2nd neurectomy

[Echryss]

Hi all. I really would need your help on this. I bought my 11 years old gelding 2.5 years ago. Came straight from Bulgaria.
Performed great for a year (jumping, competing in small classes up to 1.10).
Started stumbling year and a half ago. Vet said "back pain", we treated his back every 4 months and each time there was a period of soundness.
However the 4th time did not work, started stumbling again and went lame on January.
Did everything, (bute, therapies, injections, prp, sea therapy, exams, xrays, ultra sounds, corrective shoeing etc etc). Still lame.
On Friday an experienced vet/ surgeon from abroad came in to examine him and discovered... he had had a neurectomy before I bought him! ...
Still shocked. I am frozen.
Cant really tell when exactly, maybe in 2017. Maybe earlier. So I cannot tell how long the results lasted.
Told me the nerves had started growing back again, and that s why he was hurting and the reason the therapies did not work.
He suggested a second operation without committing for the results.
1. Has anybody had a similar situation?
2. Did the horse return to full work after the 2nd neurectomy?
3. Is it true that the 2nd surgery has less good results than the first?
4. How long have the painfree periods after the surgeries lasted for you?
5. Is there no chance now, that the nerves are back to try and treat the inital reason for the problem?
6. If the case was degenerative, has it deteriorated over the years, after the surgery? Did you carry on with supplements and corrective shoeing or other methods to delay the progress?
7. Would you recommend a 2nd round that might allow him to work for a couple of years (seemed to enjoy competing amd sjowjumping) or should I let him retire already, (only having enjoyed him for a year and a half) with some pain (he doesnt look miserable, he looks happy, playful and energetic).

 

[Echryss]

Hi all. I really would need your help on this. I bought my 11 years old gelding 2.5 years ago. Came straight from Bulgaria.
Performed great for a year (jumping, competing in small classes up to 1.10).
Started stumbling year and a half ago. Vet said "back pain", we treated his back every 4 months and each time there was a period of soundness.
However he got lame on January. Finally realised that the source of the problem was at the right front foot.
Did everything, (bute, therapies, injections, prp, sea therapy, exams, xrays, ultra sounds, corrective shoeing etc etc). Still lame.
On Friday an experienced vet/ surgeon from abroad came in to examine him and discovered... he had had a neurectomy before I bought him! ...
Still shocked. I am frozen.
Cant really tell when exactly, maybe in 2017. Maybe earlier. So I cannot tell how long the results lasted.
Told me the nerves had started growing back again, and that s why he was hurting and the reason the therapies did not work.
He suggested a second operation without committing for the results.
1. Has anybody had a similar situation?
2. Did the horse return to full work after the 2nd neurectomy?
3. Is it true that the 2nd surgery has less good results than the first?
4. How long have the painfree periods after the surgeries lasted for you?
5. Is there no chance now, that the nerves are back to try and treat the inital reason for the problem?
6. If the case was degenerative, has it deteriorated over the years, after the surgery? Did you carry on with supplements and corrective shoeing or other methods to delay the progress?
7. Would you recommend a 2nd round that might allow him to work for a couple of years (seemed to enjoy competing amd sjowjumping) or should I let him retire already, (only having enjoyed him for a year and a half) with some pain (he doesnt look miserable, he looks happy, playful and energetic).

 

[Meowy Catkin]

Sorry I can't help, I just wanted to say how sorry I am that his veterinary history had been hidden from you. Hopefully someone who knows more about neurectomies will be along soon.

 

[spacefaer]

Neurectomies are usually the last resort, when nothing else has worked and the only other option is pts. It usually works for 4-6 yrs. Given that it's only lasted for a couple, I wouldn't be keen to redo.

Do you know why he had the initial procedure?

I would be very wary of contemplating redoing it - the second time has a much lower success rate.

I also would never jump a horse that had had a neurectomy - I would be wary of cantering over rough ground too, as he can't feel where he's putting his foot.

There is also a higher risk of problems from accesses and puncture wounds as they can't feel it.

What is your vet suggesting?

 

[Echryss]

Thank you. Well its not exactly given that the first time lasted for a couple of years. Its just an assumption. From the way it works, I assume that they operated on him and sold him away.
There is no way I can get in touch with the previous owner, or maybe... thats a good idea, instead of asking my dealer find the bulgarian dealer, maybe I could find the owner myself...

Neurectomies are usually the last resort, when nothing else has worked and the only other option is pts. It usually works for 4-6 yrs. Given that it's only lasted for a couple, I wouldn't be keen to redo.

Do you know why he had the initial procedure?

I would be very wary of contemplating redoing it - the second time has a much lower success rate.

I also would never jump a horse that had had a neurectomy - I would be wary of cantering over rough ground too, as he can't feel where he's putting his foot.

There is also a higher risk of problems from accesses and puncture wounds as they can't feel it.

 

[ester]

Is this a PSD neuroectomy or more than that?

