Good News/Inconclusive News

The vet was out this afternoon to see Ramsey.  The good news is that we couldn't find any sign of life-threatening problems.  The coffin bone shows no signs of reinfection or fracture. The coffin bone that he does have is in great shape.  The dark blotches that are visible on the right, near the hoof wall are the areas of poor wall connection that I have pared out trying to drain this abscess.  The 'bite' taken out of the coffin bone is what was removed at Cornell when he had surgery.

The vet was very happy with how I am trimming his foot.  Her words were "an absolutely amazing job", which was nice to hear.  Up until this week, I had been feeling very good about how his feet look these days.

The one thing we did not find is a clear area of infection or an easy fix.  There is no track that we can follow to drain the abscess.  I am generally adamantly opposed to draining abscesses from the bottom of the hoof, but with the missing coffin bone and poor wall connection in that area, Ramsey is always at a much higher risk of a repeated bone infection, which would likely be the end of him.  If we could have isolated the infection, we could have tried draining it.  I know that it is in his heel and I think that is why it just won't rupture.  It is hiding out, deep in the soft tissue at the back of the foot and because the tissue is so soft in that area it just "makes room" for the abscess rather that forcing it to find a way out and finally heal.  I think that the shadow I've outlined below may be the infection, hiding in amongst the most vital and sensitive of tissues.  That is definitely the area where all the pain is.

The only thing to do is to keep trying to draw it out.  I've changed my approach to that today.  I have been soaking, wrapping and using Magic Cushion.  Tonight, I packed the foot with a sugar-dine poultice instead.  That is just a mixture of sugar and betadine mixed together to form a paste.  It is a strong antiseptic that will also draw moisture out of the foot, hopefully bringing the abscess with it.

On another positive note....Since she was here with the x-ray machine, I had her take a new film of the fetlock.  I wrote here in some detail about what Ramsey's foot looked like at this time last year and the arthritis he had developed at that time.  We didn't see any sign of arthritic changes today however and the sesamoid bone (that knob on the right) is much smoother looking.  Goes to show that, if caught early and treated right, arthritis can heal.

Now, if we can just this this darned abscess to pop without causing any other damage, he'll be in good shape.

Nothing Simple

On Monday, Ramsey came up lame on his bad foot.  He presented with all the classic signs of a hoof abscess and that is what I am still hoping it ends up being.  However, this is Ramsey and this is Ramsey's bad foot - there is no such thing as a "simple" abscess given his history, missing coffin bone and anatomical issues resulting from it. 

Most abscesses resolve themselves in 3-5 days.  Tomorrow will be day 6 and, unless there is dramatic improvement overnight, the vet will be here in the afternoon to take x-rays. 

I have been checking Ramsey's temperature multiple times per day.  Normal for him is 98.7 - 99.9.  When his temp edged up to 100.5 (which is still within 'normal' range) I put him on antibiotics.  He was back to 99.7 as of ten minutes ago.  Possibly paranoid, but I'm not willing to take the chance and I know what normal is for Ramsey.  If it is the beginnings of a fever, the earlier I start the antibiotics, the more likely they are to work.  "Within Normal Range" is just that, a range, which is why it is so important to go out and take your critter's temperature when it is healthy and happy. 

Ramsey is bright eyed, not terribly depressed and has a good appetite so I am still hoping that I will go out in the morning and find some sign that this abscess is going to rupture on its own.  I will let you all know what happens.

This Again

I'll let you all know how we make out.  For now....

.....pardon me while I go find a big tree to bang my head against. 

