Saving Nureyev (Cont.)
Updated: Friday, November 9, 2001 3:38 PM
From Cast to Brace
Posted: Friday, November 9, 2001 3:38 PM
In August, after the horse's 14 weeks in casts, Dr. Howard began to worry about the leg becoming useless.
"The longest you hear of a cast being on is seven, eight weeks, maybe 10 weeks in a rare instance," said Dr. Howard. "Usually if a horse has to keep one on past 10 weeks, the thing isn't going to heal. The leg is in a cast and not being used. The bone becomes brittle. They've got to get weight-bearing on it at a maximum of 10 weeks or you're looking for a lot of complications regardless of whether the initial injury heals or not."
Changing the cast was a very painful experience for Nureyev. The leg that had been held firmly in place suddenly was given movement. When Nureyev tried to move it without the cast, the pain was terrible.
"There were a couple of times I barely got the cast back on, even with a lot of medication for the pain," said Dr. Howard.
The veterinarian had decided the cast would have to come off, but was worried about the transition from being firmly supported to having little support on the injured limb. If Dr. Howard tried to use only bandages, there would be movement in the injured area and more pain. With pain comes stress, and with stress comes other problems -- laminitis, colitis, or perhaps another respiratory infection.
"So we decided to go with a brace," said Dr. Howard.
When the last change was made at about 14 weeks, Nureyev was anesthetized and laid down one last time. With the cast removed, Nureyev's right hind leg was measured so a brace could be ready when the last cast was removed.
To obtain a brace, Dr. Howard contacted Mike Farley, who had been involved in brace work with humans before starting work with foals and adult horses. Farley said there was an adult brace in Lexington that was not being used. The brace formerly had been worn by the dam of Miswaki (who stands at Walmac).
The brace was re-fitted by Farley, and blacksmiths Steve Collins and David Nadeau worked with him to make a shoe that would attach to the brace and hold it in place. The brace was put on two weeks after the last cast had been applied. Dr. Howard said it worked very well in place of the cast, and Nureyev had little pain while wearing the brace.
"It gave him just enough support and confidence," said Dr. Howard. "He took right to it and started bearing weight on it. That was another big hurdle to get over."
The brace was kept in place continuously for about four weeks after Nureyev was taken out of his last cast. About the first of September, Dr. Howard gradually started weaning Nureyev from the brace. He was out of the brace for 30 minutes the first day, then an hour the next day. Nureyev was worked up to having the brace off 12 hours at a time. On Sept. 18, the brace was removed permanently.'He Bears Weight and Walks on It Good'
In his final three days of wearing the brace, Nureyev was allowed outside his stall without the sling for the first time. He was walked about 15 feet away from the barn to a grass and dirt area outside his stall. Then on Sept. 19, Nureyev was walked for the first time outside without support for his injured leg.
"He bears weight on it and walks on it good," said Dr. Howard, "but he still has some constant, dull pain, and probably will until that joint is completely fused. Radiographically, it looks like it's about 60 % there.
"Until it fuses, there probably is some little movement in that injured area, which is real painful. He still experiences some pain, but it's not intolerable pain where he has to be medicated or it keeps him from eating or doing what he wants to do."
With the use of casts comes muscle atrophy to an injured limb. Since August, Dr. Howard has been working with Nureyev to try to get the muscle atrophy reversed. He, along with Mimi Porter, has used electro-stimulation, ultrasound, and laser therapy, as well as the hand-walking.
"He's gradually coming back," said Dr. Howard with satisfaction. "When he first came out of the cast, his flexor tendons and his suspensory ligaments felt like strings of spaghetti. You could hardly palpate his suspensory ligament."The Rest of the Story
"It's going to take a lot of time, but we're going in the right direction," surmised Dr. Howard. "Whether or not he'll be used next season, we really haven't decided. If he is used, it will be delayed as far as the regular season goes. But we really can't make that decision right now until we see how good he gets in the next three-to-four weeks."
Under construction at Walmac is a private barn and breeding facility for Nureyev. He is scheduled to remain at Hagyard-Davidson-McGee until the middle of November.
The last phase of Nureyev's convalescence before he could be returned to Walmac will be weaning him away from the sling that he has worn since May.
"Before we move him to the new facility, he needs to be confident in laying down and getting up on his own without the sling," said Dr. Howard. "I'd hate to undo any healing. The joint is pretty stable now, but I just don't want to take that chance. I want to get as much healing in that joint as possible and stabilize it before we try to move him."
Nureyev's new stall at Walmac will be twice as big as his current 18-by-18 foot home because he will not be able to be turned out for a long time. Dr. Howard said Walmac will install an Aquatred (underwater treadmill) to use in rehabilitating Nureyev and will continue with the hand-walking for at least a year.
"I think he's got a pretty good chance (of being breeding sound)," said Dr. Howard. "I think nobody would want to say one way or the other right now. I think a lot of people would be disappointed if he couldn't breed.
"He's beaten the odds, by a long way."Read Nureyev's Obituary
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