Differing advice from 2 vets- Experienced opinions needed please

[kellyb]

Hi, I am going to try to summarise our issues to keep this from getting way too long so if I accidentally leave out some important info, please just let me know.

We have a Haflinger gelding (my daughter's hore), 11 years old. He has a very aggressive spavin in his right hock and has had it for a bit over 2 years. The other hock apparently has fused and we had no idea anything was even wrong with that one. It may have happened before we had him. For this Spavin he has had 2 treatments of Tildren, a dose of "Osphos" , was on danilon for some time then that was stopped as he seemed to improve a little, then had a rather sudden setback and got very bad again. The vet prescribed bute and we have been giving that to him for a few months. We did stop for awhile to see how it would go but he was in alot of pain so we started it up again. the idea was that the joint would fuse after a year - year and a half and he would be fine enough for my daughter to continue riding.

He has also had allergies which we think are now a sort of sweet itch. We have had the vet out numerous times for the allergies over the years. They have taken a skin scrape and it is not a parasite. It was not textbook sweet itch but seems to now be going that way. His skin is black beneath his coat so sometimes he just has black areas all over his face from sores and rubbing at his face. The allergies are extremely bad right now with large sore areas over his rump and all over really. He has fly rug but he tears them very quickly and sometimes his field companion removes them for him! The midgies seem to find any holes are in there in a second.

I should add that we have used all manner of fly repellant, anti-itch formulas and soothing/healing creams, none of which seem strong enough to combat this problem. We have also paid for a weeks worth of antihistamine for him but that had very little, if any effect.

About 5 weeks ago I saw him, for the first time ever, licking or eating a little hole of mud/soil he had created. He looked particularly miserable and his leg was very bad. He seemed to be barely able to walk though he was standing and his other leg was a bit swollen. He was also suffering form his allergies quite badly.

I called our vet, who has treated our horse since we have had him and he felt, without seeing him in person, that the other leg was swollen from bearing the brunt of the bad leg. He said it may be that the allergies which have become such an issue may be due to the stress of the leg for such a long time. He suggested that it was time to "put him to sleep".

After much deliberating I decided to get the opinion from another vet at a different practise. This vet said that he would treat him with a steroid injection into the hock which may also help to stop the itching. I told him our vet had said that he would not recommend steroids due to the possibility of laminitis. Our horse is not particularly overweight but as a haflinger he is a well built chap and definitely not the slim type! He has never had laminitis since we have had him. I called our first vet back and talked to them about the steroid option but they were not keen at all to try them, saying that within a couple days our horse could be laying in the field suffering a terrible case of laminitis which would leave him in agony. ......

The worry is: the hock is not fusing but instead is getting worse (we had xrays which confirmed that about 8 months ago). Sometimes he can barely walk around, literally, and looks very unhappy. He has also not been his usual self for sometime...BUT sometimes he is walking ok and is a bit better. We go over to his field to see him expecting to see something awful but instead he is grazing and looking like he is not too bad. The itching is obviously very bad and really getting him down. It does seriously affect his quality of life and makes him miserable. We are unable to control it at the moment, no matter what we do..washes,creams, coats etc.

When he has the good days we think there is no way we could put him "to sleep"!! But then he has the bad days and we think it is cruel to keep him going.

Does anyone have any experience with any of these issues? Particularly the use of the steroids and the possibility of laminitis?

I tried to keep that from getting too long but Im afraid there was a lot of info to share...sorry.

 

[twiggy2]

Not sure what you have to lose by trying the steroids, i would give it a go and watch him like a hawk.
If you don't it sounds like Pts is required anyway so if he does get lami then your decision is made but you have tried all the options, if he comes right then what a result?

 

[Booboos]

Poor little horse and poor you! I think where you are now it is sensible to try the steroids. If they help then that's great, if they cause laminitis then you need to think what is best for the horse's welfare and take the difficult decision to PTS.

