Mystery hind lameness, getting worse, no improvement on Bute, vet says PTS - what do I do?

Dun Mare

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Sorry this is long, I've probably missed a few things but I'm in a bit of shock and just want to do the right thing.

Background:
So 19 year old mare, native connie type X. I've owned her 10 years, always been very low level - mostly hacking and until covid we had weekly lessons at the local riding school but nothing competitive. Last few years just hacking (I broke my ankle so had a little time off before we both got back into it) I just want to show we are not massive jumping/showing machines. Always been spooky, averse to schooling and was VERY nappy as a 6-11 year old but we worked through that and has been a happy hacker since. I feel we're closer because it took us a while to get to this point. Never been lame or ill, had one small injury to OS cannon area 8 years ago.
June/July this year we started having fortnightly lessons with our old instructor, again low level just getting back into it. Maybe the 4th one, she noticed my mare's shoulders seemed stiff, we did a longer warm up and a lower level lesson. Thought she's got cold and wet in one of the summer's storms that week. Gave her a couple of days off and then hacked, seemed better than ever. 2 weeks later next lesson, very forward hack there and within a couple of strides instructor pulled us up and said she was off behind. Looked 'stifle-y' to her. Stopped immediately, went home and not ridden since.


Main story: very low level hind lameness spotted in August in trot only, stopped riding immediately. Usually very stingy with rugs but have kept her rugged up ever since. Thought possible abscess but after 5 days decided to call vet to be on the safe side. They came (not our usual) heard her age and straight away said hock arthritis. I questioned this as no sign beforehand but we did a bute trial, hard to say at time if it made any difference and decided if it continued that I'd get her hocks x-rayed. He also nerve-blocked the OS hind up to below hock as thought at this stage it was this leg with no improvement.
I got chiro out who said she didn't think it was joints, no obvious discomfort, just the stiffness she would expect from a horse who was due to be seen etc. Anyway fastforward another 4/5/weeks, could now see a shortness on NS in walk so got our usual vet out, hocks x-rayed, all clear but she still thought inject hocks and said would see a difference in 5 weeks. Still a question over which leg it even was so thought bilateral.

She got steadily worse after this (not suddenly but there was gradually more of a hitch in her step) and when they came for the reassessment the vet was very surprised they hadn't improved and said that ruled out hocks. Talked about how worse she was and suggested it might be a case of long term bute. End result suggested 6 weeks on bute (2 twice a day for 2 days and then 2 a day after). Over this time I had been waiting for a vet physio to come out with an Indiba machine. I updated her to say horse now on bute (had been 2 weeks) and she basically said that meant she couldn't do Indiba. I then spent ages on phone trying to speak to vet and physio to work out what we're doing. In talking to vet I asked whether I should just take her off bute as it wasn't doing anything. Cue vet explaining that was very unusual and she would come and xray neck as she hadn't done any neuro tests on her and wonders if Wobblers. I panic now, physio comes out next day, again can't really any points of discomfort except slightly in pelvis/hip area. Asks if she is a very stoical horse (vets also previously asked this) - until this I would say she has never had a problem saying No to something she didn't like!
Physio says she is walking as though she has a peg leg - I had literally googled this previously as that is exactly what it looked like. Swinging NS leg out to side very straight to step forward on a short stride. But no real 'pain' points. Seems very optimistic and says we can work on it and she doesn't mind a challenge!

Vet comes out 2 days later Thursday just gone, thinks she's worse again. Can't xray due to bad weather (no indoor facilities) and does the neuro tests on the ground. Is very surprised how well she does and strong in sway test and says she doesn't think its neuro now. I get hopeful until she sits me down and says we've come to end of the line diagnostically, that area (hip/pelvis) hard to scan and that if she's not responding to bute and getting worse it must actually be something unusual or major, i.e. she's in pain and not showing it. At a push she has said load her up on bute for next 2 weeks along with paracetamol to see if makes any difference. But that basically this is for me to come to terms with PTS and find the other pony a companion.

