Indy’s OCD Surgery

Surprisingly, I was not the nervous wreck I thought I would be the morning of the surgery.  Well, for the most part.  I admit I nearly lost it and there were some tears in my eyes when he went into the padded room for his anesthesia.  However, I knew that Indy was in the best hands possible and was going to be just fine.  I also knew that I was making the right decision for him and he will be so happy once he heals and can run around pain free.

I’ve got lots of pictures and videos to follow as I walk you through the surgery.  I initially didn’t think I could watch, but science won out and I did.  It was pretty amazing!

We began the morning by having an IV catheter sewn into his neck and having some pre-surgery antibiotics.  He got a little sedation for this part, as they were huge, uncomfortable needles being used.  When the sedation wore off, he was in a very playful mood, despite not having eaten breakfast.  I stayed with him in his stall, grooming and patting him.  His adorable face and wonderful personality helped keep my mind occupied as well.

His next step was to head into the exam room where his mouth was rinsed out to prepare for the intubation tube.  He was really good for this.  He also was super while his hocks were wrapped up.  He then headed into the padded stall where he would be placed under general anesthesia.  While awkward for a horse to step onto, he was very good.  This is the room where he will lie down.  From here, he will be hoisted into the operating room and onto the table.  I did not watch this part.

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The padded room where he was given sedation and gently laid down.

I’ve seen a lot of horses upside down and under anesthesia. To me it’s never a pleasant site to see.  Indy was made as comfortable as possible and had a wonderful team keeping a close eye on him.

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There is a big hoist mounted in the ceiling that lifts Indy up by all four of his legs.  His head was gently carried in and he was delicately laid down on the padded table.

Prepping him for surgery took a long time.  He was first hooked up to a machine that monitored his blood pressure, heart rate, and gas exchange while ventilating him.  He was given IV fluids throughout, as the anesthesia process can cause dehydration.  His front feet were wrapped, padded, and secured down, folded across his chest.  His hind feet were wrapped and lifted in the air, placing them in a secure position for the surgery.

His hocks were then scrubbed, scrubbed and scrubbed some more.  It is always imperative that any surgical area be completely disinfected and as sterile as possible, but particularly so if you are going to enter a joint.  An infection in the joint can be life threatening.

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Preparing the tools

The surgery began.  Arthroscopic surgery is a minimally invasive procedure.  A small incision, about the size of a pencil, is made and a fiber optic camera is inserted.  Another small incision is then made for tools.  The camera is connected to a monitor where the surgeon can then see inside the joint and guide his tools.  A side note on this; the image on the monitor is displayed is a mirror image.  Add this to the fact that Indy’s legs were in the air and thus the joint upside down – the surgeon had to move opposite to what was portrayed on the monitor and opposite the typical picture of the joint that we have in mind.  By watching his skillful hands move without a bobble, I would never guessed until I was told!

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The surgery setup.  The camera and saline line are in his right hand.

They started with the left hock, which needed the most work.  The videos below show part of the process.  This was the video that was aimed at the window where I and the Indy Fan Club were watching.  The surgical team had a much bigger and clearer screen!

Throughout the process, the joint was kept well lubricated and flushed using saline.  A spoonlike tool was used to loosen the OCD pieces that were still attached to the bone.  This tool could also be used to help smooth any rough edges and debride any improperly formed bone and tissue.  Next, you’ll see the Rongeurs, (a scooping tool that reminded me of the game “Hungry Hungry Hippos”) come in and remove the bone fragment.

On the next video, you’ll see the Rongeurs working on a lesion where part of it was already removed.  On some of the bigger pieces, a section would come break off when attempting removal.  It’s a good demonstration of just how weak and improperly formed these lesions were.  Over time, these pieces would break off on their own (as one did) and be free floating around the joint, causing damage and pain.

The assistant then held the piece in her hand so I could film how big that piece actually was.

This last video shows more impressive Rongeur action.  Sometimes the pieces were a little more connected to the joint and would require a slight tug.   In case you were wondering, the floating, waving thin pieces of tissue in the videos is the synovial membrane in the joint.  Indy’s membranes were working overtime, trying to keep the joint lubricated to compensate for the lesions.

