Tuesday, January 22, 2013

Moving Zeffie

2007 was pretty much our last hurrah with showing. He won his division at Rochester State Fair in gymkhana. It wasn't much but it felt like such a huge accomplishment! I moved him to another barn the winter of 2007. I rode there in fits and starts for a few years before he moved to Virginia. We went to the New York State Breeder's Show with the show team from the barn. I did not compete but I brought Z along to expose him to new stuff. We got to ride in the Coliseum on the fairgrounds and I was so tempted to sneak him onto the racetrack and have a gallop but all the gates were locked. He behaved himself each time I rode him and in his stall next to his buddies. But the CRPS reared its ugly head again and after the first night of sleeping on a cot in the cold trailer my gremlin had taken over. I had to leave early but I still count it a fun experience. Back home on the farm I rode Z everywhere. I always loved trail riding the most. I took him to the beach with a couple of other horses a few years before and there was about a 2 mile stretch of pristine beach to gallop on and he took off like he was shot from a cannon. We met with another TB on the beach and we had to race. Z was younger than the other guy so we gave them a head start, but as soon as I let him go he over took the other horse in about 3 strides. I also took him to a few hunter paces. We got penalized for going too fast, but we had a blast. He did jump some of the lower jumps that were available but I never jumped him at any height. We had a dirt road off the main road that we could gallop on too. So some days I rode in the ring, and some days we took a quiet walk down the road. He would go out alone or with other horses without a problem. He is so versatile. He could do a pleasure show one day and a gymkhana show the next. He seemed to know when the Western saddle went on he was going to be able to run. He is and always was my motivation to keep pushing through the bad days and trying that new therapy or injection or nerve block because it gave me more time to be with Z. During the really bad years my dad would drive me out to see Z and he has grudgingly admitted that I always seemed more "alive" after a few hours at the barn. During those bad years I was on every medication conceivable. I was drugged out on Fentanyl patches and took so many other oral medications that I felt like a walking zombie. I was still in pain. But I didn't care. Looking back 2008-2009 were probably my lowest times. I was depressed, drugged, angry and frustrated that the treatments weren't working. I remember going to the barn and spending one particular day in a daze. I thought about giving up, selling Zephyr and going on disability. I knew if I sold the horse that would be it. I would give up the fight and roll over and just accept that I won't get any better. I had also been through 3 back surgeries from a herniated disk, was having uncontrollable leg tremors that put me in the hospital at one point. I was bringing my cat in from the screened in porch when my leg started spasming and I lost my balance and put my hand through the glass portion of the door. I cut my hand and elbow enough to get stitches. In November of 2009 I lost my job. The doctors had written me off as a lost cause. The cold was too much to bear. I went to see Z one more time and then I drove to North Carolina to live with my parents again.

Thursday, November 29, 2012

"You have CRPS"

