Dr. H came out again yesterday Friday to do part II of Gracie's neuro exam, since I was feeling well enough to be able to longe her.
I had her waiting with her surcingle, longing bridle with snaffle bit, and a halter on over the bridle, when Dr. H pulled up to the barn. She had me work her at the trot and canter in both directions with her head free and Gracie obliged with some really nice work. I haven't longed her in weeks and she was being snappy with the voice commands, arching her neck and working in a controlled manner. I told Dr. H that Gracie was showing off for her.
Kathy has said that the mare has been almost timid in her manner with people ever since she trampled me, like she knows. Kathy admitted she was probably wanting to read this into her, but I can't deny it. Again, I don't know the thought processes of these animals but there are some individuals that really do seem to dwell on things. Gracie has been almost shy around me, tentative. I'm not giving her the benefit of the doubt though. I have worked around stallions and for the indefinite future, I will behave around her as if she was as unpredictable as a stallion. Don't get me wrong: the mare has improved TREMENDOUSLY in her ground manners with people even before the incident, especially now that she is in a setting where EVERYONE demands respect: that consistency has been one of the best things that could happen to her. But I'll never trust her 100% again. I probably shouldn't have to begin with, but I think all of us think, "It's my horse. She'll never do anything to hurt me." Wrong. It's not that they'll do anything to deliberately hurt us; most of them won't. But they are still 1,000+ lb prey animals and accidents happen.
Anywho. The exam.
So Gracie trotted, cantered and walked on command with her head free, then we placed the side reins as low on the surcingle as possible but on a looser setting to encourage the mare to stretch down. She didn't really stretch down; she continued working the way she normally does but didn't place a foot wrong. So we then played with tightening one side rein at time and working her in both directions, so she got to trot overbent to the inside and counterbent to the outside of the circle. Gracie was uncomfortable with being counterbent but not in a neurological way, just in an "I'm not really used to this" sort of way. But she obeyed my request anyway. Dr. H also had me work her with both reins at the tightest setting so that she was hyperflexed and...nada. Perfectly normal movement in her hind end.
Unable to trigger a problem, we set her free in the paddock in front of the barn, the one where she has fallen the most while running at liberty. I will note that most of the grass in that paddock has died off with the freezes we've been having and it had snowed the day before, which was now melting...so the paddock was ESPECIALLY slippery and muddy on this day.
Gracie moved out sans side reins and I used the longe whip to request that she canter. She cantered about, head up and tail flagged in the same fashion she does when goofing off. I asked her to speed up as she ran around the perimeter of the paddock and she did, but being careful to slow down in the corners, something which she has never done before. We reversed direction and she did the same thing. Dr. H asked that she change directions a couple of times and...nothing. She gave a couple of tiny slips with the inside hind leg, but caught herself each time. Not even close to falling.
Dr. H had me walk her away and toward her while I had Gracie move in serpentines with her head up in the air. She then wanted to see her do tight circles with her head in the air.
Nothing. Gracie's slight neurological abnormality is that she swings her hind legs out slightly more than the average horse, but this could also simply be just the way she moves.
We discussed further diagnostics and I asked for neck x-rays, since in part I of the exam Dr. H had found a thickening of Gracie's neck muscles even with C-2 + muscle tremors when pressed.
|So this is what it looks like when taking equine neck radiographs in a clinical setting. The white and teal machine is the x-ray machine; the plate is located in that white square on the opposite side of the horse's neck. Since my vet has a portable unit, she held the machine between her hands and I held the plate on the other side.|
Photo from Woodside Equine Clinic.
NOTHING. Completely normal vertebrae. No bone spurs, no spondylosis, no major impingement of the spinal cord, no signs of arthritis at all. Or rather, nothing blatantly obvious on radiographs taken in the field, which are admittedly not the most precise/detailed, but it's what I can
The next step will be EPM titers, but I won't do that until later. When I can afford it. Because veterinary and human hospital bills.
