Sunday, December 6, 2009
Sunday, November 29, 2009
Tuesday, October 27, 2009
Wednesday, September 30, 2009
Sunday, August 9, 2009
Niki and I think Snoopy is making progress. Why? Because he's not getting any worse. He's being lunged 3-4 days a week, which is rebuilding his stamina as well as his leg, and Niki is tack-walking him one of those days. The first riding session, she rode him for about 5 laps and his leg started to feel spongy (not as supportive) for the last 1/2 lap. The second time, the leg still felt sturdy after 5 laps, so she dismounted and called it success. The third time, the leg still felt sturdy, so she trotted him a few paces, just to see if he feels under saddle like he looks from the ground.
He does, but he wasn't extra sore the next day when he was lunging (light trotting only).
We're calling this progress. Our philosophy is, if Tuesday, he doesn't limp for 1/2 lap, and on Thursday, he doesn't limp for 3/4 lap, it's progress. To get him limp-free will take as long as it takes.
In the meantime, once Niki feels confident in his ability to be quiet at the walk (so far he has been), she's going to tack-walk him in the big arena, where he can walk in a straight line instead of constantly curving right or left. I hope to be there, to provide pictures!
Thursday, July 23, 2009
She lunged him a bit before climbing on, then walked him for about five laps before he started seriously dragging his leg. According to Niki, "He didn't buck and he didn't collapse under my weight, so I consider it a success."
Saturday, June 13, 2009
Tuesday, May 26, 2009
Wednesday, May 13, 2009
Thursday, May 7, 2009
As hard as it seemed to do two weeks ago, it was much easier today. Of course, it wasn't cheap. Tina is on vacation this week and Christine is taking care of the horses and the dogs; these are my two go-to gals when I need Snoopy to be hauled anywhere. Unfortunately, the ultrasound specialist, Dr. Rantanen, was only available today, so I had to call a professional horse transport.
Enter Chuck and Stacey of Chuck Erb Horse Transport. Chuck's name is actually much longer than "Erb" – it's got about 25 letters – so he just uses the first three. We arranged for pickup at 11:30, to be down at Dr. Martinelli's by 2 pm.
Before we left, I decided to groom Snoopy a little so he'd look nice for the doctor. As usual, Snoopy wanted to bite my shirt, play with the brush and generally invade my space. We spent five minutes working on our tough-love relationship. I'd curry him and he'd stretch his neck out to enjoy it, then he'd turn and try to nip my shirt and I'd smack his nose.
When Chuck arrived, I warned him that a) Snoopy is a land shark, and b) he might be a little high-spirited. Snoopy proved me wrong by walking quietly out to the street, to Chuck's enormous vehicle. It was like a horsie limo – it cost about as much, too. Chuck was, however, a really nice man, and very good with Snoopy.
So I followed Chuck and Snoopy from beautiful Chino Hills,
This is the route we took.
When we finally got to the Twin Oaks Farm, Dr. Martinelli's intern, Dr. Walker met me. She immediately had men to take Snoopy to a stall and unwrap his leg (we had put a standing wrap on it for shipment), gave me paperwork to fill out, and then escorted me to the office to meet with the other doctors. Talk about efficiency!
Let me just say that I loved, loved, LOVED Doctors Martinelli, Rantanen, and Walker. They put me at ease, and spoke to me like we were all people trying to figure things out, and not like a team of gods answering the tiresome questions of a mortal.
We began by reviewing Snoopy's x-rays. They all agreed that Dr. Fischer had done a really good job and that the bones had properly fused.
Next, we went outside to watch Snoopy trot.
"Wow, he's really lame," Dr. Martinelli said.
As Gibbs would say to DiNozzo on NCIS, "Ya think?"
Dr. Walker then administered a little cocktail to sedate Snoopy so he wouldn't kick Dr. Rantanen during the ultrasound. My big black horse was in dreamland within moments.
I watched over Dr. Rantanen's shoulder while he slid the sensor over Snoopy's fetlock and pastern. At first, the screen reminded me of my first ultrasound of my son when I was pregnant. Then a bizarre shape took form in the graininess.
"See that?" he said. "Looks like an alien."
"So that's what's wrong with Snoopy," I told him. "He's got an alien infection."
