"And, when you want something, the entire Universe conspires in helping you to achieve it." -The Alchemist, by Paulo Coehlo



Friday, June 12, 2015

I Love My Vet

This is a post about how awesome my equine vet is. :) And about Gracie's hocks.

Long-time readers will maybe remember last year when I first got Gracie, her owner mentioned that she thought G-Mare might have some stifle issues. Based on some of the stuff she did with her legs (like tightrope walking with her hinds) and her complete and utter lack of quadriceps muscles, it made complete sense to me. I've rehabbed horses with stifle issues before so this was no biggie.

Some of that wonkiness improved with both fitness and the addition of Previcox + a joint supplement (Actiflex 4000 in our case, recommended by my vet and I've been thrilled with the results) once we diagnosed Gracie's high ringbone in her front right pastern last summer. My vet could see some of the blonde mare's hind end weirdness but she didn't want to work that up until she was less lame from her ringbone. We decided we would reassess in a year.

Over the winter, G-Mare got a full neurological workup after the whole concussion + gate slamming incident, and she ended up being pretty much normal.

That still left me with a mare that occasionally did weird things with her hind legs, like the random crossing of her hinds while moving forward in a straight line or knuckling on her hind fetlocks. As in, landing on her fetlocks. She would do one step like that out of several hundred thousand steps and she always seemed fine afterwards. She could feel the misstep and corrected herself immediately with an annoyed toss of her head. But I'd never seen a horse do something like that and wondered what the hell??

And then I started noticing that these missteps occurred when we had big temperature swings. If temperatures were consistent, she would be absolutely fine. After a particularly sudden cold snap this spring, I was longing G-Mare on the hill of the mare field at the previous farm and she was having a really hard time with her hinds. She ultimately chose to just walk because she couldn't deal with it and I didn't push her. I had been thinking for a while now that maybe she had ringbone in her hind fetlocks as well: the problem occurred because she couldn't seem to lift her hind legs enough to get full clearance while moving along at gaits faster than a walk. She wasn't dragging her toes at all, as it would have shown on her hooves. She was just having a hard time picking up her legs sufficiently when the weather changed suddenly. So then I thought, "Well, she's gaited and she has all of this knee action. She should have hock action to accompany that but she doesn't."

Hocks. She didn't have hock action. If her hocks hurt, she would have a hard time bending them all the way to achieve full clearance of her hinds when moving at speed.

With that in mind, on a day that Charles was with me so he could assist, I did an upper limb flexion of her right hind, which seemed to be worse than the left at the time. (She was stepping a bit short on it, especially on turns to the right, and was occasionally swinging it more medially than the left when walking in a straight line.)

Like so. Photo from here.
The problem with this type of flexion is that you can eliminate the fetlock easily (note in the photo that the leg is being grasped just above the fetlock joint-the fetlock itself is not being forced into a flexed position), but given the way you have to flex the leg, it can be hard to isolate the hock from the stifle completely. I cranked the hock as much as I could while trying to not flex her stifle as much, holding the leg for 60 seconds.

I then had Charles immediately trot her out.

Gracie trotted out REALLY lame on that leg. As in, hobbling lame.

Voila! Theory confirmed. It was most likely hock but there could certainly be some stifle involvement. I made a mental note and scheduled to have her hocks checked the next time my vet was out.

On 5/30/15 Dr. L came out for vaccines for my two and we worked up Gracie's hocks. Conveniently, Gracie had been standing at the trailer for almost an hour while we got Lily away from the stallion and then vaccinated her, so G-Mare was cold by the time we got to her. Dr. L noted that the mare was definitely stiff in the hind end on trot-outs and the longe in both directions. Based on flexions of her stifles and hocks (Dr. L was able to isolate one from the other) it was determined that G-Mare was indeed sore in both hocks. I was given the option of just injecting lower hocks and seeing if Gracie felt better, or getting x-rays to be 100% sure we were injecting in the right spot. Given the cost of the injections, I decided that an extra $80 in films was worth it to make sure we were treating the right area. On this day her left hind was worse than the right, so we chose to get x-rays of only that leg to confirm that the arthritis was in the lower hock (less mobile) and not the upper hock (more mobile, more of a PITA to manage.) This would save me a little money from not obtaining radiographs of both hocks, and my vet felt it was a reasonable guess to assume that both hocks were affected in the same areas, as it is the way hock arthritis most often presents itself.