To say I'm shocked is an understatement. She really doesn't look like a horse in a massive amount of pain, is at the gate for breakfast and tea, banging on the gate and calling. Has good appetite, not dropped any weight and doesn't have that pained expression on the face. She is grazing but moving around field very slowly and has lost muscle from her hind end.
I had the trimmer out on Friday as already booked. She is a pretty hard woman and was also shocked they had suggested it (although she is very holistic and doesn't trust vets!). Said she definitely didn't have that pained look but did say she was more reluctant to weight bear on that leg than previously and was worse than when she saw her 4 weeks ago.

However I have never wanted to be one of 'those people' who keep a horse going longer than they should.

It's just so hard as no idea what it even is despite having multiple visits. From the start it has never been about keeping the horse riding just getting her comfortable. Have our own fields so that's not a problem. My old mare was 33 so I just thought I'd have at least another 10 years before having to deal with this.

By big fear is that it's just something that needs time and I PTS on the vets say so too early.
But we are going into the worst months of the year and though our fields are not that muddy we only have natural shelter and I would hate it to get worse and we're in freezing February.

Honestly until the vet suggested it I don't think I was anywhere near to a PTS decision but the fact she put it bluntly for a quality of life means she must think it is that bad to warrant it. And looking back she was starting to angle towards this 2 weeks ago at the hock reevaluation.There is only one other vet practice around here which she did say I could get an opinion from if I wanted but that they didn't have access to any other diagnostic equipment so again it would be narrowed to same area etc with no other course of treatment. Nearest Bone scanner is 7 hours plus away and as we've not boxed in the last 10 years I wouldn't do that to her now.

It's the fact it hasn't got better with 3.5 months field rest, in fact much worse. And doesn't seem to be responding to any pain relief.

Don't know what I want from this really but I've been reading thread after thread on here trying to work out what it could be and how I could help since the beginning so thought I had nothing to lose. I've gone from thinking PSD, arthritis, cracked pelvis to just now PSSM. But wouldn't these respond to bute? I realise I'll never know the answer but thought someone else might have had the same experience.

Please be gentle. The very last thing I want is my horse in pain with no end.

I feel the vet has put me on a countdown to 2 weeks and that's it.

I have videos if that helps.
 

TPO

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Sorry that you're going through this.

Some blunt questions:

Is she insured?
Do you have access to funds [for vet work up]?
Roughly, where about in the UK are you? 7hrs seems quite extreme.

Personally I'd hire a 3.5t with experienced driver and box her to vet hospital for a lameness/performance work up with the aim of getting a diagnosis. I'd tell them that she was/wasn't insured so my budget was insurance cap (for diagnosis and treatment)/my budget is £X, so to work within that and advise me of costs as it progresses

I've always found uni vet hospitals very helpful in this way.

Once there's a diagnosis then decisions can be made as required.

At this point I think you need to crack on getting to the bottom of it for both your sakes.

Take care
 

Orangehorse

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Have you looked at his hips? Mine had arthritis in the hip, after having all sorts of flexion tests that hadn't shown anything. He was only very slightly lame and went on for several years on danilon.
 

Dun Mare

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Thanks for reading it all.

We're in Cornwall, nearest is Gloucestershire. Apologies actually looks like 5 hours. But is that fair on a horse who hasn't travelled in 10 years and likes routine?

She isn't insured so it's all been out of my pocket. So far it has been £2.5k

The vets would say she has had workups
 

TheMule

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Thanks for reading it all.

We're in Cornwall, nearest is Gloucestershire. Apologies actually looks like 5 hours. But is that fair on a horse who hasn't travelled in 10 years and likes routine?

She isn't insured so it's all been out of my pocket. So far it has been £2.5k

The vets would say she has had workups

There is a referral practice in Devon- Western Counties.
If you want to pursue answers, I'd go there.
 

