Monday, June 25, 2012

Progress Report: GG and Cora

ONE WEEK LATER
I returned to Cora's barn a week later to check on the progress of the lumbar swelling and to find out how GG's RP saddle trial was going. I arrived before the vet, so was able to check Cora's back and get a full report from GG. After a week of riding in the ReactorPanel saddle, the swelling on the loin was considerably reduced but still present. GG reported that Cora had exhibited saddling anxiety and wouldn't stand still under her old saddle, but with the RP, she was calm for saddling and mounting; it was a night and day difference. The best part? GG said that she could feel how happy and relaxed Cora was during their rides on the rugged trails around the ranch. 


THE DIAGNOSIS
Dr. Isbell arrived with her portable ultrasound equipment, which is state-of-the-art and very high resolution. She was able to see that the damage appears to be a fracture at the anterior tip of L1, the first lumbar vertebra. She conjectured that the crunchy area was the result of fibrous tissue in the area which was the body's attempt to heal and stabilize the area. Because this is an area of the back that is quite mobile, full healing is unlikely. However, it is quite likely that Cora will remain usable for her current job: a trail horse. She is in very little pain at present, and seems to have good mobility and soundness. As a follow-up, an x-ray will be performed to confirm the diagnosis. 

PHOTO JOURNAL


This shot shows the swelling on Cora's spine after it was shaved for the ultrasound. It was described by the vet this way:  


"Soft tissue lump on right side of L1 that is mildly to moderately sensitive and about 2-3 cm in diameter."
T   This photo shows a "basic" gullet on Cora; you may be able to see the raised area, which crosses her spine diagonally from left to right. While this gullet is adequate for the width of her spine and spinous processes under normal conditions, she will need a wider gullet to be sure to clear the injured area. Why? When turning, the inner edge of the panel will move closer to the spine and we want to avoid putting pressure on the swollen area at all times.






With a ReactorPanel, it takes just a few seconds to adjust the rear of the panels and to set them farther apart. This widened gullet ought to be sufficient to clear the damaged area, but GG will need to test-ride the saddle to be sure. If this is not enough clearance, the next step will be to add a thick wool felt pad, and then to cut a large and symmetrical oval in the center/rear of the pad to be absolutely certain that there is no pressure at all on the injury.

NEXT STEPS
GG has switched to the ReactorPanel Endurance model to see if the external thigh block may be enough of an incentive to switch her from Western to English. Meanwhile, she's continuing to ride Cora and to monitor her back while waiting for the confirmation of the diagnosis via xray. If there are any unusual twists to this story or profound new information, I will update this blog then. Otherwise - until next time!

Carmi

Friday, June 22, 2012

Case Study: Saddle fit related swelling on the spine at the thoracic-lumbar junction


GG and Cora
Saddle-related swelling on the spine

After spending nearly fifteen years exploring the horse’s back, it’s unusual to see pathology that I’ve never seen before. Last Saturday, that’s exactly what happened. Here's the entire story...so far.

History
A little more than a week ago, I received a call from a local rider, GG. She recently acquired a Tennessee Walker mare, Cora. The mare came with a raised area on her back but it didn’t seem painful, nor did it concern the veterinarian who conducted the pre-purchase examination.Next, GG spent quite a bit of money on a really good western saddle with the intention of keeping Cora as comfortable as possible. Thinking all was well, GG was quite distressed when she finished a trail ride and removed her supposedly well-fitting saddle to find a contusion on Cora’s spine, right on top of the existing lump. She evaluated the area and concluded that the screws in her flex-tree saddle had pressed directly onto the spine, creating the damage. She asked me to come determine why this saddle didn’t fit, and what Cora might need instead. 


Initial Examination 
I arrived at the barn to meet Cora, a petite mare with a visible swelling at the thoracic-lumbar junction. This is the spot on the loin of the horse where the thoracic vertebrae end and the lumbar vertebrae begin. Pressing on the bump gave the sense of something popping, as though there were nitrogen bubbles in the tissue. The feeling is similar to the crunch of compromised cartilage that can be felt in many aging human knee joints. The mare was not particularly sensitive to palpation of and immediately around the swelling, but did have a mild painful reaction in the Latissiumus Dorsi, or the long back muscles, on the left side of her body. I have never seen a presentation like this before, and had no idea if the problem was primarily muscular or primarily skeletal. Because she did not seem to be in significant pain, we proceeded with the fitting.

Cora’s Saddle Fit Problems
When we examined Cora’s saddle, we found that the tree angles were a poor fit for her shoulders; the tree was too long for her short back, and it was too flat from front to back, resulting in bridging. We were able to find a substitute saddle owned by one of GG’s friends which addressed all of these issues: the tree angles were correct and so there was room for the shoulder; the tree had more rock and so followed the curves of Cora’s back, and the saddle was shorter and so did not extend back past the last true rib.

A Good Pressure Test: Not the whole answer!
We saddled Cora with the test saddle and our Port Lewis Impression Pad to conduct a pressure test of the borrowed saddle. GG rode for the 20 minutes required for a test and I had the opportunity to watch Cora move. She seemed to be a rather tense member of the Walker family, keeping her head fairly high and neck and back tense while she was ridden. She was extremely forward, sometimes even frantic it seemed, scrambling a bit as she rounded corners of the small arena. GG is a balanced and confident rider. The pressure test showed a very even distribution of weight under the saddle with no obvious pressure points.

After unsaddling Cora, I checked the swelling on her back and found that the “crunchy” area, formerly quite small and fixed, was now quite diffuse. The nitrogen bubble effect could now be felt while palpating an area 2” in any direction around the swollen area. It appeared that the pressure of the saddle pad directly on the swelling had caused this effect and we contemplated cutting a large hole in the saddle pad so that were would no longer be pressure directly on the spine. However, before we could do this…

The ReactorPanel Difference
…we decided to try a ReactorPanel saddle on Cora. Though GG has only ridden western in the past, she was curious about our saddles and how they work. Right away GG was intrigued by my ability to create a wide gullet in the rear of the saddle so that I could avoid putting pressure near the damaged area. She got on for a test ride, and after feeling Cora stretch her neck out, relax her back and go extremely quietly and calmly, GG had to give me a hug on my way out of the barn. The transformation was amazing!

Current Status
At present, we do not have a diagnosis for Cora’s back problem. Because it’s so unusual,  I’ve requested to remain involved during the process of exploration with local veterinarians. I also reached out to my friend and brilliant diagnostician, Dr. Kerry Ridgway DVM who provided excellent advice (if anyone reading this would like to know more about the back-and-forth discussions, please email me).

GG has been riding in the ReactorPanel VSD Summit, and is very pleased to report that the swelling on Cora’s back has gone down quite a bit and is, in fact, the best it’s been since she got the horse. She has written me several very touching emails detailing their progress together. While she knows that she has more research and work to do, she clearly expressed her happiness and gratitude for being able to improve her horse’s quality of life through better saddle fit.

Next Steps
I will be attending the meeting with local vet Dr. Diane Isbell for an ultrasound examination tomorrow afternoon, and will keep monitoring GG and her progress with her RP saddle trial. I’ll update this blog with the results of both events!