Dr. L's associate had the digital x-ray developer with him on this day so she took the films and told me she would call me later that evening to let me know what she found once she could see the results.

One of the things I absolutely love about her is that she treats me like an equal. My equine veterinary experience is limited to what I have lived with my own horses, seen in horses around me, or read in veterinary articles like those in Equus. I'm a huge horse nerd: pretty much all of my spare time that is not spent on a horse's back is spent reading about them.We were taught large animal medicine in tech school but it was nowhere near as broad as what we learned about cats and dogs. My vet often asks me, "Do you know what we would do now?" My answer is most often either, "No," or "I have an idea but would love to learn the specifics." And she'll give me a full run-down of what she is seeing, thinking and her recommendations for treatment, from most cost efficient to most expensive, and the pros and cons of each. I have never had her strongly push me to do the gold standard (aka most expensive option) nor felt judged for not choosing that option when I've taken a more conservative route. The only problems where treatment is a black-or-white type of thing is when it's a matter of life and death. Otherwise, there are usually several shades of gray available in terms of treatments.

Another thing that I love about her is that she is incredibly up to date on treatment modalities: she knows what old school stuff still works and also what new cutting-edge stuff is worth spending money on. (You'll get to see all of this in action in a second.) She will not only explain it to you but will tell you where she read it/saw it/heard about it/for how long she or her associate have been doing it and the results they have had, and the pros and cons. She believes in alternative medicine and has a personal dog that has slipped disks in her back whom she maintains mobile with acupuncture because the dog is not a surgical candidate due to other health problems. She is incredibly passionate about both horses and veterinary medicine and it is hard to not get excited about both of those subjects when talking to her. She also has an unbelievable knack for remembering horses and their problems and histories off the top of her head. When you think about the fact that she probably sees hundreds of horses a week, it is an astounding ability. I mean, I can't remember all of our patients and their issues without looking at a chart unless the patients or their problems are particularly remarkable/unusual! I trust her implicitly.

So now that I'm done yakking your ear off about how much I love my vet, on to Gracie's hocks. :)

My vet called that night to confirm that yes, Gracie's arthritis was in her lower hocks (good) and we scheduled the appointment for injections for Friday 6/5/15. I decided that since we were paying an arm and a leg for the injections already, I might as well just do her front right pastern (the one diagnosed with ringbone last year) as well: it would save me a barn call fee and a sedation fee. The reason why I chose to do these lower hock injections without any sort of qualm: lower hock bones, precisely because they aren't very mobile, eventually fuse. Once they fuse, the horse is not in pain anymore and you don't need to do any more injections. So you inject to keep the horse comfortable while waiting for that to happen. It's a process that can take several years to happen and IMO is worth the temporary investment to keep a horse comfortably in work in the meantime. Her front pastern, being a mobile joint, is a completely different scenario: the bones are not going to fuse. We don't want them to! But given that the bony changes of that front leg are barely visible on x-ray (as in, if my vet hadn't pointed them out, I wouldn't have seen them!) it is worth it to me to inject this joint to see if we can reduce some of the soft tissue inflamation around the joint capsule to see if we can make Gracie more comfortable. More on this in a minute.

During the week I talked to both my vet and Charles and we decided to haul G-Mare over to my vet's clinic since it was only a short 20-minute drive from the barn! And it would save us an $81 barn call fee. I'm a dork about this kind of stuff and for whatever reason was kind of excited over the whole notion of driving our horse over to the vet's for a routine procedure like all the cool kids in Blogland are able to do. :)

On said Friday morning I received a text from my vet: her associate and owner of the clinic lives on site and had had to bring his personal horses into the barn because of the rain. She said she could just come out to the farm and waive the barn call fee, and asked me to let her know if this was okay. I texted her back that this was absolutely fine. I arrived at the barn early to feed the girls and douse Gracie in fly spray since we were going to be working with her legs: this would minimize stomping. Dr. L arrived on time like she always does, and the first thing she showed me was a bottle of a product called Sarapin. Sarapin is an injectable analgesic used off-label in horses: it was originally developed for people. Dr. L and her associate have been using it for several years now for joint injections in horses that are particularly painful. The product basically numbs the joint for 48 hours post-injection, cutting out wind-up pain.

