Monday, 19 October 2015

Vale Uno

Uno, as many of you who read my little blog will know, is the son of the massive but gorgeous Rose, by a lovely Irish Sport Horse stallion, Highland McGuire. Uno managed to fracture his knee through the growth plate on the outside of the joint around two weeks of age and was not well managed for the first two weeks following the injury. There's more on that in the posts I wrote at the time in 2013.
After a year of intensive treatment and therapies, including body work, chiropractic work, monthly and sometimes weekly trimming and lots of love, it became clear that Uno's knee had not healed well and he was in apparently chronic pain.

Uno getting a massage from our wonderful friend Tatjana.
He was taken to Canberra Vet Hospital and the amazing Rebecca Walshe gave him a thorough examination, noting initially that his knee joint mobility was extremely limited. He could not bend the knee beyond about a 100 degree angle - no pain shown, it just wasn't happening. X-rays showed the fracture had essentially 'blown out' and a large piece of bone was now sticking out from the side of the knee. He had other changed to the joint that were not particularly obvious on the x-ray but Bec just kept shaking her head and saying, "That's not how the knee is supposed to look!"

I asked Bec what she thought his pain level was like. She and I have made some hard decisions before and I trust her implicitly. She also knows I'm a realist and I don't keep horses alive when their quality of life will be poor. She said his pain is probably quite chronic and as the arthritis in the joint progresses it will become more acute. We talked about managing it, but give his overall sensitivity to drugs (he scoured and became ill at the drop of a hat!), the fact we would just be delaying the inevitable, and the expense involved, it seemed a pretty pointless exercise.

I was taking him home to bury him. I can't describe the sadness I felt at this information. He was really the loveliest person and carried lots of hope and dreams for the future on his bony shoulders!
Uno on his last morning

The photo below shows the knee. The midline is obviously not straight and the 'knob' on the lower left part of the knee is where the bone fragment had come away and was essentially floating out on the edge of the knee.

This hock on the same side as the injured knee was continuously puffy with no heat or lameness shown.
I called the wonderful Robyn Larson-Shelton from Equine Miracles who has been my horses' bodyworker for over six years now. She had helped me treat Uno's initial injury and had worked on him his whole life. It was Robyn that triggered the decision to take him to CEH for a review and x-ray. When I told her the news she was upset but we made the decision to see if the vet who came to euthanise Uno would amputate his off fore and off hind for Robyn to dissect to see what the joints actually looked like. Then Uno could be contributing to learning into the future and his life wouldn't be wasted quite as much as it felt like it already was.

Suzanne from CEH came out with a truly awesome Vet Nurse (who's name I never remember but I love her!). It was a horrible grey cold day to fit our moods. Once Uno said goodbye to my son Ben, and he was put to sleep, the grizzly but unbelievably interesting work of removing the two legs began. Suzanne gave me some fantastic insights into where the foreleg muscles attach into the shoulder, what muscles and tendons move which bones and was really interesting. Thank you, Suzanne, you made a horrible day into a valuable learning opportunity.

As an aside, Suzanne told me donations of horses for learning opportunities is rare and I was somewhat disappointed to know I could have actually donated Uno's whole body to vet science. Something to bear in mind if you need to euthanise a horse....

The dissection of Uno's joints was a revelation and a real confirmation I had made the right choice. His elbow and knee joints showed advanced arthritis - he had the knees of a 20 year-old, not a yearling, and it was clear he would have been in significant, chronic pain. Interestingly, his hock joint also showed evidence of an OCD - osteochondritis dissecans - which is essentially a piece of cartilage that had come away from the joint and was floating around. It can occur through injury.

I have included pics below of the dissected joints for those of you that are interested. They are graphic, however, so don't view them if you don't want to see that kind of thing.
Uno's muscular development was fairly poor and he was always very tense through his neck and withers.
Saying goodbye to his buddy Ben, my 4 year-old son with Down syndrome

Graphic pics

The off elbow joint. You can see the advanced wear of the cartilage and right into the bone. This would have been very painful
The elbow. The pink groove in the joint is simply not supposed to be there.

The hock. Robyn is pointing at a fingernail-sized piece of cartilage missing from the joint.
The knee. The piece of bone on the extreme left that isn't attached to anything is the fractured fragment.
The lower leg through the knee joint. The hole at the top is where the tendon passes.

So, Uno has gone and is no longer in pain. We planted an orchard of fruit trees (lots of apples which he would have loved), and he was joined by his mate Phoebe, our wonderful dog, who we lost to aggressive cancer only a couple of months later.

If you have any questions about the pics you see, please ask away. I will pass them on to Robyn if they're beyond my expertise. Or you can attend one of Sharon May-Davis' workshops on anatomy and ask her!