I thought I would go insane with the pain. Each time I went back to the surgeon at MGH though he said it was normal. A few months later he wasn't so sure. My doc back in NH was the one who diagnosed it and sent me to a pain clinic. My gremlin did not appear like other CRPS sufferers. I had the extreme sensitivity to touch, the crazy amount of crushing, burning, ice pick jabby pain but I had no skin/temp changes at first or anything to really suggest it wasn't a different peripheral neuropathy. The pain docs were further stymied when they tried a series of stellate ganglion blocks that *should* have helped but I only got temporary relief. It wasn't until about 6 months after my surgery that other changes started happening that led to the eventual words no one wants to hear. "You have CRPS". Before that moment those letters meant nothing to me. It was a boogeyman that physical therapists threatened you with to do your exercises. When I asked what that was the usual response was "you don't want it." Why would I look it up? I did my exercises, even after the last surgery I tried to desensitize the scar like I was taught but it was way too painful to touch. I went through a series of braces to wear and finally found one that although it hurt like hell to get on, once it was on things were okay. It was similar to the one I had in 2003-04 but a bit more high end. Wind couldn't get through it, and it stayed in one spot so it didn't rub. I modified it to be able to put it on like a vest and I added straps for stability. I was on a ton of meds, none of them working except to drive me insane. Nothing touched the pain. Zephyr's 6 year old birthday came and went. With a series of nerve blocks and PT after to work on the numbed arm I had some relief. By September I had another job working at a cat only vet clinic. I loved it. The people were great and I learned a lot. The pain was manageable with narcotics but since I had been on them so long I was able to get some pain relief and still be able to function with taking them. I was still in PT. I had a "numbing cream" to put on the area around the sensitivity with the hope it would trickle into the sensitive area. It worked okay. I started riding again. Got a few lessons, got to know my horse a little more. Our bond strengthened as I worked on the ground and in the saddle with him. Rex came to visit a few times. Things started getting more serious with us. I figured if the guy is willing to fly up to freezing cold NH when he is used to Florida and hotter climates he is worth a second look-see. We enjoyed each other's company so much but it was still a long distance thing. Still is actually..
I started helping out with the farm's Therapeutic Riding Program and came to the realization that there are MUCH worse off people than me out there. I constantly researched ways to either get rid of or at least suppress my little gremlin. Because he was little at this point. My PT referred me to a physiatrist clinic in addition to the one I was still going to. They helped even more with trigger point injections. I was eventually referred to a different PT; one that specialized in CRPS. At that point I was getting ticked off with being moved around to so many different places but I am glad I got treatment there. I still call her sometimes with questions. Time went on and I got "used to" my little gremlin. I tried to keep him a Gizmo and not let him turn into a Spike but sometimes it happened anyway. I used my basic training trick of locking pain away all the time. I refused to let CRPS rule my life. I was told repeatedly "use it or lose it". Its a lot easier to say those words if you've never experienced that kind of pain before. People told me to sell Zephyr. It wasn't fair to him that I could ride sporadically and there were days I was in too much pain to go see him. Right across the street but he might as well have been on the moon those days. I couldn't sell him. I kept telling myself things will get better. They have to. That brace was my lifesaver. My shoulder didn't hurt as much in it. By 2007 I was riding regularly and I was gearing up for the 2007 show season with Z. He had a passion for barrel racing and gymkhana games. He learned a lot of balance technique and lead changes going around barrels and weaving poles. He did not like the English pleasure shows as much. Neither did I. I had to dress up for those. And that was painful.

Shoulder reconstruction - Mass General

So I lasted a few months in my brand new job, about six total, and was out on long-term disability for you guessed it, shoulder instability. Before that I felt great. I was riding, playing ice hockey again, getting back to normal. Finding an ortho surgeon after being so long in the military was daunting, especially with my experience with a well-known Massachusetts hospital that missed a complete subscap rupture on an MRI. But I did find one and followed up with him as my shoulder got progressively worse and worse. He decided to send me to the big guns at Harvard Shoulder Service, affiliated with Massachusetts General Hospital. The doc there was going to fix the damn thing once and for all with a complex revision reconstruction called a Latarjet procedure. He was also toying with the idea of a tendon transfer but thankfully my subscap was still attached and did not need it. But with all the instability over the years the ligaments and tendons in my shoulder were stretched and lax. What he did was take my coracoid process and flip that upside down so it would form a bone block so my shoulder would no longer be able to dislocate. He also did yet another revision capsular shift. In addition to the Cryocuff he had done a nerve block so I felt blissfully pain free when I woke up. Until the meds wore off and then it hurt alot. And that is when my life changed. I didn't have a name for it yet and wouldn't for a couple of months yet but the intense burning pain was new and immediate and the doctor said it was normal. At first with the extensive surgery I had I tended to agree with him. It was definitely more painful than all the other surgeries combined that I had over the years but who was I to argue? I would learn to argue later, but by then my gremlin had appeared and bought prime real estate in my shoulder.

