Earl’s One-Year Post Trauma Report

December 16th marks the one-year anniversary of Earl’s “alive day.” Most of you are already familiar with the accident that nearly took his life but if you need to refresh your memory, you can read his story HERE.

Several months ago, I noticed Earl was dropping his shoulder and bobbing his head at the walk and trot. He also stood splay-footed in the front projecting his left leg forward. That indicated to me that he was experiencing some shoulder, or perhaps neck, pain. I consulted my vet clinic and a daily dose of Equioxx was prescribed. He seemed improved but was still ouchy some days.

In October, Earl came up very, very lame on his front left leg. To me, the leg seemed to be asleep – kinda like when we sit in a weird position too long and our leg looses functionality and gets the pins and needles sensation. Earl would swing the leg forward instead of lifting and striding straight ahead in a normal gate. At times, he would drag the leg as if it were too heavy.

The vet came out and executed a soundness exam. Given abscesses account for the large majority of lameness issues in horses, that was the natural starting point. Dr. Mansfield took x-rays of his hoof, which were unremarkable. In short, there was no obvious hoof abscess. She then performed a shoulder x-ray that showed some signs of arthritis – that’s no surprise, given he was pinned under the manger on his left side. The trauma sustained during that event certainly could cause arthritis. But was that enough to make Earl so lame? I wasn’t convinced.

In my own opinion, albeit an uneducated one, I felt it was neurologically related. I theorized that the source of the lameness was somewhere in his neck, spinal cord or brain – a byproduct of his trauma.

I had him examined again when the lameness persisted and the vet, Dr. Kathryn Sharbrough, suggested putting him back on vitamin E and Gabapentin. After a couple weeks, he was back to his post-trauma baseline.

Throughout the past year, holistic equine therapist and practitioner, MJ Alyesworth, came and provided various treatments to improve Earl’s circulation, reduce inflammation and encourage cell regeneration. Anything that could be done to improve Earl’s quality of life has been provided.

One of the most difficult challenges has been Earl’s emotional rehabilitation and the post traumatic stress he developed in the wake of accident and recovery. His demeanor changed from easy-going and submissive to angry, domineering and downright violent at times. As someone who has and knows PTSD all too well, I knew right away that he was afflicted by the condition too. If he sees a syringe, he’ll pin his ears and strike out for instance. If he knows you are going to mess with his neck, he’ll body-check you against a fence or wall.

I know for a fact it’s not personal against me or the vet and that’s not even his personality trait to behave so badly. It’s not his fault, He’s just associating the pain from the past and manifesting those fears and emotions through the most basic of physical responses.

Once his neck wound closed and I no longer needed to poke and prod him, I set about trying to rehabilitate him emotionally through positive reinforcement. Though he and I grew closer and solidified our bond once more, he was still depressed and he longed to be back with his pal, Sir Prize. Ultimately Andy and I decided that we would try reintegrating them again.

For a time, it went well… until it didn’t. Even though Earl is nearly 2,000 pounds of solid draft horse and appears fully grown, he is still a baby who loves to romp and play. Sir Prize is the type of horse who’s ALL ABOUT HORSE PLAY and will instigate rigorous activity. But Earl’s delicate health situation made their benign play damn-near hair raising to watch at times. Earl is now once again on his own, but he does share a fence line with his pal.

To keep Earl active, he gets walked in-hand and ponied on trail rides. He also does free lunging exercises with me in the round pen to keep his mind sharp. In all appearances, he seems happy and healthy. But horses are stoic creatures who hide their pain and sometimes the only way to see if they are clinically healthy is to run routine diagnostics.

When Earl was released from the ICU into my care on December 31st last year, Tryon Equine Hospital sent me home with his diagnosis and prognosis. His future was “guarded.” As there’s no crystal ball, Dr. Emelie Setlawke felt as though Earl’s lifespan would be dictated in-part by the narrowing of the cervical canal and subsequent impediment of the spinal cord – amongst other critical factors at that time. You can see his discharge notes below.

