The Big Day

It's been quite a busy last couple of days...weeks. River and I have been absolutely overwhelmed with new experiences and information. A lot of you have been keeping up to date via Instagram, but there was just no way to share all the details during such a hectic time. Plus, some people probably missed it all together so I wanted to write it here for anyone interested as well as for my own reference while the memories are still fresh.

If you haven't read the original post on this subject click here, it'll tell you more about what's going on and why. Otherwise, read on...

Really the process of getting River to the vet started well before Monday (getting kids to grandma's house, arranging pet sitting and so on), but Monday was the day we were set to make the drive and the first day River had any knowledge that something big was happening. My husband and youngest daughter went with us too. The baby because she's only two months and still nursing, and my husband to help with the baby.... and because of course I love their company too.

The trailer drive to the clinic would be about three and a half hours long, with stops. It would be the first time River ever trailered alone,or for that long, or left her home since arriving when she was four months old. We had spent many training sessions over the past months practicing loading and unloading, making short little trips up and down the neighborhood road, and making every encounter with trailering a great experience for her, but unfortunately we had to make a big jump in her training for this all to happen. Making such a long trip to such an unpleasant destination was definitely not ideal at this stage in her training, but sometimes things happen out of order and you make the best of it.

I was determined to do everything possible to make the experience a pleasant one, or at least as pleasant as possible. We made frequent stops, she got lots of rewards and got to enjoy a nice hay meal on the way. I also chose to use an oral calming supplement to help any nerves she might have. Nothing too aggressive, just enough to take off the edge. Again, making the experience a relaxed one was my biggest priority. I wanted to do everything possible to avoid having to force her to "deal with it", which could very likely undo all of our training up to this point.

Call me controlling, call me paranoid, but the truth is that bad experiences hold a much heavier weight in the memory than good or neutral experiences. You need a much higher proportion of good experiences to bad ones if you want to maintain a positive association with an action or location, and River had no experience trailering away from home since arriving as a weanling; good or bad. To put it very simply, if this trailer ride was traumatic for her she would have every reason to be anxious traveling away from home or loading into the trailer at all in the future. So you can see why I might be very worried and careful about this particular trip.. it was set up to be the worst possible first trailer ride away from home.

Thankfully, River seemed to be completely un-phased. She jumped right up into the trailer, munched on her hay the whole drive, and enjoyed the view. I'm sure she was a little unsure of what was going on, as you can imagine anyone might be when tied up in a metal box with cars, semis and trees whisking by, but she did amazingly well. I want to say I was surprised, but to be honest I wasn't. I was fully prepared for the worst, but not surprised when she exceeded all reasonable expectations. I mean, this is River we are talking about. No ordinary little filly. ;)

We arrived at the vet clinic a little after four in the afternoon. We checked in at the office then unloaded River, taking her to the large covered jogging pad where we were asked to wait.

We had never been to this clinic before, but the facility and activity were very comforting right off the bat; clean, busy but not chaotic, and horse friendly. Right away I could tell this was an extremely popular clinic that ran very efficiently but was friendly too.

It was nice to get River unloaded and then let her just take in all the sites, I was in no hurry and preferred not to rush her. She was a little excited, but not overly worried and definitely not frightened. Every horse she saw she wanted to rush over and great, but she did really well staying with me and soon settled down. She spent a lot of time sniffing the ground, I'm sure she could smell the many many horses that had walked there before her. It was probably quite the sensory overload.

It wasn't long before a staff member appeared and offered to take River off my hands, to whisk her away to her stall for me, but once I let them know I would like to do as much of the handling as possible they were more than willing to let me do so. Not all clinics allow owners to be as involved as I like to be, but for me personally it's hard to be okay with handing any of my horses off to a stranger, especially a yearling that has never been handled by strangers. Thankfully this clinic was absolutely more than accommodating and welcomed my involvement, and in return I was very careful not to be in the way.

