De-nerving

Wimbles

Wimbles

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We've been haviung issues with my big lad's coffin joints since march time and despite several different treatments including going barefoot, specialist shoes, injections into the joint we're not getting anywhere fast and my poor lad is not a happy boy even though he's not that lame.

My Vet has been really, really good with us and have have the upmost respect for her opinion but we are now being referred to Newmarket for arthroscopy and she has receommended that if they don't find anything during the procedure that will actually "fix" him then he should be de-nerved.

This immediately sounded some massive alarm bells and it's left me with my head in a spin. Both my vet and the ones at Newmarket seem very upbeat but the thought just fills me with horror.

I'm not bothered if my boy can't be ridden again, although he is the sort that loves going out for nice hacks, but I can't really face leaving him in any sort of pain to rot in a field.

I'm so confused so any experiences people have had would be greatfully received to widen my knowledge before deciding anything.
 
I would say that if you decide to have it done, then you need to keep your lad in work and checked regularly as he can't feel if he damages his feet or stands on sharp objects so it becomes your responsibility to look after them for him.
Best person to talk it through with really is your vet as they will know you and your horse best.
I know some are totally against it and it's not something I've seen done , but I'm not against it.
 
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I have the same issue with my horse - and surgery is not a route I would go down, personally.

As long as he's field sound and comfortable as he is - then that is fine. After that he will be pts.
 
Wimbles said:
We've been haviung issues with my big lad's coffin joints since march time and despite several different treatments including going barefoot, specialist shoes, injections into the joint we're not getting anywhere fast and my poor lad is not a happy boy even though he's not that lame.

My Vet has been really, really good with us and have have the upmost respect for her opinion but we are now being referred to Newmarket for arthroscopy and she has receommended that if they don't find anything during the procedure that will actually "fix" him then he should be de-nerved.

This immediately sounded some massive alarm bells and it's left me with my head in a spin. Both my vet and the ones at Newmarket seem very upbeat but the thought just fills me with horror.

I'm not bothered if my boy can't be ridden again, although he is the sort that loves going out for nice hacks, but I can't really face leaving him in any sort of pain to rot in a field.

I'm so confused so any experiences people have had would be greatfully received to widen my knowledge before deciding anything.
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So what has been done to date? X-rays, MRI? On what evidence has the coffin joint been diagnosed?
 
Sorry to hear about your horse - and Amymay I'm sorry too, I didn't know - your lad is such a handsome chap.

I'm afraid I wouldn't like to go down the de-nerving route. My wonderful horse has had to be PTS because of de-nerving for PSD, and he seemed sound and to be doing so well, we were out competing and even contemplating jumping, meanwhile those ligaments were falling apart. If he hadn't gone lame again, the first I would have known would have been when he broke down completely. I feel an incredible level of guilt for pressing on with him, when I didn't know how bad things were. I don't think I could do that with a foot de-nerving simply because of the huge amount of things that can go wrong in the foot, and also because of my personal experiences with foot lamenesses. Everyone would have a different view, however, and there probably is no "right" or "wrong" decision on this sort of thing.

You've got to do what feels right for you and your horse under veterinary guidance; to be honest s*d what ever anyone else says.
 
Similar thing was said to me regarding my mares injury, tear to DDFT and inflammation in navicular bursa. My vet said that if the injection into her bursa didnt last this time that de-nerving was the last option. Prior to that she would have required an MRI to confirm that there was nothing else going on and to be honest, I would have followed my vets recommendation, whatever it was. He is a top lameness expert and I have utmost trust in him. You would need to take very special care with the foot that was involved i.e. farrier keeping a look out for anything untoward, and be careful what you did with your horse and where you rode it. I personally would prefer my horse to be comfortable and not to live on bute etc for the rest of her life.

Pony on our yard had it done as it had navicular, owner had never looked back and had no problems with the pony either. Its a personal decision and one that no-one should judge you about. Its whats about best for your horse at the end of the day and your vet is the one qualified to tell you best.

