Small Improvement

Dr. Meg came today to evaluate Nox's suspensory ligament injury.  Here's a short timeline/description of all of the evaluations so far:

• Oct. 2013 - I noticed that Nox seemed more lame (limping) than usual, and I stopped working him for three weeks, hoping to see some improvement.  No improvement, so I called the vet.
• Nov. 15, 2013 - Dr. Meg came out to evaluate him and diagnosed him with a tear in the right hind suspensory ligament at the origin.  Nox was put on stall rest.
• Jan. 6, 2014 - Small progress but Nox needed to stay on stall rest.
• Mar. 5, 2014 -80% improvement.  We continued modified stall rest with very light lunging at the walk and trot (Nox could not stay calm and he was going crazy in his stall and in the ring)
• Jun. 27, 2014 - Evaluation showed major setback.  Nox's injury was much worse and Dr. Meg recommended stall rest with no work, or moving him to another stall that had a paddock.  I moved Nox to the new barn in July, where he has a larger, more open stall and a small paddock.

This brings us to today.  Dr. Meg watched Nox move at the walk and trot and performed a flexion test.  Nox, as usual, jumped around and bucked through most of the evaluation.  He just gets so excited when he's allowed to do something other than stand around.  He looks just like a Lipizzaner Stallion performing "airs above the ground".  If you've never seen the Royal Lipizzaner Stallions perform, I highly recommend googling videos of the "airs above the ground".  My parents took me to see the Lipizzaner traveling show and it was one of the best nights of my life.  Nox shows natural talent performing the capriole - he would have make a great war horse, apparently.

Anyway!  Dr. Meg noted that he is still sore on the right hind, indicating that the ligament is still injured.  She did an ultrasound so we could see what was actually happening in there.  She gave Nox a sedative and set up the ultrasound.  Everyone gathered to help and observe.

Dr. Meg, Best Husband Ever, Penny, and Robin gathered around the ultrasound machine.

I squatted in the corner, held Nox's head, and whispered sweet nothings in his ear while keeping an eye on the screen.

Nox gets nervous if I move too far from his head while he's sedated.

The ultrasound showed that the original tear has healed a little bit - it's about 1 mm smaller than it was 10 months ago.  There is a second smaller tear that is new - Dr. Meg thinks he may have done that back when he was going crazy on stall rest and may explain why he was so much worse in June.

So, there is a small improvement to the ligament tear and he is healing, but very slowly.  As I expected, Dr. Meg would like to restrict his access to the paddock.  The sand is a bit too deep and he is moving around too much in it.  Since he's so much happier having access outside, she suggested that if the paddock can be modified, we can make the paddock smaller.  He can have just enough room to step outside and turn around.  Penny immediately said that they will make any modifications needed to keep Nox happy.  I'm pleased with the evaluation and encouraged, as is Dr. Meg.  Any improvement, no matter how small, is good news.  We might also try a round of shockwave therapy, which may help speed things along.  The shockwaves irritate the soft tissue and promote healing, but it isn't always as effective on older injuries, but I think it might be worth a try.  

Nox came out of the sedation slowly.  He was still a little drunk and woozy and wanted to lean on me, so I let him.  We stood like this for about 5 minutes, he resting his head on my shoulder, while Dr. Meg wrote her notes and I checked my work emails.
     

   

He was snoring a little.

Showing off

I'm mentally preparing myself for the inevitable stall rest recommendation that I'm 99.9% sure will be coming on Wednesday.  I'm noticing that Nox is spending much of his time standing in his stall anyway, since he likes to play with his neighbors and escape the flies, so I'm really hoping he won't mind being closed off from his paddock.  It also appears that Nox and his neighbors are starting band.  Nox is learning to play the chain (video by Best Husband Ever):

In the meantime, while Nox continues his recovery and band practice, I have plenty of horses to ride at the new barn.  A grey mare named Ellie has recovered from an injury and illness and she's ready to be worked again, so I've been lunging her and will start riding her today (weather depending - it's raining as I type).  Another boarder has offered her horse for me to ride, as she wants him to get more exercise.  I'm also still working with Baya, who is for sale.  Baya is a very special horse and Penny wants her to go to a very good home, so she is priced high.  She has so much potential, she is easy to ride and handle, and she performed so well at her first show this past summer.  There was a professional photographer at the show and he took some great pictures of Baya and I:

This is my favorite photo.  I love the tail swish.

He decided he was done with the therapeutic shoe phase of recovery...

Look at those pretty gold dapples!

Nox looks good, doesn't he?  He's healthy and happy, he hasn't had a nosebleed in a month (he had 3 total, still no idea why), and he's a pleasure to be around.

He's also torn off two of his four shoes in the past week.  Nox needed a lift pad on his right hind leg to ease the pressure on his torn suspensory ligament, and to make sure he was balanced, he had lift pads on both hind hooves.  He also had shoes on the front for support.  Well, he stepped on the right hind shoe and tore it off, along with most of the hoof wall.  My farrier couldn't put the shoe back on because there wasn't enough hoof wall to nail it to, so I had him take off the other hind shoe (no point wearing it if the injured leg doesn't have one).  Two days later he stepped on the left front shoe and tore that off, so I had the farrier remove the other front shoe.  Now he's barefoot.

Nox has his lameness evaluation next week Wednesday.  I've already told Dr. Meg that he's barefoot and she was a little concerned.  It's almost been a year since he was diagnosed with the injury, and when I walked him around the ring today (just a short slow walk), he was still limping.  I didn't even need to trot him to see that he is still off.  Dr. Meg is going to do an ultrasound this time and look at the ligament - is it healing?  Did it heal wrong?  What the heck is going on?!?  It can take a VERY long time for these types of injuries to heal - a year is typical and more than a year is not uncommon - but I'm not seeing any improvement.  It could be that the paddock, while good for Nox's mental health, is not good for his ligament tear.  I'm guessing... speculating... expecting... that the vet will want him back on stall rest.  I'm hoping that stall rest in his new stall won't be as dramatic as stall rest in the old place.  In this stall, Nox can hang his head out into the barn aisle and play with his neighbors and the various barn critters.  He can also hang his head out the other door and look outside.  Hopefully, if he must go back on strict rest, this stimulation will keep him from going crazy.

I'll keep everyone posted and wish us luck at our vet appointment!  For now, enjoy these lovely early fall pictures...

Seriously, how does he have this much muscle after 11 months of stall rest?

Nox has a pet cat named Hutch.  She hangs out on his paddock fence and stall door, and she likes it when he nibbles her neck and back.

 

They are adorable together.