Rest in peace, Misty

You may have figured by now after no new posts for a while that the news on Misty's progress is not good.

After weeks and weeks of continued draining from abscesses with her severe lameness, I started questioning the ability to clear up the abscesses.  I had suspected that the infection was affecting the bone inside her foot though weeks of antibiotics had not made any difference in the drainage or her level of pain.  On September 19th, I retook radiographs of her front feet.  They showed that there was even more bone loss than there had been in previous radiographs. 

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When bone infection is involved in the hoof, the most effective way to clear it up is by very invasive surgery and curetting out all the affected bone.  Given that Misty already had so much bone missing, I didn't think that was an option for her.    Still, I didn't make the call to euthanize her for several weeks.  After the radiographs, I was really heavily considering it, but as you can imagine, that is not a decision to take lightly. 

Misty's spirits were usually good and she was cheerful and always ready to eat.  And once every few weeks, she would have a good day where she was very comfortable and walking better without putting all the weight on her hind end.  Those days would make me really hopeful, but they only lasted a day.  Most of the time, she was very painful (though still cheerful) and very slow getting around overcompensating with her hind end to put less weight on the front.  It was her attitude that kept me trying for her.  She always was so easy to work with, accepting everything I had to do to her with grace and never getting cranky.  She'd occasionally try to walk away from me when I came with meds, but her crippled front feet would stop her quick.


I had been considering euthanasia for weeks, when one sunny warm day on October 7th, I went to feed the horses in the morning.  Like I often did on days that I was home, I let Misty and Jake (with grazing muzzle in place) out into the yard to graze.  On this day, I watched Misty closely as she took 10-15 minutes to walk the very short distance from her pen out the gate to the grass.  She kept stopping and standing there shaking her head with frustration that her front feet would not let her get where she wanted to go. 

It was her frustration that made the decision suddenly easy.  Once she got out into the lawn, I gave her additional pain meds, more than I would normally because I'd be worried about organ damage.  Then I slowly led her to a valley just on the other side of the pasture that was lush with long grass.  I let her graze that whole day along with her pony, Jake, then I peacefully euthanized her. 


After her death, I opened the bottom of her hooves because I wanted to see just how extensive the damage was in there.  On the left foot with the most pain (but interestingly not the most bone loss), the amount of necrotic corium was not surprising.  The "good" right front foot also had quite a bit of necrotic corium, but not as much as the left. 

I know I made the right decision for her.  After all the trying, the foot soaking, antibiotics, pain meds, ulcer issues, and not seeing any improvement at and only more bone loss after a few months, I don't think there was much hope for her to ever get over it.  And given that it was getting colder and the ground might freeze soon, I didn't want to wait until she was even more miserable before making the call.


I really was at peace with making that decision because I know she was as comfortable as she could possibly be, and undoubtedly more comfortable than in her previous situation right up until the day she died.


And I'm really sad to have to report that I also euthanized Jake, the pony, that day as well.  I haven't written at all about Jake's time with us because Misty's care was so intense as it was.  But Jake came to us as an older pony with previous issues with metabolic syndrome and laminitis.  His front feet were permanently damaged and had dished growth from his previous laminitis episodes.  And he was thin with unusual fat pads over his hindquarters.  His ribs showed easily and his hair was long and hadn't shed out this summer.  We actually shaved him to make him more comfortable when the weather was hot.  I suspected Equine Cushings disease, and indeed he tested with high ACTH levels indicative of Cushing's disease.  Jake hadn't had any recent episodes of laminitis when we got him, but even so, he was quite sore in his left front especially on hard and slanted surfaces.  So sore that I felt bad asking him to carry Wren even on short rides, so she graduated quickly to Stormy this summer.  I suspected arthritis in Jakes lower limbs, but never radiographed him. 