Dr. Rantanen took a series of snapshots of the foot with weight on it and weight off it. He followed the suspensory ligaments from one insertion point to the next. While I watched, Dr. Martinelli began to talk to me about bone scans as another diagnostic tool in our search for Snoopy's lameness. As he talked, I thought I saw the dollar bills floating, out of my wallet and into the walls of the barn.
Between the x-rays and the ultrasound, I waited for those magic words: "Aha! There's the problem." But they never came. Dr. Rantanen kept saying that he saw no problems with Snoopy's ligaments. He showed me the pictures he'd taken and explained what he was seeing in each one to prove his point. Quite frankly, I had to just believe him. I mean, he could have pointed to a dark spot and said, "See that? It's Swine flu." Who was I to argue?
In a nutshell (and completely paraphrased for the medical-terms-impaired), this is what Dr. Martinelli told me:
"Dr. Rantanen can't find any soft tissue damage, so there's no need to do shock wave or stem cell treatment. His x-rays show that the bones are fused properly. So basically, there's nothing wrong with him, except that he's lame.
"I think, although radialogically, he's fused, functionally, he hasn't. He just still hurts from the initial injury and surgery. I won't give you a 100% guarantee that he'll end up completely sound, but I think right now it's still too soon to tell.
"In the meantime, I think you should take the kid gloves off and let him be a horse. Turn him out, don't worry if he runs around and kicks up his heels. If he's quiet enough, ride him at the walk. Just don't let him do any reining slides again."
What he said made sense to me when I equate it to human injury. I've never broken anything, but after my C-section, there was a loooonnnnggg period of time where I could not do situps because there was a range of motion where I just couldn't feel my stomach muscles. In addition to the fracture, Snoopy has had an incision to install plates and screws. The bone has to be traumatized by the foreign objects. When you toss in the blood vessels, muscle, nerves, etc that needed to be cut or moved around to get to the bone, why wouldn't he still have some soreness at the trot?
So the good news is there's nothing wrong with my horse. The bad news is that he's still lame. The better news is that I can relax and let him have a little fun.
Oh, and BTW, Snoopy was a complete gentleman at Twin Oaks and never tried to eat any of the doctors or attendants, which Dr. Martinelli teased me about constantly. "Oh, watch out, he's gonna chew on you," he'd tell the helper as Snoopy laid his sleepy nose in the crook of the guy's arm. Isn't that just like a kid?
Sunday, May 3, 2009
Dr. Rantanen will not be available this week, but should be next Wed May 6. He will confirm with me this week, but you may look into transportation options for mid-day on May 6th and let me know."
Thursday, April 23, 2009
Here's what happened instead. Tina and Niki are at the Hollywood Charity Horse Show this week and couldn't trailer Snoopy to San Marcos. Christine (my other friend with a trailer) is in Elk Grove at a horse show and couldn't take him, either. This meant I had to hire a professional horse transport. They're nice people, very easy to get along with and take excellent care of the horses, but they are Expensive - As - Hell. They're easily triple the cost of what Tina or Christine would charge me.
But I didn't see any other options, so I booked Stacey and Chuck to take Snoopy to the doctor. The problem was that they wanted to know when they were doing this, since it was a day trip and Snoop had to come home. It was a very reasonable request.
I called Dr. Martinelli, just as he requested, to find out when to bring Snoopy down. I called him on Monday. Then I called him on Tuesday. Three times. Each time I called him on Tuesday, I had Stacey calling me shortly after (telepathy on her part, I'm sure) to get the status.
My options were few at this point. I could just arrange for a mid-morning transport and hope for the best. Maybe we'd get down there and the ultrasound doctor wouldn't be there, which means we'd go home and I'd have paid $400 for a car ride. Or we'd get down there and the doctor wasn't coming until late afternoon and I'd have to figure out how to get Snoopy home. We could hitchhike, but Snoopy doesn't have opposable thumbs.
Or I could cancel.
In the doctor's defense, I know they get busy. But I hate calling and calling and calling - to a black hole. I begin to feel like a jilted lover. "Please, can't we just talk?" Or a stalker.
I was so revved up about seeing this doctor, and finding more information about Snoopy's injury, and I still am, but if we have to re-schedule, that's the way it is. I'll get in touch with him again (even if I have to call in Dr. Murphy) and try to make an appointment when Tina or Christine can take him. That way, I've got a little bit of wiggle room if the appointment doesn't go as planned.