 

[be positive]

Firstly the spavin, I don't see how the risk of laminitis, which real but not a certainty, can be worse than having him pts, obviously being pts will end his pain but to suggest it without trying the steroids seems rather unfair as it works for many and although he may be a high risk type for laminitis if you are prepared for it and take extra care it must be worth giving him one last chance.

The itching may be helped by steroids although they will normally be oral rather than given indirectly through the joint injections, if he has the injection and it helps the itching then it is win win, however with many skin issues it is something inside them that causes the reaction we had one that failed to respond to various treatments suggested by the vet including having an inconclusive biopsy that stopped itching completely after going onto a course of NAF detox and coming off of all hard feed for a while before being carefully introduced to a very simple low sugar/ starch token feed, it is worth trying as licking mud suggests he may need something in his diet or something cutting out, do you give him garlic as that can cause problems in the gut and make itching worse yet vets often recommend feeding it to repel flies.

Not sure if that helps at all but if he were mine I think I would give him one last chance, take serious measures to prevent laminitis and hope the injection works for him, if it fails to help or he gets laminitis then the tough decision will need to be made but knowing that you have tried everything makes it slightly easier to deal with, they rarely go down in the field as dramatically as your vet suggested, keep him off grass for a week or two, soak hay, give little or no feed and exercise gently as appropriate and you stand every chance of avoiding it, being prepared and aware is half the battle.

 

[ester]

I'm not sure why it is news that the hock is not fusing?- Osphos and tildren both extend time to fusion and he has had 3 of these treatments in total.

I have an aged welsh cob, he recently had his first hock injection and has had them elsewhere before (they didn't work in feet) my current vet has been suggesting that current research is suggesting the link with steroids and lami is not as strong as first thought and I think you can mitigate slightly. They have to stay in post injection while it works anyway and IMO it is worth the risk to get them comfortable. He doesn't have much quality of life atm and if it goes wrong you deal with it then.

I think your first vets are catastrophising a bit suggesting he would be off his feet in 2 days lying in the field!

I'd want topical steroids on the skin itchiness too.

 

[BlairandAzria]

Like Ester said Osphos and Tildren are both working to extend the life of the joint, not fuse it. You could actually fuse the joint by injecting ethyl/alcohol, this has quite a high success rate.

Also the steroid injection may well help the joint (the risk of laminitis is there, but as far as know, definitely not inevitable - and you could take steps to mitigate) I am doubtful how much a steroid injection in the hock would help the skin issue, I too would be cutting all feed (certainly remove any sugar/ wheatfeed/ pelleted feeds) and get a topical steroid cream ( I might even be tempted try a topical hydrocortisone cream - caneston or such from boots, after discussion with the vet of course )

Good luck I hope you find a solution for your pony.

 

[kellyb]

"keep him off grass for a week or two, soak hay, give little or no feed and exercise gently as appropriate and you stand every chance of avoiding it, being prepared and aware is half the battle.[/QUOTE]

Apologies for sounding dumb here but I have never dealt with Laminitis before- when you say keep him off grass, do you mean stable him?

 

[kellyb]

Apologies for sounding dumb here but I have never dealt with Laminitis before- when you say keep him off grass, do you mean stable him?

 

[kellyb]

I'm not sure why it is news that the hock is not fusing?- Osphos and tildren both extend time to fusion and he has had 3 of these treatments in total.

I have an aged welsh cob, he recently had his first hock injection and has had them elsewhere before (they didn't work in feet) my current vet has been suggesting that current research is suggesting the link with steroids and lami is not as strong as first thought and I think you can mitigate slightly. They have to stay in post injection while it works anyway and IMO it is worth the risk to get them comfortable. He doesn't have much quality of life atm and if it goes wrong you deal with it then.

I think your first vets are catastrophising a bit suggesting he would be off his feet in 2 days lying in the field!

I'd want topical steroids on the skin itchiness too.

