Friday, August 31, 2007

Patience and The Nature of Healing

I think patience has got to be the number one quality one needs to see through the rehabilitation of a chronically sick horse. After doing 4 little light hacks, Lutine showed up with a minor, but noticeable, amount of head bobbing again in trot when being ridden on the road. She wasn't head bobbing in trot in the field minus a rider though, and she wasn't lame at the walk or even shortening her stride at the walk with the rider. Now, we've been long reining on the roads and the hard surfaces for weeks in the walk and with a little bit of trot with no sign of head bobbing and even without boots. So the addition of the extra weight of the rider had obviously had some sort of effect. I decided to write to some of the barefoot professionals that I know to ask about their experiences of rehabbing 'navicular' horses and whether there just are some horses that will never come sound. Bless them, to a man (or woman!), they sent me some wonderful, detailed and constructive replies. Here's some exerpts:

From Paige Poss, awesome lady who runs

Wendy, I have been reading some of the different things that you have done to get this horse well. I am learning a lot from you and Lutine. I think you are doing a fabulous job. I have to tell you that occasionally I do run across a horse that is beyond my help, but it is never just about the feet. You asked about navicular horses, but in reality, it is "sick" horses that are so hard to heal. I just gave up on a lovely mare that I have been trying to help for 2 years. I was just her trimmer for the first year, but I actually owned her this last year. I was treating her with many different modalities and was getting marginal results. The reason I gave up is that she felt terrible most of the time. The relief she got was always very short lived. Like you describe Lutine, Colleen was completely toxic. I think she had been compromised her whole life, but that is a whole other story. I think you have come much further with Lutine. It sounds like she is doing well much more that she is doing bad. That is great! OK, on to your real question. Yes, I do see navicular horses that take a very long time to heal. I mentioned this on the list a long time ago, but no one commented that they see the same thing. I think this may be what is going on with your horse. I have noticed this many times over the years. As the foot begins to heal and the horse begins to use the back of the foot more, the deep digital flexor tendon will want to work properly. Working properly means that it will need to slide over the navicular bone. What happens with a lot of navicular horses is that they form adhesions between the DDFT and navicular bone. When these start breaking apart, the horse gets sore. I think of this as a type of healing crisis. I don't want it to happen, but when it does the horse comes through it better than ever. If she likes having a job, then I would continue with light work even if she is lame. I don't know what your boarding situation is like, but if you can keep her working.

I am going to attach some pictures of a horse that clearly had issues with the DDFT. This horse also was a foundered horse. Many times the horses that are deemed "navicular" really are laminitic also. I think you already feed her like she is a LGL. Am I remembering correctly? This is a picture of the DDFT on the front foot. It does not look like it was stuck to the navicular bone, but it was clearly not healthy.

Here is the next picture. This is the same horse. It is just his healthy back foot. Isn't it amazing the difference in color? Clearly the front foot was not as healthy as the back foot. I think that over time with proper management these tissues would heal. I just wanted you to see what may be going on inside your mares feet. I would continue to have patience and let the healing continue. Paige

I am going to send you a few more pictures that show how much damage there really is to that foot. The bone on the left is from the healthy looking back foot and the right is of the unhealthy looking foot. This is looking at the top of the coffin bone and navicular bone, so it is a weird shot. What jumps out at me is that not only the tendon is an odd color, but all the tissue looks damaged. The bone is yellow, the tendons and lateral cartilages look yellow. I know that I often see a pumpkin or yellow tint to some feet that are compromised. I have often thought it was serum from an inflammatory reaction, but I don't know this to be true. It is just my anecdotal theory. Keep in mind that both of these feet were from the same horse. Both feet were kept the same way. One is not damaged from sitting out too long. Both dissections were done the same day.

Just to reflect a little on what Paige was saying, here is some information from an orthopaedic medicine website about tendon adhesions and their formation:

Problem: Precise digital function requires smooth gliding of flexor tendons within their sheath. Tendon adhesions following injury or repair limit gliding, thereby decreasing active range of motion of the digit as compared to passive range of motion.

Etiology: Violation of the tendon surface, whether traumatic disruption or from attempts at surgical treatment, results in production of adhesions via the normal inflammatory response. The limited space between the profundus and superficialis tendons and the theca, is a primary contributor. Once adhesions develop, tendon gliding within this confined space is affected, and active digital motion is diminished.
Pathophysiology: The process by which flexor tendons heal is debatable. The conventional theory is that peripheral fibroblasts from the surrounding connective tissue invade the zone of injury and serve as a source of reparative cells. In this theory, the tendon itself is believed to have no intrinsic ability for repair. New evidence seems to indicate that the epitenon cells migrate into and across the zone of injury along a fibrin lattice, and collagen fibers, formed by the epitenon and endotenon fibroblasts, bridge the laceration site. Vascularization of the repair zone is from within the proximal end of the tendon by proliferation of vascular channels. These studies suggest that the tendon possesses the intrinsic ability to participate in the healing process.
Peripheral adhesions attach to the repairing tendon, potentially limiting tendon excursion during flexion and extension. Although adhesions may add strength to the healing tendon, it is unlikely that adhesions are an essential component of the reparative process.

I find this interesting too because this is from a website about adhesions in the tendons of human digits (i.e. fingers) and actually, here we're talking about the equine digit - after all, the DDFT is the 'deep DIGITAL flexor tendon'.


Blogger Jane said...

Wow Wendy, thanks for this... a great resource!! Glad to hear the old adage of ride that horse is holding true to Lutine, even with all her issues! Keep up the good work! :-))


8:36 PM  
Blogger Lulu's friend said...

Thanks Jane - and lovely to see you and Magic doing so well. You're our inspiration!

8:47 PM  

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