Fluffypiglet

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slightly confused why Your vet inject hocks with clean X-rays? I would be tempted to get a second opinion from the Osteopathic vet Tom Beech who travels round the country. If he’s anywhere near you sometime soon you will hopefully be able to get an opinion. Ive never used him but sounds like you have nothing to lose? So sorry you’re in this position. I hope you get answers.
 

Dun Mare

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Have you looked at his hips? Mine had arthritis in the hip, after having all sorts of flexion tests that hadn't shown anything. He was only very slightly lame and went on for several years on danilon.
This is the area (pelvis/hip) the physio pointed out. How was yours diagnosed?
Did yours get worse though? And did the danilon help? I wonder if this is it but why the bute is not helping?
 

Tiddlypom

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I’m afraid that vets fees soon add up with multiple visits from a less well equipped or experienced vet practice who can’t pin the lameness down.

There must be a decent referral practice nearer to Cornwall than Gloucs?

Has she had an internal ultrasound scan? My incredibly wonky mare has after sustaining a major pelvic injury in the field in early lockdown, and it ruled out # hips although nothing untoward could be found. Had it been a hip #, the prognosis would have been bleak and she would have been PTS. As it is, three years later she is still wonky but pain free. The internal scan was done at a small equine referral centre with just 5 vets, not a huge place.

Because of the delay due to the early lockdown rules constraining vets my mare didn’t get her internal scan til 5 months after the injury, and my vet said that by then there would be no point doing a bone scan.

Good luck.

ETA My mare’s right hip is 3” lower than her left hip, but she is happy, pain free and fully mobile. The vets still don’t know exactly what she’s done, but whatever it is is ‘big’. It’s likely to be a mix of bone and soft tissue.
 

Glitter's fun

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@Dun Mare Sorry you are having to deal with this.

I do feel strongly that you need a diagnosis, otherwise you will spend the rest of your life wondering if you did the right thing.

Your vet may or may not be excellent with horses but she is poor with people- talking you round to pts when you are not ready for it is wrong of her. Your mare has been like this for some time so a bit longer spent getting to the bottom of it isn't unkind.

Only you know your exact practical 'logistics' but I'm wondering if a chat to the other vet practice might come up with some alternatives. Yes, they may not have a scanner but where do they send horses to be scanned? Do they know somewhere nearer? Could your horse be transported with a stop somewhere to break the journey?

Do a lot of phoning round & get every opinion you can & someone will come up with a clever solution that at least allows you the peace of mind of a definite diagnosis.

[[[hugs]]]
 

Birker2020

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I agree with those that say you really need a referral to a centre of expertise where they can use proper diagnostic imaging equipment.

The answer may not be what you want to hear but the you will have a diagnosis. When you are in inner turmoil and can't see the wood from the trees (and believe me I know what that feels like 100 times over) then getting an answer is a blessed relief.

I think a professional transporter would be your answer, you mare would be fine travelling I'm sure.

You don't know if your horse is in unresolvable pain so IMHO I wouldn't consider pts at this moment in time.

I really do wish you the very best and please keep in touch to let us know how you get on. You've got this. Always around to PM if you need to vent x
 

Highmileagecob

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Is there anything else going on in the background that you may have dismissed? Thinking teeth, puncture wound to sole, tendon injury, any diarrhoea/loose droppings, any abdominal discomfort? Is she lying down and getting up ok? You mention she is a Connemara type - any signs at all of skin warts or melanoma? I'm another one who is surprised that your vet would inject hocks 'just in case.' particularly if the x-ray didn't warrant intervention. Does Bristol Vet. School have a referral facility?
 

ester

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@Dun Mare

Your vet may or may not be excellent with horses but she is poor with people- talking you round to pts when you are not ready for it is wrong of her. Your mare has been like this for some time so a bit longer spent getting to the bottom of it isn't unkind.
Vets don't tend to say PTS lightly, it is not appropriate for them to mention it only when an owner is ready, they are advocating for their patient.

