Have you ever or would you ever challenge you vets advice

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happyhacking:)

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My mare has recently developed a skin condition to which as of yet we have not discovered the root cause of (see http://www.horseandhound.co.uk/forums/showthread.php?t=525666&highlight=poorly+pony for full info)

Vet has today prescribed her with steroids to help with the itching but as she has a higher chance of getting laminitis than most I am extremely concerned about giving her the drugs. Vet has downplayed the risks of the drugs but it has done nothing to ease my concerns. My gut screams don't do it right now. I am going to get a second opinion as soon as possible.

My question is really what would you do in my shoes? Would you go ahead and give her the drugs or challenge the vet?
 
What about getting a second opinion? I would and have in the past and the new vet picked up on the issue that the old one hadnt over 6 months of treatment!!!wouldnt do any harm
 
I would definitely challenge a vet if I felt that strongly. My gut feelings have been correct in the past, vets are often taking a well educated guess in their advice. As an example, I would not box rest again as I have in the past, my view and experience is it can cause as many problems as it solves.
 
I'd challenge the vet. One said exactly the same about steroids for a friends lami prone pony who'd not had an attack for years. Could be coincidence but it did have an attack after. Not had one since either. I'd want a second opinion.
 
My vet has always advised me not to use any steriod drugs with my lami prone pony so I would challenge. I don't think they mind at all, they know you have the horses best interest at heart. Although they are experts in all the medical aspects they don't know the history of the horse as well as you do. If lami is a risk, I would take no chances.
 
Yes.

Horse diagnosed with blown tendons from tight bandaging, as opposed to full blown lymphangitis. Told to be put on box rest and not moved.
We knew it was the latter as horse had not been bandaged ever whilst in our care and previously had a horse who had an almost fatal lymphangitis attack. Ignored vets advise, even though we'd argued whilst they were there saying it was NOT due to bandaging but our voices still did not get listened to.
Vet wasn't to come out till another weeks box rest and bute. We walked that horse out constantly almost every day to try and get his legs back down. Called the vet back out as legs were still getting bigger soon as he was put away again, and 2 weeks later, he FINALLY officially got diagnosed with lymphangitis from a different vet. Worst case I've ever seen of it. And that was ignoring the vets advise and carrying on walking him, when he'd been ordered complete box rest. Dread to think what they'd have looked like if we'd just gone along with the vets advise.

Normally, obviously I'd say go with the vet, but, some things, you have to make a decision whether to risk it and go with your gut feeling on it.
 
Depends on the vet. The man I try to always have who has been treating my horses for years (partner at the practice) and never has made the wrong call yet, probably not. That said, gut instincts do mean a lot and on our gut instincts we challenged the young obnoxious vet who said our horse couldnt have cushings because of his age, breed and type. We were right. I think gut instincts are important and more so if you don't have complete faith in your vet, perhaps you could get a second opinion from another vet perhaps from another surgery who someone could recommend, to prevent bias? :)
 
Yes! Vets are only human they don't always have all the right answers, and I'm not doing them a disservice in any way, in fact I think they should be cut more slack for not always getting it right first time. Maybe it's just me (and I do have a science/medical background) but I always do my own research on anything and will always challenge my vet (who I totally respect) if I don't agree. She is your horse at the end of the day.

And FWIW I would only ever give steroids to a lami-prone horse if it was a localised injection (ie into a joint or something), it is not worth the risk to me. Itchy skin is no fun for the horse but laminitis is at best incredibly painful and at worst fatal. Steroids will more than likely work to calm the inflammation and help break the itch/scratch cycle but I'd be asking to see a skin specialist to test for allergies, have skin scrapes done etc.
 
Yes of course you should challenge your vet. Not in a "challenging" way but in a way that allows you both to dicuss openly the matter in hand. They are humans too you know and make mistakes and don't know your animal like you do. I challenged vets for my cats and horses - cat had cancer when she was treated for earmites!!!!!