Someone told me this before regarding the Tildren and Osphos. I did ask my vet about that and he said something along the lines that it is a little more complicated than that and that the idea is that the "good" cells are supported to work harder creating the good bone and the "bad" cells are stopped form creating the bad bone - or something like that. I asked the second vet too about that and he did agree that was what he would have suggested also. I read up about it and it did seem to be support what they said though I do agree with you that it sounds like it would have an opposite effect.

 

[kellyb]

There is a lot of excellent advice here. Thank you all. Interesting that everyone seems to be agreed that they would try the steroids.

I feel a bit awkward with my vet, who I have always liked very much. His colleague made it very clear that my vet would not recommend it nor would the colleague and gave me the scary story about risking our lovely boy experiencing horrendous pain before being pts.

I am really surprised that neither vet offered a steroid cream as some of you have suggested.

There is something that I thought of which I would like to bounce off you.... If your horses damaged joint is relived of it's painful symptoms by the steroids and then you can ride him more and do more with with him, that joint will just get more damaged, even though he may not feel the pain, right?

For example, I read this on the horse journal website:

"However, in a way, corticosteroids also contribute to the demise of the joint by blocking the pain and inflammation that is associated with the damaged cartilage. Without that mechanism there to stop the body from using the joint, the rate of joint deterioration will accelerate since owners will continue to create trauma in the joint by riding the horse. So, where is the Catch 22?

Choosing injections so that your horse can be comfortable on a daily basis rather than have them live a long life of pain due to osteoarthritis makes sense. You just need to be aware that the slippery slope starts with the first injection, because from then on, it’s difficult to stop periodically injecting the joint since its rate of demise will accelerate as a result of overuse."

What say you?

 

[Boulty]

Heya my own horse had hock spavin and like yours one leg fused but the other refused to do the same. We managed to keep things under control with bute and exercise and plenty of turnout for about 5 years (we tried tildren initially to no effect apart from him colicking every time it was given). We tried steroids into the joint as a last resort and it did give some improvement but only for maybe 2 months before he started to stiffen up again and was then worse than before the steroids. Said horse also had some issues with mild sweet-itch like symptoms (only in the last few years of having him) and he dropped a lot of weight and muscle (in hindsight I do wonder if he was starting with cushings tbh) and really struggled to hold his back legs up for his feet picking out. As the steroids had only had a very short term effect and bute wasn't really helping any more he was PTS in the end as we felt we'd run out of options and it wasn't fair. My horse did not suffer laminitis and the risk is supposed to be relatively low but that said a friend of mine's horse DID suffer laminitis after this procedure with no history of it so yes it can happen.

Something else that may be worth looking at as an option is the ethanol fusion where they inject ethanol into the joint with x-ray guidance with the aim of fusing it. I think it's one of those things that either works well or not at all but may be worth looking into (although I do think it can only be used in certain cases)

In short if the alternative is PTS then it's definitely worth looking at the other options out there even if they may have side effects.

 

[Goldenstar]

For me it's all about quality of life for them and for me .
So to be blunt if it where me I would call it a day .

 

[Sandstone1]

I think if he were my pony, I would be getting a different vet and going with the steroid injections. If he is as bad as you say it's at the point where his quality of life is such that pts will be the only outcome if you carry on as you are.
It's worth trying the steroids and it may well help. At least then you will have tried everything.
With regards his skin, have you considered a veterinary dermatologist?
Could you ask to be referred?
I wouldn't worry about upsetting your vet, the ponys life is the most important thing. You have every right to want the best treatment for your animal and that's much more important than your vets feelings!
Good luck and I hope things improve.

 

[ester]

Tildren and opshos certainly are more complicated than just stopping them fusing I agree, in fact I am not sure even the producers know quite all the mechanisms they use.

Yes you can get onto a cycle of injecting, however I would much rather a horse have a shorter period of more quality life than have one lame for an extended period. What you describe was the reason I didn't start injecting when we very first noticed the problem a couple of years ago, it wasn't that bad and it was manageable with work and physio at that point, but well he is 23 now so has limited time of working life left and only had an issue in that one spot.

