Only the most extreme measures offered hope for a high-strung mare whenwhen heroicheroic plagued by a series of devastating hoof problems—including laminitis. effortsefforts

By Ric Redden, DVM, with Christine Barakat wentyyears ago when I first OCD had progressed and the nearby started taking on coffin had developed degenerative paypay offoff with hoof problems others joint disease. Awesome would never be Tthought hopeless, I knew sound for riding of any kind. At that little beyond the fact that point, Deb just wanted to make her a their owners were desperate for some- comfortable broodmare. one to at least try. From these horses— But neither shoeing nor medication those who recovered and those who had a lasting beneficial effect. Eventu- didn’t—I learned things that I’ve put to ally, the decision was made to cut the use in other cases. As a result, we can nerves serving that area of the hoof save horses today that 10 years ago and inject the coffin joint in an effort wouldn’t have had a chance. to reduce inflammation. The procedure This isn’t to say that I never recom- should have made Awesome instantly mend that a be put down. When sound, but it didn’t. That’s when Deb pain turns to suffering—which I de- called me to come to her Cre Run Farm fine as pain with no hope for relief— in Doswell, Virginia. I think euthanasia is called for. But I don’t arrive at that point quickly. In Complications arise fact, that’s how I came to treat an I examined Awesome and con- Arabian mare named Im Awesome Tu. firmed that her situation was precari- Bred for racing, she was “big—big ous and unfortunately typical. Her and beautiful,” recalls her owner diseased navicular and coffin bones Deborah Mihaloff. “And she grew like had demanded so much attention that a weed that first year.”As a 2-year-old, another problem seemed to have the black filly entered race training cropped up out of nowhere. and was successful on the track. Then But it had existed all along. New she developed a persistent soreness in X rays of the right hoof revealed her right front hoof and was sent to the extensive ringbone—arthritis of the University of Pennsylvania’s New lower joint. The denerving Bolton Center for a diagnostic workup. procedure had eliminated the discom- M V X rays revealed osteochondrosis fort associated with the navicular and D , N E dissecans (OCD) in the right front nav- coffin bones, but the ringbone was D D E R icular bone. OCD is one of several de- even more painful. C I R ,

Y velopmental orthopedic diseases that Equally troubling was the possibili- S E T

R occur when a horse grows more rapid- ty of mechanical laminitis developing U O C ly than bone can properly form carti-

S in Awesome’s left foot. When a horse O T

O lage. Rest and medication seemed to isn’t able to bear weight on one front H AN UNEXPECTED TURN: Bred to race, P D

N control Awesome’s condition for a few limb, the other takes it on. This con- the Arabian mare Im Awesome Tu A S

Y showed early promise on the track. A months, but eventually she was lame stant load—sustained over days and R

X Then she began to develop a series F more than she was sound. weeks—diminishes the blood supply. O O H An evaluation revealed that the Eventually, the blood-starved tissues of serious hoof problems.