At first they had River in one of their large partially covered pens, which I really liked for her, but apparently the vet changed the instructions and wanted her in the barn, so into the barn she went. She hesitated a little going into the stall, it was quite closed up and a touch smaller than the stalls she's used to at home, but after a second she walked in calmly. Immediately she found her hay and was content. I stayed with her for a time before leaving to go talk to the vet.

I had never met the surgeon that was going to be performing the procedure before, but he came highly recommended and had quite the resume. However, I did want to meet him to hear his plan of action and to put a face to the name before leaving for the night. Thankfully, he was very nice and I felt very confident in his abilities to take care of my baby even after just a short talk. The plan was to do a set of x-rays on her in the morning and then the surgery would happen the following morning, Wednesday.

Originally I had thought the surgery was supposed to be on Tuesday. My plan had been to drive River to the clinic on Monday, for her to stay overnight then have the surgery the next morning. Then she would travel home the following day. I was going to stay at a hotel nearby for those two nights so I didn't have to travel back and forth, and so I could be there for River, but unfortunately I messed up and made things a touch more complicated by bringing her a day too early to the clinic.

I'm not going to lie, I was an absolute mess when I realized I wouldn't be able to stay near the clinic for all of those days. There was no way my husband could take off work that many days in a row or that I could find a sitter for my older kids for that many days. We ended up turning around that evening and heading back home, leaving River at the clinic on her own with no real idea on when I would be back. I wasn't sure if it would be possible to get back to the clinic again before the surgery, which gave me such extreme anxiety. The walls caving in kind of anxiety.

I knew she was in good hands, as far as professional care. It wasn't that I thought they wouldn't take care of her.. but like I explained before she had never had any medical procedures like this before or even been away from home. Yet here she was, being dragged hours away from home to be handled by strangers and have painful medical procedures done.

On top of that, most horse people use traditional handling methods when working with horses. I've spent a lot of time and effort training River in a very different way than most people approach horse training. While she acts and behaves just like any other horse as far as manners and behaviors, I've been very careful not to use negative reinforcement and positive punishment to enforce my will upon her. However, especially at vet clinics, there are lots of situations where a horse may not want to walk into an area or accept a shot, or be willing to stand quietly for x-rays, etc... and most of the time people use negative reinforcement and positive punishment to "encourage" the horse to do this or that in a timely manner. Everything from twitches to chains to whips and scary noises to get the horse to do what's asked of it. These actions used even by the most professional and kindest of humans are still at their core scare and force tactics.

I'm not going to say that there isn't a time and place in emergency situations where these tactics may be absolutely necessary for the long term well being of the horse, but with all of the careful training I have done I was confident that this situation was not one of them. If I could be there any time she hesitated to walk into a stall or stand for x-rays I could use positive reinforcement to get nearly immediate results that didn't require scare and force methods.

Using more traditional methods may temporarily get her (or any horse) to do what the handler wanted, but it would also encourage her to be more afraid of walking into scary places and more worried about strangers in the future. So while yes, I had done everything possible to set River up for success so far, and the people at the clinic were very nice and professional, there was still a high possibility of creating negative associations. Just like I talked about earlier with trailering, bad experiences far outweigh good experiences and I was trying so hard to avoid having all of my hard work flushed down the drain in a matter of days.. maybe even minutes.

God is good though, so very good.

As I was sitting on my couch the next morning, trying to figure out what in the world I was going to do with this mess I had created... trying to be logical despite the exhaustion, the emotions, and the anxiety... it all kind of clicked together. After a quick couple of calls I managed to get it arranged so that my sister in law would come with me back to the clinic to help with my youngest, while my two oldest went to their grandma's. We would get to the clinic in time for me to spend an hour or so working with River, walking her around getting her used to the facility, and then spend the night near the clinic so we could be there for the surgery the next morning. The plan at the time had also been for us to head home after the surgery without River, then come back the next afternoon, but thankfully things happened to get even simpler and we ended up taking River home the day of the surgery! Something I would definitely have preferred not to do, but sometimes you have to go with the lesser of two evils and this was just one of those situations.