Re. the skin, at the time of injecting Frank we shared the visit with one that struggles with sweet itch. The owner was essentially told that although she didn't want to she had no choice but to start treating with steroids or the wounds were going to become infected, the horse was suffering and to leave it would be a welfare concern.

IMO you cannot do nothing for either complaint.

Ethanol fusion might be an option but doesn't always last as the nerves regrow and can also mean they move a bit differently.

I do wonder if your vet is thinking that if he is not field sound on bute anyway, steroid injections might be clutching at straws rather.

I think you either throw everything at him to see if he can be improved sufficiently or PTS. TBH the more I read your post the more I think your first vet might have it right. I'm not sure barely able to walk is likely to be improve that much by injecting.

 

[FfionWinnie]

It seems like a fairly simple choice to me, sadly, you've not got many options and you can't continue as things are. Inject the steroid (and I would also want some specifically to treat the allergy) as a last ditch attempt before he has to be put down for welfare reasons. I wouldn't be happy continuing the way he is at the moment without trying something new and calling it a day if all avenues are exhausted.

 

[Casey76]

Hock spavins are, in essence, an inflammatory response. By giving bute and/or Danilon (anti-inflammatories) (as well as the Tildren and Osphos) you are prolonging the fusion process.

Where in the hock joint(s) is the spavin forming? If they are limited to the lower three/four joints (which, when fused, will not effect the locomotion of the leg), then your vet should be looking into speeding up the fusion process - unfortunately this can be a bit rough and ready - my vet told me that the facets of the effected joint(s) are assaulted in order to promote osteogenic activity - this can be done mechanically with a drill or needle, or chemically with ethanol.

Keeping them moving and/or exercised with no anti-inflammatory support will also speed up the fusion.

Adding anti-inflammatories can delay fusion by 6-12 months depending on the extent of the effected joints.

If it is the mobile 3/4 joints (sorry, I can never remember which way round they go), which when fused will effect the locomotion of the limb, then I think you have far fewer options.

The itching can be combatted to a certain extent - Boett rugs (which are expensive, but are probably still the best on the market), full face masks, topical steroids, additional steroid support when needed.

 

[ihatework]

I don't think either vet is necessarily wrong, they are just offering different options.

Ultimately you cannot do nothing as that is not fair on the horse. So you either intervene and spend money in an attempt to alleviate symptoms and restore sufficient quality of life or you call it a day. Neither is wrong so you need to decide fairly quickly which path you wish to take.

If you decide to treat then in my opinion the risk of lammi from IA steroids is low enough that I would always take that risk. It is quite possible that joint injections will only offer temporary and partial relief though. I would personally be thinking more along the lines of trying ethanol fusion.
Regarding the sweetitch, have you tried the immune type injections now available? It probably won't help so much mid season but if the hocks are treated and improve it might be something to consider next year. What would be worth trying is oral prednisolone however that is a lammi risk and yes I think you would need to consider stabling as part of the management.

Good luck with whatever you decide. Ultimately go with your gut. If your pony is having more bad days than good then maybe you need to listen to your first vet - it's actually not that common for a vet to come right out and say PTS so maybe consider that they are seeing a really quite unhappy pony?

 

[Polonaise]

There is a contradiction here. Fusion of the joint is caused by advanced joint disease, the end result may well be soundness but the process of getting there involves a lot of inflammatory response, something that traditional treatments are designed to counteract. By giving bute/danilon/steroid/osphos etc. you are reducing the inflammation which is designed make the joint healthier and hence will slow down the destructive process that leads to fusion. If the horse is in too much pain to be kept comfortably in the paddock (+/- anti-inflammatories) then I would suggest referral to a specialist to see if the joint can be chemically/surgically fused or whether a local neurectomy is possible or PTS.

