Is it really possible for an Equine Clinic to get it wrong?

I know, PF.
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They did nerve blocks, and they said that the nerve block in his fetlock made no difference to his soundness, but the one in his stifle did, so they xrayed the stifle.

Here is what is written on my invoice:

Livery
Nurse attention and checks
Referral exam re lameness
Low palmar digital nerve block (WHAT'S THAT?)
Low 6 point nerve block left hind (WHAT'S THAT?)
Radiograph stifle (both limbs)
Intraepicaine
Tibial/ peroneal nerve block left hind
Inject stifle joint left hind
Equimidime injection
Torbugesic injection
Danilon Equidos

I have just spoken to my vet and apparently, he has a full detailed report there which he read to me. He seems to think that, because the nerve blocked the fetlock and it made no difference, the swelling is being caused by him being box rested. I'm none the wiser, to be honest. I still want to see the xrays.
 
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They didn't even x-ray the fetlock!!!
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Goodness me!! I would be furious
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My vets spent literally hours x raying Be's fetlock the night she was admitted to check for fractures etc.

What does the swelling feel like? Is it quite hard, or soft?
 
My experience with WCEC was that my particular vet was like Willo The Wisp to get hold of! Every time I phoned the surgery, they would give me his mobile number and he would be driving round Devon somewhere and the signal would go down more times than a tart's knickers. He seemed a pleasant man and was great with my pony, but communication skills were zero. What finished me with them was when he took hoof X-rays and then took so long to talk them over with my farrier that said farrier refused to work from them. And yes, they were very expensive. I did get the bill reduced by half. To be fair, a friend of mine who uses them (and recommended them to me) is very happy with them. Perhaps it depends which vet is assigned to you!
 
I am a little puzzled as to why your vet would refer you to another clinic that then had to refer to Liphook for advice. I'd prefer for the referral to Liphook in the first place. The general procedure with nerve blocks, where there is no obvious cause is from the foot up so I am assuming the vet blocked the fetlock with no improvement of lameness. Sometimes obvious signs can be misleading. When I worked at Liphook an xray would be the first stop before an ultrasound although this was 9 years ago!

It is normal to do a comparison xray of the other limb to see whether that limb is affected or not. If both are affected, which is common then it is far more cost effective to scope both at the same time.

To me it sounds like the investigations have been as I would expect but I'd have preferred to cut out the middle man and gone straight to Liphook as they are just fantastic. I hardly dare say it but they are more than likely to want to get their own set of xrays before surgery too.
 
Palmar digital nerve blocks desensitise the navicular bone and bursa, hoof cartilages and digital cushion. The six point block will do the whole of the fetlock and the upper portion of the pastern (*I think*). It sounds like they've blocked foot, then fetlock, then hock (the tibial and peroneal nerve block) with no improvement, which is what has led them to the conclusion that it is the stifle, and then they've found the OCD when xraying. I think i'd still be inclined to get the fetlock checked just to be sure, simply because you don't know how long the OCD has been there, and it is obviously very expensive to go down the arthroscopy route.
 
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I am a little puzzled as to why your vet would refer you to another clinic that then had to refer to Liphook for advice. I'd prefer for the referral to Liphook in the first place. The general procedure with nerve blocks, where there is no obvious cause is from the foot up so I am assuming the vet blocked the fetlock with no improvement of lameness. Sometimes obvious signs can be misleading. When I worked at Liphook an xray would be the first stop before an ultrasound although this was 9 years ago!

It is normal to do a comparison xray of the other limb to see whether that limb is affected or not. If both are affected, which is common then it is far more cost effective to scope both at the same time.

To me it sounds like the investigations have been as I would expect but I'd have preferred to cut out the middle man and gone straight to Liphook as they are just fantastic. I hardly dare say it but they are more than likely to want to get their own set of xrays before surgery too.