What is wind-up pain? This is a big deal in veterinary medicine. Wind-up pain is built-up pain; this can happen during very painful processes, like a bloat + gastric torsion or during an orthopedic surgery. Once you allow extreme pain to build up (to wind up), it is very hard to control. You end up chasing the pain, giving the animal higher doses of pain medication to try to make them more comfortable, and succeeding at maybe only numbing it a little while sending the animal into a drug-induced bad trip from the combination of pain halo and unfamiliar environment in the veterinary hospital. If you are able to PREVENT wind-up pain, you'll have a MUCH more comfortable animal that will recover much faster to boot: proper pain management has been linked to greatly improved recovery times in animals post-op. Since animals can't really tell us in words how much they hurt, it is up to the doctor and technicians to make an accurate guess based on the animal's vital signs (elevated respiratory rate, heart rate, blood pressure can all indicate pain) and demeanor. Prior to anesthetizing an animal for surgery, we like to give what we call pre-anesthetics: usually a sedative and an injectable analgesic (the analgesic is most often a morphine derivative like hydromorphone. Injectable NSAIDs like Rimadyl control inflammation but not pain. Morphine derivatives work at pain receptors to completely block out the sensation.) This not only allows us to use less anesthetic gas to keep the animal under, it also helps control any pain the animal might feel during surgery. You can anesthetize an animal or person and have them comatose, but that does NOT mean that they are not going to feel pain if you don't give them an analgesic prior! The person monitoring anesthesia (most often a veterinary technician, but sometimes it is a veterinary anesthesiologist or a criticalist) is in charge of monitoring the animal's vitals during surgery and one of the things they are looking for are spikes in the animal's heart rate and/or blood pressure: these can indicate that the animal is feeling what is happening and could potentially wake up. You don't just bump up the anesthetic gas; you also give a dose of analgesic to help the animal out. They can and do wake up from pain. And then you have to deal with all of that wind-up after, chasing after it with drugs to try to get it under control. It's like trying to run on foot after a runaway horse.

The woman with the stethoscope is counting heart beats on her watch while monitoring anesthesia on this dog.
So with arthritis and other situations involving chronic pain, you do end up with wind-up. Gracie is an incredibly stoic mare but the fact that she would occasionally start out limping on her right front leg (the one with ringbone) despite what appeared to be very mild arthritis, indicated that that leg was actually quite painful. Historically she usually warmed up out of the slight limp but my vet figured her pain had to be pretty bad for her to be showing it at all. Why so painful if the arthritis is so mild? Dr. L has been reading about MRIs of equine legs being done to get a more accurate view of how arthritis affects them and one of the things we are seeing is that bony damage can appear mild on x-ray while the horse also has a lot of inflammation around the joint capsule - the increased pain is from soft tissue damage. This type of damage is not visible on radiographs but DOES show up on MRI. My vet suspected that Gracie's pastern is probably one of these cases. Soft tissue inflammation in the joint capsule can be more painful than the bony damage of arthritis itself.

Going back to the Sarapin, I chose to use it. It is inexpensive and incredibly safe: no adverse side effects have ever been reported during its 70 years on the market! Dr. L has not see any bad reactions to it in horses. 

Here is the label information, which is the same info that Dr. L gave me:

Sarapin is an injectable analgesic indicated for the management of muscular or neuropathic pain that may be treated by local infiltration or nerve block. The distillate of a suspension of powdered Sarracenia purpurea (Pitcher Plant), SARAPIN® has been used safely and effectively for pain management by physicians for over 70 years.
Although the mechanism of action of SARAPIN® is unknown, its analgesic properties are thought to be the result of its selective effect on the C-type nerve fibers. This targeted action effectively manages pain by acting on the sensory nerves, without any effect on motor nerves, with no tissue destruction or systemic reactions, and without any change in skin sensation.
SARAPIN® can also be used as a trigger point injection. Toxicity tests revealed that SARAPIN® is harmless, and no adverse events have been associated with the use of SARAPIN® throughout its 70 year history.