Forward, backward, onward

For those interested in feet, it's about time we had a recap and an update on Lakota.  It's been just about a year since I started working on him and it has certainly been an interesting journey thus far.  We started out with a whole laundry list of problems despite a lifetime of excellent, conscientious care:

• Distal descent of P3 (otherwise known as a sunken coffin bone).
• Badly flared and poorly connected hoof walls.
• Severely under-run heels.
• Runaway toes.
• Contracted heels.
• Six degrees of coffin bone rotation.
• A poorly developed, weak and diseased frog.
• A deep and persistent central sulcus infection.
• A severe mineral imbalance and life-long deficiencies of key nutrients.
• A coffin bone showing damage and remodeling caused by constant pressure and bruising.
• And, only 2 mm of sole protecting the bottom of that coffin bone from the outside world.

 6/27/13

I took over care of Lakota's feet out of desperation.  Every farrier who had worked on him to that point had generally made things worse for him.  They did not mean to, but I don't believe they recognized all the different, yet intertwined, problems going on with this horse.  Each one focused on just one aspect of his feet and assumed the rest would take care of itself.  Riding Buddy and I have taken a very holistic approach to all of the foot problems we had been struggling with and made changes in diet, management, environment....everything.  I worked on his feet all summer, trimming them every two weeks and, by Fall, we had made significant progress.

10/27/13 Still troubled, but sounder than he ever had been....

Unfortunately, not long after the above picture was taken, Lakota broke through a fence and gorged himself on windfall apples causing an episode of laminitis.  About a month later, he got out on a pasture that still had a significant amount of grass under the snow cover and had another episode (don't ever assume that winter grass is safe for a highly sensitive horse or donkey).  Last month, Lakota came up severely lame with a bad sub-solar abscess that set us back even further.  He was finally sound enough (barely) for me to work on his feet again about three weeks ago.

On a much more positive note, he had a new set of x-rays taken about the same time and, despite all the setbacks, Lakota now has 10 mm of sole depth.  That may not sound like much, and it is still terribly thin, but it is 5 times what he had last year.

3/30/14 before trim.  You can see that the front of the hoof wall, which had nearly become straight in the Fall, once again has a slight dish to it, caused by his back to back bouts of laminitis.

3/30/14 after trim.  It's not all bad.  Despite the setbacks, this is still a MUCH stronger hoof now than it was one year ago.  The heels are dramatically improved, much less under-run and de-contracted.  He has a relatively healthy frog, it is still somewhat weak, but all signs of disease and infection are gone.  The bars are no longer folded over on themselves and, he has 10 mm of sole.

One of the most difficult aspects of correcting all these issues is that the hoof gets stuck in a kind of endless negative feedback loop.  The walls need to be trimmed way back, especially at the toe, in order to get healthy connection and sole growth.  However, with such thin soles, those overgrown walls are all that he has to support him.  The soles won't grow because all the energy of the foot is going into growing excess wall, the walls can't be controlled because they are all that is protecting the soles.  Round and round it goes.  Unless something can be done to break out of this loop, it will never end.  That is where Lakota has been stuck for the past 15 years.

This is where the casts and dental impression material come in.  The dental mold provides support, cushion and stimulation that the sole needs...

The casts (hot pink was on sale - 1/2 off!) provide even more support and protection as well as stabilizing the entire hoof capsule while still allowing for expansion and contraction.  These are what gained us that hard won sole depth.  We're hopping for more.

The most interesting thing to come out of Lakota's recent bouts with laminitis can be seen in the photo below, taken mid trim.

We horse people tend to think of laminitis in a rather limited, one-dimensional fashion.  We generally focus on the toe and think in terms of rotation of the coffin bone.  This isn't really accurate though. The coffin bone is the anchor for the entire hoof capsule, it is the planetary core that the crust is attached to.  No matter how severe the laminitis, it is not the coffin bone that moves downward, even when we think of it as puncturing the bottom of the foot.  The coffin bone can't move, it is joined to the bone above it (P2) and that joint does not fail during a bout of laminitis.  Rather, it is the hoof capsule that loses its attachment to its anchor and rotates upwards, affecting every part of the foot - not just at the toe, but the quarters, heels, sole - everywhere.