In August, Jake flaired up with heaves.  I attempted to treat the heaves, but the steroids caused him to become laminitic in his front feet.  At the same time I was treating him with pergolide for Cushing's disease.  After stopping the steroids, his breathing became worse, and his front feet stayed tender.  He didn't seem to be responding to the pergolide, though I did not measure his hormones again.  As Jake's breathing became worse, his feet remained sore (despite pain medications), and winter was approaching, I was also wondering what was going to be the best choice for him.  His breathing effort made his ribs really stand out.  Jakes heaves was a result of his hay eating habits due to his worn out old teeth.  He would rummage through any hay looking only for the small particles on the bottom.  I just couldn't see how he was going to get over the lung inflammation since he couldn't be on grass without a grazing muzzle or he would develop laminitis.  And winter was coming with the prospect of feeding more hay and hard frozen ground. 

Jake and Misty had become best friends in the few months she was with us.  When they were out grazing, if they got separated (usually because Jake would wander off in search of longer tender grass that he could get through his grazing muzzle while Misty was left behind due to her crippled feet), they would both suddenly realize they were separated and whinny to each other until I went and found Jake and brought him back to Misty.  It was really sweet.  So given Jake's compromised condition, and the thought of how lonely he'd be without Misty, I decided to let him go peacefully with her.  Jake spent that whole day grazing the long lush grass in the sunlight without a grazing muzzle alongside Misty.  I think they really enjoyed themselves on their last day, and that makes me feel at peace.

Healing Misty - no hoof no horse?

Misty's back feet, while not laminitic, have problems too.  Her heels are quite underrun and her foot was overall very overgrown. 

While trimming them, I found evidence of old bruising in the heels.  She seems comfortable on them though.  I will continue to keep her heels rasped back to the frog and shorten the toe in an effort to change her angles and encourage the heel to grow more down rather than forward.

After being comfortable for a few days on her fronts after her big trim, Misty became uncomfortable again.  I was decreaing her bute dose, so wondered if it had anything to do with that, but bumping the dose back up, did not make any difference.  At the same time, I began to notice a bump over both coronary bands above the toe.  She was landing exaggeratingly heel first while slowly walking.  I suspected bilateral abscesses.  She was so sensitive over the coronary band that she would not let me soak her feet, so I just let her go.

It took a week, but she finally burst abscesses out of both coronary bands.  They were nasty.  The right front foot was much worse than the left - abscess was much bigger and pussy.

I expected her to be more comfortable after the abscesses finally burst, and she wasn't really getting there, so I decided perhaps I needed to work on getting her toe more parallel with the coffin bone inside.  It was also time to lower her heels again.  They were growing pretty fast.  It had only been about 2 weeks since I did her first major trim.

I lowered her heels, then started working on her toe and found a nasty black pocket in her hoof wall at the quarter.  I expected that this all communicated with the coronary band  at the toe.

I looked more closely at the bottom of her foot and found a flat that was soft and has some black oozy stuff under it.  I grabbed the flap with the hoof knife and ended up peeling away the whole sole on that outside hoof, exposing very soft grayish material - the material put out but lamina trying to cover themselves and produce new sole.  I was millimeters from the coffin bone.  At the time, my first thought was I was going to have to just euthanize her.

Thankfully, a little bit of hoof wall was still attached (though loosely) which kept her weight off that super soft material which was also quite sensitive.  After I watched her walk around on that foot, I realized she was no more tender than before, so I decided to see what would happen.  Afterall, if I quit now, neither of us would be benefiting.  Dealing with hoof abscesses sure is discouraging though.  Misty's hoof abscesses are huge.

I retook radiographs and the extensive nature of the abscesses could be seen. 

After exposing that soft tissue, I soaked her feet in iodine water for an hour. 

I had to do nerve blocks to make her feet less sensitive in order for her to leave her feet in the soaking water.  Then I booted her in softride boots with iodine soaked guaze covering the areas where her absesses were draining and over that soft sole. 

She drained for several days at the toe on the left foot (where I had opened up an abscess pocket that communicated inside when I trimmed) and at the coronary band on the right foot.  She does lay down a lot, but also is up and fairly mobile often.  And, she has gained a little bit of weight in the short time I've had her.  She is still bony, but is losing the sharpness.

Healing Misty - first trim

After Misty had been here for a few days on 2 grams of bute twice a day and housed 24/7 on deep sand, I did her first big trim. I had trimmed about 1.5 inches off her toe out front and lowered her heels a week before while she was still at her previous owners.  Now, based on having seen radiographs I took off as much as I dared off the front of her toes. The goal is to improve her break over and get rid of the deformed hoof capsule to prevent further deformation.