Just remember you are the customer and have a right to discuss things openly and honestly. Don't be discouraged by the status a vet has and combine advice with your own 3D research.

That is my view. I have a good relationship with my vets I feel because I do the legwork and then ask the questions.
 
Yes I have discussed his diagnosis and treatment in the past, I would say challenge is a strong word lol. I would not however ask for a second opinion, he is a very good vet and has dealt with horses for the best part of 30 years. I will ask him lots of questions about his diagnosis of an illness and how he came to the findings of it, I was doubtful with him once and he did take longer with the horse to make certain he was right.
He will stand and talk to you how he came to his diagnosis, he will freely admit that some owners know how their horses work on the inside and will listen to you whilst sorting the horse out. Vets are not gods they make mistakes, but its half the battle if they actually understand you as a owner.
 
I am going to see how she goes over the bank hols and hopefully with the weather the way it is she can stay rugged and won't do herself anymore damage. I'm claiming on the insurance for this and not following vets advise will this cause a problem?
 
Sorry have just read your original thread, sounds like your mare has been having a horrid time :( and your vet has been doing a great job and the steroids seem like a last resort. I would definitely still suggest getting a referral to a skin specialist and possible allergy testing. Sue Paterson is an expert in skin problems and allergies in the horse, she is based in the north west but if you're not then she may be able to recommend someone in your area. She really is very good.
 
:eek: Yes challenge/ discus your worry with your vet by all means, after all who actually knows the horse best, you do of course, and why solve one problem to risk to create another more serious one, vets are only human and like anyone can make the wrong decision, for which we horse owners have to pay for, you know in your own mind it isn't right, so if it were me I would go along with my thoughts, after all finding out what the problem actually is would be the first step, as how do you know what you are treating
:)
 
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Hi OP,

Only just seen your post, so apologies for late reply. Your mare's itchiness may well be dietary, caused by turning out into the sandschool (and ingesting sand, which is a gut irritant) and then the whole sorry process began. It may be another trigger, of course, such as an insect bite in a delicate place e.g. lymph node, you'll never know! Whatever, inflammation can be a body-wide process, so what you're seeing on the skin is just an extension of what's happening on the inside. The body is essentially a big tube, with the lumen (centre) running from mouth to bum. The skin (epithelium) coats both the outer and inner surfaces and are therefore subject (mostly) to the same physiological reactions.

When the gut epithelium is damaged, it can take a while to regenerate (and in severe cases, such as Crohn's, parts fail to regenerate, as the stem cells are also killed off). So, one weekend of being off grass wouldn't be enough for a sugar-induced itchy pony, for example (but you'd probably see the effects in that time).

Steroids have limited success anyway, if her gut is already sensitive, as any rich grass will exacerbate the condition (my 'sweet itch' mare needs to have limited grass intake). They would help, though, but I can understand why you're worried about giving them to her.

I would take her off the grass (starvation paddock, not box rest) and feed her a laminitic diet - the equivalent of chicken and rice diet for a poorly cat/dog! So, soaked hay, linseed, an oat straw chaff or beet. Very gentle things with no irritants. If she's fed garlic, then definitely remove this and same for any starchy feeds, no matter how little she normally gets. Your problem now is that she's in chronic irritation mode, so simply removing the original trigger isn't enough. Her gut is now susceptible to things which wouldn't normally bother it.

It takes at least a week for the gut epithelium to regenerate from mild damage (the cells divide in the crypt of the small intestine and then migrate up the villus and differentiate to their final cell types). Every time you 'insult' the gut, you slow down that process. I'd even be wary of feeding live yeast at the moment, as if there is severe damage, there's a small risk of systemic infection (fungaemia). If she improves when treated like a laminitic, then you can introduce the yeast later, when her gut is healthy and you want to maintain it that way!

If you safeguard against laminitis by diet and grazing restriction, then the steroids shouldn't be a problem. There's nothing to stop you compromising and lowering the dose, either.

