Since I'm having a rest day (from the gym anyway!), here is the latest on the patient:
All signs are good. The physiotherapist checked him earlier this week and he is not reacting to palpation of any previous sites of pain. This made me very happy to hear. He is coming along nicely in the Pessoa. Tries to evade a little bit to start but once he's working correctly he sticks with it. It will take a while to increase strength in his abdominals and his back so hopefully this need to evade will decrease with every session, and disappear altogether over time. I'm sure a lot of it is also muscle memory, and developing trust in us that what we are asking will no longer hurt like it has previously.
He is wearing heart bar shoes behind, and has plastic resin wedges along to the heel. In addition to this, he has a sort of putty filler along the sole which is intended to increase the weight bearing surface of the foot. He was taking a lot of weight around his heels, and this needs to change. Hopefully this current, short term set-up removes the pressure on his lumbar region and his stifles. If I'm honest his feet are the part that worry me more than his body. I don't think I'll truly unclench until he's out of the heart bars! I don't like heart bars at all...
The great news regarding shoeing is that he can be safely turned out this way, with boots and supervision. So he can get out and get moving once he's here :)
It's very important for me to remember that he will never be cured. I suppose you could compare this to something like laminitis or ulcers, in that you can never get complacent and it's a lifetime management issue. He used to get physio with me every six months, just for a check-up. It will have to be more frequently now, but the hope is that if he reaches a healthy plateau we can gradually increase the space between check-ups.
Likewise, I must pay constant attention to his reactions to touch. Any changes in behaviour, or resentment towards grooming, being handled, mounting, riding are symptoms. Not that I ever think of horses as naughty, behaviour like this is communication of a problem. If he does show signs like this, it's best to be safe than sorry and nip any backward steps in the bud. It's going to take a long time to get him sound and keep him sound, and it wouldn't be difficult to undo all that good work.
He is due to receive his second round of mesotherapy before he comes home. Which is in less than two weeks. And I'm still not sure I'll see his lovely face before I leave!