I took radiographs after her trim, and while much improved, there is still a lot of material in front of her coffin bone.  Her angles are hard to assess because she was variably weighting her feet during rads, and I wanted to take them quick and not make her stand on a block for very long.  The best news is that she actually has some sole depth!  We have something to build on!

I shot really quick rads of the solar margin of her coffin bone (totally rough because I did not take the time to clean the sand out or pack the grooves with playdoh (because of all the sand and how painful she was standing on one foot).  It is really hard to see, but the solar margin of the coffin bone at the tip is eaten away.  At one point she had some pretty significant pedal osteitis.  I don't think it is active right now though.  It has a sclerotic rim and seems well defined.  That bone will never come back.  There are also pockets at the quarters where the hoof wall is not connected to the underlying tissue.  These feet are a disaster.

The next day, I took her out for a walk and I could not believe how good she was moving!  She looked almost normal while walking through my round pen, striding out and looking comfortable.  While standing, she still shifts from one foot to another constantly, but the walking comfort is huge.  Before we got to this point, Misty wasn't really rocking back on her haunches, but reluctant to move and carefully setting a hoof down while quickly walking up with her hind feet to support herself.  So, this striding out and looking seriously almost normal is amazing!



While her improvement is wonderful, it is only the start. She still needs to grow a whole new hoof, if even possible. Previous growth rings show that she is growing very little at the toe, and quite a bit at the heel.  I will have to continue to keep the heel rasped down as new growth comes in.  And she will continue to be at risk for abscesses.  She has previous evidence of blowing an abscess out of a heel on each hoof, and out the top of the coronary band on one.

Healing Misty

Misty's story will be an interesting, and potentially heartbreaking one. I can't tell you much about her past, but I can say that she is a 4 year old Standardbred mare that foundered very badly back in January. She has not been managed appropriately since then and her feet may be irrepairable. But her stoic nature, and sweet eyes made me give her a second chance. I am her proud/scared/worried new owner. This story is just beginning again for Misty, and it may yet be even more heartbreaking than it has already. She may remain uncomfortable and painful, or even become worse, and if that happens, I am prepared to help her pass on peacefully. But in the meantime, we will be doing our best to get her comfortable, keep her feet trimmed correctly, and encourage new hoof growth. Cross your fingers...we need the luck.

Misty upon arriving at my house. She is wearing the styrofoam pads I had asked her previous owners to use instead of shoes, which had been nailed on the bottom of her misshapen hooves just to try to get her sole off the ground. However, the styrofoam was crushed flat and not doing any good. While still at her previous owners, I had removed some of her super long curled up toe and lowered her heels, but was afraid to do too much without radiographs, which we had not done at that time. Then applied the pads...but the pads have to be layered on and replaced every time they become crushed down.

The first changes I made now that Misty is at my house: 1) House her in deep sand (initially was about 6 inches deep of dry sand). 2) Keep the wraps off and give her rotten feet a chance to dry out. 3) Start her on antiinflammatory medications - phenylbutazone.  4) Offer all the free choice grass hay she can eat, 5) Start a complete mineral/vitamin supplement that will support healthy hoof growth. 

Her toe is growing very slowly compared to her heels, if at all, and the deformed hoof capsule is contributing to further deformation.

She has also blown at least 3 abscesses at some time in the recent past on her two front feet, and could potentially blow more. I'm hoping she just keeps the majority of her hoof capsule intact. I worry about this huge crack at her heel and I'm hoping it doesn't extend forward any further, or pinch new growing tissues.

She also has a very convex sole and the sole just in front of the frog is pushed out the most. This makes her very uncomfortable on hard surfaces.

These are the quick rads I shot through her wraps and pads while still at her previous owners (right before I took her home) because we were all curious what was going on inside there.

Obviously there is rotation and sinking of the coffin bone, with an excessively curved dorsal hoof wall, but not much else can be assumed because there is tape and a pad also in the view.

This journey with Misty is just beginning, but I will continue to post about our progress (or lack thereof).  It may be a year or two in the making (time to grow a new hoof), or it may be over in a few months.  It all depends on her comfort.