Another trip to a clinic

Today I took Louie up for another evaluation at Annabessacook Vet Clinic. I had an appointment with Dr. Lund and a new vet at the clinic, Dr. Boulton. Louie looked pretty worried when I came out of the barn this morning with his halter. Being caught lately has not equalled anything fun for the past week. He was good though and even loaded quite well into the trailer. I arrived a bit early for my appointment so I put Louie in one of the stalls while I waited for Dr. Lund to arrive. Louie immediately got down and rolled in the nice clean shavings in the stall. Now that's a typical mule for you. Dr. Boulton was already at the clinic when I arrived and introduced himself.

Once Dr. Lund arrived, we took Louie into the indoor arena. He was trotted in straight lines and circles and showed consistent lameness of his right rear. He was flexed forward, back and to the side. That produced positive results. Mostly when flexed forward and sideways. So, both vets agreed the next logical step was nerve blocking to isolate where the problem is. There was much discussion on this as Dr. Boulton wanted to start at the hoof and work his way up. If the problem ended up being in the hip, it would cost me $700 to $900 for the nerve blocking not to mention all the needles Louie would have to endure. I just felt so strongly that Jennifer Brooks, the physical therapist, was right on the problem being in the pelvic area that I made the decision to start at the hip. Dr. Boulton didn't seem thrilled with this decision but Dr. Lund seemed to understand my reasoning.

So, a hip block it was. And my oh my what a big needle is used to nerve block the hip. 5 inches long and Louie could not be sedated. So, Louie's hip was shaved in preparation for the block. He's really looking quite interesting with his already shaved hocks and stifles. Louie was given a local. He jumped when the first one was administered but was ok for the second one they did. And when it came time for the big needle for the nerve block, I just held my breath and could hardly watch. Poor boy!!! Louie was SOOOOOOO good about it. His head was up and he swished his tail some but that is all he did. It is just amazing how tolerant this mule is. They don't come any nicer in the disposition department then Louie.

Louie was then put back into a stall to let the block take effect. After about 20 minutes, Louie was taken back out into the arena and trotted again. Lo and behold, I suddenly had a nearly 100% sound mule. Not perfect, but close. His reactions to the flexion tests were also significantly reduced. By this time, Louie was viewing Dr. Bolton with less then warm fuzzy feelings. Though he was only showing his displeasure with worried looks when Dr. Bolton approached him. And Louie was cuddling right up to Dr. Lund, the vet tech and me if I was close enough. He would just lay his head on our chests if he could.

No further diagnostic testing was done at this time. Dr. Boulton's opinion is that Louie has degenerative joint disease. The cause, he said, could be a number of things such as an old injury, OCD, or possibly a malformed hip joint which he compared to hip dysplasia in dogs. Both Dr. Boulton and Dr. Lund said they felt the next best diagnostic option would be to take him back to Myhre Clinic for a nuclear scan. But, this would not likely make any difference in his prognosis or treatment, but only satisfy curiosity. And, at $1200 to $1400, is not an option. With today's visit, I am already up to just about $1000 in vet bills. I asked Dr. Boulton if the problem might be a soft tissue injury such as a torn muscle. He felt quite sure this was not the case. He said that a soft tissue injury did not fit with the progression of Louie's injury where he slowly (over a period of 4 weeks that I noticed) got worse. He felt that if Louie had gotten a soft tissue injury, he would have been very lame immediately, and then slowly gotten better when I stopped riding him. The only other option suggested was to inject his hip joint to see if that helped. But, for right now I'm just going to let Louie rest and recover from his past tough week. I will give him some bute to help reduce his discomfort and any inflammation resulting from all the diagnostic work that has been done with him.

I have to admit my head is just spinning at this point. I am sick with disappointment. I feel so bad for Louie as he is just the sweetest mule on the face of this earth. And while I am grateful that the Myhre clinic took Louie on for the teaching conference, I am disappointed that they did not follow up more with making an effort to diagnose a pelvic problem after Jennifer (the physical therapist) suggested this to them. I know the clinic staff and Dr. Myhre were very busy with the conference and there just was not enough time to follow up with some diagnostic procedures that might have been done. And everyone at the clinic was extremely nice I was treated with respect by everyone as the owner of Louie and made to feel very welcome at the conference and encouraged to be an observer in any part of the conference I might find interesting. I very much appreciated that. But, I do feel a better follow up could have been done. I did pay for the initial exam, radiographs and hock injections. And, as a paying customer, I think a little better follow up could have been done. Louie was already having ultrasounds done on his hocks and stifles. I seems it would not have been too much of a problem to include his pelvic area as there were a number of signs indicating there might be a problem there and it was requested by the physical therapist.

Maybe I just expect too much. With all this push for the nuclear scan, while I fully understand it is a state of the art, top of the line diagnostics tool and can appreciate it's benefits, I sometimes feel like vets are getting so dependant on their high-tech, expensive to the client, diagnostic machines, they are not depending on their own eyes, ears, hands and brains to diagnose these days. I know in my frustration, I'm being a little unfair here but the physical therapist who has had only her own visual and hands on observations to depend on has seemed far more attentive and intuitive to the things that are going on with Louie.