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My vet referred me there because they have stabling on-site and could do the checks there all in one go (a bit like Liphook I suppose). The vet that dealt with Lanky then sent the xrays off for a second opinion to an orthopaedic surgeon who is well respected, from Liphook. He is going to be doing the surgery, which I believe is better as none of the vets at this clinic have a specialism in this area. I also think he got a second opinion from Liphook in particular because he was a vet there until fairly recently.
 
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They didn't even x-ray the fetlock!!!
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Goodness me!! I would be furious
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My vets spent literally hours x raying Be's fetlock the night she was admitted to check for fractures etc.

What does the swelling feel like? Is it quite hard, or soft?

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The swelling is on the harder side, and yes, I am furious. They say they didn't xray it because there was no improvement in soundness when a nerve block was applied to the fetlock joint.
 
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My experience with WCEC was that my particular vet was like Willo The Wisp to get hold of! Every time I phoned the surgery, they would give me his mobile number and he would be driving round Devon somewhere and the signal would go down more times than a tart's knickers. He seemed a pleasant man and was great with my pony, but communication skills were zero. What finished me with them was when he took hoof X-rays and then took so long to talk them over with my farrier that said farrier refused to work from them. And yes, they were very expensive. I did get the bill reduced by half. To be fair, a friend of mine who uses them (and recommended them to me) is very happy with them. Perhaps it depends which vet is assigned to you!

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Hmmm yes, our friend really rates AW, but she IS neurotic and has him out for a split hair, and he will treat it! LOL. He loves her - she's his best client and I think they even exchange Xmas cards - you can guess why! My vet up there is DR (not sureif you will know who that is as he is quite new and not a partner).
My farrier, Martin, is not keen on them!
 
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Out of interest, what degree of lameness is/was he?

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My vet put him at 4/10, but tbh, I don't have a clue what they decided at the clinic because they wouldn't blasted well talk to me for long enough each time I phoned. It was all a matter of how quickly they could get me off the phone. He is better than he was at onset of lameness. I have seen horses a LOT LOT lamer than him - my laminitic mare (I know completely different) was incapable of moving even a few steps even when she was in the early stages; and this is such a serious diagnosis that both my farrier and I would expect more lameness than he is displaying (he is also a very big horse at 17.3hh, so not twinkle toes either!). He is bearing weight on the affected leg, some days better than others and for longer than others.

My normal vet said that the report says the xrays show fragments of cartilage floating around and that they want to go in, have a look and remove and fragments and smooth over the cartilage.
 
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Palmar digital nerve blocks desensitise the navicular bone and bursa, hoof cartilages and digital cushion. The six point block will do the whole of the fetlock and the upper portion of the pastern (*I think*). It sounds like they've blocked foot, then fetlock, then hock (the tibial and peroneal nerve block) with no improvement, which is what has led them to the conclusion that it is the stifle, and then they've found the OCD when xraying. I think i'd still be inclined to get the fetlock checked just to be sure, simply because you don't know how long the OCD has been there, and it is obviously very expensive to go down the arthroscopy route.

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So are you telling me that they didn't block the stifle at all? As there are only 3 nerve blocks on my invoice and you have accounted for those with foot, fetlock and hock. The report my vet just read to me says that with the stifle block there was a 50% improvement in lameness, and that they believe the reason there was not more substantial improvement was that there is swelling around the stifle (soft tissue related).
 
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Vets can get it wrong.
One of my horses has been diagnosed with, over the years (wait for it!);
Liver failure
Heart failure
Brain tumours.

Oddly, she is now 20 yrs old, in such good health that of the last two vet visits, one guessed her age at 14 (
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) and the other was waxing lyrical about how great she looked.
If I had your horse, Lankydoodle, I'd have turned it out for a few months, using my 'wait and see' technique (assuming he is not suffering, of course).
S
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LOL.