Background: Subscapularis tendon repair -West Point

Well I didn't have enough time to be scared of another surgery because between my consult and pre-op appointments I think I had a week to get everything approved by my command. My surgeon was.. is? amazing. Excellent surgeon but he also did a fantastic job of telling me exactly what he was going to do and why and in the process scaring me shitless. Keller Army Community Hospital was one of my better experiences with hospitals. The first time he walked into my hospital room the night before surgery he has a whole slew of interns with him. My case drew some attention and was interesting because of the type of surgery he was going to do. The bright-eyed look of the interns made me think of predators circling around a fresh kill. I was a little unnerved. But I trusted him. More than I  have trusted any surgeon past or present. Surgically he had to do a ton of work. He determined that my capsular shift surgery I had in Guam most likely failed almost immediately since he was able to see ruptured sutures in with a mass of scar tissue and adhesions. He repaired the subscap tendon with a graft and freed up a lot of the adhesions that were causing major range of motion difficulties. He also redid the capsular shift. By far the most extensive work up to that point on my shoulder. Woke up in PAIN. Still doesn't compare to today but I maxed out on the PCA pump within hours and they had to over ride it several times throughout the night. Then the next day: knock knock "are you ready for PT?" Ummm noooo, I just had surgery! But yep I was down there within the half hour doing PT alongside Army hockey players and a couple football players. The PT techs were, what I thought and was used to, insanely brutal and I think I passed out during one nasty range of motion exercise. The rest of the week went better, but PT twice a day for those first 5 days? Oww painful. I could not wait to go home! Well I got home and I was all set to see Z for the first time in a week and my parents put their foot down (along with the doc.) It would be a couple weeks at least before I was allowed to go to the barn. I guess that is good - I overdo it at the barn and pay for it later. Still do but Z was younger, just turning 4 and he was still a little "unpredictable". No sign whatsoever of my gremlin that would show itself a few years later. My shoulder hurt but it was a surgical healing hurt, not the abnormal out of control pain that CRPS feels like. What I didn't know while I was laying at home in bed was the woman who had agreed to exercise Zephyr for me was riding him incorrectly and was pushing him way too fast for a 4 year old to handle. I wanted to go slow with him. He needed time to figure things out mentally as well as physically. I wanted him to settle into work slow.  I wanted him to take his time with his healing knee and a more worrisome suspensory strain. He was sound to ride but he needed to be brought back gradually, not quick and harsh. What he got was rushed training and taught to carry his body in the wrong way that was making him crazy. To get away from it he did what comes naturally to racehorses. He learned to bolt; grab the bit in his teeth and run through everything. When I finally made it to the barn I saw her riding him this way but Z had had enough and before I could yell out he had taken off out of the ring and over the huge manure mountain and decided to leave her there. He is 12 now. He still has issues stemming from those short months of incorrect training, although he is getting MUCH better.
Finally! Got to see my boy. And he is leaning on my arm

Most of his 4 year old year I was rehabbing and trying to make my arm stronger. More rehab, more doctor's appointments. I was able to take the all important Army Physical Fitness Test eventually after awhile. Range of motion was still horrible though and I still felt a "clicking" in the joint. Knowing there would be a ton of scar tissue I expected this to some degree and scar tissue HURTS when it breaks up. I rode a little bit but I gave him some time off to really let that suspensory ligament heal. With that injury I knew I would not jump him. Because of the concussive force their front legs take when they land it would be too much for that ligament to take and I didn't want to take the chance of ruining him. My event prospect plans had changed just like that. But my shoulder wasn't 100% yet either so those plans were probably long screwed before he got hurt.
Towards the end of 2004 I knew my shoulder was still not great. I could do more but it was more painful and the scar tissue and heavy adhesions were to blame. The Army started the medical board process to discharge me. This takes forever if you have ever been through one and it meant more physicals and shoulder examinations than I can count. My surgeon was on the medical board committee that would ultimately decide what would happen and he supported the decision for me to get out. I could do my job yes, but keep in mind we are still at war and I was undeployable. But before I was discharged I was given one more surgery; to free up the extensive scar tissue and remove some extraneous sutures that were no longer needed since the subscap tendon had healed. I had good relief after this surgery, had better range of motion and rehab was nearly a breeze. My 4 year obligation to the Army was complete in 2005 so I declined the medical board and rode out the last few months and was honorably discharged. And I found a job doing the same type of work that I was doing for the military.