I thought it was really cool. The goal here with the Sarapin was to cut out ALL of that wind-up pain in Gracie's pastern and re-set her back to 0 when it came to pain. The drug works by numbing the area's pain receptors while not interfering with the horse's sensation of the leg itself. She would still be able to feel the hoof and pastern just fine, she just wouldn't feel the pain in the joint anymore. Well, at least for 48 hours, which is how long the Sarapin will last: just long enough to allow the injected steroid's anti-inflammatory effects to kick in.

With equine joint injections, you can inject just a steroid or a steroid + hyaluronic acid cocktail. The HA additive is used in more advanced/more painful cases. The general consensus is that you start with just the steroid and if the horse is needing injections more often, you add the HA (average timespan for joint injections of less mobile areas like lower hocks is every 1-2 years; for more mobile areas like the pastern, you're looking at injecting every 6-8 months.)

Gracie had a low dose of Dormosedan IV (it works both as a sedative and an analgesic) and I couldn't help giggling at her as I watched her head go lower and lower, until her nose was almost touching the ground. It wasn't long before she was both snoring and drooling, eyes closed!


High mare is high.
I warned Dr. L that Gracie had STRONGLY objected to clippers over the winter when trying to do a bib clip on her, despite being maxed out on her acepromazine dose AND twitched at the time! Dr. L very carefully clipped G-Mare's pastern and lower hocks....and it was a total non-event. Gracie didn't even flick an ear at the buzz of the clippers. She was enjoying her drugs.

Clipped front pastern
Dr. L then did a surgical scrub on all 3 clipped areas, alternating Betadine scrub with rubbing alcohol 3 times on each area, then leaving a gob of Betadine plastered on each site for 10 minutes for maximum contact time. (Most antiseptics like Betadine and chlorhexidine need x amount of contact time to kill any bacteria on the skin's surface.)

Scrubbing the hock.
You can really see Gracie's medial flare on this hind hoof. She has flares like this on both hinds. I don't rasp them off because she needs them: she would tightrope walk more if I removed them. I'm wondering if now they'll reduce/disappear?

Betadine scrub allowed to sit on clipped pastern.

Scrub on right hock.


Scrub on left hock.
The pastern was saved for last, as it was the most painful area. In the meantime, Dr. L did G-Mare's hocks. Dr. L repeated the surgical scrub right before injecting the area. She prepared the drug cocktail for the hocks (methylprednisolone + amikacin, which is an antibiotic), then donned sterile surgical gloves and had me hand her new needles in a sterile manner: she used brand-new needles to inject the sites for maximum aseptic technique. (As it should be. Since my job is to help fix veterinary disasters, I have a problem with vets that don't swap out needles before injecting. One day I'll tell you the story of the dog that came to us with a giant abscess on his shoulders from having been injected with subcutaneous fluids at the regular vet's, using a re-used needle. A liter of fluids under the skin that had turned to pus. Sure a vet can get away with re-using needles a lot of the time. But when things go bad, they go really, really bad.) My vet inserted the new needle first, waiting to see if any joint fluid bubbled up into the needle hub so she could observe the color and texture (it should be clear and slippery, kind of like egg whites), then attached the syringe and injected the cocktail.

As it turned out, Gracie had more joint effusion in her left hock than her right, indicating that the left had been more affected despite the mare presenting the week before as being worse on the right. This confirmed what I had noticed: she was sore in both legs but seemed to alternately be worse on one or the other. I had originally thought the left was worse: the injections confirmed this also. 

I used to royally suck at noticing hind end lameness, but it was really cool to be able to confirm that all of my observations and assumptions in this case had been spot-on!

Cockeyed resting drugged mare stance.
On to the pastern. Dr. L repeated the surgical scrub, then administered a local block, as this type of joint injection tends to be more painful. She repeated the same process as before, except this time the cocktail included amikacin, triamcinolone (a different type of steroid), and Sarapin.

It was also a non-event. Gracie didn't even flinch over the injection.

Dr. L then applied a nice padded bandage to protect the area for the next 24 hours; I was to remove it the next day.

All done.
In the meantime, Dr. L and I had a pretty fascinating conversation that I wanted to share with you guys because it's more of an insider conversation: not the kind of thing that usually comes up between a veterinarian and a non-veterinary pet owner.