My mare is ok by the way and hasnt needed any further treatment. Shes in full work and just competed at Dressage, doing very well when shes not being a spooky girl!!
 
I am normally dead against de-nerving for most of the diseases that it is used as a treatment. But in your case, provided that it is definitely joint damage and not soft tissue damage causing the problem, and provided that you are very aware of how much damage he could do to a numb foot if you don't spot he's in trouble, and if he is no more than early teens, then I would have it done. Otherwise I would have him put to sleep. I hope it doesn't come to that decision, good luck at Newmarket.
 
Should have said that he's 13.

The other thing I'm struggling with is whether of not I should just have him pts now?!?!?

I know I should trust the vets and that I probably sound very un-caring but honestly it's not like that. I just know I'd never forgive myself if I missed something after him being de-nerved. He just means the world to me.
 
Wimbles said:
Should have said that he's 13.

The other thing I'm struggling with is whether of not I should just have him pts now?!?!?

I know I should trust the vets and that I probably sound very un-caring but honestly it's not like that. I just know I'd never forgive myself if I missed something after him being de-nerved. He just means the world to me.
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De-nerving is a salvage procedure, and is usually reserved for cases like navicular disease. If you have had all the work up properly, which it sounds like you have, then I would go for arthroscopy. Should there be a horrific amount of cartilage and boney damage, then get the vets to call from theatre to talk you through the best options. I have not used de-nervation in a situation like this one, but I'm sure the vets must have good reasons for discussing it.

Every case is unique and have very different treatment protocols for it. Speak to your vets, they know all the ins and outs about the case, before making a decision.


Best of luck
Imogen
 
Wimbles said:
Should have said that he's 13.

The other thing I'm struggling with is whether of not I should just have him pts now?!?!?

I know I should trust the vets and that I probably sound very un-caring but honestly it's not like that. I just know I'd never forgive myself if I missed something after him being de-nerved. He just means the world to me.
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I understand you completely. There are far worse fates for a horse than for him to be quietly put to sleep. He does not know that he "might" have had more years of life and he does not care. You, on the other hand, will know that he is safe and can never be in pain again. At the same time you will spare him and you operations and upset.

Has anyone told you that there is a one in 100 chance that he will not survive the general anaesthetic? And a higher risk than that is that he will injure himself thrashing around as he comes out of the anaesthetic? A friend of mine had a horse's infected hock joint flushed under anaesthetic and the horse ruined her knees (in a padded recovery suite under CCTV observation) trying to get up so she was pretty much unrideable ever again anyway. Cut nerves also regrow and often have to be done again.

I love my horses but I am less sentimental than most people. In your situation, I would have him put to sleep.

I feel for you, it's a hard decision.
 
I'd never have a horse of mine de-nerved. As others have said, it's very much a last ditch cover up when all attempts to resolve the underlying issue have failed. It doesn't address what is happening in the foot one iota so the foot will continue to deteriorate. If the horse could be kept happy on a couple of bute a day, there's no reason to think of not being ridden as "rotting in the field". There's loads of interaction and in hand walks that can keep both of you happy and if the time comes when he can't be kept comfortable on a couple of bute, then pts with dignity knowing you've done your absolute best for him.
 
This was suggested as an option for Jesper but I wouldn't even consider it. The thought doesn't sit well with me. Personally I'd rather have a happy retired field sound horse, than a de-nerved horse that I could ride. As others have said it does not fix the problem, but instead hides it. The joint will continue to detoriate it's just you and your horse won't know about it. I'm afraid it wouldn't be for me.
 
cptrayes said:
The first part is true. The CEPAF study showed there is about a one on a hundred chance that a healthy horse will not recover from a GA. The second part is not true. The CEPAF study INCLUDED recovery as part of the GA. It does provide the greatest risk overall, and that is why the 1% chance is stated to be as high as it is.
Most horses do recover uneventfully and all pretty much all sedated until the anaesthetic drugs have left their system so that they get up calmly when ready. But some do thrash about despite best care. Assisted recoveries are used as standard in a lot of clinics to minimise this risk too. Personally I think this risk will continue to drop in the future.
Don't forget this statistic also covers all the "healthy" horses with full limb casts on from fracture repair that panic.