Because nothing ever seems to go as planned these days.
Sunday, April 12, 2009
Dr. Martinelli couldn't have been nicer when he called finally called me. He had actually read my blog and could discuss Snoopy's case in detail - not only that, but he had a way of talking to me that didn't either condescend or talk above my grasp of medical lingo. In other words, I felt like we had a conversation.
As I suspected, before going through any treatment, he wants to do an evaluation, which is fine with me. I mean, why should he give my horse shock wave treatment on MY say-so? The really good part of this is that he contracts with a doctor who has a digital, high-res, state-of-the-art ultrasound and can get much better pictures of Snoopy's pastern. The not-as-good news is that the doctor (he told me his name, but I can't recall it right now) is semi-retired and has a sporadic schedule. We've set the appointment for a week from this Wednesday. I'm to bring Snoopy's x-rays, too.
He sounded a little worried when I told him Dr. Fischer didn't see any reason why Snoopy would return to full soundness. While he said this was certainly possible, Snoopy's injury being in the back of his pastern makes it one of the more difficult types of desmitis to treat. He's had horses take as long as 18 months to recover from this, so he likes to take the kind of pessimistic, long-term view. That way, owners are not looking for the miraculous, 6-month healing.
So hopefully Snoopy and I will find a ride down to San Marcos on April 22nd. I think it's also the weekend of the Hollywood Charity Horse Show, and both Tina and Christine may be too busy to give us a lift. Wish us luck!
Wednesday, April 1, 2009
I went over the same things that I told Dr. Nieto - or whoever it was - about Snoop's broken foot, short-striding, handwalking since August, yadda, yadda. I added in what Dr. Pollard had written down for me to tell him about the diagnostic anesthesia: "Abaxial nerve block was essentially negative. Low 4-point block was 80%+ better."
Dr. Snyder was as patient and nice as Dr. Nieto-whoever and said that it sounded like insertion desmitis was the correct diagnosis. He offered three options:
1. Stem cells - I thought this therapy was only useful for new injuries, but Dr. Snyder told me they've been having a lot of success with chronic problems. The downside to this therapy is that it's wildly expensive, about $3000. I'd have to sell a lot of copies of Freezer Burn to justify it.
2. Shock wave - Dr. Snyder assured me that this was much less expensive, and wouldn't harm Snoopy at all. The worst that could happen is that after spending money on the treatment, it wouldn't work.
3. Continue with the current therapy - which is just walking.
Dr. Snyder recommended the shock wave plus the walking regimen. He said the next ultrasound (due April 26) would show whether there was any improvement. Actually, he sounded like he would be interested in knowing how the ultrasound turned out.
So that's what we're going to do. Tina spoke with Brigid (Dr. Murphy) who said Dr. Martinelli had the best shock wave machine around. He is down in San Marcos, but he's the head of California Equine Orthopedics, and he treated Copper, Tina's old show horse, so he sounds pretty good. I'll set up the appointment, then figure out how to get Snoopy down to his facility.
I'm actually kind of excited to have him treat Snoopy. I don't want this blog to sound like I just want my horse to be instantly healed. If it takes a year for him to recover, it takes a year. What I want to avoid is for Snoopy to end up an invalid because we didn't push enough, stretch him enough, etc.
Trust me - I'll keep you all informed.
Monday, March 30, 2009
This morning, I called UC Davis and asked to speak with Dr. Snyder. The woman answering the phone said she'd put me through to his voicemail if he didn't answer. Of course he didn't answer - what doctor every answers? It was a little disconcerting - there was no outgoing message on his voicemail, no "Hello, you've reached me." Instead, I heard a beep, then Little Miss Computer Voice told me to press 2 to continue to record my message. I pressed 2, heard another beep, and recorded what I'm certain is a long, rambling, message, accompanied by every phone number I will be even close to - I considered leaving the number to Albertson's since I plan to do some shopping later, but I didn't.