Of course, I might be way off the mark, here, but the things I've suggested won't make her worse, so maybe think about giving those a try. By all means discuss it with your vet, too (or find one with an unhealthy interest in microbiota and the relationship with the gut, like me :D ). Until recently I worked in gastro-intestinal disease (would love to return to it, but with the state of science in this country, I don't hold much hope...).

p.s. Forgot to add, my sweet itch mare is managed like a laminitic. She had open wounds when I bought her, but the vet yesterday had to be told that she had sweet itch...
 
I think that you should see it more as working with your vet, by voicing your own opinions and having a discussion. I don't understand people who blindly accept what they are told. I have been right a fair few times-ringworm, gastric ulcers, laminitis etc. But I see the relationship with the vet as a partnership, they only see the horse for a snapshot in time, you see it all the time. Our vets are great but I still ask lots of questions and do my own research.
 
Fransurrey thanks for the info. She is on about half an acrea st the mo normally they are cut right back at this time of year but as she had lost so much weight we opted to leave her on a bit more. She was taken off the garlic on Sunday and put onto a simple systems Lucerne feed(which she had had before). She is also on a linseed, seaweed, brewers yeast and spearmint supplement and good hay and nothing else.
 
Yes I would challenge them but I realise that it is easier said then done sometimes - I have spent the last 20+ years challenging docotrs on a daily basis so know that despite what they may think they don't always know everything:)

At the end of the day you are their customer and your horse is their patient but it is still YOUR horse - so make them exp0lain and justify their treatment - they will expect you to pay the bill without a query (mind you check that to as my ex- vets tried to charge me for treating someone elses horse:o)
 
Yes go with your gut instinct. I was pretty much told to have my boy pts and prepare for it after he infected his navicular bursa and damaged the ddft. He didn't come as sound as the vets wanted and at one point I was told to think about how I wanted him pts I told the vet I wanted to give him another week. He's still with me now and is sound in walk and almost in trot something he was never meant to do again. Had I listened to my vets he wouldn't be here but saying that I was prepared to make a decision and it was only the fact he seemed so happy in his self that he wasn't pts.
 
yes, I have had to do it on more than one occassion, and when I felt I wasnt getting the service I should have been, I simply changed practices. The vets I have now, are muc better and listen. Also if you dont have confidence in what they are doing, then you are going to suffer as well as your horse. You have to trust your vet and have confidence in their ability otherwise, if you arent satisfied and lose your horse, you will blame yourself, I know, I speak from experience.
 
I did. My horse was having seizures and the recommendation was to have her put down and replace her. 15 years later she is still with me and sadly, has outlived the vet.
 
Yes I have done, my old mare who was very blooded, felt unlevel to me when going round corners. No one else could tell and no one could see any lameness when trotted up or lunged. I called vet out who said she was fine, possibly a bit sore due to recent shoeing so bute for a few days.

I disagreed so called a different practice who said yes she looks a bit lame, nerve blocked her(what a nightmare) and said I can't really tell where she is lame so box rest and bute and I will come back. She came back out with the senior partner of the practice who immediately said she's lame on both fronts, x-rayed and discovered navicular, fairly advanced.

Girly has remedial shoeing, is a field ornament with light hacking and has maintained a good level of soundness. I just dread to think what would have happened if I had listened to the first vet
 
happyhacking:) said:
My mare has recently developed a skin condition to which as of yet we have not discovered the root cause of (see http://www.horseandhound.co.uk/forums/showthread.php?t=525666&highlight=poorly+pony for full info)

Vet has today prescribed her with steroids to help with the itching but as she has a higher chance of getting laminitis than most I am extremely concerned about giving her the drugs. Vet has downplayed the risks of the drugs but it has done nothing to ease my concerns. My gut screams don't do it right now. I am going to get a second opinion as soon as possible.

My question is really what would you do in my shoes? Would you go ahead and give her the drugs or challenge the vet?
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We had some horrendous misdiagnosis at our last yard. I'll only use one vet I trust 100% and advice from OH's father. And even then if I had concerns I'd get a second, third opinion.

