Wednesday, July 27, 2016

Brego's hoof wall resection

WARNING: Graphic pictures. Do not continue if you don't want to see.

Brego had his hoof wall resection yesterday. According to my vet, it was NBD for Brego (of course, he had good drugs on board and lots of people taking care of him). For me, it was super nerve-wracking - I was so worried they would get in there and find something really bad. Plus, I wasn't there for it, so I had to wait for updates as my vet could send them.

The procedure went off with no problem. He got a special set of custom shoes for support, and then they started removing the hoof wall. As they started digging, they discovered that the entire hoof wall, all the way down, was dead - there was no connection to the laminae underneath. When they got to the top of the hoof, they didn't find a keratoma, but instead a pocket of damaged and infected cells. That area got cleaned and debrided until nothing but healthy cells were left.

The theory that the vets (there were four in attendance) and the farrier have is that years ago, Brego either had some tiny bit of infection or foreign body travel up from the toe all the way to the coronary band, or he had some slight damage to the coronary band. He blew out an abscess in exactly the same spot almost two years before we got him, so this whole thing probably started back then. He then went two years with no abscess, blew one out last spring, then went ANOTHER year with no abscess, then six months, and then it really became a problem this year. But, guy has been walking around with a compromised hoof for quite some time, and he's so stoic that nobody even suspected.

As for recovery, the plan is a little up in the air. He's staying at the hospital for the next week, and right now his hoof is just wrapped with daily bandage changes. We may continue with daily changes once he comes home, or we may put a hoof cast on him. He'll definitely be on stall rest or in a very small paddock for a while, but whether that is weeks or months we won't know until we see how he progresses. Once we are sure the hoof is growing back in normally, the vet wants him to get as much (careful) movement as possible since movement helps the hoof grow. Total time to grow an entirely new hoof is 9-12 months, but he should be able to return to at least light work long before that.

So, please keep your fingers crossed for an uncomplicated recovery and a beautiful, perfect new hoof!

And now the moment you've all been waiting for... the gory pics. Seriously, if you don't do blood, please don't look.

Cutting guides for the resection. You can see just how many abscesses he's blown out in the last few months.

Starting to nip out chunks.

So much hoof to get through!

Here's what it looked like after they nipped out some of it. That black section in the middle is dead hoof that doesn't connect to the laminae underneath. 

After using the nippers, they got to work with the dremel (I would have had to leave for this, gah). You can see how many holes there are down the hoof wall, and how much dead area there is under it all. Poor guy.

Did I mention there was an audience?

Hoof wall resection complete. The white part is laminae.  Note how his coronary band is pushed up and bulging? That's where the root of the problem was.

Post-debridement under the coronary band. You can see that it's no longer bulging and the coronary band looks more even all the way around.

Today I get to FaceTime with my vet during the bandage change so I can see everything up close and personal. Ah, the magic of technology!

62 comments:

  1. Gah that is gnarly... Hope for a speedy recovery for Breggo!

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  2. Gory, but fascinating!! Fingers crossed.

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    1. I agree - gory but completely fascinating.

      Here's wishing Brego a speedy, uninterrupted recovery.
      Grow, Hoof, Grow!

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    2. It's probably less gory and more fascinating when it's not your horse!

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  3. These pictures are actually really interesting! Idk if I'd be able to see it in person, but sending lots of well wishes and a speedy recovery!

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    1. Yeah it's easier to look at not in person. I don't think I could have watched after things started bleeding. Eugh.

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  4. SO COOL AND SO GROSS!! Love it! Best wishes for Brego's recovery!

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    1. I'm more on the gross side than the cool side .

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  5. This is fascinating. I'm sorry that it was such a huge problem but I'm glad that you are solving it!

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    1. Yup, now we just need to grow a whole new hoof!

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  6. I definitely scrolled past all the pictures without looking, so thank you for dropping them in the bottom of the post. Poor Brego! I am hoping he has an uncomplicated, quick and fully recovery!

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    1. Brego is completely unconcerned about all of this - he's totally sound on that foot and is loving all the cookies and attention from the vet staff.

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  7. That is straight up CRAZY!! I hope Brego recovers quickly and well!

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  8. Gnarly! Glad they were able to get such a good start for his road to recovery!

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    1. Yup, now just 9 mos for a new hoof...

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  9. WOW I had never heard of something like this before him and it was just as gross as I imagined it would be. Poor Brego! Hopefully he makes a full recovery and no more abscesses ever!

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  10. And now I'm terrified Penn has the same problem and will need the same solution. Eek. Wishing Brego a quick recovery!