The problem with leaving a message is that I really need to have Snoopy's big folder in front of me to discuss his injury and treatment in terms a doctor can understand. So I'm hoping Dr. Snyder returns my call today, while I sit home, patiently waiting for the Home Depot to deliver and install my new water heater. The past week has been trying for the Carline household. The microwave is broken, the water heater leaked all over the garage (and the shut-off valve broke, meaning we spent most of Friday night and Saturday was spent without water entirely), the dishwasher won't drain and there's a leak under the kitchen sink. When the bees showed up in our chimney on Sunday, it really was the last straw.
And, to top it off, my horse is still lame.
Saturday, March 21, 2009
To recap, we're trying to find the source of Snoopy's discomfort with his left hind foot. The fracture has healed. Dr. Fischer thinks it's tendinitis, at least the equine version. The exact wording was, "the superficial digital flexor tendon was enlarged at its insertion and had hypoechoic areas in each branch."
His recommendation was to handwalk Snoopy for 30 minutes a day and bring him back in 60 days for more tests. This might be fine if we hadn't already been walking Snoopy for the past, oh, eight months or so with no improvement. My insecurity about Dr. Fischer's diagnosis comes from watching him do the ultrasound - he never seemed to have that "AHA" moment, when he points to something on the screen and says, "Look at that." He only waved his finger about and used words like "seems to be", "looks like", "maybe". I don't care how sure he was about his diagnosis when he spoke to me in the office, I didn't see that same degree of certainty in the examination.
Oh, and NOTE: **To All Horse Owners Who Have Ultrasounds Performed** When they are doing the ultrasound, request that they print at least TWO copies of the ultrasound pictures. As state-of-the-art as my equine hospital may be, they cannot save the ultrasound electronically, like they can their digital x-rays. So everytime I want a second opinion from another vet, they have to send the original to the vet, along with a SASE to send it back when the vet is finished with it. This is important to know.
I called UC Davis and spoke with Dr. Nieto, who talked to me about Snoopy's problem for about 20-30 minutes, then said he'd rather not look at medical records, he'd rather see the horse at this point. He told me that the first thing he'd do is perform his own ultrasound, then do pain blocking to pinpoint the source of Snoopy's pain. This is also called "diagnostic anesthesia" - you numb the hoof, see if the horse still limps, then numb the fetlock, and work your way up the horse's leg to find out where the problem is.
Dr. Fischer had refused to do this blocking. According to him, you risk injuring the horse by allowing him to put full weight (or full range of mobility) on a hurting limb. The other vets I spoke with disagreed with this. Their arguments were that: 1) you only trot the horse briefly to see if it still hurts, and 2) after you perform the procedure, you put the horse back in his stall until the anesthesia wears off.
I scheduled Dr. Pollard to do the pain blocking. He had to cancel the first appointment, but he was on time the second time and I watched him work. We started with the hoof. There was no change in Snoopy's trot; full stride on the right and a half-stride on the right. It was a little funny to watch Snoop walk the first few steps with a numbed foot - he couldn't find his foot or the ground, so he kept lifting his foot uber-high, then kind of slop it down. After awhile he figured it all out and was as good a patient as he could be, under the circumstances, the circumstances being that Dr. Pollard didn't want him sedated while we trotted him.
Dr. Pollard next went to Snoopy's fetlock. Snoopy was, by this time, very happy to be out of his stall and be allowed to trot, even if it was supposed to be slow and even, with a stud chain. Poor Niki has bad knees and a broken toe, but Tina was sick with some kind of crud and couldn't jog very far, and I'm the mom, so no one trusted me with him. (This is okay, I understand. I taught him all his bad behavior.)
The fetlock numbing made him trot a lot better. Not 100% better, but a lot better. Dr. Pollard officially described it as 80%. He wrote me a note to describe his findings and told me to call UC Davis again and offer to send them the x-rays, the ultrasound and his findings, to see what they have to say.
By the time I got home, it was too late to call, so I emailed Dr. Nieto, reminding him who I was and what we discussed, etc. The next day, I got this email from him:
"Dear Gayle, I think you have the wrong person. I have not talked to you about your horse. Sorry, Jorge Nieto"
WTF? His was the name I heard when the woman at the office said she'd transfer my call. His name was what I heard when the voicemail picked up. No one else on the website has a name even NEAR 'Nieto'. Did I spend 30 minutes talking to an imposter?
Honestly, I felt like someone had punched me in the stomach.