However. One of ours was on steroids for an undiagnosed skin condition. It was pink lotion rubbed on to skin problem areas, and made an incredible difference in days and wouldn't hesitate to use it again. This didn't stop us looking at the root though. It was only to clear up whilst correcting the root problem.

I'd use lotion, I wouldn't use anything more though without knowing the root and I certainly wouldn't be happy about it being the solution. We used it to heal and then sudocreme after.

Personally I'd look where she's being turned out and comb the areas for allergy giving things? We have a field of four where one will have awful hives and the others don't. The others don't react so bad but also aren't so blooming nosy to stick their faces in everything! Just because they aren't reacting to something doesn't mean she's not allergic. I'd drag the vet out to see the area she's kept and I'd perhaps try different turnout areas to eliminate causes. Don't change too much at once though or you may mis the real problem.

Pan
 
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As others have said trust your gut!

You are not challenging your vet quite the opposite! My vet is happy for me to chip in with anything and I have said no to some treatments and often gone back to basics!

I would also ask to be referred to a horsepital as well, Rossdales would be my first choice asking for head of medicine Professor Celia Marr.

I agree with you everything is connected - your horse's immune system is having a battle at the moment and not having won the war (previous strangles, peritonitis and lami)

All the previous problems are auto immune and our horses gut has not developed over the last 40 million years. For the size of animal the horses gastro intestinal system is rubbish! Hence why yard pups always are eating horses poo as its got loads of nutrients in that the horses gut has failed to use!

I would not rule out any allergy yet including photo sensitivity! Our environment at the moment is beyond weird one minute hot summer temps then below freezing the next!

I would start to treat with aloe vera though both internally and externally! There are plenty of aloe vera products about both juice to put in the water and gels for the sores.

I would also bath (weather allowing) in aloe product as well and try to get the bacterial infection under control.

Absolutely the very very best of luck! Been there and got the T shirt! Discovered my 'open wounds' on my horses white bits were from the bedding would you believe yes, nice safe horse bedding! No other horse was affected only mine!
 
Lucerne is alfalfa, isn't it? My ponies can't deal with alfalfa in the spring and summer (doesn't seem to be an issue in winter). A lot of horses and ponies are alfalfa intolerant, so bear it in mind, as she might be more sensitive in her current state. :)
 
She seems to like it and has begun to put on some weight since being on it. Normally she would have remained on the happy hood but as it contains garlic we made the decision to take her off it for the time being.

So take her off all feed? Soak her hay and reduce the field right down.

Have heard conflicting advise about aloe Vera and have heard that it can cause an allergic reaction itself? She has never had any contact with it to my knowledge. Has anyone used any form of aqeouse cream or similar with any success. Vet is proposing steroid tablets as she is coming up in new itchy spots daily and therefore a steriod cream may not be pf any jelp anyway. Being an Icelandic she is rapidly loosing her winter coat which is not helping the situation at all either.
 
Most of the top laminitis vets regularly provide advice with regards to treating laminitis with steroids. Oral steroids (ie pred) have not been related to laminitis attacks. Infact, research suggests a very tedious link between any admin of steroids and laminitis. I believe only triamcinolone has actually been implicated in steroid induced laminitis. Question your vet if you like, that is your prerogative. However, admin of oral steroids to laminitics or those at risk of laminitis is standard practice in certain diseases and disorders. Of course every time steroids are administered to horses a cost/benefit analysis is made. How itchy is this horse? How is it affecting her quality of life? What funds have you available to find out the cause of the issue(dermatological investigations are expensive)? These are all factors in determining whether steroids are necessary for your horse.
 
Having said all that, topical steroids ie creams have a lower risk and while they may not completely clear the problem might improve it. If investigation is ongoing however or biopsies are to be carried out, your horse should not be on steroids during the work up. Janet littlewood is an excellent dermatological specialist based in Newmarket area and utilised by many practices around the country for referrals.
 
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