My vet and I had a long conversation about neuro horses vs clumsy horses. My vet doesn't feel quite comfortable assertively saying, "Yes, she's safe to ride," even despite everything we've ruled out, but she did admit that she has seen horses FAR clumsier than Gracie. Case in point: OTTBs just off the track. She recommended doing lots of longing over ground poles, grids and cavaletti at various gaits; using the back half of a Pessoa-type rigging system to get her to step up more under herself; lots of hill work, which is easy thanks to the hill in the back field; some flexibility exercises, like carrot stretches; and myofascial release, which she demonstrated on Gracie's neck.
|Kind of like this. Photo from here.|
Dr. H also had a very good point that I had not thought of: this is the most Gracie has moved in over a year. At the previous barn, the footing in the mare field was so muddy and rutted half the time that the horses didn't move around much. They just walked and grazed but they didn't run because they all knew it wasn't safe to do so. I actually had never really seen Gracie gallop around at liberty until the day I released her in another field for Kathy to take photos of her. (See photo in sidebar on the right.) In the winter they just stood at the round bales and ate round the clock; in spring and summer, she wore her grazing muzzle during the day, which resulting in her pouting in the run-in shed the entire time she was wearing it. She didn't walk around at all until the evening when the muzzle was removed. Dr. H said that it is possible that she was simply adjusting to being able to move around more, to being able to actually gallop, and having to learn to rate herself and be careful depending on the footing because she had not had the need to do so for over a year. This was a brilliant point that I had not thought of. On the other hand, she said, the stress of moving can trigger EPM symptoms in a horse that has it, even a mild case of it, so it still isn't a bad idea to test for it. We did pull the blood for the test right then and there and Dr. H will freeze the serum so we can send it out in a couple of weeks after the current vet bill is paid off.
I feel a little bit better about this horse, though there is a part of me that goes, "What if she has something that would show up on a myelogram?" That is the proper way of diagnosing neuro issues: contrast dye is injected into the spinal canal, which makes it light up on x-ray, allowing you to clearly see any narrowing or impingement.
|Myelogram of a horse's cervical vertebrae. The arrow is pointing at an impingement of the spinal canal. This horse was diagnosed with Wobbler's Syndrome. Photo from here.|
In conclusion: when it comes down to it, she only has the slightest offness that could be nothing at all
For now though, the neurological person is not working with the possibly neurological horse.
I haven't read a blog post yet where someone talks about what it feels like to have a concussion so I'm going to talk about it. It's been interesting in the sense that I had never experienced anything like this before and some people have said that the way mine has manifested is unusual. I don't know if it has to do with the fact that I hit the back right side of my head and not dead center in the back or the front, but the main symptom has been vertigo and resulting motion sickness. (I don't often go internet sleuthing for more info on stuff that is wrong with me if I already saw a doctor because I'll just end up finding stuff to worry about more.)
For the first week, I felt like I was smashed drunk all the time. This would be great if this was a sensation I enjoyed, but I really, really hate it. I have been drunk all of one time in my life and that was enough. So this was kind of a cruel punishment. It would be worse in the morning when I woke up because I'd invariably forget and sit up too quickly in bed and the world would spin crazily around me. The feeling would improve around mid-morning then linger. Real improvements would be felt at the end of the day, only to start all over again the next morning. The difference would be that the severity of symptoms would be slightly decreased with each passing day or they would plateau earlier in the day than the day prior. It has been a very slow progress. If I get very tired, I will feel more dizzy. If I rest it gets better, which is good at least.
Walking outdoors has been...interesting. Forward movement in the beginning made it feel like I was moving forward very slowly but the entire world was coming at me way too fast, and I'd have to think very hard about keeping my balance. I'm far better now while walking, but I still get this sensation if I try to run faster than a slow jog. At a jog it just feels like the world is shaking in counterpoint to my movement, which is more tolerable. And nope, I'm not going out for jogs: I'll just jog a few steps once a day to see how my brain is feeling, to note the improvements.
I will tell you that if you are concussed and you have Transition lenses on your glasses, you may want to go to a non-Transition lens pair or contacts in the meantime because the darkness of your lenses in bright sunlight against the brightness around your glasses can make your symptoms worse. You'd get the same effect if you have small sunglasses. If the sun bothers you, go with larger sunglasses so you have less glittery brightness shining through around them.
I was told that bright light itself and moving lights at night would be confusing or make me feel ill, but neither has been the case. If I'm not wearing the Transitions I'm fine in the sun, and bright lights at night whether moving, flashing or at a standstill, have not been a problem whatsoever.
In the beginning, I couldn't even avert my eyes sideways, down or up: this would make me nauseous. Two days in, I could look down while walking and to the left and the right, especially if I was sitting down, but I could not tilt my head sideways to the right nor look straight up. Most things were more comfortable to the left than to the right, so for a while there I was joking that I was like a poorly trained horse: I was preferring everything on the left! I couldn't lie down on my right side either: my world spun if I did and would not stop. It was so incredibly awful that if I made the mistake of turning over while sleeping, the instant rapid dizziness would wake me up and force me back onto my left side. After 10 days, I can finally lie on my right side again with minimal dizziness, and tilting my head back to look up is not a problem anymore. However, bending down to tie my shoes is still somewhat challenging: I do get moderately dizzy and it's better if I can sit down to do it or lean against a wall.
