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  1. April 18th It was a rainy day and Dr. Barrow did an abbreviated visual lameness exam of her movement walking in the stall. Then she palpated and lifted back legs, manipulating them to see where she was comfortable/uncomfortable moving them. Reina has fluid at her stifle joints, more on the L than on the R. Some swelling at the pastern on the R hind and outer Suspensory branch is more swollen than the inner. Dr. B believe's R's main issues stem from her 2007(?) injury (possible splits) and is the cause of her "protecting" her L leg. She also feels the issues w/ R's R leg are because of the L leg injury. She has been chronically overloading the R leg to spare her L. Dr. B thinks if we can help R become more comfo9rtable on the L, it could ease the strain on the R if she will use her L leg more. 3 x-rays and Dr. B will email the images to me. High ringbone (mild) present in the R leg, due to the overloading and twisted way she stands and moves. Plan is for a Denoix suspensory shoe on the R to relieve some of the strain on the suspensory and drain/inject hyaluronic acid/steroids/Abx into the L stifle and to consider PRP therapy for the suspensory after I check finances. Same evening, more detail: Reina has a bone spur at the top of her short pastern bone and the rounded end of her long pastern has a corresponding spot of grayness where the bone is receding away from that spur. There is also a gray spot on the underside of one of her sesamoid bones. The 'peaks' of her sesamoids look good and that is actually where Dr. B thought the problem would lie. Because it doesn't, she thinks the lameness issue is a chronic one and not an injury. She thinks the slip in the mud aggravated it and caused the swelling I noticed but that it probably would have continued to this point regardless of the slip. Because Reina has been overloading her R hind, has suspensory branch inflammation and 'sinking' in her pastern, the short and long pastern bones are not aligned correctly, they're being over-flexed and the ringbone area swelling is probably in response to that movement/angle that shouldn't be there. She's hoping that relieving the fluid on the L stifle and shoeing the R hind with the Denoix suspensory shoe will correct the twisted angle she stands on her R hind, relieve strain on the suspensory branches and allow her to stand on her L hind w/ little/no discomfort after treating her stifle and allow her R hind to recover and return to normal, or close-to-normal, function. This will be a long recovery process but Dr. B is optimistic it will make her more comfortable. We also discussed her body condition, which I feel has been poor for more than a year. No fat and obvious lack of muscle, especially along the topline. Dental was done Septermber 2013, so teeth are good. I fed Nutrena pelleted feed top dressed with Rice Bran for added fat. I shared w/ Dr. B that I've seen Reina crib 3-4 times and have physical evidence of chewed 2x4s and a half-circle of tooth depressions on top of a retaining wall pole. She agreed cribbing could contribute to her lack of weight/condition but upon physical exam, she feels pain is probably the main issue. Based on how she stands and moves with the issues shown through exam and xray, the areas of muscle loss are a clear indicator for Dr. B. She did ask me to switch feed to something with higher fat and lower roughage. I told her about R not finishing her pellets in a timely manner and she feels the "complete feeds" fill some horses up and make them not want to finish larger amounts. So, I'll be looking for a feed that meets Dr. B's requirements. Dr. B recommended Seminole or Triple Crown. I think I can find those products w/in 15-20mi of here. April 25th I started transitioning in the Triple Crown feeds into her ration yesterday and she *loves* them! She kept her nose in the feed pan and ate every bit. Her aluminum Denoix shoes (I bought 2 because I don't know how many times, or if, they can be reset) arrived yesterday and I'm waiting for a call-back from my farrier to have it set. I've never had shoes on a horse. We have an appointment on Friday 5/2/2014 @ 2pm to draw fluid off her stifle(s) and inject Hyaluronic Acid, steroids and Abx into the joint capsule to eliminate inflammation. I need to ask if Reina could return to light riding and if our efforts should focus on pain-free or low-discomfort pasture sound instead of light riding. Right now, my goal is to eliminate the pain in her stifles and I want the heat and swelling OUT of her lower R hind leg. It cannot heal with heat/swelling and I think we need to be aggressive about its' treatment. May 2nd I had my farrier put on the Denoix shoe yesterday and Reina had worn it about 24hrs when the vet arrived. Dr. B and I believe we see marked improvement so the shoe is working GREAT in helping to support her leg. The swelling in her R suspensory is down considerably but still enlarged closest to the pastern joint. We also noticed Reina standing with weight on the leg and the fetlock was the most upright I've seen it since I noticed her injury, though the pastern still snaps downward when walking. She doesn't walk with a limp or carefully, she steps right out, so it doesn't appear to concern her. Dr. B says that ligament may never return to its pre-swollen form but that shouldn't be an issue if we've got the original inflammation under control, and it seems the previcox pain pills, diclofenac anti-inflammatory pills and diclofenac gel are working very well, so I am to continue. Dr. B did say she likes to use a good drawing salve but not to use it on top of the diclofenac gel I am currently using. Dr. B injected both stifles with hyaluronic acid, steroid and Abx. The R stifle was pretty good, just a little fluid. The L one wasn't good. There was bloody fluid in the L stifle's joint capsule and that fluid should be clear or pale-yellow. She said this is a sign of cartilage loss and bone-on-bone arthritis from a chronic condition. She said this would have begun a *long* time ago. I'm to call Dr. B w/ an update in 2wks to note yes/no improvement. She stated sometimes this more affordabe treatment works wonderfully and we'll know in a few weeks how well she's feeling. We may need to repeat the injection for the L stifle in another 30-60-90 days. If there is no improvement and/or improvement plateaus, meaning she still won't use her L hind leg to allow the R suspensory to heal, we will consider PRP therapy (harvesting platelets from Reina's blood) to inject directly into the suspensory tendon. PRP usually has excellent results because the anti-inflammatory response is strong and helps create a structure for lesions or tears to rebuild upon. She also discussed IRAP, though that is considerably more expensive and would be a treatment more in-line for the stifle while PRP works best in the tendons and ligaments. I guess we really need to see what Reina needs fixing the most; suspensory or stifle. Reina's possible return to light riding is very questionable at this time.