July 10, 2015

Gem Update: She Came Home :)

There is so much to write about and honestly I am just too worn out to do it in any entertaining way, so unfortunately you will have to deal with blathering in a semi coherent fashion.

We went up for 9 am to get Gem this morning. I was anxious to see her myself and get a chance to talk to the vet face to face so that she couldn't avoid my questions. She met us with a smile and led us over to Gemmie.

She brought her out of the stall and unwrapped the leg to show us the hoof and explain some things. What I saw was actually better than what I thought I would see. It was certainly better looking than her picture led me to believe.


There is a fair amount of primary healing that has occurred which is a great thing. There is no drainage at all, no odor and the swelling is pretty darn good. She has been off bute and is still using the leg.

I learned some new things I hadn't heard about before.

Can you see the wire sutures through her hoof wall? Yeah, apparently Gemmie had sliced right through the coronary band and was about an inch away from leaving half her hoof out in the pasture by itself. I didn't have it in me to ask what would have happened then. I'm just thankful that wasn't the case.

In any case this matters for a couple of reasons. The main one is that those tiny pieces of wire are what is holding her hoof wall on that side to the leg. It needs to heal and it needs to heal well. She will most likely end up with a permanent deformity to the hoof wall due to the trauma. How bad of a deformity will depend on how well it heals and how much damage was really done. The vet is hopeful that it will just be an unsightly ridge, but it could end up with a lot more than that. Time will tell.

She also said that her heel bulb will end up deformed as well. I don't really care about looks, although function is an issue, but this is also unavoidable.

Luckily she did not injury the frog or sole of the hoof which is why she is so sound on it. The hoof should remain fully stable and functional.

One of the bigger concerns (along with the hoof wall remaining stable and healing) is a condition known as "Quittor". I had never heard of this before, but the vet explained it as infection of the side bone. Gem fractured her side bone and part of it was removed in surgery. There is a chance this could become infected and create a massive pus filled wound. That would be very bad. So far she has shown no signs of infection at all and we have done quit a bit to prevent it: local limb perfusions, IV antibiotics and she remains on orals now as well. It appears the risk remains for about 6 months post injury, so even if all the soft tissue heals we still won't be out of the woods completely.

Overall though she said that Gem is super fit, very nice and has a great chance of returning to endurance again. WAHOO!!!

But then she went on to say that the side bone can cause residual pain. She said that this can be fixed in the future if it occurs, but didn't say if that would require another surgery to remove the remaining part or what. Residual limb pain and endurance don't really go hand and hand, so we will just wait and see on this.

While it isn't vital information I did ask if she thought she would end up needing shoes on her fronts and she seems to think so. Now she isn't a barefoot person to begin with, but I have a lot of thinking ahead of me. I don't want to shoe her at all and want to allow the hoof to form the shape and condition it needs to function. However, it is no longer a normal hoof and has suffered pretty severe trauma, so if a shoe is needed to provide support, then so be it. My bigger concern with barefoot is the deformed hoof wall and heel bulb. Depending on how it all ends up healing, she may need shoes as no boots will fit that. Time will tell on this too.

After that we talked about the plan. She wasn't comfortable removing any sutures due to it not being fully healed yet and I was ok with that. She really didn't want her in a soft dressing at all because there is too much at stake and too high of a risk if it were to be traumatized again. Letting it sit quietly is the best option.

So Gem went into a second cast.

Padding it up

Fiberglass and vet wrap applied (pay attention to those swirly things on the side)

Wrapped above with padding and elasticon to prevent shavings getting into the cast
She will wear this for 10 days and then we will return to get it removed and the sutures hopefully out.

I will need to change the upper wrap daily and check for any rubs. Any sign of pain, heat, flies accumulating on the cast or bad rubs and I am to call immediately and get her seen. Those would all be very bad things to happen.

She will remain on oral doxycycline twice daily until then and we are continuing the ace at home until we know how she will behave.

I did learn something really cool while there.

See those swirly things on the cast? There is a set on either side. They looked like little clear plastic tubes and she placed them over the cast padding, but under the fiberglass. I asked if it was for stability or to create room or what???

They are gigli saws!

