track with this thing now, and while we are here, Mochs will only be seeing that doc to manage this.  So we have that doc, plus a fantastic farrier, look for Mochs out and about this Spring!