"...or, alternatively, shoot the horse."

This is a blog post I've been mulling over for a few weeks but didn't want to publish it while I was annoyed and disappointed - there is no denying though that this post is an attempt to find the silver lining(!).

A few months ago I saw that the British Equine Veterinary Association (who have their annual conference in September) were asking for submissions of abstracts of clinical research papers.  These are for a section of their conference where short presentations are made on various research topics, often where research has been done by practitioners in the field.  The call for abstracts said:

"Abstracts should report recent clinical research. This may include observational reports on clinical case series, accounts of new techniques in vitro or in vivo experimental studies; preliminary findings will be considered. "

Encouraged by Nico's owner Emma, who has herself presented abstracts at the conference, I approached Professor Peter Clegg (who has provided regular help throughout Project Dexter) and asked whether he thought it would be worth submitting the results so far.  He was supportive, and said that to increase credibility we should focus only on the horses who had been diagnosed using MRI.  With his help and Emma's we put together an abstract in the required form (300 words or less) giving brief details of the rehab we do and a summary of the results.

Palmar hoof rehabilitation: a means of increasing soundness in horses with DDFT/collateral ligament injuries within the hoof. 
Aims: To assess whether a specific rehabilitation protocol which improves palmar hoof development and medio-lateral balance provides a comparable/better prognosis for long-term soundness than current treatments. Methods: Twenty-three horses with forelimb lameness that had been diagnosed on MRI as having damage to the DDFT and/or collateral ligaments of the DIP joint were rehabilitated over approximately 12 weeks. Shoes were removed and horses kept on surfaces which maximised comfort and encouraged movement (including shingle and sand). Free movement on these surfaces was encouraged. Diets were low in sugar/starch with balanced minerals and adlib forage. In-hand and ridden exercise on varied surfaces formed an important element of rehabilitation. Palmar hoof development and medio-lateral balance were regularly monitored with photography, using video footage to assess foot placement (toe-first/heel-first). After ~12 weeks horses returned home to continue a normal exercise programme. Results: Twenty-three horses (aged 5-13yrs) were enrolled with 17 programmes completed and 6 still ongoing.  Of the 17 horses who completed, 14 have since been maintained at the same level of work or higher than before their diagnosis, 2 improved but did not return to full work, 1 had rehab interrupted by colic surgery and is in light work. Improvements in palmar hoof development occurred relatively rapidly, with most horses’ landing changing from toe-first to heel-first within 2-6 weeks.  Soundness on hard surfaces and on circles typically improved once this landing was established and palmar hoof development also improved with exercise on varied surfaces once horses were landing correctly. Conclusions: Horses with this type of diagnosis may benefit from therapeutic rehabilitation which  improves palmar hoof strength and medio-lateral hoof balance.  Practical Significance: This type of rehabilitation may improve the prognosis for long-term soundness with specific lameness conditions of the foot Acknowledgments: Constructive advice from Prof. Peter Clegg; Jeremy Hyde BVetMed MRCVS. 

As this is an area where conventional treatments don't have a particularly good success rate, I had hoped that our results - even as preliminary research - would be good enough for BEVA to want to learn more.  It was therefore very disappointing to be told that the abstract had been peer-reviewed but not accepted.  Although I asked for feedback, no reasons were given as to why they were not interested or how I could improve the data to make it more useful to them.

I would have fully expected a healthy level of scepticism, even incredulity and was certainly up for tough questions but, as always, I was hoping to generate enough interest for someone to undertake further research and maybe even - the holy grail - obtain funding for follow-up MRIs on horses who have undergone rehab.

Its all the more frustrating given that a significant proportion of the vets I talk to ARE interested.  They want to offer better alternatives to horses and owners than a "guarded prognosis", prolonged box rest, "inevitable" degeneration or euthanasia and - like me - they would love more information as to exactly what is happening when these horse's feet change so fast during rehab.

I'll keep on plugging away gathering data for the research, of course, and meanwhile if any of you have bright ideas for galvanising interest, then please email me!

There are a couple of other avenues I am still exploring so I am trying not to be disheartened. My favourite quote, from David Wootton's "Bad Medicine", always cheers me up at times like this and is so good that I make no apologies for including it here on the blog for the umpteenth time:

"Think for a moment what surgery was like before the invention of anaesthesia in 1842...  Imagine taking pride above all in the speed with which you wield the knife - speed was essential, for the shock of an operation could itself be a major factor in bringing about the patient's death. 


Now think about this: in 1795 a doctor discovered that inhaling nitrous oxide killed pain..yet no surgeon experimented with this.  The use of anaesthetics was pioneered not by surgeons but by humble dentists. One of the first practitioners of painless dentistry, Horace Wells, was driven to suicide by the hostility of the medical profession.


When anaesthesia was first employed in London in 1846 it was called a "Yankee dodge".  In other words, practising anaesthesia felt like cheating.   Most of the characteristics that the surgeon had developed - the indifference, the strength, the pride, the sheer speed - were suddenly irrelevant. 


Why did it take 50 years to invent anaesthesia?  Any answer has to recognise the emotional investment that surgeons had made in becoming a certain sort of person with a certain sort of skills, and the difficulty of abandoning that self-image.


If we turn to other discoveries we find that they too have the puzzling feature of unnecessary delay...if we start looking at progress we find we actually need to tell a story of delay as well as a story of discovery, and in order to make sense of these delays we need to turn away from the inflexible logic of discovery and look at other factors: the role of emotions, the limits of imagination, the conservatism of institutions.


If you want to think about what progress really means, then you need to imagine what it was like to have become so accustomed to the screams of patients that they seemed perfectly natural and normal...you must first understand what stands in the way of progress."