In this photo, you can see a butterfly-shaped pattern of "bruising" right in the center of the hoof, on either side of the frog.  This is not bruising from an external source, it is the damage that was caused to the lamina of the sole during a minor laminitic episode.  It has taken this long for it to grow out enough to be visible, both front feet look exactly the same.  It is clearly visible here because there is so little pigmentation in the foot...not something you'll see every day (thank God). 

That lack of pigmentation is interesting in itself.  Lakota does have very white feet, however, constant pressure and bruising to the bottom of the coffin bone can cause the sole to lose pigmentation as well, similar to the way a scar will grow in white on dark colored horse. 

Note: I did not trim anything from this sole, only used my knife to scrape away the dirt so that I could really see what was going on.  The line drawn in front of the apex of the frog is approximately where the white line should be (hopefully, will be someday).  The short line just in front of that is where I brought his toe back to in this trim.  This may look scary, but most of that toe is lamellar wedge, the hoof's version of overgrown scar tissue that needs to be removed.

Lakota was sore when I started, but walked off much sounder after his trim and has improved since.  I'm happy to have been able to stick with one of my cardinal rules of hoof trimming - the horse should be at least as sound after the trim as he was before.

A Foot Update

It feels like progress has slowed a bit with Ramsey's foot.  The hoof wall is still growing fast, but the sole has a long way to go yet.  I think there is still a lot of dead tissue that needs out grow out before we get healthier hoof.  The back of the hoof wall keeps curving in toward the frog more and more as well.  I don't know if that is caused by the internal damage to the foot or the constant bandaging.  Since it has not happened on the other side of the hoof, I suspect the former with the latter possibly being a contributing factor.  I will share these photos with the vet, see what he says.

Right after I took these photos, I massaged some of my ointment into the foot and all of that scaly stuff on the side finally came off.

To me, it looks like the coronet band has become oddly stretched and elongated.  I have not ever seen anything like this before.  I really think it is the result of 3 months of constant bandaging and I have been trying to think of different ways to wrap the foot that would allow more air circulation, but I haven't come up with anything yet.  It has to be foolproof so I haven't dared experiment much.

In spite of how odd everything looks, Ramsey seems very sound on the foot.  He moves easily and freely with no limp and no sign of pain so I am not terribly worried.  I have been trimming the foot just a little bit each week, hoping to maintain it in tiny steps rather than trim it all at once weeks from now.  I think we will see much healthier growth once he can go without a bandage.

Speaking of bandages, I had been trying to stretch out the bandage changes to every 3-4 days, but I think I am going to have to go back to doing it every other day.  The back of his heels get so dry that the bandage rubs and chafes, making it sore.  I am still using my beeswax salve on it, which has really helped, but it needs to be reapplied more often.  I don't want him to get sore and I certainly don't want it to get infected again.  His heels were looking really good, but we seem to be losing ground so, back to every other day.  Not only is this time consuming, but between bandage materials and medicine, it costs about $10 every time I change it.  Oh well.  I have been trying to make the bandage lighter, but....

When I did this bandage change, I noticed that Ramsey now has a tiny white spot.  I don't think it is genetic though, it certainly wasn't there before.  It looks to me like a tiny scar, which often grow back in white.  It makes me wonder if this could have been the original injury that caused all of this.  I always assumed that it was a stone bruise that started everything, but it is possible that a puncture wound in the leg could have been the route in for bacteria. 

Both of the donkeys love to scrounge and nibble in whatever brush they can find, Ramsey could easily have punctured his leg on a twig or thorn.  Given how tiny this spot is and how thick and dark Ramsey's fur is, I doubt I would ever have seen it.  The actual scar under that white fur is about the size of a sesame seed.  

Ah well, now Ramsey can boast of a light point after all.

A Foot Update

Ramsey's foot seems to be healing well.  There continues to be good granulation within the hoof and there is no sign of infection at this time.  He is using it normally and showing very little sign of lameness.  I was even able to trim the hoof a little a few days ago. 

