Originally published in the January 2009 edition of Dressage Today, reprinted with permission. Subscribe at DressageToday.com.

When I looked at the pain in the eyes of my 11-year-old Spanish Arabian, Bold Brahim (Jesse), and saw his non-weightbearing front leg, I promised I would do everything possible for him. At that particular moment on a rainy day in February, the mystery of how he suddenly went lame did not matter as my focus shifted to healing. With a grade-5 lameness rating (5 being the worst), I continued down the path of typical vet care—hoof testers, X-rays, visual assessments, feeling for heat, pain medication and waiting. But after several weeks, Jesse’s condition worsened and I realized it was time to explore other diagnostics.

Bone Scan & MRI
In April, we took a two-hour trailer ride south to California Equine Orthopedics in San Marcos, California, to see Dr. Mark Martinelli for a bone scan and standing MRI. There would be no more speculation and process of elimination. I would finally know what was wrong. The next day, I learned that Jesse had a deep flexor tendon injury. The severity of it was written across Dr. Martinelli’s face. He suggested that I return to meet with him and his colleague, Dr. Norm Rantanen, which I did. They shared in detail the harsh reality of Jesse’s condition, explaining that he had a very uncommon injury in the right front hoof capsule and that three centimeters of his deep flexor tendon were completely destroyed.

Then, they introduced the possibility of stem cell treatment with the caveat that, though there had been several successful soft tissue recovery cases, there were no other cases like Jesse’s for them to reference and no guarantees. Since there weren’t any pieces of tendon to surgically put back together, filling the empty space with stem cells seemed the only option, but I wasn’t convinced. They recommended another MRI in four to six weeks to see how the tendon was doing. I was also referred to Dr. Sylvia Greenman, an equine rehabilitation/leg specialist, who would soon become a new friend.

Walk This Way
At our first appointment, Dr. Greenman prescribed pain relievers, anti-inflammatories, medications to increase blood flow to the tendon and something to protect Jesse’s stomach. After the prescriptions were filled, I was delighted to learn that we were going to begin physical therapy—hand-walking to promote healing and prevent adhesions, leg wraps for extra support during walks and barefoot farrier instructions that included “a lot of hoof.” Then came the difficult reality check. She said that it would take a minimum of 15 to 18 months for the tendon to heal, if it was going to heal.

So, one hoof and one boot at a time, side by side, seven days a week, our rehabilitation journey began with Dr. Greenman as our coach. Jesse’s body became our compass as the painfully slow process of growing the tendon back began. We started hand-walking on hard surfaces in straight lines for five minutes and carefully increased the time as he improved. When we reached 20 minutes, all medications were stopped so Jesse’s leg could “talk” to us without symptoms being masked by drugs. To my dismay, short stepping returned, and the rehabilitation rollercoaster began.

Stem Cell Treatment
The veterinarians encouraged me again to consider increasing the odds for Jesse’s recovery with stem cell treatment. After researching online and getting approval from my equine insurance carrier (The Equestrian Group in Scottsdale, Arizona), I agreed. Dr. Greenman harvested fat from Jesse’s left hind buttock, which is a newer process than the more common sternum harvesting. Then, she packaged the sample and sent it to Vet-Stem in Southern California for the lab process of separating the stem cells and preparing syringes. We intended to harvest enough cells to freeze some for another treatment later but, due to the cell count in the sample, the lab work only yielded one syringe. One chance for the procedure was all we had, unless I chose to put Jesse through another difficult cell harvesting surgery.

We made another trip to San Marcos for a second MRI before Drs. Martinelli and Rantanen carefully piloted the ultrasound and MRI-guided injection of Jesse’s cells into the void in his tendon. After the procedure, they shared new MRI images with me that indicated a reduction of swelling and a very slight improvement in the tendon with no visible adhesions. But, along with that glimmer of hope, Dr. Rantanen cautioned that the tendon was the consistency of oatmeal. It would take very little to cause it to fall apart.

Two Years of Rehabilitation
The daily walks continued. Jesse and I patiently persevered. My sense of humor returned as we increased our walks to 30 minutes and then, in late summer, we reached 60 minutes with no signs of lameness—a major hurdle overcome. Our reward, four months after diagnosis, was to finally incorporate weight-bearing and walking under saddle. The light at the end of the tunnel finally began to shine.

More methodical work was before me, coupled with trying to keep my spirited horse quiet. We started with 30 minutes of hand-walking followed by 30 minutes of walking under saddle, then 20 minutes in-hand followed by 40 minutes under saddle, until he stayed sound at 60 minutes under saddle.

Trotting under saddle was incrementally added in the fall. First, we did five minutes of trotting after 55 minutes of walking with the goal of 20 minutes of trotting before moving on to canter. In November, we had almost reached our 20-minute mark when we had our first major setback. One cool and breezy morning while I was riding, Jesse let his pent up energy go—bucking, twisting and turning. Our hardearned soundness disappeared. Short-term medications were prescribed, and we were back to hand-walking only. Per Dr. Greenman’s request, his front feet were carefully shod to provide additional support.

We worked through the November setback until April when Jesse was again diagnosed as sound at the walk and trot. Then, shortly after we received approval to go back to walking and trotting under saddle, he had another energy explosion in-hand. Say it’s not so! was all I could think as Dr. Greenman announced a grade 2 out of 5 lameness—the worse Jesse had been in many months. Medications for a short time and walking on hard surfaces in straight lines was again the all-toofamiliar regime. Over the next four months, Jesse improved significantly but, in September, there was still a slight lameness—grade 1. So, we stopped trotting, continued walking and scheduled monthly vet checks as faith and perseverance grounded me.

Two years after Jesse’s injury, Dr. Greenman met me at the stables and I held my breath as I snapped a longe line on his halter. With his head held high, he sure-footedly trotted, cantered and bucked as our wonderful vet looked on wearing a telling smile. He was sound again. We did it! Rehabilitation now shifted to improving Jesse’s overall fitness. We gradually increased the load on the tendon at the trot and canter and began working in the sand arena again, instead of just on hard surfaces.

During the uncertainty of our long healing journey, I always believed in my heart that the human/animal bond can, indeed, overcome obstacles. As I walked beside Jesse each day with a prayer on my lips, the light never left his eyes and the special people we needed appeared as we defied the odds together.

Diane Barber welcomes inquiries about her healing journey with Jesse at her Web site equestriandesignery.com.