I don't remember how the subject came up, but we started talking about cats. I was telling my vet that cats are pretty much the one animal that I love as much as, or even a little more than, horses (if that's at all possible). I think all cats are adorable. Even old crunchy grumpy cats. Even after 15 years owning them and 8 years working with them, I still feel like a little kid when I see a cat: it's this instant heart-warming love that I can't help.

Doing paperwork in the company of one of our feline patients.
In typical Siamese fashion, she had been wailing for attention and everyone was ignoring her, so I finally got her out of the cage and sat her on my lap. She curled up happily (look at her tail!) and got to work purring up a storm while I worked. She didn't even need to be petted; she just wanted human company.
Happy purry kitties = pure awesomeness.


Accompanied by the ancient, pointy, but very sweet resident cat at the previous barn.
It's how most people feel about dogs, though because dogs usually like people in general, it is extra-special when you are able to win over a cat, who aren't usually quite as easy. It takes skill, tact, and a clear understanding of their body language to work with cats, and it's a challenge that I thoroughly enjoy. Dr. L was saying that she likes them but she is terrified of them and it is because of her fear of working with cats that she chose large animal medicine!

My jaw dropped: I'll take a 10 lb teethy clawy weed-whacking ball of angry fur any day over a 1200 lb animal trying to strike out at me in terror. I LOVE horses, duh, but the reality of how dangerous they can be when afraid and cornered while trying to do unpleasant things to them is what made me go for small animal medicine.

Dr. L had some pretty unique experiences though: before vet school she worked for a long time at a clinic that did trap-neuter-return work with feral cats and the employees were constantly getting bit and having to go to the doctor or even the hospital for antibiotics. Cat bites are second only to human and primate bites in terms of danger: cats have pasteurella in their mouths and their bites tend to be deep punctures, making them far more likely to fester and become infected than a dog's bite, which is more likely to rip the skin. It's scary shit. Since bites often tend to happen on fingers and hands, people can sustain permanent nerve and muscle damage from infections that run deep if the person doesn't seek prompt medical attention. After hearing Dr. L's story, I don't blame her for being afraid of cats in veterinary scenarios! I would have had second thoughts about small animal medicine if I had been in that sort of situation where I was seeing coworkers being bit by cats left and right prior to tech school.

The really cool thing was that in her last year of vet school, Dr. L was allowed to trade patients with classmates during clinicals. One of her friends loved cats but was terrified of horses, so Dr. L told her that she would take the classmate's horses if the classmate would take Dr. L's feline patients.

The trade-off was immensely successful: the classmate ended up working with this one cat that no one else could touch...but she would sit on the classmate's lap and let her do anything to her. Dr. L ended up with this classmate's equine patient who had horrible eye ulcers and needed daily eye medication. Have you ever tried to apply eye medication to a horse every day? It is absolutely NO FUN at all. Dr. L figured out pretty quickly that this horse was highly food motivated and gave directions that only she herself would feed him. The horse would let her do anything to him because he knew he would get fed afterwards. Win-win all the way around, each doctor ended up working with their preferred species, and it makes a great story to boot!

So I shared my story: I'm not the absolute best at handling cats in our veterinary practice, but I'm maybe second or third-best. I adore them, but a fearfully aggressive cat is a force to be reckoned with no matter what. However, one of my main coworkers, Leah, is amazeballs with angry cats. She is a dog person and is a professional show dog handler on the side, but she loves asshole cats. She is incredible at restraining them without stressing them out. If I have someone I trust holding onto a cat without stressing it out further, I can do pretty much anything to that cat smoothly, gently and swiftly. Leah and I often tag-team the most aggressive cats. We have had kitties that needed to be boxed down with anesthetic gas at their regular vets before anyone could touch them come through our doors, and between the two of us we'll draw blood, get x-rays and blood pressures sometimes without even needing to muzzle said cats.

Dr. L said that most horses give you plenty of warning before they explode. Cats also usually (there are exceptions...) give you plenty of warning, but just like with horses, you have to know how to read them as well. Cats are both predators and prey animals and in many ways, they react like prey animals first. Just like a horse would. They have a lot in common behavior-wise with horses. They just happen to be small (thank God...) and have very sharp teeth.