42 EQUUS 348 die and the horse develops laminitis. My immediate goal was to enable MAY 25, 2002 SEPTEMBER 4, 2002 SEPTEMBER 5, 2002 Awesome to comfortably bear weight on her right hoof to protect her left hoof until the pastern fused, controlling the pain of the ringbone. I outfitted her right hoof with a device I designed called a “modified ultimate.” It’s essentially a cuff around her hoof with a wedge and breakover properties that allowed her to raise the heel at will. This enabled her to bear weight on her foot without putting her heel down, which was especially painful for her. The mare walked comfortably while wearing the device, and I returned to Kentucky hopeful that her condition would improve. However, after just four months, FROM BAD: The telling changes of ring- TO WORSE: In less than four months, TO CATASTROPHIC: To complicate matters, the mare’s “good” left Awesome was dramatically lame in her bone appear in the short pastern bone the changes characteristic of the front hoof showed evidence of developing laminitis—a result of left front hoof, and I made the return of the right front hoof. The condition arthritic condition had progressed having to bear a disproportionate amount of weight. A venogram trip to Virginia. It didn’t take much for became evident after the coffin and significantly. Awesome was lame and of the hoof revealed large areas at the front that were devoid of me to determine that the worst had navicular bones were treated. suffering extreme pain. functioning blood vessels. happened: She had developed lamini- tis in her “good” hoof. vidual’s breed, age and occupation. In Ill-suited for a sling within seconds the tissue turned To temporarily replace the hoof contrast, the venogram of Awesome’s I had planned to begin work on from a whitish color to bright pink, wall, I cut a thick piece of felt, soaked No hoof to stand on left hoof showed large areas at the Awesome as soon as she arrived, but then bled freely once the vessels it in Betadine, laid it over the laminae Big—very big—and I took a series of X rays, looking for front and along the palmar surface she was very high-strung. We needed were decompressed. That was an and taped it in place. Then I cast the the telltale swelling between the coffin (below the bone) that were devoid to put her in a sling, but she was so indication that the circulation had leg, using the pins I had placed in the beautiful, the bone and hoof wall that indicates fail- of functioning vessels. Deprived of wired that even sedation wouldn’t returned, and it made me very hopeful. cannon bone as support. Essentially, blackArabian filly ure of the laminae. There was a slight blood, the laminae in those areas help. Over the next two days, however, If I don’t see that within 30 seconds the lower leg was floating in the cast entered race swelling, but from the radiographs would soon fail. she seemed to acclimate to the sling. I of taking a hoof off, things usually with no weight put on the hoof. Awe- alone, it didn’t look that bad. I knew I I knew from looking at the veno- felt she would tolerate it well enough don’t end well. some was immediately comfortable. training as a had to do a venogram—a technique I gram that we had only a few days to for the procedure. 2-year-old and developed for horses in 1992—to pro- save her. She was experiencing mas- With the mare completely suspend- A DRAMATIC PROPOSAL duce an image of the circulation within sive vascular shutdown. The laminar ed, I anesthetized her lower leg and experienced the hoof. Then I’d know for sure what tissue was swelling within the rigid placed two surgical pins at the lower success on was going on. hoof capsule. Unable to expand, it was end of her cannon bone. They extended I placed a tourniquet around the like a tourniquet, cutting off circula- beyond the skin and with the addition the track. fetlock to cut off all blood to the hoof. tion and causing further damage. of a cast would eventually take on the Next I injected dye into the vein at the The gravity of the situation required entire load of the left leg. Using a pastern. The dye filled all the function- an immediate and extraordinary solu- Dremel tool, I then cut around the ing veins, arteries and capillaries of tion. I proposed shipping Awesome to lower edge of the wall of the left hoof, the hoof. I took six radiographs of the my clinic in Kentucky so I could totally separating it from the sole beneath hoof in 45 seconds—the dye disperses remove the hoof wall to restore circula- it. Because the laminae were so rapidly from the vessels. tion to the laminar tissues. damaged, it was an easy job. Once In a healthy horse, the images re- After a bit of thought-provoking dis- the sole/wall junction was separated, veal an extensive network of blood ves- cussion, Deb agreed. Outfitted with a I carefully peeled the entire hoof wall TWO-STEP PLAN: Together with a cast, surgical pins placed through Awesome’s left sels. Though quite similar from horse cast to keep weight off her left foot, the from the foot. front cannon bone (left) bore the entire load of the leg. Then the hoof wall (right) was to horse, these networks have unique mare made the journey to Kentucky, I gently massaged the exposed removed to restore circulation to the laminae. characteristics depending on an indi- nearly beating me home. laminae to restore blood flow, and

44 E QUUS 348 september 2006 september 2006 EQUUS 348 45 and even buck in the round pen we was causing the tendons attached to it keep her in.” I was a bit worried about to contract. That, in turn, was pulling that last comment. the bones of her foot out of alignment. The fetlock was knuckling over and One giant step back she was unable to support weight on Unfortunately, my concern proved to the limb. be warranted. Being back at the busy To make matters worse, the fusing breeding farm brought out Awesome’s of the coffin bone in the mare’s right nervous tendencies. The bucking and foot—where she had extensive arthri- cavorting became more frequent and tis and OCD—wasn’t going well. In inevitably took their toll. The hoof she fact, the coffin joint was eroding and had grown was complete but very weak its support ligaments were breaking and immature. The pounding it had down, causing the short pastern bone been subjected to had destroyed the to luxate forward over the coffin bone, new laminar connections. Two months which was not good. Awesome was ly- after coming SELF-RESTORATION: Although not as home, Awe- strong as the original structure, the The hoof she had grown was complete hoof wall that had been removed some was eventually regrew. Here it has not yet significantly but very weak and immature. reached the level of the shoe. lame again in her left front hoof. I recommended that ing down more than she was standing she be shipped back to my clinic in and her obvious pain was not relieved One giant Kentucky. My goal at that point was to by medication. step forward unweight the hoof as much as I could The mare needed to wear several and keep her quiet to prevent her from The end of the road casts over the next five months until damaging it more. At this point, options were bleak. she grew a new hoof. Normally this I realized that I needed to abandon Awesome was falling apart. I called process takes an entire year, but using my plan when I examined Awesome Deb and told her I thought we’d done this procedure, the hoof can be re- and found that she had developed seri- everything possible. Extremely upset, placed in six to eight months. Four ous complications. The coffin bone of she asked me to give the mare just one weeks after surgery, I removed the her foundered hoof was infected, which more day and see if there was anything pins from Awesome’s leg and recast it so she could bear some weight on the OCTOBER 27, 2003 NOVEMBER 3, 2003 cornified tissue that would eventually become her new hoof. Then every two to three weeks after that, I changed the cast. During this time the mare stayed in a large box stall and learned to relax a little. Every week I gave Deb a call to update her on Awesome’s progress. In March, I performed another venogram and found that the circula- tion in the left hoof was nearly normal. I telephoned Deb and told her I was shipping her mare home just as soon as I put on some specially designed supportive shoes. “She looks amazing,” Deb called to tell me afterAwesome A BAD POSITION: The coffin joint of YET ANOTHER SETBACK: An infection arrived back in Virginia. “She’s happy the right hoof eroded and luxated in the laminitic left hoof caused the and her coat is glossy and she’s mov- forward, pulling the entire structure tendons to contract and the hoof to ing well. She certainly is not sound, out of alignment. begin to knuckle over. but she is comfortable enough to trot