Tuesday, November 27, 2012

Background : Z to West Point

So I bought a horse. Now where the hell am I going to put him? I very luckily found a place literally across the street from my parents and I boarded him there. It was the perfect place to work with a youngster. Being a working farm, Z got used to all manner of machinery and noises. There were cows to stare at. There was a huge ring and a smaller round pen for free lunge work. Great owners, great people. I never would have gotten as far with Z without them. I needed someone that had worked with young OTTBs because Z was way younger than what I was comfortable with. Most of 2003 he was busy detoxing, gaining weight, learning how to be a horse again and healing physically and mentally. I almost lost him a few times. He was very head shy, any sudden movements and he would flip his head up and more often than not hit himself and scare himself all over again. But he settled a little bit at a time and under the expert guidance of the barn owners. One of the things you lose when you board a horse rather than taking care of it yourself is the little day to day quirky behaviors. He certainly has a lot of them that I have seen over the years, but no one sees it more, or little nuances in health changes, than the barn staff and the owners. I am forever grateful to all the barns he has been at. I did ride toward the end of 2003 but they were very brief rides. What I did do was take him everywhere on the lunge line, just hand walking. We walked the trails, we walked the roads, we did everything from the ground first before I even got on his back. He was nursing a knee injury and I was still struggling with a painful and unstable shoulder. We really couldn't do much. And without getting all Seabiscuit  mushy movie-ness we rehabbed each other. Mine would eventually need more surgery but I didn't know that. Z did not take the pain away, as he doesn't now, but he does make my life better. I can pull out my little basic training trick and lock the pain away for a time.

So with 2003 ending I took Z to his first show toward the end of the year. I was not expecting much, I just wanted to get him out and about. There was a fun show that we went to as a barn group and he did very well considering the lack of work he had and the time to get ready for it. I don't think we placed in anything but it was a good experience. The youngblood Thoroughbred did not kill me (or anyone else).
 Towards the end of the year Z is starting to slow down! 

Going back to the shoulder, I was at a loss. My arm was still weak, my PT was losing hope and the Army was grumbling. The brace you see in the above picture gave me enough stability that I could ride and I could work. My life revolved around that horse but I loved the military just as much and more importantly it was my paycheck! So I petitioned the military clinic for a second orthopedic opinion and in the beginning of 2004 I got it. I was headed to West Point to see some of the most talented cutting edge surgeons in the Army. 

I remember going down to New York and I think my mom was with me for the visit. I didn't know what to think but after a clean MRI, trigger point injections, nearly a year of intense physical therapy and even a visit to a psychologist, I wanted answers. I got them when the head ortho surgeon flipped the MRI up on the screen and he looked at me and said "I thought you said the MRI was clean". I gave him the report to go with it and he left for a few minutes and then came back in with an associate of his. He pointed to a blurry spot on the MRI and said "This is not clean. Your subscap tendon is up here flapping in the breeze and the other half is mixed in with scar tissue and adhesions. We would like to do surgery immediately." So I was booked in for yet another surgery. Emotions were running high and confused. I was glad I had finally had answers but I was pissed that this went missed for nearly a year while it just got worse and worse. I think I might have had a week to get everything signed at work and then I was back at West Point, back under the knife. 

Monday, November 26, 2012

Background: Meeting Zeffie..

Zigzag Dan: AKA Zephyr, Zeffie, Z : A 12 year old Off the Track Thoroughbred. This means to non-horse people that he is an ex-racehorse. Not Kentucky Derby material in the slightest. He started off relatively well, meaning he made it through training and into his first races but "retired" at the age of 3. Good parents, just couldn't make it on the racetrack. That's okay. I found him. Or rather - he found me...
This picture is shortly after I purchased him for the grand price of $2000. His gray color was what brought the price up a little. He was a mess when I got him. He bled from his lungs when he raced (which is probably why he sucked) so that had to be fixed. He was lame in his knee from repetitive stress on undeveloped bones, ligaments and tendons. He was head shy. He was scared to death he was going to be hit. And he was underweight. He "needed groceries" was a common saying. He had to detox off all the drugs he was on, legal and most likely some illegal, all at once, cold turkey. But I am getting ahead of myself..

In 2003 I had just gotten home from Guam. I had been through Basic Training, AIT, and my first duty station.
I had also been through 2 shoulder surgeries for a right shoulder that just did not want to heal. I had so much bone deep pain when I came back that I was quickly seen at the military clinic and then referred to a specialist. I started PT back up and was under the care of an civilian ortho surgeon. Civilian PT and military PT are two entirely different things. Both want the same thing and are after the same goals, they just go about how they get it a lot differently. My physical therapist was pulling her hair out by the time I finally decided to get a second opinion about why my shoulder was not recovering. I was working full time, but still considered light duty, was "on profile" meaning I had certain restrictions and I was unable to complete the all important Army Physical Fitness Test because I was in so much pain. I heard whispers of "malingerer" from other Soldiers and I really can't blame them. I didn't know what was wrong but I kept pushing through. My physical therapist called the ortho doc in Guam at one point and the gist of the conversation was "its your problem now". I was at such a low point, depressed, confused and wracked with pain. I needed an outlet. I decided to go back to horses.

