Thursday, 5 September 2013

Is this acceptable?

Does anyone think that this is an acceptable way to release a horse from hospital? with dried blood on his back which is now two days old? I took off some yesterday, too, this is not all of it. Am I making a fuss about nothing here, or is this simply not acceptable when I have paid nearly £40 a day livery?



On the plus side, he is home and moving incredibly. When he puts his head down to eat, the whole of his back is arching upwards in a very pronounced curve. He has most definitely never been able to do that in his life.

Now, onto the rehab. What a shambles. The full notes, verbatim, are as follows, with my own comments in italic bold so you can differentiate them.

- 3 weeks box rest with in hand walking. Start at 15 minutes daily for first 7 days then increase gradually up to 30 minutes daily at the end of 3 weeks.  The rehab notes from the hospital where this operation was pioneered say one hour a day in hand from day one. Why the big difference?

- 3 weeks small pen/yard turnout with lunging in a pessoa starting at 10 minutes daily increasing by 10 minutes per week.


- Consider resuming ridden exercise at 6 weeks post op depending on back comfort.  4 weeks hacking in walk, 4 weeks walk and trot, followed by 4 weeks walk trot and canter. Continue intermittent lunging throughout.

- Once back in full work consider return to normal turnout - try to keep restricted until that point.   I'm sorry? Can you run that by me again?  You want me at six weeks to put twelve stone of rider and tack onto the newly operated on back of a horse which you don't think is fit for full turnout until twelve weeks later? Are you out of your  mind?


The rehab program makes no sense to me at all. We have a horse whose back was tied in knots which we have cut out, and now they want him confined and not to move too much. What has been cut, we do not want to heal together again, that's the whole point of this exercise.

And if a horse is fit to carry a rider on its back at six weeks, it's fit to canter in the field on its own. I would not dream of riding a horse whose back was not fit fot him to run around in a field.

I can't talk about this with anyone. The surgeon has gone and  I don't have his number. The vet will stick by what the surgeon has said. The whole thing smacks to me not of what is best for the horse, but of massive back-protection so that no-one can be blamed if it does not work.

Thankfully, I have broad shoulders. I will do what I think is right for Ace at the time. Right now, he's in the barn where he can move freely, and Radar is in the field. There is a gate that they can talk over, which  has been extended and fortified by SH so that no-one can decide to jump it or put a foot through it.  Things will stay that way until we think it is safe to let them be together, and then Radar will go in with Ace overnight.

Meanwhile, he has the most extraordinary volume of penicillin to be given - 45 ml twice a day, twice what I have ever given any other horse, the poor pincushion. And he is on a small amount of bute. How much that is contributing to the enormous increase in his back movement remains to be seen, but the signs are extremely promising right now.




17 comments:

  1. I think i'd be taking the rehab notes with a big sprinkle of salt!
    30 mins walking a day by 3 weeks isn't even close to an hour a day from day 1, you know him well enough to adjust it accordingly though - heres hoping he keeps that flexibility. :)

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  2. I'd never ride a horse that isn't turnout sound!

    Sometimes washing a fresh operating wound isnt good, particularly spinal. Mostly hosing. However surgical scrub and a sponge should have been used!!!! Use pink wound soap around the incisions at most for awhile.

    Re penicillin, spinal surgery is very close to csf fluid which is a direct line to the brain. Infected csf is deadly as it causes meningitis. Hence prophylactic antibiotics :)

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    1. ah, that explains the massive antibiotic shots. Thanks Styric, very interesting.

      So, if he's rideable at six weeks is he ready for turnout? Or if he's not ready for turnout for 18 weeks should he not be ridden til then??? I will be accepting whatever answer Ace gives me to that question!

      C

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    2. Yeah it does. Meningitis is nasty, and kills fast. A friend with EDS just got brain surgery to install a shunt, and contracted a staph infection. She's not likely to make it the week unless something dramatic happens with the drugs :(

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  3. There was no reason not to clean off the blood and serum not near the incisions. Leaving it there can cause skin scalding.

    As for the rest...are there any websites from other surgical facilities where you might be able to find alternate regimens? I would think that just standing around in a box would not be good for more than, at most, a week. There MIGHT be an issue with the skin/tissue's not healing well even with the staples if he moves about too much. That would be the only concern I could think of. Otherwise, I would think moving about would keep him from developing scar tissue in the incisions.

    You need to talk directly to someone--like the surgeon--who can explain the rationale behind the restrictions.

    I am with you on being frustrated. I completely understand.

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    1. I'm afraid the rational is probably 'so you can't sue my xxx if it fails' Jean. Given how crazy the 'ride but don't turn out' instruction is, I'm just going to go with my own judgement.

      C

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  4. Glad he's home! I really dont like box rest it causes so many additional problems. I can't see how being in the barn can harm him and surely the movement in there must be better than turning tight circles in a box. I'm sure your gut instinct will tell you what to do but its a shame the rehab notes weren't more helpful.
    Hope his tummies OK with the antibiotics.

    Lyndac

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    1. I agree on the tight circles Lynda. He is avoiding them in the barn.

      I have him on omeprazole until the antibiotics and Bute end in two days. So his stomach should be all right.

      C

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    2. I agree on the tight circles Lynda. He is avoiding them in the barn.

      I have him on omeprazole until the antibiotics and Bute end in two days. So his stomach should be all right.

      C

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  5. the other thing about the blood still there - it's the same after human ops sometimes, i've noticed when i've had one... keep dry! is the mantra, which is fair enough as one doesn't want the wound splitting through wet, and all you can do is dab at it. but would have expected everything save that area to be cleaned up! as for ride but don't turn out... .....
    TBH, even if he's in his stable he could roll, and what damage woudl that do? they don't say don't let him roll, do they? sounds like good old fashioned B********s to me ....

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    1. That was my theory. They wont clean the wound itself for awhile, but they shouldn't have left it all over! You can take surgical soap and a sponge fairly close without damaging it. Laziness.

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    2. They've told me to hibiscrub it daily Claire, they don't want it kept dry.

      C

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  6. The wounds are immaculately clean, this was just sheer inattention to detail as far as I can see.

    Sorry about your friend :-(

    C

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  7. well that's just bad nursing after op, then, should have been cleaned! if only to avoid fly strike anywhere .....

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  8. Sorry to keep referring to T's hospital stay, but they bathed him before sending him home simply because he's been in a stable for 3 weeks so they wanted to freshen him up for me. So to send a horse home with dried blood from an op I think is simply unacceptable!
    As to the "rehab", I definitely think you're right to just go with gut instinct and what Ace tells you he can do, that "program" is a complete load of bull****.

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    1. Thanks Sarah, it's nice to know I'm not alone with this.

      C

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