This is a hard post for me to write. Most of what I do is either a) clearly stupid or b) uncontroversial within my discipline, but joint injections are a little more contentious.
Like most endurance riders, I’m pretty deeply paranoid and I plan out every option I can think of ahead of time. I know my “hard limits” for treating most equine health problems, and I’ve got a bunch of little checklists and flowcharts constantly running in my head. Earlier this week, I pieced together some possible symptoms I’d been seeing this fall and decided that Dixie’s hocks were maybe sore.
- Dixie’s been reluctant to go downhill a few times – alone in the dark at VC, in the slippery mud at Briones two weeks ago, and intermittently on the local trails for the last few months.
- She’s started picking her way downhill, zigzagging across the trail instead of walking straight down.
- She (infuriatingly) refused to hold her back feet up long enough for me to trim them earlier this week.
Dr. Lefkowitz got our history and watched D trot out straight and in circles on a hard surface and in a softer arena. She palpated all her joints, flexed her and had her trotted out again, went at her with the hoof testers, and looked at the rads I got last month. (I was rather proud that D didn’t even wiggle an ear for the hoof testers.) The vet thought there were some arthritic changes in her front left fetlock, which I hadn’t expected but wasn’t surprised by. They blocked her LF and lunged her again and she was much improved, but still not really moving under herself like she should and has in the past.
So she recommended injecting Dixie’s hocks and her fetlock. We could’ve done more rads, but like flex tests, they’re not dispositive. (That’s a real word, but it’s also a legal term of art – probative evidence means something probably happened, and dispositive evidence decides the issue. “You’re my husband so you’re the father of my child” is probative, but a DNA test on the baby is dispositive.) Anyway, sometimes you can’t see the changes on x-rays, and sometimes a horse flexes horribly but stays sound or vice versa, so it’s not always easy to say for sure what’s going on in those joints.
“Have you ever looked at a dollar bill… on xylazine, maaaan?“
We headed back into the exam room, sedated Dixie (she’s a very cheap drunk), and did the injections. The tech (who was great, but I don’t remember her name and it’s not written on my paperwork) Betadine scrubbed the everloving shit out of D’s joints* while the vet prepped the injections.
*Of course, in the two days between deciding that Something Was Going On and actually seeing the vet, I researched the shit out of equine joint problems. I am in no way a vet, but I can slog through google results with the best of ’em. The major risk with joint injections is infection, which is rare but Very Bad Indeed. Current best practices that I read about were to: scrub really well, don’t clip or shave, use the smallest gauge needle possible, and pop the needle in and let the joint fluid drip out to clear any debris in the needle – Pioneer did all that. They also bandaged her ankle (but not her hocks – they’re so hard to wrap, and they’re higher up so they’re probably not going to get foreign matter in them).
Anyway, they loaded her up with some IV bute, wrote some really nice case notes/discharge instructions, took a vast but not unexpected amount of money from me, and sent us on our way.
I kept D inside for the rest of the day and unwrapped her bandage on Saturday. She’s back outside, but on “stall rest” with 15 minutes of handwalking til Monday or Tuesday, then I’ll slowly resume our regular schedule. None of her joints are warm or puffy, so I think we’re in the clear. And she’s definitely moving better (straight, free action, no hesitation) downhill already – I don’t know if it’s just the bute or if her hocks are feeling better from the shots already, but yeah, there was something going on.
The real question isn’t “will you treat something that’s treatable,” it’s “what’s next?” And for us, it’s more of the same. If her fetlock bothers her again too soon, or if it’s been a couple years of biennial hock injections and they’re not pain-free and finished fusing, we’ll try to find some other sport that we both enjoy this much. But Dixie really does enjoy endurance rides, and many successful high-mileage horses go through this (even if not everybody confesses it on their blog!), so yeah, I’ll give her a chance to keep doing endurance.
It’s basically the same thing I said after her tendon pull in 2011 – if she re-injures herself in the same spot, I’ll reconsider our sport, but I’m going to give her a chance again. How soon is “too soon” w/r/t the fetlock? I’m not sure; I kinda hate the thought of needles in joint capsules. But shit, if I had a bum joint, I’d probably get cortisone shots if they let me keep doing what I love to do.
After paying the vet bill, I had enough money left to buy Dixie a big candy cane. And I’d already bought my own horse-related presents – memberships to NASTR, CALSTAR, and WWHA for 2014, whee! Merry Christmas, if that’s your thing, and happy solstice to everyone in the Northern Hemisphere! We’re over the worst of it and the sun is coming back – whew!