Horse has been lame since August, unfortunately not all questions are answerable and at this point it has been unresolvable for 4 months.
OP if you want a second/specialist opinion that's not inappropriate but definitely needs doing ASAP. Western Counties have a good rep.
A pony that isn't field sound on 2 bute a day and deteriorating cannot just be left as is.
 

ycbm

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My big fear is that it's just something that needs time and I PTS on the vets say so too early.

You wouldn't ever know, so the only thing to do with that thought is to put it out of your mind.

The first thing that comes to mind when I read your posts is that she has broken her pelvis. It's very difficult to diagnose but the absence of a pain response from anywhere or response to bute makes it not un likely, imo, that she has a relatively pain free but unstable pelvis fracture.
 
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alibali

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I'm sorry you're in this position with your mare. You are obviously very fond of her and want to do the right thing by her.

You have 3 options, firstly take her for a full work up at a fully equipped referral practice, secondly PTS or thirdly turn away and see if time heals.

The only option I think would be wrong is the third I'm afraid. The lameness has worsened over time with no riding and only field turnout. I cannot see how prolonged turning away would improve things if they have only deteriorated so far.

As to whether you should pursue further diagnosis/treatment then unfortunately there needs to be a financial consideration. You could well end up spending as much again quite possibly more and end up with a diagnosis that doesn't offer much hope of improvement. Though of course you may get a diagnosis and treatment plan after relatively minimal further tests. There is no way of foreseeing the costs or outcomes. Only you are able to decide if you have the funds, if you are willing to spend them and also if it is fair to put your mare through the process.

Sorry to be blunt but I have to agree with your vet that if you decide not to pursue diagnostics and treatment for either of the very valid reasons of finance or welfare mentioned above then the only fair option for a horse that is deteriorating on field rest is PTS. It is the most difficult part of horse ownership and familiarity makes it no easier. Try to comfort yourself with the fact that horses have no concept of the future all they know is today.
 

Sandstone1

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None of us on here can tell you whats wrong with your horse, most of us are not vets and no one can or should try to diagnose whats wrong. You need to get either a second opinion from a good equine vet or send to a good vet hospital or pts. You can not leave a animal in pain thats for sure but only you can decide how much money you can spend trying to find out whats wrong. Its a really hard one and you have my sympathy. I think if I was in your position I would get a second opinion but its for you to decide whats best for you and your horse. Im sorry you are in this position.
 

Pearlsacarolsinger

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I think if she were mine I would get her to a good referral vet for a 2nd opinion. I suggest that you start a thread asking for recommendations, there are quite a lot of HHO members in the SW. I'm sure some of them will know a good vet. I'm afraid I don't think much to a vet who injects hocks, just in case so I wouldn't rely on their judgement.
However pts is never wrong if the horse is in pain, even if you don't know why
I'm sorry you are in a difficult position.
 

dixie

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I bought my current horse from Cornwall from a selling yard. She said she didn’t think any of the vets in Cornwall were much good for this type of thing and regularly gets a vet down from Somerset I think.
If you want to follow the diagnostic route it might pay you to ring her and see if you can take your horse there? Depends where you are in Cornwall I suppose.

If you’re interested pm me and I’ll give you her details.
 

Bellaginajack

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I bought my current horse from Cornwall from a selling yard. She said she didn’t think any of the vets in Cornwall were much good for this type of thing and regularly gets a vet down from Somerset I think.
If you want to follow the diagnostic route it might pay you to ring her and see if you can take your horse there? Depends where you are in Cornwall I suppose.