I am guessing it's too late for that now, isn't it, shilasdair?
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My insurers will love it - exclude everything and then I have to pay for the op myself.
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I think you may be too late...you should take my approach - when the vet told me my girl had heart failure about 10 years ago, I laughed.
S
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Palmar digital nerve blocks desensitise the navicular bone and bursa, hoof cartilages and digital cushion. The six point block will do the whole of the fetlock and the upper portion of the pastern (*I think*). It sounds like they've blocked foot, then fetlock, then hock (the tibial and peroneal nerve block) with no improvement, which is what has led them to the conclusion that it is the stifle, and then they've found the OCD when xraying. I think i'd still be inclined to get the fetlock checked just to be sure, simply because you don't know how long the OCD has been there, and it is obviously very expensive to go down the arthroscopy route.

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So are you telling me that they didn't block the stifle at all? As there are only 3 nerve blocks on my invoice and you have accounted for those with foot, fetlock and hock. The report my vet just read to me says that with the stifle block there was a 50% improvement in lameness, and that they believe the reason there was not more substantial improvement was that there is swelling around the stifle (soft tissue related).

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If your vet says they blocked the stifle, then that that must be what 'injection into stifle' was. With 50% improvement it does seem likely that the stifle is involved, but it still seems strange that the fetlock is swollen and hot as well.
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LOL.

I am guessing it's too late for that now, isn't it, shilasdair?
grin.gif
My insurers will love it - exclude everything and then I have to pay for the op myself.
grin.gif


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I think you may be too late...you should take my approach - when the vet told me my girl had heart failure about 10 years ago, I laughed.
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LOL! Oh well. You have said what my farrier said, which was 'you're a bloody idiot. you should've just rested him and buted him and waited.' Hmmm. It was the fact he wasn't getting any better with the rest, bute, penicillin, and normal vet said about referring for the tests, I turned to him and said 'we could do that and in a few weeks he could still be bad and we won't know why so will have to refer him anyway.' Only now do I realise the implications of what I said.
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Maybe he'd have been BETTER! Grrr.
 
I am playing Devils Advocate here but if the block in the stifle improved the lameness then there is a problem in the stifle (which sounds like they have diagnosed as chips in the joint) These would not go away on their own. They could xray the fetlock too but then you would possibly end up with another problem unrelated to the lameness that needs treating as well. If their brief was to examine and identify the lameness then I'd say that is what they have done. If however the brief was to examine the fetlock lump then yes, I'd be fed up.

On the bright side you would have to notify the insurers anyway, if you didn't and then had a problem with the leg you would invalidate your insurance by non-disclosure of facts.
 
From my experience it is very possible for an equine clinic to get is so wrong. I suggest you write down any thing that you cant quite understand and then go back and ask the questons until you get the answers you are happy with. Dont allow them to talk down to you or use big words to fob you off. I had a perfectly good high level education and i like all humans get things wrong, vets are NO exception.
 
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I am playing Devils Advocate here but if the block in the stifle improved the lameness then there is a problem in the stifle (which sounds like they have diagnosed as chips in the joint) These would not go away on their own. They could xray the fetlock too but then you would possibly end up with another problem unrelated to the lameness that needs treating as well. If their brief was to examine and identify the lameness then I'd say that is what they have done. If however the brief was to examine the fetlock lump then yes, I'd be fed up.

On the bright side you would have to notify the insurers anyway, if you didn't and then had a problem with the leg you would invalidate your insurance by non-disclosure of facts.

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Yes I do completely agree with what you are saying. He went to the clinic, referred by my vet, as he had a swollen, slightly heated fetlock and the vet could not attribute it to infection as he'd had IM Penicillin and it hadn't helped. Their brief was to conduct a lameness investigation.

