A lot of you (like a lot) have been asking me for a Presto update for a while, and the truth is that he’s been a bit… complicated, and I was waiting until I had some kind of actual resolution before I threw all this word vomit out into the void. Plus I just legit could not handle talking about it while there was still so much uncertainty. In the meantime I’ve been emotionally spiraling pretty freaking hard (did I binge eat like 5 boxes of Little Debbie’s in a week and impulse purchase an OTTB to cope with my variety of emotions? Perhaps. Despair tastes like swiss cake rolls, just FYI.) and if I was rude to anyone who asked about him, I’m sorry, please understand that mentally I’ve been in a very bad dark place about this whole thing for like a month. It’s a lot better now that we know what’s going on and it’s not what I had feared, but y’all know how this stuff goes with horse people. I was replaying the worst case scenario over and over in my mind for weeks.
Anyway, this is gonna be a long one so buckle up. When we last left off with our giant intrepid baby hero (ish) he had a very minor suspensory strain that needed a couple months rest. He was sound, the leg was cold and tight, the prognosis was excellent, we did some shockwave to help things along, and everyone was feeling pretty good about things. His final scan appointment was made to check on things one more time before he got the all clear to return to work, and he showed up to that appointment dead-ass lame… ON THE OTHER LEG. The original injury looked fantastic and was clearly not the issue, but now we had to figure out wtf was going on in the other leg. In all this time he has never been lame, so this was a confusing curveball to say the least.
Flexions and hooftesters didn’t show a whole lot. He was a bit reactive to the hooftesters (well, that kind of borderline where you’re like was that a reaction or has he just lost his patience) so the vet was like well his feet seem a bit sore, lets give him a couple weeks, get some films of his feet, get him reshod, pack his feet, etc. We did the films, which looked pristine, talked to the farrier, and we gave him a couple more weeks.
He went back and was still quite lame on that left front. He was no longer reacting to hooftesters, so we did some scans, took some more films of other parts of the leg, and tried some blocking. Again the scans were clear, his xrays looked great (at this point I have xrays of like both front legs in their entirety and they’re beautiful, which is kind of a surprise in and of itself given his size and his history, so there’s that?), and the only thing that really showed up on the blocking is that when he did the coffin bone the lameness definitely improved. It didn’t go away entirely, but it improved. My options were: inject the coffin bone, give him 10 days, and recheck, or – send him straight to MRI for definitive diagnostics. MRI is obviously hella freaking expensive. I asked the vet how optimistic he felt about the coffin injection being the solution and he was 50/50 on it. I asked if he would want to do the coffin injection either way, and he said yes. So I opted to inject the coffin bone and gave him another week.
Presto went back for his next checkup and showed a slight improvement, but not much. Definitely still lame on the LF. At this point it was clear that an MRI was inevitable if we wanted a definitive answer, but the vet needed to try to pinpoint exactly what parts to order the MRI for. This meant we needed to do more blocking. Again he started at the bottom, but this time Presto got LAMER as the blocks went along. It was very weird, and something the vet said he’s only seen happen a time or two before. He took some films of the elbow just to make sure we weren’t missing a cyst or something wild (I told you I now have films of the legs in their entirety), and at that point we had to call off anything else for the day because now his entire leg was blocked and we still had no clue. Another appointment was made for a week later where we’d start over and try the blocks again.
This time he did respond normally to the blocking, and showed some improvement to blocking at the foot and ankle. The vet ordered the MRI for basically everything below the knee on the LF just to be sure, and the appointment was made for a week later. At this juncture we were all thinking that he likely had a soft tissue injury in the foot (probably DDFT or collateral ligament) which is a big deal and potentially career-altering or even career-ending. I’ve had a not-great experience with a collateral ligament injury in the past, and I was replaying that whole thing over and over in my head on repeat. I was already trying to prepare myself for the fact that his eventing career could well and truly be over before it really even began, and I had to make some kind of peace with it. Plus all of this was costing me a stupid amount of money, which is stressful in and of itself. All of that is why I spiraled pretty hard and did NOT like being asked about Presto in general by anyone outside of my inner circle that already knew all the details. I was trying to cope with the loss of a dream that I feared was coming, and everyone asking for Presto updates on social media was just kind of twisting the knife in deeper (not anyone’s fault, totally understand why people were asking, just explaining why I mostly did not respond or may have been testy about it, depending on the day. Sorry for that. This is the downside to being so public.).
So he went last week for the MRI. Which, cue some panic about the anesthesia and all the risks associated with that, plus the cost, plus the absolute cinderblock of dread that had been sitting in my stomach for weeks at what the images might show us. He got dropped off on Thursday for his MRI on Friday, so I knew I wouldn’t hear anything until Monday. I spent most of the weekend just trying not to think about it to be honest.
On Monday I heard from Megan (poor Megan has had to coordinate all this and take him to all of his 9000 vet appointments plus deal with me and Presto and all of our emotions) that the vet had called her and given her an initial diagnosis, but he had some follow-up questions for the radiologist and was waiting to call me to give me the full rundown until those got answered. So what was the initial diagnosis? A bone bruise to P2… an unusual place for a bone bruise and something the vet had never seen before. NATURALLY. Because Presto. But my initial reaction was immense relief, because at least it wasn’t “tear of xyz soft tissue”, which is what we all had feared.