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Camera picture of a lesion being scooped up.
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A larger lesion where the top half popped off during removal.
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You can see how uneven the lesions are, and how weak they are.

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Reaching under the synovial membrane to grab a piece.

The right hock didn’t take nearly as long.  All told, the surgery lasted two hours.  They took a radiograph of the left hock before stitching up the small incisions, then carefully wrapped him up.  He was hoisted back to the padded recovery stall to wake up.

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The left image is the left hock directly after surgery.  The right image is two weeks prior.

You can see on the x-ray where the surgery occurred.  The one from two weeks ago shows the free floating OCD lesion superimposed on the front of the joint, seeming to point at the letter L on the film.  Below that is the area where the smaller flaps and lesions were.  Thanks to Indy’s young age, he will remodel this area quickly and properly, laying down nice, strong, correctly formed bone.

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Free floating piece that was removed from the left hock.
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Total pieces that were removed from the left hock.  They were very vascular!
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Pieces removed from the right hock.

Suddenly, lots of whinnying erupted from the recovery room.  Indy was awake and announcing it to the world.  Due to his age and size, he metabolized the medications very quickly and woke up fast.  Typically after anesthesia horses are shaky and sweaty.  Indy was both, but he did make it to his feet and soon was walking around well enough on his own.  He actually tried to trot down the aisle to his stall!

(Please note that the wonderful woman holding his tail is doing so to support Indy and help keep him balanced.  Should he stumble or lean too far, she can help to right him.  He was still slightly sedated, though he didn’t think so!)

He could start eating hay immediately, much to his enjoyment.  He hadn’t eaten in a while so he was very very happy to have that.  We toweled him off and he got to wear his first cooler.

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Still a little confused as to what the heck happened to him, but happy and kind as always.

I stayed with him for a while, then let him be on his own to relax and process.  The sedation and anesthesia drugs make horses very sensitive to sound, so even something that he is used to, such as me coughing or the noise of my clothing, would make him jump a little.

When I came back that night, he was his normal self.  He enjoyed a thorough grooming and seemed completely unfazed by his wraps.

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Relaxed and back to normal!

He was thrilled when dinner came and cleaned his bucket like always.

This morning, day 1 of recovery, he was very social and clearly feeling well.  He had rolled in his fresh shavings and eaten everything he was given.  He had left his wraps alone overnight, though they were starting to itch.  Thankfully, he’s got a friend next to him on stall rest as well.  He will be staying at the clinic for the duration of his stall rest, where he will have company all day and lots of activity to keep him entertained.

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“Chillin'”

I can’t wait for him to be able to go outside and try his new hocks.  I know he is going to be much more comfortable!  One day of stall rest down, 20 more to go.  Then a month in a smaller turnout.

I’ll be working on creative ways to keep him happy and busy while stuck in his stall!

Thank you to everyone for your support and positive thoughts.  I appreciate everyone helping me through this!

 

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More pre-surgery

I need to play a little more catch up!  Tonight I will sit down and put together a new blog post about the actual surgery.

First though, I wanted to share some more of our pre-surgery work because I am so proud of my little (big) guy.

I started putting standing wraps on him in order to get him used to the wraps he will have on after his surgery.  I had my boyfriend hold him while I slowly put them on his hind legs.  As you can see from the below video, he strolled off without an issue.  Most horses would be picking their legs up high and hopping around, or shaking their legs trying to get it off.  He didn’t even seem to notice!

We then spent a lot of time just strolling around outside, since the weather is cooperating this week.  He will be on stall rest for three weeks following the surgery, so I wanted him to get out as much as possible for now.  He was very curious this week, and I encouraged that.  Where he wanted to go and investigate, we went (as long as he wasn’t pulling me to get there, he still needed to have his manners!)

In particular, he wanted to go say hi to any horses he could, of course.

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He’s a social butterfly

I was away for work on Wednesday, but my friends brought him down to the clinic for me.  His surgery was Thursday morning, and he couldn’t eat anything that morning.  We figured it would be best for him to be in the clinic overnight.  That way, when the barn was getting fed and turned out, Indy wouldn’t be sad and feeling ignored in his stall.

They reported back that he was a perfect gentleman for his additional x-rays, hock clipping, and blood work.  I had expected him to be, but hearing that certainly made me proud 🙂

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Look at those sexy shaved legs!