When we arrived back at the clinic on Tuesday they had already done her x-rays and I was never able to find out how River did for that, but she seemed to be in pretty good sorts. She was a little more nervous than she had been when I left her on Monday night, but I suspect that was due to being cooped up the whole day and the calming supplement I had given her for travel wearing off. It could have been also as result of the x-ray handling, but I don't know that for sure and I suspect even if it didn't go as smoothly as possibly it probably didn't go poorly.

We walked all over the facility, switching between hand grazing to exploring new scary areas, all while encouraging calm and confident responses. I also occasionally brought out the target for some focused work, which helped calm her any time she seemed overly distracted or nervous. Overall though, she was so very good. She was curious and confident, never once hesitating to walk somewhere I led her. She loved getting to meet new horses and explore new areas.

I did talk to the vet again, since he had by then had a chance to examine her x-rays closely. We talked about the angle of her her legs, the growth plate inflammation, the offset cannon bones, the quality of the joint, and the desired results we hoped to get from the surgery. Unfortunately this vet wasn't as talkative as I would have liked. I wanted to hear all of the details and and talk about her future with him, but while he had great "bed side manner" he wasn't exactly spilling over with information. However, what I did take away from our conversation was a slightly more positive outlook on the whole situation, though nothing had really changed.

What I've learned in the last couples weeks about legs, growth plates, and joints has been overwhelming, but highly educational and information I will value in the future. I'm very grateful for the opportunity to learn something new, I just wish it had come about under better circumstances.

I briefly explained what was going on in my last blog post about this, but I've since become more comfortable with the information and feel I can articulate a little better what's going on.

From what I can understand we are dealing with a combination of things that are feeding off of each other. First, an inflammatory disturbance (physitis) in the distal radial growth plate just above the knee (or carpal joint) that has caused abnormal widening of the growth plate on the inside of her knee (giving her knee a boxy abnormal look). Second, this caused uneven growth in the legs causing one side (the outside of the leg) to grow faster. In combination with offset cannon bones this is all causing carpal varus to occur (bowed legs).

Apparently though, the offset cannon bones are not as severe as they look in person. The abnormal growth on the inside of the knee off the growth plate gives an optical illusion of the cannon bone being far more offset than it really is. The radiographs showed a much straighter line to the knee than it appears, which explains why I never noticed it much when she was younger and it has become "worse with time".

I also learned that if this is going to be a problem then it does usually show up about this time in horses.

"Epiphysitis seems to attack at two levels of equine development. If the condition afflicts the ends of the cannon bones, it normally will be manifested when the weanling is four to six months of age, although there are exceptions.

It also can strike at 12 to 20 months of age. When horses are afflicted at that age, the problem area normally is at the end of the radius or tibia—above the knee or hock. It is at these ages that physeal closure of the respective long bone growth plates occur—four to six months for closure at the distal surface of the cannon bones and 12 to 20 months at the distal surface of the radius and tibia." (source)

So, what can be done about it? Well, if caught early enough diet change, corrective trimming, rest, and some other options are available, especially for younger foals. However River is much older and the chances of conservative therapy helping were extremely unlikely. Actually, nobody ever mentioned conservative therapy to me, that's just what I read about later. The overall impression was that if we were going to have any chance as helping her at all we had to act quickly. Which is where the surgery option came up.

Thankfully there is a procedure called a Transphyseal Screw Insertion (pictured next). A single screw is placed through the growth plate on the convex aspect of the limb (in this case the outside of the leg). As the horse grows this screw will slow down the grown on the outside of the leg and allow the inside to continue growing. As the limb grows it will in theory progressively straighten, but all of this requires River to have another growth spurt before the growth plate permanently closes. If she doesn't, the surgery will fail to help in any way and she will remain bow legged for the rest of her life. The vet did repeatedly express to me that we would either be in the winning category or the loosing category in regards to how effective this procedure would be. It'll either help or it won't, only time will tell. In the meantime, we knew we had to at least give it a try.