Routine exams have been performed over the last year to track Earl’s recovery and two weeks ago, Dr. Kathryn Sharbrough came out and captured x-rays of Earl’s neck, shoulder and legs to see how he’s doing one-year post trauma.

I knew all along that Earl would never be 100% – the doctors warned me of that. The fact he’s made it this long is nothing short of a miracle and for that I’m grateful. So when the x-rays were sent off to an equine radiology specialist for evaluation, I anticipated unfavorable results of his existing conditions but I could never have predicted there would be new issues revealed in the process – some even more scary than previously predicted.

Here’s a Cliff’s Notes version of the radiologist’s findings:

12/29/2021 X-Ray Review: The initial radiographic study done 29 December 2021 indicates the presence of a soft tissue defect at the level of the C1-2 joint.  There is soft tissue swelling associated with the soft tissue defect.

02/24/2022 X-Ray Review: The second study done 24 February 2022 indicates the presence of a periosteal reaction arising from the caudal ventral margin of the wing of C1.  There is soft tissue swelling associated with this periosteal reaction. On this study there is a suggestion of mild subluxation of the atlantoaxial joint with the space of the joint between the atlas and the dens being mildly increased.

12/01/2022 X-Ray Review: On the study dated 1 December 2022 there is subchondral bone roughening of the bone supporting the occipital atlantal joint. Dorsal and ventral aspects of the joint are affected. There is now a visible bony fragment located between the dorsal lamina of C1 and C2. There is now rounding and blurring of the tip of the odontoid process.  The joint between the odontoid process and C1 is still mildly widened.  There is some sclerosis of the odontoid process. There is a mid cervical bony proliferation of the articular facets not previously recognized.  This is felt to likely be C4-5.  The bony proliferation is superimposed over the vertebral canal. There is mild distention of the joint capsule in the left metacarpal phalangeal joint.

Here’s the reviewing doctor’s conclusions….

The initial cervical radiographs indicated the presence of a soft tissue defect and soft tissue swelling associated with the wing of the atlas consistent with a history of a poorly healing wound. Subsequent images suggested the presence of periostitis on the wing of C1 and on the dorsal process of C2.  This is interpreted as representing possible direct trauma or tearing of muscle and ligamentous attachments to the bones at these sites.

The more recent images indicate the presence of an advancing osteoarthritis of the occipital atlantal joint and of the atlantal odontoid joint.  The periosteal reaction on the dorsal process of C2 has not completely regressed but is not overtly active.  A calcification between the lamina of the 2 vertebrae may indicate prior injury of the ligamentum flavum.

Here’s the new and scary bit – The bony proliferation in the area of the articular facets associated with C4-5 seems to have occurred since the previous study indicating proliferation of the articular facets and possible impingement on the vertebral canal.

The soft tissue wound and periostitis associated with the wing of the atlas has apparently healed by the time of the most recent study. Mild degenerative joint disease in the left rear fetlock may be related to the previous traumatic insult.

So what does this mean for Earl? Here’s the doctor’s recommendations…

The cervical radiographs indicate progressive osteoarthritis of the occipital atlantal and mid cervical joints.  Management of these progressive changes with exercise restriction and anti-inflammatories may be necessary if the patient becomes uncomfortable.

Dr. K has suggested steroid injects when and if Earl comes up lame again. As for Andy and me, we plan to stay status quo with Earl, which is to keep him happy and healthy as long possible. Once his quality of life begins to wain, we’ll have to make some tough choices. However, with the C4/C5 impediment diagnosis, we may not be the ones deciding – that may be Mother Nature’s choice.

Depending on Earl’s health in the coming weeks, I will haul him to Aiken for collection so his genetics will be preserved for decades to come. Since the clock is ticking, I thought it best to act now before it becomes too late. If collection fails, at least Earl sired two fillies in April 2022, Pearl and Opal so a piece of him will live on.

Earl is a special horse in more ways than one. He’s a survivor, He’s a miracle, He’s my baby.