Dr. L has a very calm demeanor and a very quiet way of talking, and is just really good with horses, also being a lifelong horsewoman herself. Lily for the most part has always hated vets but she'll greet Dr. L, touching her with her nose, and allow her to do anything to her without the slightest fuss. My vet has the right vibe about her to be an equine vet; it would have been a waste of her natural abilities if she had done anything else!

It was a fascinating conversation because cats and horses are two species that I consider to be very similar in the most surprising ways, and not everyone realizes it. Cats and horses have far more in common, down to even the cellular level, than cats and dogs. My professors in tech school used to mention it on tests, "Your two favorite animals!" anytime there was a question that had the same answer for both species. Even their blood does the same weird things on a normal basis (rouleaux, platelet agglutination) that are considered abnormal in any other species.

Rouleaux is when red blood cells stack themselves on top of one another like coins.
Completely normal in horses and cats.
At this point Gracie had decided that she wanted to go back outside...but she was doing so one slow step at a time while taking a nap inbetween steps.  I told her that at this rate, she would make it back to the field by tomorrow. I took her lead rope and Dr. L held onto her tail to balance her and between us we walked her out to the mare field.

She woke up significantly once she was back out in the field, and we watched her walk off to join the other horses. Dr. L then left for the day, giving me instructions to start riding G-Mare for 20-30 minutes a day after 48 hours of rest, for the next 2 weeks, and then increase her workload slowly over the next few weeks if she remained sound.

On Sunday I hopped on Gracie for the first time since her joint injections. She walked off calmly at my request...then realized nothing hurt and went, "I CAN CANTER EVERYWHERE!" and did this sort of crazy flailing before I could stop her. She took two very lame steps, "OW OW!" and I was able to bring her back to her gait and she stepped out sound again.

She felt amazing. Like she had four legs. I have never felt her feel so good. She decided to spazz out at the trailhead, which involved me dismounting and having a come-to-Jesus moment with her, but I had a very compliant Mareface once I was back in the saddle. Except for the fact that she wanted to go-go-go!

Future rides have involved some acepromazine to keep her calm. She has been fabulous though: no fussiness at the beginning of rides at all. We had both put up with the fussiness once we realized it was just her expressing her discomfort as she warmed up out of her joint stiffness: once warmed up, she has always been fine.

More photos of our on-site trail wanderings so far:

Yeah. And it's not even the same river as at the previous barn. But it's just as awesome!! :D
Awkward photo as usual. I swear he has both hands on the reins while riding!
He was giving her rein so she could drink.
So pretty.
Is that a new trail on the other side of the river?!
Trail going into the trees.


And another trail!
We'd never been up this way. I told Charles, "I don't think this is Dr. L's idea of 'light riding'..." but he was already halfway up the hill.


And filmed me going up it...
Lily was barefoot and the footing was shale rock. She took offense at the rocks: I don't blame her!
We found another hill leading off of this trail, the one I point at in the video.
We found this hill, too. We didn't go down it at this time; just made a mental note to come back later! :)
We ultimately dismounted and went right back down the route we had taken to go up: we were watching out for Gracie's joints.
So yeah, so far so good. :)  Gracie gets 2 weeks of light riding during which we'll discontinue the Previcox. The goal is for her to be comfortable without it. If she's still going well 2 weeks post injections, we will slowly be ramping up her exercise levels, with the hopes of having her back in full work in 4-5 weeks post injections.

Apparently G-Mare loves water bottles. The colder the better!










18 comments:

  1. Keep your vet, keep your vet tight and close! I love my farrier and vet for similar reasons. Always willing to talk you through every option in great detail, always willing to teach you, they don't treat me like a child, and they know I read and will listen to what I have to say and then explain why it sounds good or doesn't sound good. They aren't in the business of nickle and diming clients, up front about costs and always willing to take payments. When I read people's equine professional horror stories it makes me afraid to leave. But then I read a glowing experience from someone like you (eloquent, educated, curious, compassionate etc) and then I have hope again :)

    Glad Gracie got a diagnostic and a plan :)

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    1. Finding a good vet had been one of my bigger concerns when we moved to MD from FL; our FL vet was a little old school but he was one of the better ones in the area where we boarded at.When moving up to Frederick, it was far enough that I was afraid I'd have to switch vets: it was a huge relief to learn we were still within her service radius!