 

Keeping Indy Busy Pre-Surgery

It’s not really the best thing to see at the bottom of your discharge paperwork – “keep Indy as quiet as possible before the surgery.” He’s 8 months old, how the heck am I going to manage that??

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He’s going to miss his best bud for a few weeks 😦

Thankfully the vet did say he could continue going out with his friend. Yes, they will run around and play, but the main thing is to keep him from doing excessive things.  We don’t want him to do more damage to his hocks.  This meant no tearing around loose in the indoor and no long walks or jogs.  Thankfully the weather does prohibit a lot of physical activity anyway!

So how to keep him in “training” so to speak? How do I keep him stimulated and behaving? Well, we can still train and keep him mentally satisfied at least.  We can still go for walks in the indoor and around our track.  Here we can practice halting, turning (though not too tight!) and general leading.  He does like to watch the other horses being ridden and worked and is generally very well behaved when they go by.

I asked a friend at the barn, who also works at the clinic, what I could do to better prepare Indy for his big day.  She was thrilled that I asked and said he is sure to be the best behaved baby they’ve had. She said please teach him to clip, especially around his hocks and hind legs. She also suggested I get him used to wraps on his hind legs, as he of course will be wrapped afterwards. She also thanked me in advance for making their lives simpler!

Clipping, as you know, we’ve already been doing. We still have refresher courses about twice per week.  He’s been super about it and very relaxed.  I actually even gave him a little bridle/halter path.  I made sure to focus on his hocks and entire hind leg.  He took it extremely well; even resting a hind leg while I ran the running clippers up and down.

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It’s hard to see because he’s so fuzzy, but we’ve clipped a halter path!

I then grabbed a pair of polo wraps and brought him in his stall.  I was alone in the barn and did not want to put him on crossties for his first wrapping experience.  He was enjoying his hay when I knelt down next to him and rubbed the polo on his leg.  He is used to me squatting down next to him as I have done since his birth.

I then wrapped his leg, from fetlock to hock.  I got to the end of the polo before I remembered the large piece of Velcro at the end.  I prepared myself, which turned out to be unnecessary. He didn’t flinch, just continued eating his hay.  I forgot how much Velcro he has been around; his fly mask, his first blanket, Shady’s things, etc.

Now to be in a safe spot for the hopping around……

There was no hopping around. He picked up the wrapped leg three times, picking it up high towards his belly, putting it down, then picking it up again. That was it. He kept eating the entire time.

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First time being wrapped – didn’t care

I then wrapped the second leg, going over the hock this time and halfway up his gaskin.  No reaction this time either. I brought him out of his stall and into the aisle. He didn’t even do the usual “chicken walk” most horses do.

We headed to the indoor, where some of my friends were. They said something must be wrong with him to be behaving better than old horses. We walked and did a little trotting, he was great.  We headed back to his stall where I easily removed the polos and told him what a good boy he is.

We will continue with the wrapping, adding standing wraps, and the clipping review just to keep him fresh.  This will only help keep his stress levels low while at the clinic.

In Shady News….

In all the busyness of Indy news, I forgot to update on Shady.  My last post about her talked about her randomly swollen ankle.  Apparently she decided being out of work was boring and she didn’t need the extra attention on the ground anymore, so the swelling went away.  I showed up at the barn after a week full of wrapping, icing, liniment, and Back on Track boots to find a perfectly normal ankle.  Sounds about right.

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Shady, all wrapped up.  She would wear these for a few hours before bed. The hood was just being tried on!
Now I can begin the worrying of “what if it got better because I gave her time off? What if I put her back to work and injure it worse?” And a plethora of more questions to keep me up at night.

I had spent lots of time watching her go, either in hand or on the lunge line.  While she wasn’t off on that ankle, she definitely looked weak behind.  Sometimes it is hard to tell the difference between off and weak.  Especially, I feel, when it is your own horse.  When it is my own horse emotion takes over and I know nothing.

In this case, watching her go, I could see that she was very weak in her stifles.  Her swollen ankle was not a good thing by any means, and please don’t suggest that it was to Shady.  However, it did give me a chance to step back and really watch her, from the ground.  This is something I used to do often, but somehow I have gotten a little away from that.