I have been treating the large hole in his hoof with a product called Equisilver with very good results.  This is a chelated silver solution and, while I had never heard of this product prior to Ramsey's surgery, I was glad to see it when I was presented with it at Cornell.  I have had near miraculous results using silver solutions on bad and non-healing wounds in the past.

I was even more intrigued by this product as it is labeled as a respiratory treatment for respiratory infections and allergies.  I spoke with the vet at Cornell about it and he said they have been having excellent results as both a wound treatment and respiratory therapy.  I intend to talk with my own allergy doctor about it, if it can do miracles for horses with chronic breathing problems, it ought to be able to help me. 

As I hope you can see, the wound in the hoof is clean, dry and showing some healthy tissue growth.   

The extremely painful blistering around his coronet band and his heel bulbs is also healing.  While it still looks rather awful and is sensitive, it is no longer terribly painful to him and there is some nice healthy tissue appearing there as well.  It would really benefit from some time in the open air, but that still isn't an option.  I have been using some of my homemade beeswax salve on it recently and that seems to be helping.  It moisturizes without being gooey and the wax provides a protective, antimicrobial barrier. 

I spoke with the vet at Cornell this afternoon and since Ramsey is doing well and is no longer in pain, he is cleared to get more exercise as long as I can keep the foot clean and dry.  That is a challenge in this miserable weather and my search for waterproof footwear continues.  His Build-a-Bear shoes aren't up to the standing water and the snow storm expected this weekend.  I'll figure something out though, it is high time that Ramsey get to go out and be a baby donkey now and then. 

Movies

I took these on Friday, which turned out to be the last day of Fall, Winter is here (and no, I still haven't figured out how to clean the inner workings of my camera.  It looks complicated so it's just going to have to stay dusty for now - just like my house.  The barn is clean, but....we just won't talk about the house:). 

Ramsey's leg has straightened out more since this was taken and it looks good.  However, another abscess broke out of the back of his foot on Saturday.  I have been on the phone with one vet or another every day this past weekend.  We aren't sure what to make of this development.  It may be the original abscess still finding it's own way out rather then using the great, huge, gaping hole in the side of his foot where he had surgery. 

He is not terribly lame at this point, which makes us think it is not the joint involved (that would be bad).  I think it is possible that the original abscess has walled itself off and solidified so completely that it is now acting as a foreign body, causing irritation.  If that is the case, it will have to come out somehow before the foot can heal properly.  If this does not resolve by tomorrow, I will have it x-rayed again.  I am watching it very closely. 

On a lighter note...Emma doing some dancing practice (with Ramsey thumping and bumping me and the camera, you might need some Dramamine towards the end:)...

A Very Sick Donkey

Ramsey's foot abscess has invaded his whole body and he is very sick.  His temperature is all over the place and he is very miserable now.   I spoke with the vet yesterday morning and she agreed that if he wasn't better by the end of the day, she would come out.

Right up until I left for work yesterday afternoon, he was still bright-eyed, cheerful and eating well.  I was concerned though, because his temp was still high and I wound up coming home early as I was worried about him.  By the time I got home, his temp had dropped to 97.8 (which is almost too low) and he was depressed and not eating or nursing. 

The weather is not helping as it is truly miserable with temps in the low forties and constant rain.  Snow or sleet is expected overnight.  Thank goodness I bought Ramsey a blanket, he really needs it right now. 

Since he quit eating and drinking, I am very worried about dehydration and weakness.  The vet finally made it out this afternoon and we gave him IV fluids, which I will continue for the next three days.  He has a an IV catheter under the green vetwrap. 

He seems to be having some trouble laying down on his own and this afternoon, when the vet was here, he lost his balance when she was looking at his foot.  He clearly wanted to lay down so I just eased him down rather then prop him up.  I sat with him and held his head in my lap and he wound up sleeping through the entire catheterization process.  It made him a perfect patient, but it scared me to death.  