Here are photos showing how the screw is placed into the knee. The second image is an actual radiograph (not River's) with the screw on a limb that has bowed.

The next morning came really fast. The surgery was scheduled for eight in the morning, but I knew they would start preparing her before that. I really hoped to be there for it, but wasn't sure I could make it to the clinic early enough since I had my baby with me. Thankfully though, I drove up right as they were leading River out of her stall and I was able to be there with her while they prepared her for surgery.

A cleaned out mouth, a couple of partially shaved legs, and a catheter later River was led to the next room where she would be laid down then carried to the operating area. She handled everything so well, even though I knew certain things were catching her off guard... like the catheter and the leg shaving. It helped she was partially sedated to make it less stressful.

While I couldn't be in the room with her while they laid her down or performed the surgery I was able to watch from a viewing room above the surgery area. I also videoed the whole procedure live for my own reference later on, but also so many of you could be there with me during such a nerve wracking event. Thankfully, everything went so smoothly and an hour and a half practically flew by, but I definitely felt the let down after; relief, exhaustion, and so much more.

Watching River be carried by her legs was one of the hardest moments. It puts so much strain on their bodies as all their weight is up against four bands around their pasterns. You can see it in the pictures in the video above, and I know as a result a lot of horses require body work to recover from being carried in such a way. But again, we are dealing with a lesser of two evils situation here.

Once they had her on the table they set to work finishing shaving her legs and prepping her for surgery. The inital prep nearly took longer than the surgery, and it seemed even longer as I anxiously watched from the window not knowing what to expect. Watching them cut open her legs and then drill into her was nerve wracking to say the least, but not nearly as traumatic as I expected. Probably because there was a lot less blood than I thought there would be. When they closed the legs up it was only just a few small stitches, if it hadn't been for the bandages or shaved legs you probably couldn't tell anything had happened.

When everything was said and done she was carried to a second padded room where she would be woken up. Waking up from anesthesia is another peak stressful moment during surgery. Being prey animals, horses don't take waking up from such a deep sleep very well. While they are still shaky and disoriented their fight or flight instincts kick in very suddenly and they can become dangers to themselves as they struggle to get to their feet.

They keep the horses in a very dark quiet area to reduce the stress on them during waking, so I wasn't able to be in the area with her, but as soon as she was on her feet and well enough awake I snuck in (meaning I didn't ask permission, haha) to talk to her and help comfort her. She was stiff and confused, but looked really good all things considered. Later I was informed that she recovered from anesthesia unusually well, that most horses take much longer to become stable and return to normal. I was glad to hear it, though at this point it didn't surprise me much. Remember? We are dealing with no "normal" filly here. This is River we are talking about. ;)

Once she had plenty of time to wake up she was walked back to the barn from the operating area. As soon as she was out of that padded stall and back outside again there was such a relief on my part. It was done. This whole event that I had been so worried about for two weeks now was in the past. She had trailered beautifully, handled being at a new place beautifully, had a successful surgery, and was now awake, happy, and alert. We just had one last step to take, to get her back on the trailer and home again.

We waited quite a few hours before attempting to make the drive home. I was hesitant to bring her home so soon after surgery, but I knew she would be far less stressed at home than she was at the clinic and it was only a couple hours of driving. Also, the actual procedure was minimally invasive all things considered, she wasn't probably in any acute pain and was freely able to move about like nothing had ever happened. She would have stayed longer if the surgery had been more involved or her recovery more painful, but it was so nice to be able to take her home where she could relax and be with familiar people and horses.