If you opt not to do surgery that is fair enough. But understand the risks fully to make informed decision making exactly that.
My 2p? I'd do the arthroscopy- look and see and make your decision based on that. I'm sure I'd denerve for a coffin joint issue. :confused:

Good luck.
Imogen
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Thanks so much to all of you for replying, each one gets me thinking about every aspect of this which is exactly what I feel I need to be doing.

I trust the vets, they've done the training, I have not but I also know the nagging doubts in the back of my mind.

Imogen Burrows, just wondering did your last post mean to say I'm sure I'd denerve for a coffin joint issue or did you mean to say I'm NOT sure? It just read a bit more like the latter.

He is definitely going for the arthroscopy but I feel that I need to know what I'm on with as I don't want to have to put him through two GA's.

Thanks again folks xx
 
talk to your vets a few years ago they used to do a split ligament operation, which worked well, but is now out of fashion due to advanced drug therapies. de nerving works well in so much as no pain!! but be aware that the nerves do reform in 1 to 3 years albeit in a jumbled form. de nerving was a very common practice for many top show jumpers 15 yrs ago. they do need regular checking and safe turnout. you can opt for a partial denerving so they retain some feeling in parts of the foot. you really need to chuck this one around with your vets asking all the relevant q's/outcomes/possible outcomes/future prognosis.
 
Thanks for the correction Imogen. I'd have been a lot happier with my horse's surgery if I'd known that the stats included recovery. Can I just say how much I value vets spending their time on here to give us the benefit of all their knowledge, and for free! We are very lucky to have this resource.

Wimbles good luck, I hope it's a clear result and there is an obvious way forward.
 
Wimbles said:
Imogen Burrows, just wondering did your last post mean to say I'm sure I'd denerve for a coffin joint issue or did you mean to say I'm NOT sure? It just read a bit more like the latter.

He is definitely going for the arthroscopy but I feel that I need to know what I'm on with as I don't want to have to put him through two GA's.
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THanks for the alert - properly perceptive...I did mean the latter - NOT sure about the denerving. But I'd wait and see what arthroscopy said...might trun out to be a sound choice once you know what's going on in there. Not going through 2 GAs is v sensible - most vets will ring from theatre happily to stop this being a probably - just make sure you're where phone reception is!!! Good luck :)

cptrayes said:
Thanks for the correction Imogen. I'd have been a lot happier with my horse's surgery if I'd known that the stats included recovery. Can I just say how much I value vets spending their time on here to give us the benefit of all their knowledge, and for free! We are very lucky to have this resource.
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Not at all - hope some of the info helps....what use is it if you don't spread it around!!! :D
 
I'm also considering denerving for my young mare with a cyst in the coffin joint. Vet states she would require the upper sesamoid level nuerectomy.
I am most concerned about her ability to manage rough and uneven ground. She already trips and stumbles all the time, but I'm not sure if this is due to pain in the joint or the fact she is a gangly growing 4 yo who never looks wheres shes going, or a combination of the two. I am worried she will stumble more after the op and it will all be a waste.

I'm torn between getting the op, selling her as brood mare or putting to the blood bank, and each day I seem to change my mind.
 
Oh S, so sorry hun. Just seen your post. I didn't realise things were so iffy with him :(. Hugs.

When Tigs was lame she went to the AHT at Newmarket. When I got the results I started researching everything, including the de-nerving option. I decided against it. Nerves can grow back. There was no guarantee it would work. Nerves are there for a reason. As it turned out, in our case the operation was not an option, the damage was too bad.

I know what he means to you and we will all have everything tightly crossed.
 
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