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    1. Nah, Penn seems to be recovered completely so I'm sure he'll be fine. :)

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  11. Stinks to have to go through these kind of things, but the prognosis is looking great! Mind if I share this with my hoof nerd friends?

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  12. Wow, that's simultaneously disturbing and enlightening.

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  13. WOW that is DISGUSTING and COOL

    praying for a speedy uncomplicated recovery for you guys.

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    1. Thanks! Brego needs all the good thoughts!

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  14. Crazy and yet SO INTERESTING! Here's hoping recovery goes to plan!

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    1. Yes, I'd like a really BORING recovery, please.

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  15. Oh man, those pictures are intense. It's incredible to me that horses can survive this sort of thing. I know it's actually not that bad and apparently they don't hurt much, but it looks so bad.

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    1. It looks AWFUL, and yet somehow Brego's totally fine with it. I guess it's a good thing he's stoic?

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    1. He doesn't seem to have noticed that there's a problem, just that there are way more cookies in his life now. He's good with this...

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  17. Ok I had to scroll through the pictures kind of fast. That is super cool but also stomach-twisting. Best wishes for recovery for the big guy!

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    1. Yeah I had to sort of peek at the pics when I first saw them. Half a hoof missing is NOT OKAY.

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  18. Very tidy looking wound. Fingers crossed for a speedy and comfortable recovery for the big guy. :D

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  19. Holy cow! Fingers crossed for an easy recovery!! These pictures are pretty cool.

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  20. Very cool but very gross. Looking forward to tracking his progress, hoping it is speedy!

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  21. Whooooa, that is so fascinating! Thanks for sharing the pictures and figures crossed for an uneventful recovery!

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    1. Yes please, one super boring recovery with a perfect hoof at the end.

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  22. All the above! I was wondering when you would post about Brego. Hoping he adjusts to the rehab routine and enjoys all the extra attention,cookies, carrots etc.

    After your initial post, I googled around for Horse MRI and did find a company that makes and installs the standing hoof/leg MRI equipment. No where in the specs did they detail the limitation of size of hoof (and they were technical for space, equipment, shielding, electrical , utilities, training etc) . Presumably they made a business decision about the majority of the patients (think bell curve) and the outliers just have to do without.

    Do post updates when you can.

    M in NC

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    1. Yup, Brego feet are definitely outliers. Thanks for the healing thoughts!

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  23. Gross but I couldn't not look, although I didn't spend too long on the last two photos. Sending speedy growth & full recovery vibes to Brego

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    1. Yeeeah... blood from a hoof is not okay.

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  24. Wow, that is crazy. It's amazing what you can do to the hoof, and while it looks like "omg awful" -- he can still walk on it and be okay. Miles didn't have a resection, but he did have significant dremel work done last year and that was FREAKY.

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    1. Dremel + hoof makes my stomach flip over. SO WRONG.

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  25. Amazing that he is sound. I can't believe that I am looking at bare laminae in that picture. Knowing what they learned from the procedure, could they have corrected the problem by leaving the dead wall and just working at the top of the hoof? I realize that hindsight is 20/20 and they know what they were going to find under there, but I was curious. That is one hell of a patch of hoof wall to regrow. Although if he puts out as much hoof as Harley, it will be near the ground in close to six months.

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    1. Val, good question. The problem is that the dead wall actually wasn't very well attached, and would have likely ripped off as it grew down without the blood supply from above (gah, that gives me the heebie-jeebies just to say that). Plus it could have provided a place for infection that might have gotten into the laminae or even the coffin bone. In addition, the new wall will grow in much faster because there's no resistance pushing up from the ground. So while it might have looked better to leave the hoof wall attached, removing it should lead to a better (and more certain) overall outcome.

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    2. Very interesting. Thanks!

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    3. Very interesting. Thanks!

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  26. Perfect timing. Both my animals have abscesses this month and the vet is coming again tonight to recheck. I will show him these photos that will certainly make us both feel better. I can handle blood, but this was way worse - when you think of a splinter under a fingernail...

    Please follow up and let us know how the healing regimen goes.

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    1. Abscesses suck - I hope both your critters heal up quickly!

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  27. Omg that is seriously the stuff of nightmares. Kinda cool in a science-y way... But.... Omg no. Hopefully he heals quick!!

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  28. Very cool! So sorry for you and Brego, but thank you for sharing! Give him a cookie and a snuggle for me.

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  29. Yikes, poor guy! Hopefully he heals up quickly and without complications.

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  30. Can we have an update, please?

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