 

[irishdraft]

A pony I have on livery has had a terrible itchy hot spot under her chin vet prescribed a cream called isotherm I think it's mildly cortisone or steroid anyway it's done the trick I don't know if you have tried this one OP

 

[old hand]

I think horses vary wildly in their reaction to pain. I have one with a large jack spavin and did not give bute as it would delay the fusion. he didn't really care about it but worked through it. Success with jack spavins is very low. The side effects of bute are more than just taking down the inflammation, the manufacturers stated contra indications are joint damage. My chap moves his leg slightly differently than he did but it does not affect him and he is no different after work no matter how hard he works, but I have known others with smaller spavins that cannot put up with it and maybe the positioning of the spavin and the amount of flexion and movement the horse naturally has affects it too. Mine was referred to a specific lameness hospital maybe a second opinion and new x rays are needed to see if there is a way forward for him.

 

[Theocat]

Vets IMO aren't quick to suggest putting an animal down. If the vet who has been in attendance for weeks / months feels you've reached the end of the road, I would respect that opinion.

Horrible for both of you- I'm sorry.

 

[ash_vet]

Steroids and laminitis is always an interesting one for vets. Personally I am yet to see a horse suffer from steroid induced laminitis (5 years graduated), however it certainly can happen. I think one common misconception that many owners have is that all steroids are the same, and will have the same effects. The effects of steroids also vary upon their route of delivery, I personally would be surprised if any steroid I injected in a joint would provide any relief for a skin condition.

In terms of steroid induced laminitis I always advise that the risk is fairly low for a normal healthy horse. Elderly, overweight or horses that have previously suffered from laminitis are more at risk from developing laminitis after administration of steroids. Andy Bathe over at Rossdales did a study in 2007 where he found that in the case of 2000 horses receiving joint injections, only 3 had issues with laminitis. This was an incidence of 0.15%, 2 of the 3 had previously had laminitis, and only 1 had long term complications. Another potential complication is joint infection post injection, however we try to minimise the risk of this by performing a surgical scrub prior to injecting the joint.

Sorry about your horrible situation, and hope things work out ok.

 

[ester]

My physio said recently she had an owner who said the horse had had steroid induced lami and told everyone such.
the lami actually occurred, in the spring, nearly 6 months after the joint injection...
I'd be much more worried about infection really, although at least I guess that is more controllable.

ash_vet, welcome to the forum

 

[galaxy]

I had only met one horse who had steroid induced laminitis. He was not the laminitic 'type' as he was a 16hh ish. He was an old boy at 22 and no history of lami even when he had been very overweight in the past. He tested negative to cushings etc so certainly steroid induced which he had been given orally for a cough. Sadly his lami was serious and he never recovered and he was pts.

 

[bubsqueaks]

I had only met one horse who had steroid induced laminitis. He was not the laminitic 'type' as he was a 16hh ish. He was an old boy at 22 and no history of lami even when he had been very overweight in the past. He tested negative to cushings etc so certainly steroid induced which he had been given orally for a cough. Sadly his lami was serious and he never recovered and he was pts.

Hi - my pony has just been diagnosed with coffin joint & hock arthritis - I was given 3 options - key hole op on coffin joints, steroids, or arthramid vet - the hocks are fused so only option is bute but believe you could use arthramid on hocks although not 100% sure - she was injected last week & it's benefits could last 2 years - I chose that over the steroids as didn't want the risk of lami & preferred the longer term solution (fingers crossed).

 

[kellyb]

Just thought I would post an update in case anyone would like to know - We spoke to a third vet, one a colleague of my husband recommended. I told him our story and he agreed that he would try the steroid injection for the hock. As many people here said to try the steroids and the second vet also said so, after getting as much info as we could we decided to go ahead with it. Although he was very diplomatic about it, he did say he was surprised that our vet had not tried it already. He agreed that there was some risk but that it was very low as our horse has never had laminitis.