I emailed back: "I'm sorry to press one more time, but I called UC Davis Large Animal Hospital, Equine Clinical Services on Friday, March 6th and explained my horse's problem. They transferred me to the voicemail of Dr. Nieto, and I left a message. About 20 minutes later, a doctor called and we discussed my horse - I perhaps assumed it was Dr. Nieto? Or is there another doctor on staff whose name sounds very much like yours?"
I'm hoping that sounded like perhaps I made a mistake but perhaps you just forgot about that Friday phone call - because, because, um, it was Friday afternoon and you'd already had a few gin & tonics?
Today I decided to start all over again and leave a message for Dr. Snyder. I called UC Davis, only to be told that Dr. Snyder doesn't have his voicemail set up! Sigh. The lovely young girl told me to call on Monday, during regular office hours and they'll help me.
In the meantime... we walk.
Friday, March 13, 2009
After speaking with Dr. Nieto of UC Davis, I talked with Tina and we decided to take his advice and do more to investigate the exact location of Snoopy's discomfort. Tina thought Dr. Fischer had done blocking, although I don't recall telling her he did (just one more miscommunication in Snoopy's recovery). On Sunday, I emailed Dr. Fischer to confirm that he did not do any pain blocking on Snoopy to further pinpoint the source of his problem. He replied the same day that no, he did not perform any "diagnostic anesthesia". His reasoning was, "with a dropped fetlock, there is significant injury already present and diagnostic anesthesia can alleviate the pain and exacerbate the injury."
I remember having this conversation with him during Snoopy's exam; when I told Dr. Nieto of Dr. Fischer's concerns, his response was, "Well, we're not taxing him significantly at the time, just trotting him briefly in a straight line. And the blocking agent wears off within an hour, hour and a half, so we just keep him confined until it's worn off."
So I made an appointment for Dr. Pollard to come out and perform diagnostic anesthesia today (Friday) at 10:30 a.m. I had a riding lesson to teach at 4 p.m., which meant I'd go to Chino Hills in the morning and stay until the afternoon.
Ah, if life was only that simple. Two additional items arrived on my plate: 1) an invitation to my son's high school soccer banquet, beginning at 6 p.m., and 2) my publisher sent me the final copy of my book to proof before it goes to the printer. Now I had to go to the ranch by 10:30, return home to work on the book and prepare for the banquet, then go back to the ranch to teach the lesson, change clothes and get to the high school.
Which would have worked, except that when I arrived at the ranch this morning, Niki informed me that Dr. Pollard called and canceled the appointment. It seems he was up to his elbows in emergencies this morning and just couldn't get to any non-critical cases. Damn horses - they refuse to get sick on a schedule, don't they?
So I went back home and tried not to think about wasting my morning. Instead, I focused on what needed to be done.
Snoopy's not in any immediate danger. Dr. Pollard re-scheduled for next Wednesday morning, so maybe we can get the answers we're looking for. I just wish I had a Data Out port I could plug into my horse and get the information. Color me impatient.
Friday, March 6, 2009
This is why my boy is such a pill on the ground. Isn't he darling here? Only a few months' old, he loved to lay his head on me and get his withers scratched. This is not so darling now, when he weighs 1000 lbs. But I can't convince him that it's no longer appropriate.
It's my fault. It's ALL my fault.
Tuesday, March 3, 2009
After my initial meeting with Dr. Fischer (for which I paid $175 just for the pleasure of his company), I had lingering questions. Questions that burned in the back of my head and kept me from sleeping, mostly because I knew that attempting to call Dr. Fischer and ask these questions would be an exercise in frustration. I might as well save the call and bang my head against the wall instead - the results would be the same.
By Friday morning, Tina had the same questions as me, and recommended we get a second opinion. There is a vet down south, in Escondido who has done miraculous things with lameness in horses, so we set up an appointment with him for March 18. In the meantime, I called the equine hospital to get a copy of Snoopy's medical records. When the office found out I never got a copy of his discharge papers, they had the blonde intern email them to me. In her email, she said if I had any questions, to contact them. It was the typical "if there's anything else we can do" company line.
That's when I learned her name: Antje. I also learned her email address. This came in handy. On Sunday, I had an idea. I sent the following email:
Thank you for the discharge papers. Yes, after mulling it all over, I have tons of questions.