I think it is really important to see our horses from the ground.  Sometimes we need a reminder of how they go.  Yes, we can feel quite a bit from under saddle.  On the other hand, it is a great advantage to see how they go without us getting in their way.

I’ve now been doing more ground work and changed my riding to reflect what I have seen.  Of course her stifles would be weak; she has been out of work for about a year now.  I can’t just hop on and automatically have my Prelim horse back.  We need to start at the beginning.

Back when we were both in shape!
Now I start by letting her warm up on the lunge line without side reins.  Up here in the frozen tundra that is New England, warmup is especially important in mid January.  When she is ready, I attach the side reins.  I recently read an article about the purpose of lunging.  It was a great article reminding people that lunging is not all about “tiring your horse out.” Shady is very good so this was never the case.  My intention is to use the sidereins to help strengthen her hind end.  She lunges extremely well; I can ask her for a bigger or smaller trot, spiral in and out, or ask for nice transitions, all without her pulling on me.  I run the run through her bit and up to the dee ring on the saddle.  This acts nicely as my inside rein.

What did I observe from here? In particular I could see her left hind leg not coming through and not stepping underneath her as well as it should.  When going left she travels with her haunches slightly in and leans heavily on her left front.  Going right, she pushes her haunches slightly out and puts more weight onto the right hind.  The left hind then looks a little funny as it has to move much faster to keep up.  Her left hind has always been a weakness for us.

The side reins, adjusted properly, really encourage her to come through and use her back.  Our first session she resisted initially, hollowing and looking off behind.  I had a brief panic attack thinking she was actually off and maybe that ankle did hurt.  Then she sighed, gave in, and picked up through her back.  Suddenly she looked beautiful. Phew! She was just being lazy.

After the side reins I hop on for a short bit.  I have to remember that I too am out of shape.  Riding when we both are running out of steam does us no good.  I plan my ride ahead of time and focus on strengthening exercises for her. I also discipline myself to ride correctly the entire time.  I have to say, she feels wonderful after the lunging session!  I have already seen and felt a lot of improvement after just over a week.

Especially with the nasty winter storms that are heading our way, I am looking forward to summer!

 

OCD

When Shady was pregnant, I spent a lot of time making sure her diet was properly balanced. Obviously, I wanted her and the baby to be as healthy as possible. I researched proper diets, exercise levels, vaccine schedules; any and everything on pregnant mares. She got as much hay as she wanted, a well balanced grain diet, supplements, an in and out stall with a large paddock attached, and lots of attention of course. I had ridden her lightly up until she was 8 months pregnant, then we resorted to going for long handwalks. My vet was at the barn frequently checking on her and she was very pleased with her progression.

The average horse gestation is 11 months. Shady decided to go one full year and two weeks. The birth was not an easy one, as Indy’s legs just seemed to go on for days. When he finally stood to nurse, he was 10.3 hands high at birth. I still don’t understand how he fit in Shady!

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Legs for days!

As adorable as this giant bundle of legs was, my immediate concern was OCD. Clearly, he’s going to be a big boy, and he’s going to grow fast. Despite all my efforts at prevention, I began to notice swelling on his left hock when he was about 5 months old. X-rays confirmed it; my boy has OCD.

As I began talking with people about it, I realized there are many that haven’t heard of OCD, or don’t have a full understanding of what it is. As I am going through it personally, I want to use my experience to educate others.

What is OCD?

OCD, or osteochondrosis dissecans, is a common term heard among horse owners, especially those dealing with young horses. OCD and OC (osteochondrosis) are often used interchangeably, though both fall under a more general term of Developmental Orthopedic Disease (DOD). For the purposes of this article, let’s focus on OCD, the more advanced form of OC.

OCD is a very common developmental disease, affecting the cartilage and bone within the joints of the horse. It occurs in roughly 5%-25% of horses and can occur in any breed; however it is most common in large, fast growing breeds. In general terms, it is a growth disturbance. As the horse grows, the cartilage fails to mature properly. OCD is technically when that cartilage then forms cracks and fissures. That cartilage and bone is then loose in the joint, often referred to as “bone chips” or “joint mice.”

