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.

A Very Different Picture

Cornell sent me a disk with all of Ramsey's x-rays on it.  He has had more than 60 radio-graphs taken.  Most of them were clearly taken during his surgery, probably for guidance and to make sure they had disease free margins.

The first two pictures are the first ever taken on Nov.2 and were how the vets diagnosed septic pedal osteitis.  I am no expert at reading x-rays, but if I have read this right, this is a front to back view of the right foot.  The bottom most bone is the coffin bone or P3 (the third phalanx), and is where the infection was.  If you look at the right hand side of the bone, you will see that it has fairly clear, well defined edges.  The left side of the bone appears fuzzy with vague borders, that is the infection.  Below the bone, there is a dark oval, I think that is a pocket of abscess.  The dark spot on the bottom right is where there was a piece of hoof cut out of the sole.

I think this is looking down through the top of the foot.  Again, the right side of the bone is clear, the left is a dark, fuzzy shadow.

These were taken during Ramsey's surgery on Nov. 3.  I think the needles were used as markers to gauge whether the margins were clear.

They took some bone out, repeated the x-rays and then took more.  Several times.

They were never able to tell for certain if the joint was involved so they treated it as if it were and flushed it with antibiotics.  You can see the needle inside the joint capsule.

These were taken on Nov. 30 to check Ramsey's healing progress.  The margins of the remaining bone are sharp and clear.  No infection.

A lateral view, also taken on Nov. 30.  You can still see the hole in the side wall of Ramsey's hoof.  The shape of the hoof and the position of the coffin bone is good.  The bottom of the bone is mostly parallel to the ground.

Compare the above image to this one taken on Feb. 25. (this was taken after the farrier trimmed most, but not all, of the foot).   The length of Ramsey's heel is longer here then above, but squashed underneath him.  If you are a horse or donkey owner and you hear the term "underrun heels", this is it.  It makes the coffin bone tip back a bit.  You can also see that the coffin bone is higher up in the foot then it is below.  This can get much worse in donkeys or horses whose feet have been neglected for a long time and allowed to over grow into a slipper shape.  The farrier at Cornell started to correct this, but it will take some careful trimming over time to get this foot back where it needs to be

I think this last film is the most striking for me.  You can see at a glance just how much of the coffin bone was removed and is just plain gone forever now.  That won't grow back.  You can also see where the ragged edge of his hoof wall corresponds with the missing bone.  That won't grow back fully either.  It is amazing to me that Ramsey can even walk let alone be out playing in the snow with his mom.