They build in two saws into the cast so that when it comes time to remove it, they can remove the protective plastic tubing and then saw away the cast from the inside. She said it not only provides a nice clean edge if they want to use the cast again as a splint, but also the horses handle it really well and even the most staunch horse has issues with an electric cast saw.

How cool is that?

We took Gemmie home and settled her into her stall. She has her slow feeder hay bag and a calming supplement as well. We will keep the ace up through the weekend and then trial without it on monday. I got approval to walk her the 20 feet out of the barn to a rim of grass to let her get fresh air and hand graze 10 minutes max in one small area. No forced hand walking, but she can graze a bit.

Tonight her swelling was gone in all legs and I will keep a close eye on her. Vet said I could do no bows and standing wraps 12 hours a day and I will put them on as needed.

So now a tiny rant that is insignificant in the greater scheme of all things, but kind of point to make.

We ended up with a $3800 bill. I will go into that more in the part 2 of finances post, but thats a lot of money. Veterinary medicine (along with human medicine) is just as much about the people involved as it is the animals and too many vets are just not people friendly. If the vet themselves can't handle it, then the clinic needs to hire someone who can. Little things matter. Things like spelling my name, which I wrote very clearly on the forms, correctly.  All my paperwork and the medicine label had me as Sara Dorkowski which is about as far from my name as possible.

When I do surgery, no matter how minor, I always cater to the patient and do little things to make them smile. I put christmas trees on winter time dressings, a heart, a nike swoosh. Something small to brighten their spirits. When I come into the hospital and all my gear is red it wouldn't take a whole lot to try to use red wrap on her. Petty, yes. But seriously it is something so tiny that would have put a big smile on my face and left me feeling better. It is the details that counts.

I you are in the vet world, or any high stress situation please keep in mind that the tiny little details that don't cost any money or much time at all really do make a big difference in the perception of the care received.

Ok...end rant.


  1. I'm so glad she is home and that the wound is looking so good! YES for most likely returning to endurance! Great news all around! :D

    I had noticed the wire sutures in the original photo but thought maybe I had forgotten something about your descriptions of the wound. That is insane. But don't be discouraged: have you read the Rockley Farm blog? If you haven't here is the link: http://rockleyfarm.blogspot.com/ Horse hooves are an incredible thing and they will adapt however they need to to allow the horse to continue sound and mobile. This might mean that she won't be able to wear boots, but she might not have any problems being bare. This is one of the craziest things I've ever seen:
    http://rockleyfarm.blogspot.com/2012/02/jumping-to-conclusions.html <- That horse is sound! He has a flippered hoof but he can do cross country!
    Here is the first post about him:
    Regardless, I continue to pray and light candles that Gem heals 100% well!

    That is fascinating about the Gigli saws integrated into Gem's cast. Absolutely amazing!

    Attention to details: yes! And it's such an easy thing to do. I won't deny that I grinned secretly every time I saw Lily's bright blue bandage on her leg. Everyone is different at every hospital I've worked at, but I personally try to match bandages to patients' harnesses or collars, or at least coordinate it by sex or personality: an exuberant female dog might get pink zebra Vetrap on her bandage. Our surgery department will do little fun cutouts on Vetrap to stick to patient splints/casts that are on more long-term management, especially during the holidays. Those little details really do make a difference.

    I'm glad you don't have to deal with that hospital anymore. Communication is vital and it's awful that they weren't able to let you know *in detail* how Gem was doing during her stay with them. So happy she's home!

    1. I really hope she can return to at least LD levels. She enjoys it and has become so very good at it. I've been thinking about what I would do with her if she is riding sound, but not endurance sound and I just don't know. Karen makes me want to try WE but there isn't anyone around here who does it. Dressage drove the mare batty. Maybe driving?

  2. First., I'm so happy she is home!! Second, I think you missed a freaking bullet. That foot looks like she almost tore it in half! I'm so happy they were able to fix it and that you might be able to do endurance again. Sometimes, medicine is amazing. Third, how cool is it that there are saw blades in the cast. That was the sweetest science fact this week!!!

    1. I really did dodge a bullet. She is lucky to still be around.

  3. Thrilled she is home, and learned a lot from your entry. Hoping the deformities are minimal and that the side bone doesn't become a problem. Fingers still crossed so so tight for her and you <3