He is on antibiotics, a higher dose of Banamine and IV fluids.  The abscess did rupture out of the top of his foot this afternoon in three places.

This is the worst abscess I have ever seen.  I have only ever seen one abscess that went systemic before and it was never this bad, it responded to antibiotics almost immediately.  On the other hand, that was in a very robust, four year old draft cross who weighed 1300 pounds.  Ramsey is too young for this nonsense, I'll be sure to give him a stern lecture about it just as soon as he gets better. 

I sure hope this is not typical of donkeys.  If Ramsey does not show some real improvement by tomorrow afternoon, I may have to try to get him to Cornell. 

Abscesses, Hurricanes & Other Assorted Maladies

Ramsey's abscess broke open this afternoon to everybody's relief.  I wish it had broken out of the top of his foot rather than the bottom as there is now a hole in the bottom of his foot.  Keeping debris and bacteria out of those holes is impossible and often leads to reinfection, but it is what it is.  At least he is in less pain and for that I am very grateful.   I gave him a little bit of Banamine yesterday and today to help ease the pain and I soaked his foot (or tried to rather, I am not sure which one of us wound up with wetter feet).  I wrapped the foot afterward hoping to keep junk out of it.  I usually use duct tape for such jobs, but Ramsey's feet are so tiny, I had to use electrical tape instead... 

Abscesses are a unending problem around here.  Our soil is 80% clay mixed with 20% sharp rock.  Every Spring and Fall during mud season, someone ends up with an abscess.  Ironically, it is usually the horses who have the hardest, toughest feet.  I think it is because when a soft foot is bruised by a hard landing on a sharp stone, the foot can expand a little and provide relief for the resulting inflammation.  When the same thing happens to a hard foot, there is nowhere for the swelling to go.  As a result, the inner structures of the foot are damaged and lead to an abscess.

I have learned the hard way over the years, that the best treatment for an abscess is to not treat it.  Generally, an abscess ruptures on its own in 2-3 days.  Cutting the foot to drain the abscess can provide some immediate relief, but, having dealt with dozens of abscess, I have never yet seen it NOT cause problems later on.  Instead of healing within a week, cutting the foot can lead to years of severe trouble.  Ask me how I know...

Soaking the foot in warm water and spreading Ichthammol on the coronet band may help by softening the tissue and making it easier for the abscess to erupt.  However, with every new abscess I see, the more I believe that these things do more for me than the abscess.  On the other hand, it can't hurt, it might help and for someone like Ramsey, it makes him feel better to be fussed over and attended to.  That alone makes it worth doing.


For those of you who have wanted to hear what Ramsey's bray sounds like, I shot this by accident yesterday.  Go figure, I have been trying to get his bray on video for weeks with no luck, then I drop the camera and turn it on to see if it still works and here he is.  Unfortunately, this is the bray of a very unhappy, lame donkey baby.

Here in NY, we are all bracing for Sandy and wondering what it is going to bring.  This area suffered severe flooding in 2006 and catastrophic flooding last year from Irene and Lee.   Folks are more than a little frightened of Sandy and with good reason.  Some of these communities have never recovered, another bad flood will be the end of them.  So far, the weather forecast is saying we are going to be getting more wind than rain this time, but that is what they said about Irene as well.  There is no knowing.

I at least, am safe from flooding.  If I ever have to worry about that, we are all lost.  The wind is another matter.  Still, I am as prepared as I can be (I hope).  My main concern at the moment is if we have a prolonged power outage.  In that case, I have no running water and the contents of the freezer are at risk.  I do have a small generator and I think I can keep the freezer going a couple hours a day anyway.  I have a gas stove and wood heat.

As for water....

I've filled all of the water vessels that I have.  The equines are consuming about twenty gallons a day right now and there is about 100 gallons here.   There is a public spring with good water about a mile from here where I can get more if I need it.  I really hope I won't need any of this, but......

If you don't hear from me for a while you'll know why.  Stay safe out there folks.