Oliver
Oliver was brought into this world on March 10, 2009 with a crowd of happy onlookers awaiting his birth. On arrival, it was noticed that little Oliver was born with angular limb deformities ("crooked legs"). Because of his weak legs, he needed assistance to stand and nurse throughout the night. It is very important for newborn foals to nurse soon after birth because the colostral antibodies provide the protective immunity that the foal needs for the first few months of life. If these are not obtained, then newborns are highly susceptible to developing infections in their joints, lungs, or gastrointestinal tracts. Despite the valiant effort Oliver made at nursing that evening, he had a failure of passive transfer of antibodies from his mom. He therefore had to receive a plasma transfusion to boost his immunity. However, Oliver unfortunately developed two infected joints (septic arthritis), one of which required arthroscopic surgery to debride the infectious, devitalized bone from the healthy bone. Every day for nearly one month, Oliver was placed under general anesthesia, his joints were lavaged, and high concentrations of antibiotics were administered directly into his joints. During this time, he was also getting antibiotics through an intravenous catheter three times per day.
The orthopedic conditions that Oliver was born with were bilateral carpal valgus where the limb turns outward from the knee down, and carpal contracture, where the knee is too flexed. Because he was born prematurely, the bones in his knees were not fully developed. Therefore he had to remain on strict stall confinement in order to prevent injury to the weak, underdeveloped bones. Even after the bones were adequately formed, he still could not exercise because of the infections that he had in his joints. Without the exercise he needed to strengthen his legs, the carpal contraction was not improving as quickly as we had hoped, so he was fitted for splints that he wore on both legs that gradually trained his legs to become straighter. He also had another minor surgery to improve the valgus deformity.
With lots of persistence, determination, wonderful owner dedication, and Oliver's will to live, he definitely beat the odds and pulled through all of his medical challenges. After nearly six weeks of hospitalization we were sad to see him leave, but thankful that he was able to go home!
Lenny
Lenny is a 10-year-old Oldenburg gelding and resides at one of Austin's premier Hunter/Jumper barns. Lenny is a big fellow, and packs his owner over jumps with aplomb. Unfortunately, one unlucky day during turnout, Lenny stepped on a nail. Keeping pastures clean and safe is very important, but sometimes, no matter how diligent you are, pieces of debris can appear. It is not uncommon for debris that was left on the ground many decades ago to migrate to the surface.
The barn staff noticed right away that Lenny had gotten himself into trouble. The groom decided to take action, and instinctively removed the offending nail. Of course, this seems like the right thing to do. However, once the nail is removed, it can be exceedingly difficult to find the entry hole. If the nail is left in place until the veterinarian arrives (hopefully within the hour), then the entry point is known. Perhaps more importantly, radiographs can reveal the exact location of the nail. This will help determine a treatment plan and prognosis. Often, the nail simply enters the sensitive soft tissue under the sole. This is painful, and can lead to infection, but the long term effects are often negligible. The nail can, however, damage a vital structure, such as the deep digital flexor tendon and the navicular bursa. The deep digital flexor tendon is important for actions such as pawing while impatiently awaiting the feed bin to be filled, or, as in Lenny's case, jumping. The deep digital flexor tendon changes direction as it travels down the back of the pastern, to then connect to the coffin bone. Where it changes direction, the navicular bone acts as a pivot point. To ease this pivot, there is a fluid-filled sack between the flexor tendon and the navicular bone, called the navicular bursa.
When I arrived at the barn, the groom had successfully cleaned and wrapped the injured foot. He had paid close attention when removing the nail, and was able to show me the approximate location of entry. After light paring with a hoof knife, the entry site was located.
Since we did not know the depth or direction of penetration, we placed radiographic contrast liquid into the nail hole. We then took radiographs, and the liquid shows up on the x-ray.
By performing this diagnostic test, we learned that the nail puncture had indeed entered the navicular bursa. In doing so, it had to go through the deep digital flexor tendon. The wound was lavaged to attempt to clean any debris and bacteria that inevitably entered the wound site. This wound really requires hospitalization to be treated properly, and our hospital was not quite ready to operate. I referred Lenny to Texas A&M, where Dr. Jeff Watkins performed arthroscopy on the bursa. He and his team were able to perform a few days of thorough cleaning of the area.
Because of the quick, aggressive treatment at A&M, the risk of infection was lowered considerably. Unfortunately, Lenny is at high risk for developing adhesions. These occur when the deep digital flexor tendon and the navicular bursa form weak scar tissue. This scar tissue breaks easily during day-to-day activity, causing mild lameness and inflammation.
Lenny has a good chance of returning to his jumping career, so let's all cross our fingers for his healthy recovery!