OCD occurs when the cartilage in the joint doesn’t form normally during periods of growth. The cartilage, and the bone underneath it, becomes irregular in thickness and thereby weaker than normal joints. These pieces can then remain partially attached to the bone or they can break off and be free-floating. These abnormal pieces, whether attached or not, can cause pain, inflammation, lameness, and eventually may lead to arthritis.

This video is an excellent description of growth and how disruption leads to OCD.  This is from the discussion of Indy’s x-rays with my surgeon:

The most common sign of OCD is swelling in the joint. Lameness is often not observed until the horse begins training. OCD can form in any joint in the body, but the most common are the hock, stifle, and fetlock.

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Indy’s hocks; you can see the swelling on the left hock.

There are numerous potential causes of OCD including:

  • Genetics – horses may be partially genetically predisposed to OCD.
  • Rapid growth – Horses that grow too big and too fast are at an increased risk for developing OCD.
  • Nutrition – An imbalance of minerals in the diet has been linked to increased risk of OCD. In particular, diets low in copper increase the risk. However, one cannot just simply increase the daily Copper intake. Numerous minerals, including Iron, Zinc, and Manganese, must also balance, as they interact with the Copper in the diet.
  • Trauma – Injury or high stress on the joints can add to the irregularity of the cartilage and lead to a breakage of the bone fragment.
  • Hormones – Hormonal imbalances, in particular an imbalance of Insulin and Thyroid hormones, can increase the risk as this imbalance affects cartilage development.
  • Blood flow – One study I read mentioned that there is a possible link between temporary loss of blood flow to the joint and OCD formation. This could relate to smaller mares having larger foals cramped in their womb.  Given Indy’s size, this theory fascinated me, and I will be looking into it more.

Now that we have it, what do we do?

Weaning time, typically about 4-6 months, is considered “the age of no return.” Basically, if they have OCD lesions, they are unlikely to form additional lesions. Indy was X-rayed at 6 months old, where we definitively diagnosed the OC in his left hock joint. The piece had not yet broken off yet.

I began discussing options with multiple vets. There are some OCD lesions that can resolve on their own. Of course, OCD lesions in the hock do not resolve on their own. The best option for Indy is to have surgery to remove the pieces.

Arthroscopic surgery is the common approach. It is minimally invasive; two small holes are placed through the skin and down into the joint. A tiny camera is then placed through one hole, and a small tool in the other. The camera then allows the surgeon to guide the tools to remove pieces and clean up the area. Humans frequently have the same surgery to clean up damage to their joints as well.

Left Hock
The larger circled area is the piece that has broken off.  You can see where it would have fit perfectly with the normal bone.  The smaller circle is a loose piece that has not yet broken off.  Both pieces will be removed and the area cleaned up.

Indy has two small pieces in his left hock and one small piece in his right hock.  Both hocks will be done at the same time.  The surgery should take less than 2 hours.  Prognosis is extremely good; the overwhelming majority of horses return to full function and can reach their maximum potential. Indy will need 3 weeks of stall rest, followed by a month turnout in a small paddock. He can then return to normal.

While I absolutely hate to put Indy through this ordeal, this is the best time for him.   I don’t want him to do any further damage to his joints, I don’t want him in any pain, and at his age, he will heal very fast.  The bone will continue to remodel for at least another year, healing the area.  The initial x-rays were done in November; we made the decision to wait until wintertime, when the weather is lousy and the horses aren’t getting as much exercise in their paddocks as normal. He will recover just in time for early spring, and can race around his paddock happily.

The Importance of Friends

Since having Indy, I swear time has gone by faster than ever.  One minute, he was this gangly little thing, now, seemingly in the blink of an eye, he’s almost 8 months old, 14.2 hands, and a little horse.  That’s what he is now, a small horse.  It’s hard to call him a foal, or a baby, or a weanling now that is he bigger than all ponies and some horses at the barn!

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I had a hunch from the beginning that he was going to be big…

I thought I had everything planned out for him.  First off, I should know better right there.  Nothing goes as planned with horses.

I didn’t realize how hard it would be to find Indy the right place to have friends.  When he was 2 months old I started looking for a new barn. The barn where he was born was a great setup, with an in and out stall that had a large, grass paddock attached. There was a fenced in ring and lots of trails.  But, most importantly, it was lacking was friends for Indy.  There were two older mares there, but that was it.