If you’re interested pm me and I’ll give you her details.
Hi I'm going through similar worries it's taken 6 mths to get a diagnosis my vets who I've been with for 9 yrs sId in beginning it was absess my shetland pony became really lame overnight ,had xray on hoof and lower part of leg all fine kept saying could be tissue damage or could be anything for weeks been sending vet videos of pony walking no improvement gave bute still lame so 5 mths down the line I asked for another xray for higher up leg and shoulder which they couldn't do shoulder said it was difficult to do because pony being small, so still no answere went for a second opinion yesterday morning taken pony to another clinic they did xray and found shoulder dysplasia xray show its quite bad vet showing xray to orthopaedic surgeon to see if can have op if not will try steroid injection also they said PTS which I can't stand the thought she is only 5 yrs old she's in good spirit calls me evry time she sees me eating all the time how do you know if they are in pain when she is acting normally I hate the thought of even thinking of PTS when she's so young and healthy.
 

Foxglove

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South West Referrals at Nutwell in Exeter would be a potentially good place to start, closer than Western Counties, if you wanted to take her somewhere to be worked up
 

LadyGascoyne

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Vets don't tend to say PTS lightly, it is not appropriate for them to mention it only when an owner is ready, they are advocating for their patient.

Horse has been lame since August, unfortunately not all questions are answerable and at this point it has been unresolvable for 4 months.
OP if you want a second/specialist opinion that's not inappropriate but definitely needs doing ASAP. Western Counties have a good rep.
A pony that isn't field sound on 2 bute a day and deteriorating cannot just be left as is.

I’ve had a vet push me in that direction because her view was that the horse wouldn’t be able to be ridden again. She had seen it when I had it on expensive competition livery and didn’t think it was worth it for me to keep paying for an unrideable horse. She shared none of that with me, she just let her perception of the situation colour her judgement - I only got the whole story when I raised a complaint.

Vet had no idea that I also have a yard at home and don’t actually need a horse to be rideable, it can just stand in my field as long as it is sound enough to enjoy it. As it turns out, the horse is now sound enough to hack.

So I would consider a second opinion. My second opinion was clinically the same, but the options were different.

You wouldn't ever know, so the only thing to do with that thought is to put it out of your mind.

The first thing that comes to mind when I read your posts is that she has broken her pelvis. It's very difficult to diagnose but the absence of a pain response from anywhere or response to bute makes it not un likely, imo, that she has a relatively pain free but unstable pelvis fracture.

There is definitely something in the fact that she isn’t responding to bute. A fracture or something resulting in nerve pain may be worth investigating. I don’t know if your vets have tried gabapentin as pain relief? It is often better for nerve pain and msk issues.
 

Equi

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I couldn’t quite get the answer reading, did you ever get the vet physio and the indeba ?

I have had a similar year with my horse, undiagnosed hind end lameness on rh (suspect he has pratted about in the field) X-rays all clean and no obvious sign of injury bar a sore bum muscle so it was sort of put down to a soft tissue injury somewhere. he was boxrested with limited turnout in a boxpen and eventually we started rehab exercises with my vet physio and indeba machine every 2 weeks - now every maybe 5 weeks. The difference I suppose is that he was improving week after week and has been sound for a few months now but he had to be pushed out of his comfort zone a little bit at the start to stretch the muscles. Vet physio said it can take up to a year for total recovery.
 

Snowfilly

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You’re in Cornwall? A few of the vet practices down here are a joke, I’m afraid and there’s a couple who I wouldn’t trust to give a diagnosis unless a leg was literally hanging off.

Get in touch with Western Counties as a starting point, phone them tomorrow morning for a chat and see what they say. I’ve sent a couple up there for scans over the years.
 

Goldenstar

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She needs a proper work up with systematic nerve blocking to pin point the issue
You could either start at the feet and work up or take a punt at it being a PSD type issue at the hock and see if you get a response blocking that it’s a difficult block to do but I might start there.
Just because the vets have all thought hock
This won’t be cheap but it’s the best option for pinpointing the issue .
It’s all about how much money you can throw at it.
If you can’t or don’t want to then it’s not wrong to PTS.
 
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