 

[Echryss]

Yes a PSD, I forgot to say. However I dont know how far up he was cut the first time. The second nerve block higher up was the one he responded to, so if that means the pain is not just above the bursa but higher up, does does it also mean the nerve was cut up to that point?
Sorry I am lousy in terms.
I have sent an e mail to the vet who will operate, if I decide to proceed, but he hasnt responded yet.

 

[PinkvSantaboots]

Sorry you have been sold a horse and not had the information about it, personally I wouldn't do a second operation and I wouldn't knowingly jump one that had, I don't think you can compete them either under certain societies.

 

[Echryss]

Is this a PSD neuroectomy or more than that?

Yes a PSD, I forgot to say. However I dont know how far up he was cut the first time. The second nerve block higher up was the one he responded to, so if that means the pain is not just above the bursa but higher up, does it also mean the nerve was cut up to that point?
Sorry I am lousy in terms.
I have sent an e mail to the vet who will operate, if I decide to proceed, but he hasnt responded yet.

 

[Echryss]

Do you know why he had the initial procedure?

?

No signs of the previous owner, nowhere to be found on social media, probably doesn t speak any English, no hint of the date of the 1st neurectomy, or the reason (if he did not respond to therapies, had they tried any. I dont know how this works in Bulgaria). Devastated.

 

[ihatework]

Okay so a PSD is a different kettle of fish to a foot neurectomy. If it were the latter I’d be saying PTS.

A PSD isn’t quite as dramatic/unethical but that said I’m not sure I’d be rushing in to a second op. What do they scan like? Worth trying a course of shockwave?

Either way, I suspect you are on borrowed time for a sound competing horse.

 

[Echryss]

Okay so a PSD is a different kettle of fish to a foot neurectomy. If it were the latter I’d be saying PTS.

A PSD isn’t quite as dramatic/unethical but that said I’m not sure I’d be rushing in to a second op. What do they scan like? Worth trying a course of shockwave?

Either way, I suspect you are on borrowed time for a sound competing horse.

Well I just received a mail from the vet who might operate if I decide, so I am now even more uncertain if it is just a PSD as it was mentioned initially, its not a pretty clear diagnosis. He mentioned:

"your horse has degenerative changes of the coffin joint as well of the navicular bone and perhaps of the tendon".​

Shockwave was discussed and not considered an option. Coffin joint injections, PRP, anti inflammatory injections, bute, blister, eggbar shoes, cosequin etc etc had no results.
But how could they have results since he is already de-nerved? Could they? Or is the 2nd neurectomy the only solution if they had gone this way the first time?
PTS is very rarely considered in my country; the horse is happy, playfull, if I leave him at the paddock he starts jumping around, he is not on three legs (yet), only when he is stalled does he turn his leg inside. He might as well go live by the sea, where he spent 3 months swimming and having a wonderful life. I know tons of people living in pain, or living with health issues, myself included, why shouldn't he enjoy his life in the field even if lame?
My two options for the moment are: 2nd round, or retirement. Trying to find a third one...

 

[Regandal]

You really need the suspensories scanned to see what condition they are in. If there is lots of thickening, uneven fibres, prognosis is not so good. Have they been scanned?

 

[ihatework]

It’s not PSD then, it’s in the foot/lower limb and I’d be evaluating the options very carefully at this stage.

PSD is very specific and is just below the hock

 

[ycbm]

I know tons of people living in pain, or living with health issues, myself included, why shouldn't he enjoy his life in the field even if lame?

Because he's a preyed upon animal who is genetically programed to know that the lion eats the lame horse. That's a life of constant stress. Because humans can reconcile pain against other pleasures, horses have no way of reconciling it, and if they did, it's against being in a field each and every day in good or bad weather, it's not much of a plus side.
.

 

[Echryss]

Because he's a preyed upon animal who is genetically programed to know that the lion eats the lame horse. That's a life of constant stress. Because humans can reconcile pain against other pleasures, horses have no way of reconciling it, and if they did, it's against being in a field each and every day in good or bad weather, it's not much of a plus side.
.

Wow... thanks for this info. I wouldn't have thought...

 

[Echryss]

It’s not PSD then, it’s in the foot/lower limb and I’d be evaluating the options very carefully at this stage.

PSD is very specific and is just below the hock

You really need the suspensories scanned to see what condition they are in. If there is lots of thickening, uneven fibres, prognosis is not so good. Have they been scanned?

At first he was diagnosed with suspension ligament desmitis (in January) and the urltra sound had shown a swollen ligament. After injections, blister and three months of swimming in cold sea water, on the 24th of May the 2nd ultra sound showed a pretty good suspensory and ligament with no thickenings or oedemas in both legs.
That's when my vet suspected lower limbs, because he was unexpectedly lame at the test. He blocked him and he responded at the second chapter of coffin joints/ navicular started.

Now I am confused myself since I haven't yet received anything in written, only oral diagnosis that changes every day with every test...
No ultra sound after May 24th, but he is not swollen, no temperature and hasn't worked at all so the vet doesn't think the suspensory and ligaments are affected again.
Its pretty focused now on the right front foot and the whole story now is "he has been de-nerved in the past, nerves are regrowing, that's why nothing has worked for him so far and he is still lame".