1. We have been handwalking Snoopy since August. Another 60 days of "more of the same" does not sound like we will improve anything, does it?
2. Couldn't Snoopy's x-rays from the initial break, through the last series, be evaluated and compared to see how much (if any) the angle of the pastern has changed? If I could see that, for example, his pastern was lower and now it's getting higher, I'd have a lot more faith in the therapy, knowing that he's on the mend, but it will take a little longer.
3. Only walking was discussed as a cure for his problem. Is there no other physical therapy to be considered? Stretching exercises? Anti-inflammatories? Ice?
I'm frankly getting frustrated, not that it is any fault of the hospital. Dr. Fischer is a good surgeon and I am satisfied with Snoopy's surgery. However, I am having a hard time getting a local vet (apart from Dr. Murphy) to become engaged in Snoopy's recovery. After our appointment on Thursday, I had time to think and consider the questions above; however, my inability to access anyone with expertise to answer my questions frustrates me. My phone calls to Dr. Fischer go unreturned, so I clearly cannot seek out his advice.
I plan to be as pro-active for my horse's recovery as my wallet can afford. My next step will be to contact UC Davis' equine program to see if they can give me any other ideas.
Antje replied, rather quickly, that she'd talk to the good doctor about my concerns on Monday.
Episode II, Where Gayle Gets a Rise Out of the Doctor
I expected a phone call, maybe on Monday, but maybe not for another week, since Dr. Fischer did not have a good track record with me and the telephone. Amazingly, I got another email later Sunday evening:
Dr. Hinz forwarded me your email. I had assumed that the communications were being handled by the referring DVM's. They had sent us the films and we called them and I assumed that you were informed. Obviously, something broke down. The issue is not your horse's pastern angle but the fetlock.
Why don't you call my cell phone at <***> after 8:30 tomorrow if you have further questions and I can try to answer them. Alternatively, email works for me but it can be hard to make sure that everyone is understanding everything.
Holy smokes, it's the great and powerful Oz himself!
I sent him the following reply: "Thanks. I'll call tomorrow. Pastern or fetlock, my questions are the same."
Episode III: Making the Call
I called around 8:45 on Monday and got the doctor on the phone. We talked for almost an hour. According to him: 1) he and Dr. Murphy did try to compare previous x-rays, but couldn't find one with a comparable angle; 2) there is no drug or treatment other than time to heal a suspensory ligament; 3) there was no earthly reason for us to have to sedate Snoopy in order to walk him, and 4) while very sorry about the breakdown in communication, there was no way it was his fault.
I couldn't argue with 1 & 2, but we had a rather lively discussion about 3, where I kept repeating, "He's five years old and he hasn't been able to run free for ten months," and he kept giving me examples of psycho race horses who didn't need sedation to be handwalked. I don't care what he says, either he hasn't truly seen a "psycho race horse" or he thinks it's normal for a horse being handwalked to need four people keeping it from floating away like one of those Macy's Day Parade balloons.
As to his 4th topic, I explained to him what it looked like on my end of our tin-cans-with-string: Dr. Pollard takes x-rays and says we'll know what our next step is when Dr. Fischer reviews the films. I wait a couple of days and call, but Dr. Fischer doesn't call me back. After another week and another call, I tearfully explain it all to Dr. Murphy, who drives to the hospital, x-rays in hand, and hunts the doctor down to get our next step. By then, our 60-day rehab has turned into 75.
He still wasn't willing to concede fault, but he said he was certain our communications problems were behind us. They should be. I have his email address and his cell phone.
Epilogue: What next?
Half of me wants to believe he is correct, that walking will put Snoopy back on track. Half of me still wants that second opinion. So today, I emailed Dr. John Snyder of the UC Davis Large Animal Hospital, Equine Department. I explained Snoopy's injury as briefly as possible and asked if he would be willing (for a fee, naturally) to examine Snoop's medical records and see if he concurs, or if he'd like to see my horse for more tests.
I'm sure I'll have to auction off my organs to pay for any tests/treatment from UC Davis, but if I can return my horse to good health, it will be worth it.
Stay tuned for The Return of the Frustrated, Bitchy, Yet Proactive Horse Owner.