Accident and suspensory injury--Update--fluphenazine not working?

[LuvMyTB]

My horse was involved in a freak accident yesterday that involved him and his pasture mate getting spooked and running through/jumping the fence. He ripped open his left front leg just below the knee. Knicked an artery so it was bleeding like crazy.

Cannon bone is nicked but not fractured, thank god. Outside splint bone is broken clean through but not displaced. Inside splint bone is fractured but not displaced. The worst part is that the suspensory is torn. From what we could see, it appeared to be a pretty small tear, but we won't know anything definitive until we ultrasound in 2 weeks.

He is being pumped full of antiobiotics and painkillers, as well as fluphenazine to help keep him quiet while he's on stall rest. He's got a buddy staying inside with him but.....he is completely miserable. My poor boy. :(

If you could spare any jingles, we would sure appreciate it. I had to put my mare down 6 months ago and was just getting started with this guy.

Also--if you have any good suspensory injury resources, please let me know. I have not dealt with suspensory problems before and I really don't know what to expect, so I'm trying to learn as much as I can as fast as possible.

Thanks.

[atr]

Oh, Ouch. Poor horse, that's a lot of damage.

Poor you--that's going to be a lot of nursing care over the long haul.

So is the suspensory visibly torn? Like it's open and you can see a nick in it?

I think you may be needing to research the wonders of stem cell therapy. But yes, you are pretty blind until things settle down a bit and you can ultrasound.

Jingles for a relatively uneventful recovery and good outcome.

I've kept myself sane for the last year of dealing with my horse's suspensory problem by regarding it as being a "bonding experience." As Bronco Boy is now feeling good enough to try and unload me, I think the experience may not have been mutual!

[LuvMyTB]

So is the suspensory visibly torn? Like it's open and you can see a nick in it?

Yes. The vet said that, just from looking at it, she was guesstimating maybe a 5% tear? Not sure what that means, exactly.

[Zu Zu]

Jingles for your gelding and for you ~ how horrible ! Jingle Jingle Jingle & AO ~ AO ~ AO Always Optimistic !

[foundationmare]

So sorry that your guy sustained such a nasty injury. I'm jingling like mad for a full recovery, albeit a long-term one. Please keep us posted.

[FatDinah]

25 years ago, I had a saddlebred mare slip on ice and slice a hind leg on a metal drainage ditch (still have nightmares).
She severed the suspensory. But she recovered and basically other muscles compensated.
My vet said then that the keys to her recovery were keeping the wound clean and wrapped a long time, I hosed her daily and rewrapped for like a month, and hand walking her as much as she could, which we did in the barn aisle as it was winter.
Good luck!!
I hope this is comforting. And hope more options out there now for vet care.

[kwilhide]

My guy is back to work after about 14+ month rehab period. It wasn't a bad tear, but he and stall rest don't mesh. I had to (and wanted to) keep him turned out, so I am sure that contributed to slower healing when he did his high jinx, but I decided that he needed to heal 'being him' or we would be looking at reinjury. I tried drugs, but then he colicked and I said 'that's it' and turned him out in a little paddock, plus he had a day stall inside and a night stall outside(in summer) which really seemed to help him. He was actually calmer without drugs. Reserpine makes some horses seemingly calm but then erratic, and that's him. Having really good quality alfalfa hay in the outside paddock when first turned out also worked to distract him.

Anyway, I walked him also everyday, in addition to him walking himself, which he did, he was always strolling around. I did ACP (PRP) twice, and after about a year, he was still 'off'. I went to Doc Riddle in MD who is known for suspensory treatment, although not sure what exactly it is he does (it's a secret). In addition, I had the farrier out frequently to keep his angles correct.

After Doc's treatment, my horse came 100% sound. I wish I had gone there sooner. We are now WTC, and back to our dressage training. I have taken it very slowly, and it is now 17 months later, and he is doing really well. I am still building up his canter. I also do regular massage and chiro - it helps alot. The chiro and Doc Riddle both said to do everything you can to encourage them off of their front end, so I even added hind shoes.

Stall rest is not for everyone, and from what I have seen, the regular excercise actually has a better result. You need to stress it in a controlled manner in order to get the best healing.

Of course with his other injuries you have to manage all of it to get him to start moving, but as long as he can be handwalked, I think you have a pretty good prognosis with a 5% tear, but definitely look at PRP or stem cell.

I also kept him wrapped while outside, and iced after hand walking. And used a back on track wrap - even today, if I see a little thickening and use a back on track, it takes it right down.

[FineAlready]

I'm so sorry this happened to your horse! Those injuries sound absolutely awful. As for the suspensory, I am rehabbing a strained suspensory now. In my case, shockwave made a HUGE difference (as in, no healing - no healing - shockwave - suspensory looks great and horse is sound). I'm not sure if shockwave is as recommended for tears as it is for strains, though. You may want to look into stem cell or PRP, which I think are more frequently used for tears. I do have a friend whose horse had "complications" with stem cell, though, so I'd research that one a bit. Not sure the nature of the complications, exactly.