I have had a few minor sort of tension headaches that start at the back of my skull, below where the injury is, but they have been mild enough to be quite tolerable, enough to where I haven't felt the need to take NSAIDs until Charles asks me how I feel, I'll mention it, and he'll pass me the ibuprofen.
Head trauma does mess up your brain even if you didn't have a brain bleed or a skull fracture. Your brain still gets banged around. I normally have this laser focus for getting things done throughout the day and one of the things that allows me to do my job well is my ability to multi-task. I can think about many things at once and do many things at once and do them all well and in a timely manner. In my normal state, every once in a while I will stutter when thinking because my brain is going so fast that my mouth can't keep up with it.
Well, not so much at the moment. I'll be thinking about something and I will have a second where I can't actually say it out loud. I draw a blank. It's not because I'm thinking too fast; now it's more like there's this tiny lag in the connection between my brain and my mouth. I'll also have disjointed thoughts, where for example I think about going home and the house that comes to mind is the townhouse in Coconut Creek where we lived last while in FL. And then I think, "Wait, we don't live there anymore. Wait...where DO we live?" And there will be this instant where I can't visualize our current apartment. And there have been a lot more moments where I walk into a room and forget what I was going to do and I just can't remember what it was. I'll walk out of the room and remember 10 minutes later, instead of remembering while still standing in the room like I normally would. And I get easily distracted. I went with Charles to Trader Joe's five days after my accident so we could do grocery shopping for Thanksgiving together.
It took AN HOUR. And not because I love Trader Joe's, which I do. No, because of this:
These instances are slowly becoming more infrequent, thankfully, and yes: this is all completely normal for this type of head injury. As long as there is an improvement, it's all good. And I think that as long as I can recognize what is going on, recognize that this is not normal and still remember what my normal felt like and know that it's all coming back slowly...well, I think that's a good thing. It was nice to be able to walk into the grocery store today and get what I needed and get back out, though I still did forget two things despite having the list in my hand. Which upset me until I remembered that this is something that is more my normal.
So I am better but the thought of waiting for weeks to be 100% normal again is kind of daunting. I know I'm very lucky and I'm happy to be alive and getting better, but at the same time I'm an impatient patient, and when you have something wrong with you that affects all of your life so completely in a way that you just can't forget for a second what happened, it doesn't take long for you to feel like you've been trying to heal for forever. And you become afraid of something like this happening to you again, of being placed in this position of eternal waiting to heal again. I'm impatient to get better because I have all of these little fears creeping up on me: the fear of riding, the fear of getting injured again while working with a horse on the ground, the fear of being trampled, the fear of having so much fear that it will take over. I officially have a fear of running horses at the moment, which I hope will fade with time once I don't feel so vulnerable anymore. I stood flat against the fence the other day when letting the mares out into the front field, with this irrational fear that one of them would come tearing up to me and slam against me, even though I was nowhere near where they were headed and more than safely out of the way a good acre away. It's the kind of stuff you'll think when you don't understand an animal's behavior, "But what if they do this?" and it felt so out of character to have it pop up in my brain in response to horses of all things. On a separate occasion, when I was leading Gracie from the field for her second recheck, I got this overwhelming sense of panic because I could not get her to lead next to me; she kept walking behind me. At a very reasonable distance, over 6' away, but I could not handle having her walking behind me. I ended up walking backwards across the field while leading her so I could keep my eyes on her at all times.
For the first time in my life, I can understand the irrational fear of horses that my grandmother had, so irrational that she would burst into tears at the sound of galloping hooves. I never understood it.
I can tell you now that I know exactly what that feels like. And I can tell you that I can't wait for things to be normal again so I can think again like a rational horse person. A more cautious one, but a rational one.
If I look at it from another angle, I can totally understand the irrational behavior that some horses present when they hurt somewhere in their bodies or are not quite right. The horses that give big spooks or act out over things that didn't use to bother them, because they feel vulnerable and are more afraid of being eaten. Like Rhythm. I understood it before, but I can actually see things from that perspective now.
Gracie will be worked with to try to make her better and Lily will be ridden again, but neither will happen until I'm feeling as close to 100% better as possible. Lily is sound after her barbed wire wounds have healed. She finished her antibiotics and has been enjoying her time being a horse in the field.