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.

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