Modern vet techniques for lameness vs the old ways - always better?

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horsemad32

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So - have a friend who's spent £4500 of her insurance money on 'diagnostics' to be told what we'd figured out anyway - arthritis (and we even got the joint right!!). Treatment? Well, steroid injections (that won't cure it - nothing can, just make the horse more comfy for a bit and allow it to do more damage long-term), then when they no longer work, bute. Horse was already on good joint supps. Was it REALLY worth £4500 to find that out?

Or take another friend last year - £7000 in diagnostics to find out that her horse had slightly damaged a ligament in its neck. Again, that was the likely cause anyway, fixed by rest and physio.

Have known of others. There are undoubtedly many circumstances in which modern meds save lives and fix so much - yet what happened to turning a horse away, box rest, and why are the obvious signs of, say, arthritis, no longer considered BEFORE spending almost the whole insurance budget on tests - to tell you what you knew anyway??? And WHY have people forgotten that ANY injury needs rest and sometimes the correct exercises to heal? However much physio etc you give your horse, if you don't give it time to mend with that assistance, it won't! Everyone seems to want an instant fix these days!

I'm always one to turn away/rest first when something springs up, and I've probably saved thousands doing that - horses have always come sound, or if not, we've figured out the issue without spending £££ on expensive tests, treated for it and got a long-term sound solution.
 
Why did oriignal nerve blocks and xrays not show up the arthritis? The idea of modern stuff is to rule out sinister causes when there is no obvious minor cause. If you're happy to rest that's fine, but it's an individual decision if you want to definitively know what is wrong with your horse, you may need more advanced imaging and not everyone is prepared to turn away for a month and wait and see when you could be doing more harm than good or alternatively you could be doing the right thing. They should have options and they do. You have the option to not go down that route. That's the beauty of personal choice.
 
As above, it really is about what options you want to avail yourself of. It's true there are many more diagnostics and treatments available now, which has complicated things, and quite often it still does come down to time, albeit helped along wherever possible.

I have to say though, from my observation and discussion with other people, these whopping initial bills for, no offence, quite ordinary horses seem to be more common here than almost anywhere else in the developed horsey world. I would hazard a guess it's partly down to the way insurance works here. Owners have huge amounts of money available for initial investigation and aggressive treatment, even people who would struggle to afford any sort of high end on going maintenance. (Not meaning to offend anyone but more people across the income ranges own competition horses here than in many other countries.) Insurance companies are more interested in accute care, because that is what they are responsible for, but have no interest in optimising long term chronic care because they will simply exclude the condition as soon as their contractual obligation runs out. Vets must also know, even subconsciously, that there is money to be made within this window.

All of which encourages a big expenditure up front, a very precise diagnosis, and an aggressive short term treatment plan. Sometimes this is just the ticket - hit it soon, hit it hard. But for something like arthritis I can't really see the wisdom. Yes, the immediate crisis can usually be addressed satisfactorily but it's hardly a case of doing something for a year and never having another problem again. Added to the fact that designing an optimal management plan can take time and tweaking, which people don't want to do if the money won't be there if they take it slowly.

It is also VERY easy for most people here to access extremely high end resources. Hardly any horse is more than a day's drive from an equine MRI and many vets have well equipped diagnostic clinics.

It also means there is a big push to find *something* causative, preferably something treatable by aggressive intervention. when a cause is found there is an impetus to do a lot right away, even if a better option might be to take a more measured response. If you call the vet, even before you get a firm diagnosis, then the clock starts running. You can then turn the horse away but during that time the insurance window is closing and, if rest doesn't effect a cure, treatment options for most people become much more limited. A more common approach seems to be to try everything possible right away and then, if the horse still isn't fixed, to turn away. It might work, it might not, but there is nothing to lose anymore.

In places where people are more likely to have to pay out of pocket and access to high end facilities is more difficult, it is likely to be the culture to go with a moderate approach, at least initially, and rely more on medication than procedures. Paying owners are looking to minimise initial outlay in the hopes that a conservative approach will work for them and they won't have to pay for an expensive procedure. Vets understand that if they push too hard, some clients are likely to say they simply can't afford it. (The big vet schools now require proof of ability to pay up front, before the work even starts.)

Re turning away, people either have horses at home or they're boarded out - DIY is rare. For boarded horses turning away usually means moving somewhere cheaper and, since the owner is not doing the day to day care anyway, their options are greater. It is cheaper to turn a horse away, certainly, than to pay the sort of care fees that will result from, say, surgical intervention. If you're doing your own horses anyway, the saving is nowhere near as pronounced.

Which is not to say some of the same concerns don't crop up, especially for competition horses. There is great pressure now to keep horses "in there swinging" simply because we can, when, in the past, the only option would have been to wait and see. On the flip side, horses come back from things they never did before and, used judiciously, science can sustain a horse's useful life far past what it might have been otherwise.

Such is the march of progress. . . . .
 
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Very Common sense post tarrsteps.
I always feel insurance is a double edged sword. Brilliant a lot of the time, but sometimes keeps a horse ( or dog for that matter ) being treated long after it should have been let go. While vets know the funds are there they will keep treating it.
 
I think it's a little unfair to say that while the money is there gets keep treating. Most insurance claims don't max out. Many are put in for hundreds not thousands. That dpesnt add up to vets flogging a dead horse now does it? Im sure a small minority are eyeing up the dosh but remember only the senior vet is keeping an eye on the books- for everyone else there is no financial gain to keeping going.
As regards insurance, another thing driving these investigations is insurance exclusions. If u are insured and don't investigate your horse's lameness, you will usually get the whole leg excluded. If you pinpoint the lameness, only that Joint or tendon will have an exclusion. this means that early diagnostics are more commonly carried out.
Another issue is lack of grazing to turn away. In Ireland, horses are usually buted and box rested then turned away for 3months. In the uk people pay a fortune on livery and are v reluctant to give their horses anytime off. How many people do you know who leave their horses out to grass for 3 months? This is commonplace among competitors and hunters jn most countries out of the uk. I have come across a small handful here, mostly hunting folk.
 
My gelding (happy hacker, never competed, 11 years old and VERY low milage) went lame in Novemeber. Had a bit of time off, this and that. He's just maxed out my £5000 vet fee claim (with another 6 months left on the claim). The leg will be excluded whether I had it investigated or not. As it turns out, nothing was conclusive, so we spent £5k just to rule out a lot of things. He's more comfortable now and has a plan of action (tildren and building the muscle up).

Time off wouldn't necessarily have helped, he needed to let the damage repair and then strengthen the joint, but at least I now know if something similar happens again I know what to do.

I wouldn't claim for little things, but it depends on the insurance (especially if exclusions will come into play whether you claim or not).
 
horsemad32 said:
I'm always one to turn away/rest first when something springs up, and I've probably saved thousands doing that - horses have always come sound, or if not, we've figured out the issue without spending £££ on expensive tests, treated for it and got a long-term sound solution.
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Well if I'd turned my horse away for a year his keratoma would probably have been much more advanced and harder to remove, not to mention that the operation and extensive aftercare would not have been covered on the insurance as you only have a year from the problem starting to claim. So I'm pretty thankful for the modern approach at the moment, but if you'd asked me a few years ago after my gelding was subjected to farriers, vets, physios, chiros, more farriers, more vets and all sorts of attempts to diagnose and fix him only for him to be pts anyway, I'd have said its all a waste of time. So I suppose it depends on what the problem is which is the right approach.
 
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