      I have faith that you'll find a good vet after you move too! :)

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  2. Your vet sounds awesome! My vet sounds really similar, she's always been willing to talk things through and I know that she's there for the animal more than anything. :)

    I'm also completely terrified of cats. Put me with an evil 1200 pound horse and I'm confident and good (maybe because we've had so many crazies, lol.) but I'm freaked. out. by cats. It's weird, because I like them and wish I could be comfortable around them, but I'm constantly worried that I'm going to be scratched or bitten....very odd, haha.

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    1. It's all about knowing their body language, which can take a while to get used to because it's very particular. The easiest way to know if a cat is going to be friendly is to introduce yourself. The best way to do this is to slowly extend your hand and show the kitty one finger. Keep said finger about 2-3" from the cat's face-don't touch it yet. If the cat leans forward to sniff your finger, it's interested in being friends. It might even go ahead and rub its cheek or lips against your finger. :) If it doesn't want to be friends, it will either back away, turn away, or it might hiss. But I've never had one take a swipe at me if I introduce myself in this manner. They can be very finicky about pets: for example the vast majority of cats like being patted on their rump, right in front of their tail...but some of them get very overstimulated and will nip at you, "Okay, stop now!" They're not doing it to hurt you, it's just to tell you to stop. They are weird. Lol Safe zones for petting in general are forehead, cheeks and under the chin. They are the only species that has developed a sound exclusively so that they communicate with us: cats don't meow at one another, it's a sound that's saved only for us. :)

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  3. Your vet sounds like someone I would get along with.

    Funny about the cat thing...I felt the same way for awhile. I was so much more comfortable with horses than cats or dogs! Working in small animal has changed that a lot for me and I've become a huge cat person (I type this with a cat sitting on my lap).

    The only problem I have now is deciding what I love more...small animal or equine medicine!

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    1. I think you would get along with her too. :) She does have vet students and tech students shadowing her occasionally, so she IS an option for you for later on! :D

      I know so many horse people that are also diehard cat people that I tend to wonder if it's triggered at a cellular level, because of the whole cats and horses having so much in common thing.

      As a technician, I ultimately would have chosen equine med if it had paid better. Once I was working at small animal specialty hospitals, it seemed silly to put myself at risk in a scenario that is potentially more dangerous for far less pay. That was honestly the deciding factor. So many equine vets do their jobs without techs, including my current vet. My previous equine vet had a technician with her when she did farm calls, but that vet was also far more willing to take unnecessary risks when it came to handling horses...she was young, less experienced, and despite being a horse person herself as well, she was always getting hurt by them. Lily almost kicked her numerous times...and Lily NEVER kicks! I think her energy was a huge factor in causing that sort of reaction even in more compliant horses. That does make a huge difference.

      Enough rambling. :) It will be cool to see which of the two you end up choosing! ;)

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  4. Yep your vet definitely sounds like a keeper! Love all the details about the injections and theories behind it all. Hopefully Gracie does well!!

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  5. Sounds like a great vet. With Dusty being a vet himself we tend to get brushed off a bit when the horse vet comes around. It has happened everywhere we have been. They find it odd that he doesn't treat his own and basically just assume he knows everything. He doesn't mind but I find it very annoying.

    I like cats and we have three but and angry cat scares the crap out of me. They become flailing balls of fur, teeth and claws and yikes! I also have a harder time reading dats than dogs so maybe that's it.

    I'm glad Gracie responded so well to the injections. I often wonder if I would do injections or not. It will be a decision made when the need arises. I appreciate people writing up their own experiences with it.

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    1. Dusty is a small animal vet though, right? It's odd that your equine vets thought it weird that he wouldn't treat the family animals himself: most vets I know will have other vets treat their own pets. Unless it's fairly simple stuff like vaccines, minor infections, that sort of a thing. One of the doctors at work, a double-boarded criticalist and internist, still has an equine vet for her own mare. For emergencies she's even hauled her up to U Penn.

      Angry cats are very scary! And they are harder to read than dogs in general; their body language is virtually the opposite of a dog's. I find myself at work having to "re-set" my mentally from dog to cat and viceversa so I'm communicating effectively with my body language with that particular species.