The name of the game with suspensory injuries is patience. They take FOREVER to heal and the horse typically has to be kept on stall rest the entire time with short hand walks only. AND, you usually can't start turning the horse out until it is fully rehabbed under saddle. So, of course, that puts you in the position of getting on a super hot horse that can't be turned out and is on a very strict rehab program (i.e., walk only, then trot two long sides, etc.).

Anyway, I will say that some of the treatments for suspensory injuries are best if used very soon after the injury. I'd find the best possible lameness specialist in your area and go over all of your options as soon as possible.

Again, I am very sorry that this happened to you and your horse. Not a good way to go into the new year at all. :(

[marta]

my mare has suspensory issues in both hinds and i've read up a lot on this subject.
and front suspensories are much easier to heal.
sounds like he's being well taken care of. the rehab may take a little while but he should be fine.

just one more comment now that i've read the above post. there are two schools of thought on the turnout during rehab. some folks still believe that keeping a horse in a stall is the best way to go, however, others believe that turnout is beneficial b/c the new scar tissue has an opportunity to form while the horse is moving naturally and not standing in a stall. so discuss with your vet, read up on it, consider your horse's personality and then decide.

jingles for a smooth rehab.

[JennieRose]

Ouch! Jingles from the UK.

[LuvMyTB]

Thank you for all the jingles & stories of good outcomes--it really helps!

I do not think the fluphenazine is working on him. I expected by now to see a kind of doped-up, spaced-out horse, but I'm not. He gets upset by horses going in/out of the barn, paces, screams, etc. Every so often he takes a bad step on the injured leg and knuckles over, which makes me want to throw up.

We are keeping horses in with him but it's not making a major difference. We've had a hard time getting some of his oral meds in him because he's putting up quite a fight--something I didn't think he'd do with the tranquilizer in his system.

I called my vet today, but it being a holiday, the entire practice was off and I spoke to an on-call vet with a different practice. He agreed that the fluphenazine should have kicked in by now, but without knowing how much my horse was given etc. there wasn't anything he could do. His only suggestion was to keep all the horses in all day--not possible at a boarding barn.

I will try and reach my vet again tomorrow, but my question is--can she give him anything else now that the fluphenazine is in his system? Reserpine? Could we Ace him daily?

The barn manager is amazing and willing to do anythiing to help me keep him quiet--but I think he needs more chemical assistance. Especially since it appears that most suspensory injuries require many months of stall rest--he can't spend the next 3-4 months pacing like this.

Ugh. I think *I* am going to need some tranq to make it through this!

[Fharoah]

I am sorry the fluphenazine isn't working for you. Stall rest is really hard for some horses mine is one of them. He is currently on stall rest since Augest and I have used twice daily ace at 6.5ml although with oral administration the results are inconsistent. I would have liked a long term sedative to work but a year ago my gelding was on reserpine with no results, I had tried every kind of calming supplement and my vets feel the rare side effects of fluphenazine are to scarry and don't use it.

My horse curently has a stall that is 12x20 while his pastern is fusing. He has a very quiet buddy who is also in a 12x20 right beside him. His stall looks like this http://picasaweb.google.com/kayladrummond/Stall?authkey=Gv1sRgCIuJlPOvya7GTQ#541847970158371 4146 He also gets vitamin supplement with 6.5ml of acepromazine sprinkled on it and a 1/3 cup soaked beet pulp and flax. My horse is allot happier to have a bit of outside which you can see in the video he gets clasterphobic in just his 12x12 but does try and canter his area sometimes I am not able to make his stall any smaller. I find with ace you need to give allot (especially if oral) for me 1-2ml was recommended but didn't touch him but 5ml was very helpful but I increased 1/4cc each week.

Best Wishes!

[Roxx]

So sorry to hear about your horse...stall rest is so hard and both horse and owner :(
My mare was on fluphenazine (0.6mls) for only 1 month as I moved her to a new boarding barn and she was getting antsy in her new stall. Obviously double check with your vet but mine said I could use ACE when I needed it, which for me was when she was under saddle. She didn't need it for hand walking but every horse is different. Good luck

[FineAlready]

I didn't want to say anything when you originally posted, since it was clear that the Fluphenazine had already been given, but the Fluphenazine actually made my horse much worse when on stall rest (he's a TB). If that is what is happening in your case, I don't think there is anything you can do to counteract it. You just have to wait for it to wear off. It takes about 30 days, but it is a drug that builds over time, so it might get worse before it gets better. FWIW, I will never use it again. Given that it is a human anti-psychotic and there really isn't a true "protocol" for use in horses, I suppose it is not surprising that it creates an adverse reaction in some horses.

