Medial Collateral Ligament Damage/EMS..HELP

[ElleH0506]

I have a very loyal pony. He is a real star, competed up to Elementary level dressage and had just started Medium work with easy 70% tests. He was diagnosed with EMS/IR (insulin resistance) 9 weeks ago. He was only footy to start with and then gradually got worse. He was treated with Metformin (28 tablets daily) and his levels almost halved to 229. He was still footy so we were advised to try steel heart bars. I want to call it a mistake by having the heart bars put on but we would never know the real depth of the problem if we hadn't. Pony was crippled lame unable to walk so on and so forth. Local vet took more X-rays and had them sent to another farrier. Note; this pony never displayed laminitic symptoms as the EMS should suggest he never once had a sensitivity to hoof testers. Referred to a fantastic equine hospital for an MRI. His results showed bilateral damage to Medial Collateral Ligament. Laminae was clear and no signs of laminitis. He received Stem Cell Therapy and so the 'rehab' process begins. I have been advised box rest for 6 weeks and then a rehabilitation program to be put in to place. The rehabilitation process starts with hand walking in straight lines. I tried the hand walking before during the EMS diagnosis stage and trying to keep one leg on the ground was a challenge in itself. I'm frightened that all the rest work that we do now could be undone in an instant if I keep him cooped up for a further 6-8 weeks. I have been given a few tubes of sedalin which will work while he is having it, but what about the day when I have to try him with out sedalin? Part of me wants to put him in to his 'normal' daily routine of stabled at night and field in the day because psychologically this will prevent the 'explosion' period. My Vets think that box rest is the best option which I agree is beneficial for the resting of ligaments. However, I just can't see the benefit of standing in the stable and then doing physical work (leg flailing) to standing in the stable again. We have also had to change farrier which was heart breaking after he has shod my horses for 10 years but I think things had slipped and the foot balance just wasn't right. He is also not remedial which is what we need. Also, could his insulin levels have been raised by the amount of pain he was in from the ligament damage? Does he really have EMS? It's a mind field on the best thing to do! Help!

 

[be positive]

Vets don't seem to get how tricky it can be to walk a fresh horse in hand every day, you often risk further damage to the injury, not to mention yourself, I had two rehabs a few years ago both were high energy types that became explosive walking especially if you went onto a soft surface, they were not too bad on the concrete yard.
They were supposed to walk out then be gradually introduced to a small pen turnout which in winter was not going to be straightforward so the first, a racehorse who had done a tendon, was walked several times daily to help condition him as much as possible then he was sedated and turned out 24/7 for 6 months, he did flip but it was only minor, he settled down quickly with his new friends and the leg stood up well, he is still fine and has raced since.
The second I knew would not stay in a pen, he also would not stay alone so we went with much the same process, he walked every day, sedated with sedalin, I got him jogging in hand and having kept him in a week or so longer than initially recommended he was sedated by the vet and turned away into a small paddock that had loads of grass with a friend and he stayed there for a month before he was brought quietly back into his ridden rehab work, the injured leg is fine.

I think you must discuss your options with your vet, point out how difficult the walking is and see if you can come up with a plan that will keep you safe, a tiny pen is an option if he will stay in it without spinning around and doing more harm, if you do walk him use sedalin every day and when he is able to go out for the first few times, also make sure he goes out hungry and there is plenty to eat in the penned area.

As for the EMS I have no idea but it may well be the levels were raised due to the pain, I would continue to keep him on a suitable diet as it will do more good than harm to be on a low sugar/ starch diet and when he is able to work having him slim will be beneficial to his recovery.