      Regarding joint injections, it always depends on the particular horse and rider scenario. I've heard the pros and cons, and while I don't agree with doing it to push a horse to the next level in competition when the horse is obviously painful, I don't think it's a bad thing if the goal is to keep the horse going comfortably at current riding/competition levels, and if the horse is happy doing so.

      Gracie is so young...she's only 9. And she's kind of a mess. It's different when it's a horse in their late teens/twenties. I suspect she was broke to saddle young and ridden hard from the get-go, which would explain all of the arthritis issues that we've slowly been getting worked up. My vet thinks that front pastern ringbone must've been due to an injury when she was younger. The hock arthritis might be partially from her being post-legged and her particular way of moving: she twists her hocks when she walks. It's her normal way of going, but it can definitely contribute to this type of issue in the long term. She can always be retired but it would be a life of torture for her: she is such an easy keeper. Only horse I've ever met that needed to wear a grazing muzzle *in winter*! Retirement would mean wearing a grazing muzzle 24/7 for the next decade or two, or living in a dry lot, which can be hard to come by in this region for whatever reason. Even the current barn's "dry lot" has some grass in it; the horses there get free choice hay. I know she would gain weight even on that. She just loves having a job, she enjoys the attention and exploring on the trails. And it makes it sooo easy to manage her weight in the process! Hopefully we can keep her comfortable for many years to come so she can continue to enjoy going for rides. :)

      I'll definitely keep posting about her progress. I hope it's not something that you ever have to do with Gem at all!

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  6. I really think a good vet is worth their weight in gold.

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  7. I think someone needs to clone your vet immediately! :)

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  8. This is why I love my small animal vet, too. The talking-to-me-like-an-equal thing. And same for my large animal. I think that having worked in the field makes us more likely to find and keep the good ones. :)

    Speaking of working in the field, I started twitching when you talked about cat bites. Which makes me want to share a link: my cat bite. I don't think I've share it with you?

    Glad y'all figured out what's up with Gracie. :)

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    1. I think you're right re: having an easier time finding and keeping good vets when we have veterinary experience ourselves.

      Oooooo I remember that post! Yes, you're an example of someone needing major intervention including surgery after a cat bite! I'm glad you were ultimately okay but what a whole lot of stress and worry. :(

      My first year in tech school I got bit by a cat at the general practice I worked at. A cat that had been in for a dental bc his teeth were green with tartar. And he nailed me good in the wrist. I went to urgent care that afternoon , had x-rays taken and was started on climdamycin. Within 8 hrs of the bite occurring, I already had red streaks tracking halfway up my arm.

      I went to school the next day and had a really hard time taking notes bc of course this was my right arm. I couldn't move my right wrist at all and the streaks had made their way to almost my elbow. I was giving it 24 hrs of antibiotics before going back to the dr.

      One of my profs, a vet herself, saw me struggling and asked to look at my wrist. I had pus oozing from the bite wound. She told me, "I was once bitten by a monkey. It was a horrendous bite that became horribly infected. I cured it with Epsom salt soaks, in water as hot as I could bear. I suggest you do the same."

      I bought Epsom salts that afternoon and saw stars when doing the soak. I figured I'd go to the doctor te next day. Except when I woke up, the red streaks were receding. Within another 24 hrs, the wound was well on the way to healing. I was lucky though, and I was very afraid of cats in the veterinary setting df

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    2. for a good long time after that. I mean, how can you not be, when you realize how dangerous they can be? It gives you pause.

      I had a coworker that sustained a similar cat bite, also on the wrist. Except the scar from hers was so ugly people always thought she'd attempted suicide at some point. So she had a baby koi fish tattooed onto her wrist to cover it up. And then she kept adding to the tattoo...the koi turned into an adult fish as it went up her arm and finally into a full-fledged dragon on her shoulder. It was one of the most beautiful sleeve tattoos I've ever seen. Stunning art. It took several years to complete, but what a story to it! It's my favorite cat bite story bc it has such a great ending. :)

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  9. I took my dear sweet time reading this in pieces as I had the time over 4 days...

    A WEALTH of information! Really enjoyed it. Thank you for writing in great detail (as you always do ;-) ). I'm so thrilled you finally figured it all out. I want your vet for my vet tooooooo lol

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