 

[ester]

I it wasn't a PSD neurectomy I'd be putting to sleep. I wouldn't denerve again (I wouldn't have done a hoof denerve initially either).

When the diagnosis was 'back issues' it seems likely that he had some compensatory stuff going on which elicited an improvement when treated.

 

[Regandal]

What do you mean by ‘blister’ in his treatment? Did they apply stuff to his leg to cause blistering?

 

[spacefaer]

What do you mean by ‘blister’ in his treatment? Did they apply stuff to his leg to cause blistering?

Old school method to allegedly improve healing time with damaged tendons by applying a caustic solution
It's been proven not to work but it at least stops the horse being ridden while the skin heals
I don't think that the OP is in the UK.

 

[AnShanDan]

Well it sounds like you've got 2 issues, one being the hind limb PSD, the other being a front foot soft tissue injury, possibly of longstanding.

Also sounds like the hind limb issue may be resolved but the front one is potentially much more serious, although I'm not sure fron your descriptions which legs have had which diagnostics and treatments.

It's not a great picture but at the moment you are a bit in the dark. MRI of front feet would give you a better idea of the damage to them.

A big worry for you

 

[Regandal]

Old school method to allegedly improve healing time with damaged tendons by applying a caustic solution
It's been proven not to work but it at least stops the horse being ridden while the skin heals
I don't think that the OP is in the UK.

I suspected that, just wanted to clarify. They still fire them in some places in the UK.

 

[doodle]

I wouldn’t do a first nuerectomy never mind a second.

 

[Echryss]

I wouldn’t do a first nuerectomy never mind a second.

I wouldn't do the first one either. If you ve read the story, it was sold to me as a perfectly fit 9 yo; the simple vet test back then of course showed nothing and the horse at that time was flying. Still in shock from this news 5 days ago.
The question is simple: If the horse has gone this way once, is there an other way when the problem re appears? Or is it because he was de-nerved that the therapy for his limb does not have any effects?

 

[Echryss]

It's not a great picture but at the moment you are a bit in the dark. MRI of front feet would give you a better idea of the damage to them.

A big worry for you

Thank you.
No MRIs for us down here at the south...
Actually, as I am saying above, "Its pretty focused now on the right front foot", but still I am in dark as to what is going on exactly in there and where.
But then again, both vets dont seem to bother much about what and where exactly, after they discovered he had been operated. As I said the vets's mail says:

your horse has degenerative changes of the coffin joint as well of the navicular bone and perhaps of the tendon.​

I am waiting for a more official medical report...

 

[ihatework]

I’m not sure where you are based and what is considered ethical or not ethical but in the UK a foot denerving would be done as a last resort when other therapies had failed. Even then there would be a not insignificant number of vets who would advise against it and a proportion who would refuse to do the procedure.

Treatments now not working are likely a) because they didn’t work before and b) the horse has continued to be worked on a breaking down leg and is likely to have exacerbated any damage.

Also bear in mind that it’s not a case of one day the horse is not feeling foot and the next it’s got full feeling. This will come back gradually so I suspect it will only get worse.

In my mind, and with the caveat that the info has been limited/sporadic, I’m not a vet and I’m not party to the clinical history, if you are going to keep the horse alive then the foot would need to be denerved again.

Im reasonably pragmatic about qol in retirement, use of bute etc. But if I’ve read and understood the post correctly and if the horse were mine, he would be PTS I’m afraid.

 

[Echryss]

I it wasn't a PSD neurectomy I'd be putting to sleep. I wouldn't denerve again (I wouldn't have done a hoof denerve initially either).

When the diagnosis was 'back issues' it seems likely that he had some compensatory stuff going on which elicited an improvement when treated.

True, all the "side effects" were treated if I have to be precise. His back is fine, his ligaments are fine, suspensory fine (for the moment). When I am saying "nothing has worked" I am talking specifically about his right front foot, which causes his lamenes and which has most probably caused all the rest.

 

[Bernster]

A very sad tale and a lot to deal with. It’s always difficult balancing treatment options, wanting to do the best by the horse, and being realistic for the owner. With his history, I wouldn’t be doing any more invasive treatments. I’d see if he could be comfortable to be retired or in lighter work, or PTS if the prognosis isn’t good or your situation means it’s not possible.

 

[Regandal]

It sounds as if he’s made a reasonable recovery from the psd, but now has navicular syndrome in the front feet.
If I were you, I would take him barefoot, you can find lots of info on here and online.

 

[Echryss]

It sounds as if he’s made a reasonable recovery from the psd, but now has navicular syndrome in the front feet.
If I were you, I would take him barefoot, you can find lots of info on here and online.

Yes! thanks! now thats the way of thinking I need right now!
Sorry, PTS is definitely not an option for me right now, I cannot even pit it in words.
He is one of the happiest horses in the barn, having me in full service every day!! And he is anyway happy and playful and social as a character, I am pretty sure he ll find his way along. If I decide for retirement then most probably he ll go barefoot.