However, multiple vets have told me that you can Ace as necessary, even when on Fluphenazine. Obviously ask your vet though! I will note that Ace and Fluphenazine are in the same "family" of drugs and I've noticed that my horse is mildly sedated by Ace for maybe 15 minutes, followed by several hours (or sometimes longer) of being more amped up than he originally was. It's bizarre. But, I guess just like people, some horses just react differently to drugs. And don't get me wrong - I'm certainly NOT anti-sedation. I WISH Fluphenazine would have worked for me, and I WISH my horse responded better to Ace (heh heh heh, especially now that I have to actually get on the back of his little maniac self to "walk").

Anyway, good luck to you. Hopefully, you will find a solution to help your boy keep calm while healing. After worrying and fretting for months and months, I finally just stopped trying to find things to calm my horse down in his stall. What do you know, he settled in and calmed down on his own. All he gets now is SmartTendon and TractGuard, so no sedatives. Well, we just started using Ace again for riding on the 2-3 days a week that I get on him, but frankly, I'm not sure it's working...

[Watermark Farm]

ACE!!!! Talk to your vet about using some ace 2x/day to take the edge off until he settles in to stall rest. Fluphenazine doesn't work on all horses, but the problem with it is that if it doesn't work, you have to wait before you switch to something else (at least that's what my vet said, and it's why he encouraged me to use reserpine daily w/my most recent layup).

I've had horses do great on fluphenazine, and I've had one horse that was not helped by it.

Where is the suspensory torn? What part of the ligament? Roughly, it's like a sling that extends under the fetlock and attaches to either side. It literally suspends the fetlock, and it's a super tough piece of equipment! I would think that 5% should have a decent prognosis. Suspensory injuries are a big deal, but horses do come back from them all the time. Layup can be a long, hard deal though. I'd look into shockwave and other things like that.

You will get great info/advice here. COTH folks are very suspensory experienced! Jingles to you --- read up, ask questions, and know that there are different ways to handle injury layups. Make sure you are working with a vet who is VERY experienced in this kind of thing. Also do research total stall rest versus small paddock rest. There are various opinions on the benefits of confining a horse extensively. For example, last year my horse fractured his pelvis. I was advised to high-line (tie) him for 90 days in a box stall, ie, no laying down whatsoever. I knew this would not work for my TB. I took the chance he would displace the fracture getting up/down and against veterinary advice provided him with a 12x12 stall with 12x36 paddock and lots of drugs. I was prepared to lose him. He survived it (although nearly went nuts at the end of 9 months) and made a full recovery. I would have euth'd him had my only choice been total confinement --- he was just not a candidate for it as he would have killed himself with time, no matter what. Sometimes you have to get creative and accept the risks.

[LuvMyTB]

Watermark--the suspensory appears to be torn on the outside of the left front, just below the knee. Ultrasound next week will tell us more specifics, but as his leg was ripped open all the way to the bone, we were able to actually see the suspensory and where it was torn.


Had the situation been less critical, I would have asked more specifics about the sedation before it was given. However, at the time, we were very worried that the cannon bone was broken (rads were taken but not yet read) and we were trying to get him sutured, x-rayed and stalled as quickly as possible. I wish I would have thought to request the reserpine.

I spoke with a vet from my practice today and she did say that I could Ace him every 6 hours if necessary--2cc's IM or 5cc's orally. Good to know--we may start doing this 30 minutes before turn-out and turn-in every day. However, I am going to wait until Monday to speak to the treating vet before doing anything else.

The good news is that we are FINALLY done with the penicillin, naquazone, bute, and enroflaxcin (sp?). He was getting really obnoxious about any and all methods of administering his medications and we're all relieved that's behind us.

Thanks again for all the help, guys. I am sure I will be starting a lot of threads in the coming months as we go through the rehab process!

[Peggy]

A rehab horse at my barn was put on fluphen. His eye got softer after about two days and he was less reactive. He certainly wasn't dopey or angelic. But it mellowed him out enough that no one else got injured, they were actually able to do the limited u/s work he was allowed to do (he was starting to trot at this point), and he got better. Probably a combo of actually getting worked to burn off some adrenalin and the drugs. The vet had them giving him ace in addition when he went out. Since the IM/IV ace hadn't been doing much before the fluphen (hence its administration), the vet gave the owner oral ace tablets b/c she said some horses respond better to that.

Good luck and jingles to the OP!

[redleaflady]

Look into Ultrasound and LED light therapy. I used that with a 33% tendon laceration. She is sound and competing and has not had any further problems. Ultrasound may not be the best though with the fractures. It will heal them faster but can be painful over the fracture site. But ultrasound will help the ligament heal with more flexibility than it would otherwise. Good Luck.