My concern is that they have exaggerated it, or the problem in the stifle is not what is causing the lameness because it was the fetlock (and still is the fetlock)that was swollen and had heat in it. The worry is that they found the OCD, which a lot of horses have and causes them no problem, by accident, when the lameness is being caused by something else.
 
hi

you sound like you're kinda in the same boat as me. mine has been diagnosed with arthritis and injected on 6 weeks box rest, and catrophen injections etc, but not sure if he will come sound or not after that.

i feel i should of actually just got him back working as only started going lame after no work for nearly a month. but now am stuck if he doesnt come sound i should consider further work or decid to get him hacking again etc in hope that work will help which would mean insurance would not pay out after 12 months of illness so if that didnt help then would have to pay for further stuff myself etc.
 
DR is my friend's vet now. Before that, she was with the lady who left for Australia. My vet was SJ. My OH is telling me I shall get done for libel, but how can the truth be libellious? Wishing you all the best with your horse.
 
Vets are of the opinion at the moment that even if they get him pain-free, he won't be upto much ridden work, which is absolutely heartbreaking, as he really is a beautiful horse in every way. I can't say he's the best I've ever owned because my 19 year old cob George, hasn't had a day's lameness in the 7 years I've owned him, is never sick or sorry and always upto the job asked of him - HE is the best horse I have ever owned. Gosh, knocking on wood here!
 
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Yes I do completely agree with what you are saying. He went to the clinic, referred by my vet, as he had a swollen, slightly heated fetlock and the vet could not attribute it to infection as he'd had IM Penicillin and it hadn't helped. Their brief was to conduct a lameness investigation.

My concern is that they have exaggerated it, or the problem in the stifle is not what is causing the lameness because it was the fetlock (and still is the fetlock)that was swollen and had heat in it. The worry is that they found the OCD, which a lot of horses have and causes them no problem, by accident, when the lameness is being caused by something else.

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I can see what you are saying but the outcome presumably is still that he blocked sound to the stifle and not the fetlock. If the OCD in the stifle was not causing a problem then he should not have blocked sound to it. They could have done all the tests and treatment in the world on the fetlock and you could still have a lame horse with stifle trouble.
 
I am so sorry to hear all this is getting even more complicated! The only thing worse than a diagnosis of a serious problem is the worry of a wrong diagnosis which will leave you with a lot of heartache, potentially dangerous procedures and no resolution.

I am afraid I can't contribute much to the discussion other than my experience of OCD: when Thomas was diagnosed it was on the basis of improvement in lameness after stiffle blocks. I was told that x-rays were not definitive in diagnosing OCD as some changes did not result in problems and vice versa and that they could not really see the area with ultrasound. It was only when they did the arthroscopy that they were able to see the full extent of the damage to the cartiledge.

I hope you find out what is wrong soon!
 
Lets start with the basics - I have always been told by my vets (many in different areas of the county) that antibiotics are generally CONTRA- INDICATED for a foot abscess, especially if it has not broken open. I wouldn't use that vet again for a horse, they might be OK with a dog maybe.
 
cptrayes - he gave penicillin because both he and the farrier concluded that there was no puss in the foot or abcess or bruising (after cutting away quite a bit of hoof, using hoof testers etc, and also no heat in the foot anywhere. Sorry if that was not clear in my post when I said that he was convinced there was puss in the foot but then they were looking at the fetlock being the problem due to the swelling and the fact nothing was found in the foot at all (and no pain from hoof testers) and so gave penicillin in case of infection.

The vet was well aware that penicillin would be bad if it was an abcess (due to sterilising it), which is why he spent about an hour and a half assessing my horses, looking at the foot and deciding the best course of action. I have no problems with my normal vet - he works with in a multi-specialist practice, but he is an Equine specialist; and the head partner of the practice, whom we also use, has been treating horses before this vet at the Equine Clinic was even a glint in his mother's eye! If the vet had said there was a possibility of an abcess then **I** would not have administered the penicillin.
 
Perhaps you couldn't be there for the referral, but personally I always accompany my boys to the vet's - that way I get to ask questions on the spot and get a first hand view of the problem. But then, I think my vets are great anyway!
 
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