46 EQUUS 348 september 2006 OCTOBER 24, 2005 day in January 2004. She was out of her casts and splints, and I decided to make her some shoes that would be more comfortable. Late one evening, only the two of us were at the clinic. I tied her in the middle of the room near the shop. When I would go into the shop, she would watch me work on the shoe. She never took her eyes off me. Then when I’d walk back to her, she’d lift up her foot for me to try the A MILESTONE: Three years after Redden shoe on her. began treatment, Awesome’s right 1 It took me 4 ⁄2 hours, but she stood pastern joint had finally fused. Although there and quietly watched and helped the hoof looks relatively normal, the X ray reveals dramatic changes within. me the entire time. This was the same mare who tried to kill us when we else we might try. I thought about it to Deb, doing one of these procedures attempted to put her in the sling that long and hard and came up with one would be difficult; doing both at once first day. Now she was working with last option. put us up against some pretty big odds. me to come up with a solution for her. The next day I explained to Deb Even so, she gave me the go-ahead to It was one of the most profound and that I wanted to perform two surgeries. proceed with the understanding that if rewarding experiences I’ve had with One would involve cutting both the Awesome wasn’t comfortable after a an animal. superficial and deep flexor tendons month, she would be euthanatized. In December 2005, Awesome was of the left front and then carefully Both surgeries went well and within shipped back to Virginia. Although she realigning the digits and applying a days the mare was standing and mo- no longer wore a cast or splint and was cast for stability and to prevent cata- bile. She had casts on both legs, but receiving no medication, I stressed to strophic suspensory breakdown. she would come to the window and Deb that the mare would never be nor- Through a series of casts done over greet passersby, and she had the best mal. I told her outright, “I’ve given you many months, an increasing amount of attitude. I couldn’t have hoped for a an invalid. She’s a very good-looking weight would be put on the hoof as the better outcome. one, so don’t let that fool you. This tendons healed. The goal of the second horse is going to be high maintenance surgery, performed at the same time, The ultimate reward every day for the rest of her life.”That would be to place a pin cast on the Over the next year and a half, didn’t, however, seem to daunt Deb. right hoof to completely unload the Awesome wore a series of casts, then Awesome now lives in a small unstable joint for three weeks. That splints, then supportive shoes. During round pen and requires specialty shoe- would give the bones the time they this time, her personality underwent a ing every six weeks from a farrier I needed to finish fusing. As I admitted dramatic change. I distinctly recall one helped train for the mission of looking after her. Her gait is far from normal— the fetlock and coffin joints in both legs have fused to the point where they don’t bend—but she appears to be A FAVORABLE quite happy and her body condition ENDING: Awesome regained her and attitude remain good. head-turning good Farrier-turned-veterinarian Ric Redden, looks and no longer DVM, has built his 40-plus-year career is in pain. However, on salvaging horses that have been con- she will always sidered lost causes. From his Interna- require specialized care to maintain tional Equine Podiatry Center in Ver- a comfortable sailles, Kentucky, he has pioneered quality of life. treatment methods for laminitis, ampu- tation and prosthetic limbs for horses.

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