articular sesamoid fracture (long and very, very whiney)

["Maryanne Stroud Gabbani" <gabbani@starnet.com.eg>]

This is definitely not one of my better days. For anyone who hasn't listened
to me moan about our lacks here, I'll fill in some gaps. Veterinary medicine
isn't exactly exalted here; most of them are trained to treat chickens and
water buffalo. I've been lucky to find a vet who really loves horses and
loves his work and who tries to learn all the time. But....blood work for
horses is done in human labs, there's no such thing as a clinic in which you
can do any kind of surgery (you have to do your best with the cleanest box
you can find)...basically beyond stitches, we're on our own. Even our
medication is human and bought at a regular pharmacy.  We do have a visiting
American vet from Pennsylvania who comes two or three times a year, Dr. Jack
Leonard, and he helps fill in some of the gaps and consults via email.  Jack
is a great vet and really resourceful.

Well, he just arrived bringing me a heart monitor and so on, and he stopped
by to see Dorika who's been suffering from some intestinal complaint lately.
Blood work and examination would seem to indicate an ulcer...makes sense,
she's the type....so he prescribed Zantac and potassium chloride to sort out
the electrolytes. Unfortunately, a 3 meter endoscope is out of the question,
so we have to guess a bit.  But at the same time he took a look at her right
front fetlock which was looking swollen since we went out for a ride last
Thursday.  We'd gone out in a group and were taking things very easy, much
too easy for Dory's taste, so when we got to a spot where she particularly
likes to go for a bit of a run, she really started acting up, bucking and so
on, inciting her best buddy, a big Dutch warmblood to riot. The upshot was
that they just flat out took off on us.  We got them slowed down in short
order, and when we got home, about 15 minutes later, she was relaxing mowing
the club's grass and I first noticed the swelling. Over the next two days,
it got better with rest but puffy with even the lightest work so she was
being hand walked.
Jack x-rayed the fetlock and the verdict is an articular sesamoid fracture.
Basically, he said she overflexed and ripped the end of the sesamoid right
off. A year ago, he treated her for a suspensory ligament injury on the same
leg and he said that obviously I'd done a VERY good job of healing the
suspensory.  So now what?
Apparently in the US they can do surgery, take off the broken tip and after
a couple of months the suspensory will reattach. Do it on a lot of
racehorses and some of them even race again...tho' I doubt that they win
much, but that's just me being skeptical. Problem is that we don't have any
nice sterile clinic in which to do the surgery and recover and Jack worries
about infection from flies.  He says that with a couple of months of stall
rest (and I estimate about 10 kilos of tranquilisers) the fracture will
heal, but it will be a fibrous join and susceptible to the same injury if
stressed.  She could "be used for every day riding but not anything
competitive".  Wonderful, except that the only work she does is going to
stress that joint because we have nothing to ride on but sand....deep sand,
gravelly sand, packed sand, rocky sand, get the picture?  There is a grass
paddock with a 50 meter diameter....we use that for punishment.  If she
misbehaves all I have to do is whisper "20 meter circles" and I have the
perfectly behaved mare again.  She did a year and a half of dressage after
she almost died of laminitis, and she HATES it.  So even day to day riding
is not exactly unstressful, plus she's a terribly competitive personality,
loves to really move out and be in front in a group.  Not exactly pokey.
Which is one of the reasons I got interested in endurance...it's what she
has always loved doing and she looked to be good at it.  This would have
happened the day that we WEREN'T training, but were going out for a little
"ordinary" ride.
I think to say that I am upset would be the understatement of the year. We
finally have the first endurance race in Egypt planned this spring and I
have no horse, plus I have serious doubts about the quality of life in the
future for my best friend.  My husband, who usually complains that I care
more about my horses than about him, is quite willing to buy me a
horse...God knows they're not in short supply here....but Dory's been with
me for 10 years and you don't just switch like that.  I can't think that far
in advance now.

Well, I certainly whined enough. Does anyone have any experience with this
sort of fracture? Is she likely to be condemned to a life of 20 meter
circles?  Day to day rides in the Sahara are not exactly day to day rides in
Pennsylvania and I told Jack to think hard about that fact for a few days.
Right now his suggestion is to try the most conservative approach, give
stall rest and see what she can do.  We can always do the surgery later, but
it's about 20 times risker here. Yuck.

Maryanne Stroud Gabbani
Cairo, Egypt
gabbani@starnet.com.eg


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