I won’t get into how hard it was to find an appropriate facility.  One with potential friends, safe fencing, and within a reasonable distance from my home.  I was beginning to get desperate when I finally found a facility that boarded broodmares and their foals.

It wasn’t much of a riding facility, but what mattered most at the time was Indy.  I wanted the weaning experience to be as low stress as possible, given that it is a stressful time in his life.  I did a night time weaning first; he had his own stall at night then went out in the field with Shady during the day.  I feel this really helped easy them into it.

Finally, the day came for Indy to go out with other foals.  They were a month older and already weaned, but size wise Indy dwarfed them. The other foals didn’t mind and soon they were all running around and playing.  I was so happy for him!

My happiness faded after less than a week.  I came to the barn only to be told that the other two foals were leaving, moving to new homes.  I was crushed; Indy was losing his first friends and most likely the only chance to be with horses his age.

His only choice now for a friend was a mare that came into heat, let him try to nurse, and then squirted all over him.  Good thing he tolerates baths. A few days later the mare was mean to him instead, chasing him off and biting him.  I was pretty miserable.  I spent a lot of time with him, but it’s not the same.  He’s got to learn to be a horse too.

As much as I hate moving my horses around, it was no longer a good place for us (there were other issues as well).  We moved much closer to home, to a beautiful, safe facility.  Shady and I have plenty of room for riding, and Indy has a friend.  He will have more in the spring, but for now he’s quite happy.  Although his friend is not his age (he’s 27!) they are almost the same size and they play all the time.  He’s got plenty of stimulation with lots of horses around, room to run, and a lot of variety.  We can go in the indoor, around the track, through the cross country field, and out on miles of trails.  I was worried about a larger facility having too much commotion, but it has actually been very good for him.  He’s been exposed to a ton and also has a lot to look at.  It will keep him occupied and hopefully vice-free!

(Video is of a slow motion “drive-by” of Indy’s response to being dominated a minute earlier)

So, if you are thinking about raising a foal, this is something to really consider.  I honestly hadn’t thought it would be so hard to find friends for him.  I reached a point where, in a moment of frustration (madness?) I briefly considered looking into adopting a foal so they could have each other.  Thankfully finances and my boyfriend limited me.

Inspired by my Eventing Community

Yesterday was an inspiring day!  I was off with a great group of ladies to the USEA Area 1 meeting.  Shady and I have been out of competition for a little while now, while I made some life changes and she made Indy.  I’ve been excited to return to competition, but even more so after today.

We got there early enough to have time to mingle before sitting down.  It was so wonderful to see some old friends.  Also great was meeting Facebook friends I hadn’t actually met in person yet.  The eventing community truly is a group of fabulous people.  It didn’t matter if we knew each other or not; every time I turned around I was talking to someone about our horses.  Conversations were casual and easy to slip into; new friends felt like old within minutes.

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A friend posted this on FB after the meeting.  Look how happy Shady is!

On the down side, I was surprised to see how few people were there to pick up their awards.  Compared to our group numbers, not many people actually came to the meeting.  I must confess, this was my first meeting, but now I will avoid missing any.  We have such an amazing sport, with so much support from other members.  We need to all give back to keep the community thriving.  I was happy and proud that I donated to the silent auction and I want to continue giving back by volunteering at events when I can.

I also fought the desire to tear up every time someone won an award on their homebred.  Someday, that will be me and Indy.  As you can see, Indy has been ready for Cross Country since he was 3 days old:

(still quite possibly my favorite video ever)

Next came our program coordinators and I must say, our Adult Rider Program rocks.  I can’t wait to get out there and on an ARP team!

Finally, Tremaine Cooper, course designer extraordinaire, gave a fantastic speech on course design.  He took us on a virtual cross country course walk, explaining each fence and the questions being asked of the riders.  I hope that it truly helped everyone in the room ride their courses better this year.

For the most part, I was out-ninja-ed in the silent auction.  My inexperience showed through.  I did win a $50 entry credit towards On The Bit Events, so I am super excited about that.  Today, my calendar comes out to seriously plan the show season.

I even made it home in time to see Shady and Indy and tell them what an exciting year we have ahead.

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How I found Indy.  You can see how very excited he is about the upcoming year.