Monday, March 30, 2009

For my next trick...

I don't have anything truly revelatory to report here, but I have been using this blog as a way to communicate with the vets as to when things happened with Snoopy. After my dismal e-mail exchange with Dr. Nieto, I decided to wipe the slate and start from scratch. I would call UC Davis anew, as if I'd never called before. Dr. Murphy and I spoke on Saturday about my troubles, and she said, if necessary, she'd get involved in the mix.

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

A brake in the action

Yes, I mean "brake", as in "putting on the brakes."

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."

Got that?

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

When life gives you lemons

Okay, there's no lemonade to be squeezed out here. Only more lemons.

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

Who do I have to sleep with to get some service here?

Okay, maybe that's not the best way to start a conversation. After I mulled over Dr. Fischer's diagnosis and recommendation, I decided to go ahead and contact UC Davis' Large Animal Hospital.

I thought an email would be the best initial contact. In an email, I could describe, in a clear, succinct way, what the problem is and what I'd like the vet to do. So I emailed Dr. Snyder with enough information for him to call and tell me whether he could look over Snoopy's medical records and give me a second opinion before I drag my three-legged horse up and down the coast, looking for treatment.

By the time of this post, I still haven't heard a word from Dr. Snyder, so I called UC Davis. As is always the case, I ended up describing the entire thing to the woman answering the phone, who transferred me to a different vet so I could repeat myself to his voicemail. I'm pretty sure his name is Dr. Nieto, although the lady on the phone kind of slurred it and he seems to have an accent. They both assured me he'll get back to me next week.

WOW! As I was typing my hopes that the doctor would actually return my call next week, the phone rang. It was Dr. Nieto, who spent a good 20 minutes asking me questions and talking to me about what it all meant. His suggestion was to perform more diagnostic tests, specifically using pain-blocking to investigate where the pain is coming from. I explained that Dr. Fischer was hesitant to do this, since a horse that can't feel pain risks further injury. Dr. Nieto believes the risk is small, and the reward may be the discovery of where the problem originates. I thanked him for his time, and now I'll try to convince Dr. Fischer to research Snoop's short-striding a little more.
Wish me luck.

By the way, here's a picture I found in my files the other day:

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

The Thot Plickens

Eposide I: The Queen is Not Amused

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:

"Dear Antje,
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.

Thanks again,..."

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.
Ted Fischer"

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.