I was a little worried she wouldn't want to load back up into the trailer, but thankfully that wasn't the case. I lead River up to the trailer and waited for her to get comfortable with the idea of getting in (just a few minutes) before asking her to step in. As River was sniffing the trailer one of the clinic staff I guess was walking by and saw she wasn't just leaping into the trailer, so she wanted to help I suppose. I didn't see or hear the person before I started hearing smooching/clicking noises from a stranger getting closer, as I was in the trailer. Instead of helping though all this did was make River throw up her head and back away from the trailer so she could see what was going on. I politely informed the person that I appreciated the help but she was okay, she'd get in on her own in a minute, before continuing to let River have some time to make the decision to get in. It wasn't even a minute later before River hopped into the trailer and went to stand in the right spot. Such a good girl.

I wish people wouldn't start trying to "help" get a horse in the trailer without asking. People just like to rush things on horses, after being at the clinic for three days watching all kinds of horses and humans I was really reminded of how we just demand things constantly of our horses without a second thought to how they may feel or think about the situation. I can't tell you how many humans led/dragged their horses into small rooms through small doors and thought nothing of it, while the horses obeyed but expressed great worry and stress. It's not that they shouldn't need to go into those rooms, but why can't humans slow down long enough to let a horse think about it? Why do we just drag our horses here and there and as soon as the horse hesitates for even a second we start tapping them with whips and clucking at them like they are being unreasonable about not wanting to walk into that scary place? Just slow down..... think about what's going on from the horse's point of view. And stop using intimidation and speed to make things happen your way..... sorry, rant off.

Fast forward a couple hours later and we arrived home safe and sound! River was very excited to be home, she practically trotted into the barn to see her friends and I was so glad to have her home. I got her settled into a stall with a walkout for the next couple of days while she recovered, gave her plenty of hay, then happily said goodnight before heading to my home.. knowing that the worst was behind us and now we just wait.

I'm still not entirely sure why this all started, I was so very careful and aware of complications that can occur in the growth plates. Which leaves me and the vets to believe that this all began prior to my time with River or genetic predisposition.. Trust me though, my head is spinning for ways I could have done better or prevented this, but all I can do now is try and prevent further damage and see if we can repair any of the current damage.

The good new is, that if this surgery works River might hopefully be able to maintain a normal working life, but if it doesn't then we are back to just trying to keep her sound. There's also the possibility that the surgery will not work "all the way", and will only help a little. It's better than nothing, but my fingers are crossed that it works all the way.

Here is the tricky part though, if the procedure works and her legs straighten we will have to have the screws removed. We have to be very careful to take the screws out right when her legs hit that "straight" mark or the screws may actually cause the legs to over correct and go the opposite direction, causing another problem. So it's going to require frequent pictures sent to the vet, regular radiographs, and regular checks by my local vet. However, if it doesn't work or it doesn't work all the way we will do nothing, the screws will stay put since there is no reason to put her under for surgery again since the screws wont cause any harm.

Every day this filly blows me away with her capacity to adapt and flourish, no matter the situation. She handled this event so very well despite all the odds. She's intelligent, brave, curious, trusting, forgiving, sassy, and gentle.... everything I aspire to be. Despite being poked, prodded, laid down, carried by her feet, cut open and so much more she remained courageous and in good spirits. Never once did she second guess trusting someone or shy away from walking into somewhere. I'm so very very proud of her.

Her recovery is really going to be very simple, she returns to pasture on day three and the bandages come off at day five. She's on pain killers temporarily and anti-inflammatory medications until the growth plates close. Other than that, we just wait, pray, and see.

If you want to learn more specific details about the surgery procedure and also more about the condition River has check out these resources. (click here) (click here) (click here). Thank you to everyone that has followed along on River's journey so far. All of your prayers, well wishes, and support has been so special and uplifting to me. To know that thousands of you out there, all over the world, were praying for River and continue to do so is absolutely amazing to me and so special. I can't thank everyone enough, this has been such a journey so far and no matter the outcome I know we have a great journey still ahead of us. Keep praying for baby River.

- Adele

#river #medical