My sister and I learned to ride probably shortly after we learned to walk. Well maybe not that young but we started at a young age. Our first two horses were rescued from knee-deep filth for I think $50 apiece. Our parents had no clue at first about horses. We relied heavily on our horsey neighbor for advice and knowledge. Despite my parents lack of knowledge, my father and grandfather built our two horse barn and the first year we had the horses we had a hurricane and the barn wasn't completed yet so we walked them down to the end of the street where there were a couple of stalls available. Our first two horses were not right for us and once they were healthy again we ended up selling them. But for years my sister and I rode, either the neighbor's horses or my sister leased a few of them. I got out of horses for a time, got involved in ice hockey but I still mucked stalls to be able to ride and I knew I would want one of my own again some day.

I had connections at the local racetrack. I was also cruising through canter.org looking at trainer listings and at pictures. I went to look at a few I had called about. The first was a chestnut mare that pinned her ears and charged at me the second I walked in to her stall. The groom said she had been touchy lately. She also had Storm Cat in her breeding and those can be incredibly talented but also difficult. A gray caught my eye but I didn't know he was for sale so I walked on to another barn. I didn't see anything that screamed "buy me" which is a HUGE feat for me, so I turned around and walked back into the first barn. I caught the gray's eye again and he pricked his ears up. I went over to his stall while I waited for the groom to come back. He was a little head shy but he seemed to love a spot right above his two swirls in between his eyes. He started snoozing. The groom came back and he asked me what I thought about the mare. I turned my back to the gray and while I was talking, he took a big long drink and then dribbled ice cold water down my back. I spun around and he was like "hey". I turned around trying to think about what I was saying and he picked up the hood of my jacket and flipped it over my head. The groom said "he seems to like you". So I got his story. That he was a prospect from Florida but he wasn't doing very well and he wasn't very good in the starting gate. I learned later this meant he couldn't get a gate card. No gate card, no racing. That he most likely would be going to auction the next week or so. I could hardly believe this horse was for sale. I went into his stall, picked up his feet, rubbed on him, took him out, walked him up and down the aisle and told the groom to get the trainer/owner on the phone. Z was mine. Not much of a thorough check and that would come around in time to get me but we had such a connection. He was practically screaming at me to turn around and pay attention to him. I was a little worried about his age at first, he was much younger than what I was looking for but I decided to throw all caution to the wind and I am glad I did.

Background : 1st Capsular Shift - Guam 2002

So if the first surgery set things in motion, this one derailed the train. The surgeon for one thing did not believe anything was seriously wrong at first. The MRI showed nothing, yet my shoulder was still dislocating at an alarming rate. I am probably partly to blame because I did not go to the hospital every single time to have the arm reduced. I was friends with the surgeon's ortho tech and he taught me how to pop it back in when it comes out. It was so lax at that point that I could sneeze and the damn thing would come out. I got good at it and the dislocations were a nuisance but they weren't particularly painful anymore. But he agreed to take a look-see with his good ol' arthroscopy device and tighten things up "if they needed it".

Yup. Woke up with a big ol scar down my shoulder again and once again the promised arthroscopy got converted to an open procedure. Things were a bit looser in there then he realized. Gee it helps to listen to your patients once in awhile. I know I *sound* bat shit crazy sometimes but really I got a good handle on this shoulder. So anyway back to PT after surgery, some extended time off from work this time because the surgery involved the joint capsule and I was getting ready to head back to the States anyway. So other than the super typhoon destroying half of Guam when it went over, stopped and pulled a U-turn and hit us again, the last few months on Guam were fairly uneventful. I missed Rex's company, he had gone on shortly before my second surgery, but things weren't really serious with us. I was in a lot of pain but I hadn't had a surgery really to rival this one before so I expected things were normal. That would change but I was oblivious to that so far. I left Guam and a few short weeks later, Chara left Guam too. I was home! Natick Labs was only 2 hours away from home and although I kept up a barracks room for appearances I was pretty much living back at home. Which after being on my own took some adjusting..