We did speak briefly about the skin condition but decided to see if possibly the hock injections would have an effect on the skin. Also his allergies have eased off due to constant attention and numerous hibiscrub baths.

He did the injections today. I thought there was only one injection but he did three. Now we just have to wait and see how things go. I will update when we know more.

 

[Mince Pie]

Thank you for the update, I how the injections work for your pony.

 

[applecart14]

Hi, I am going to try to summarise our issues to keep this from getting way too long so if I accidentally leave out some important info, please just let me know.

We have a Haflinger gelding (my daughter's hore), 11 years old. He has a very aggressive spavin in his right hock and has had it for a bit over 2 years. The other hock apparently has fused and we had no idea anything was even wrong with that one. It may have happened before we had him. For this Spavin he has had 2 treatments of Tildren, a dose of "Osphos" , was on danilon for some time then that was stopped as he seemed to improve a little, then had a rather sudden setback and got very bad again. The vet prescribed bute and we have been giving that to him for a few months. We did stop for awhile to see how it would go but he was in alot of pain so we started it up again. the idea was that the joint would fuse after a year - year and a half and he would be fine enough for my daughter to continue riding.

He has also had allergies which we think are now a sort of sweet itch. We have had the vet out numerous times for the allergies over the years. They have taken a skin scrape and it is not a parasite. It was not textbook sweet itch but seems to now be going that way. His skin is black beneath his coat so sometimes he just has black areas all over his face from sores and rubbing at his face. The allergies are extremely bad right now with large sore areas over his rump and all over really. He has fly rug but he tears them very quickly and sometimes his field companion removes them for him! The midgies seem to find any holes are in there in a second.

I should add that we have used all manner of fly repellant, anti-itch formulas and soothing/healing creams, none of which seem strong enough to combat this problem. We have also paid for a weeks worth of antihistamine for him but that had very little, if any effect.

About 5 weeks ago I saw him, for the first time ever, licking or eating a little hole of mud/soil he had created. He looked particularly miserable and his leg was very bad. He seemed to be barely able to walk though he was standing and his other leg was a bit swollen. He was also suffering form his allergies quite badly.

I called our vet, who has treated our horse since we have had him and he felt, without seeing him in person, that the other leg was swollen from bearing the brunt of the bad leg. He said it may be that the allergies which have become such an issue may be due to the stress of the leg for such a long time. He suggested that it was time to "put him to sleep".

After much deliberating I decided to get the opinion from another vet at a different practise. This vet said that he would treat him with a steroid injection into the hock which may also help to stop the itching. I told him our vet had said that he would not recommend steroids due to the possibility of laminitis. Our horse is not particularly overweight but as a haflinger he is a well built chap and definitely not the slim type! He has never had laminitis since we have had him. I called our first vet back and talked to them about the steroid option but they were not keen at all to try them, saying that within a couple days our horse could be laying in the field suffering a terrible case of laminitis which would leave him in agony. ......

The worry is: the hock is not fusing but instead is getting worse (we had xrays which confirmed that about 8 months ago). Sometimes he can barely walk around, literally, and looks very unhappy. He has also not been his usual self for sometime...BUT sometimes he is walking ok and is a bit better. We go over to his field to see him expecting to see something awful but instead he is grazing and looking like he is not too bad. The itching is obviously very bad and really getting him down. It does seriously affect his quality of life and makes him miserable. We are unable to control it at the moment, no matter what we do..washes,creams, coats etc.

When he has the good days we think there is no way we could put him "to sleep"!! But then he has the bad days and we think it is cruel to keep him going.

Does anyone have any experience with any of these issues? Particularly the use of the steroids and the possibility of laminitis?

I tried to keep that from getting too long but Im afraid there was a lot of info to share...sorry.[/Qis i would ask your vet if ehanol fusion would be useful for this hock. normally when a horse has a normal steroid inj you aare advised to keep him off grass for 48 hours as thoisreduces the risk of laminitis

 

[applecart14]

Sorry phone playing up