I finally heard from the vet on Tuesday afternoon, and we had a good discussion. The short version of it is that Presto does indeed have a bone bruise on P2, which is very uncommon (I swear to god if one more vet uses the term “medical mystery” in relation to this horse I am going to freaking lose it). Usually bone bruises occur in P3 (not uncommon in jumpers, eventers, or any horses that take a lot of repeated impact to the ground, especially hard surfaces) or P1 (common in racehorses due to the repeated heavy impact on that area of the leg while galloping). P2 doesn’t take impact from the ground the way that those bones do, so it’s most likely that this one is from an impact or repeated impacts with an actual object directly to the area. We’ll circle back to that. He said that the prognosis was very good for full return to work with no lasting effects, and that the treatment recommendation was 90 additional days of rest, one injection of Osphos, and Osteon for the duration.
I had an immediate “ugh no” feeling at the Osphos recommendation, and questioned the vet about it. He said he understood my concerns but that he had never seen any issues using Osphos within his practice on horses age 4 and up. It can absolutely be a great drug and extremely beneficial (it’s intended to be a navicular treatment but is often used for other bone-related things), but there is a lot of debate surrounding how old a horse should be before they can safely receive it or what things it should be used for. There’s an article here if you want to read some of it for yourself or if you haven’t seen it before. But basically some of the concern is that with young horses it can interrupt the body’s ability to lay down proper bone, and cause damage to still-developing bone at the microscopic level. Obviously this can lead to structural weaknesses later down the line.
Y’all, I struggled with this one. I struggled a lot. The official recommendation is age 4, some vets prefer age 5, others prefer age 6. Presto is a couple months shy of 5. On one hand, it’s just one injection and most of the issues they’ve seen have come from repeated use in 2 and 3yo racehorses. On the other hand, Presto is a very very large, very much still growing young horse, and the thought of potentially causing damage to the bones that are still developing (which are important ones like spine and neck) is just… I can’t do it. It would probably be fine but my gut says no and I’m opting to go with my gut. Even if the risk is very minimal, I don’t think I can sleep at night thinking about it. I’d have nightmares of bones with holes in them.
I talked to several of my friends that I deeply respect, and got opinions on Osphos usage in this case from several other vets. The vets were split pretty much down the middle on whether or not they would use Osphos for this. A couple said absolutely unhesitatingly yes, a couple said absolutely positively not. I think that alone gave me my answer. It’s just too much risk for me to feel comfortable with, and not enough potential benefit. Would the bone bruise heal faster with Osphos? Probably, yes. But at the end of the day I’d rather give him more time off, even if it ends up being significantly more time, and not take the risk. He’s young, there’s no rush.
After talking it over more, in the end we landed on 30 days of Equioxx, Osteon for the duration, plus Magnawave and Theraplate. He’ll get 90 days rest in a small paddock, at which point we’ll do another lameness exam and see where we’re at. He might be good to go by then, or he might need longer. Bone bruises take a while to heal, so it’s hard to say for sure how long it’ll be. The excellent and extremely relieving news is that it should heal just fine.
Now, let’s circle back to how exactly we think this happened. If you know Presto at all, you know that his left front foot is his “chaos” foot, in that it’s the one he prefers to use to create all manner of chaos. He likes to put it on things, in things, and whack stuff with it when he’s bored. He’ll stand on fences with his left foot, he’ll put it in buckets and troughs, he’ll whack stall doors or trailer walls with it if he’s bored or feels like he’s being ignored. So it’s very likely that, in the course of resting for his RF suspensory, he found enough trouble with his other foot to where he actually managed to hurt himself for real. This is not hard for me to imagine at all, I have watched him stand there at horse shows and repeatedly whack that exact spot on his foot into his buckets for no other reason than the fact that chaos is his jam. He’s sneaky about it too… if you yell at him he’ll just wait until you leave and resume his mission. Pain does not seem to deter him.
After talking to a few people about it, I’ve decided to send him up to Michelle’s for his rest time. She has perfectly sized small paddocks there, neighbors right next to him all the time, there’s plenty to look at and to keep him company, and it’s pretty darn hard for him to whack his foot on her fences. Plus she has friends with Magnawave and Theraplate nearby, so it’ll be easy for him to have quick and more frequent access to those therapies. And obviously Michelle knows him really well, so I trust her to look after him. And instead of sending Gemma up to Michelle’s, Gemma can just stay here where she’s already settled in well. Change of plan, but I think it works better and makes sense.
While this whole situation has been stressful enough to take a few years off my life, and expensive enough to legit make me curl up in a ball in the corner (heeeey, anyone want to buy some shirts or a BEMER? Ha. Ha. Hahabutreallytho.) I’m extremely relieved to finally have an answer and have it not be nearly as bad as I had feared. In my head I had resigned myself to Presto only being a dressage horse and while I tried to make peace with that, I’ll admit it was a very hard sell to myself. Please no. Kid wants to run and do jompies, and so do I. With any luck he’ll be back in full swing by summer, assuming we can keep him from committing further chaos-inflicted damage to himself. Fingers crossed.