Navicular Bursa Nerve Blocks / Insurance advice

[Hollyanna]

My horse has been lame for a few weeks now, vet has her at 1 to 2 tenths lame. Initial nerve blocks narrowed it down to the feet (both front feet, although initially only appeared lame in one). We have just done a navicular bursa nerve block and this made her sound. We now believe its either inflammation of the navicular bursa or damage to the deep digital flexor tendon, both caused by poor conformation in the front feet (she has a very flat foot and little heel). The farrier has now put in heel wedges, which the vet says will help. Vet has recommended an MRI scan to eliminate the tendon issue. The x rays showed no changes in the navicular bone.

She has had the odd call out for lameness, none of which went over the insurance excess. One we believe was a trapped nerve and then another time slight lameness which the vet thought she had tweaked something messing around in the field, the vets treatment for both was a few danilon and a couple of days rest. She has been fine for quite some time but I am pretty sure the insurance company will try and wriggle out of paying so am dreading putting in my claim as the older ones were all well over a year ago. At the time the vet felt neither warranted further investigation. Now with this occurring do you think its likely they will quibble over the history? At the time if they thought i should have investigated i would have done this happily! The vets fees are at £900 already and the MRI will be circa £1100 plus livery and travel costs...... My vet has said if its the tendon that the prognosis is not good, up to year box rest and a high risk of reoccurrence. She is stressy and clingy and box walks, particularly when her friends are moved in and out of the barn so a year in the stable would not be good.... feeling a little angry that i didn't pursue it earlier but also just want to do whats best for the horse without leaving me in huge debt...

wondering what experiences ppl have had with this sort of thing both from the insurance perspective and the horses medical prognosis? If they won't pay for the MRI i wonder if I can continue on the assumption it is the inflammation and she should come sound with the heel wedges or cortisone injections? Any ideas welcome, i may be panicking for nothing?!

 

[ycbm]

Take a deep breath.

Then look at rockleyfarm.blogspot.com. they cure horses with the problems yours has all the time.

You vet is correct, the prognosis if you leave her in shoes is poor, about 20%.

As a barefoot rehab, her chances are more like 95%, with no box rest.

Try to get your vet and farrier to talk to Nic Barker at Rockley. There are many of us on this forum who have saved horses with foot lameness after being told by vets and farriers that our horses were write offs. I've done three and helped friends through two more. Rockley has done, I think, well over one hundred.

 

[be positive]

I had a livery here that was barely 1/10th lame, he blocked sound to the navicular bursa and xrays showed nothing, we discussed going for MRI but were advised to treat, as you are, with remedial shoes for 1 month although he had eggbars not wedges, I think he had a week on bute then light exercise until reassessing.
I contacted the local hospital for advice, at the time the vet treating was new to me and I wanted to make doubly sure we were not wasting time or risking doing more harm and they said they would advise the same, that if he did not respond and come sound within 4-8 weeks then do the MRI, as it happens he came right fairly quickly and it was assumed to be deep bruising rather than tendon or ligament damage.

If yours has damaged the DDFT due to poor conformation then I would look at what can be offered at Rockley they have a good record of rehabilitating horses with these type of injuries, often after the traditional treatment has failed, putting remedial shoes on and resting for 12 months will do nothing to improve her feet and with a poor prognosis I would rather try taking the shoes off and seeing what nature can do.
I have realised it is both feet involved so it may well be inflammation and bruising as it would be very unlucky for both tendons to go at the same time, if she were mine and there was no insurance to pay for MRI I would get her out of the wedges once she seems sound, transition gradually to barefoot and get the feet healthy rather than shut her in for 12 months, you may have a chance of recovery this way, your vets odds are not great and I am not sure I could put a stressy horse through that with no guarantee of soundness at the end of it.

 

[SusieT]

ycbm will of course be along to tell you the statistics behind those figures...

Ask your insurance for a pre-authorisation to confirm if they will pay for the mri then you can decide where you go from there.

 

[Hollyanna]

Thank you, Rockley Farm looks fabulous, although it sounds very expensive! I will make further enquiries!!

I did ask what the likeliness of both tendons being tweaked and the vet said they couldn't rule it out given the confirmation issues.... thank you...

 

[ycbm]

Thank you, Rockley Farm looks fabulous, although it sounds very expensive! I will make further enquiries!!

I did ask what the likeliness of both tendons being tweaked and the vet said they couldn't rule it out given the confirmation issues.... thank you...

It can be done at home, but it can be nerve wracking in a difficult horse, I won't lie to you.

If your horse is landing toe first, then research by a guy called Rooney showed that the ddft will be being damaged, and that will happen in both feet simultaneously.

It can be fixed, but it's very difficult in shoes, sadly.

My advice would be to get the MRI if you are insured for it and then ask your insurer to finance the rehab element of Rockley fees, which is, I think, half. Some will pay, some won't.

 

[Merlin1979]

I'm another who recommends Rockley. My horse is there now.
My boy had lameness work up and x Rays. He has damage to navicular bone, he was shod in heart bars and coffin joint medicated. He was sound for less than 2 weeks. My insurance did not pay out so I decided against the MRI, and put that money towards Rockley. The MRI would not have changed how he was rehabbed so it was unnecessary expense.
Going back to insurance, my horse had an abcess last year, infected nail hole the year before and unexplained lameness for 5 days 3 years ago. This was the basis for not paying out. I won't be renewing my policy.
My horse is doing very well and I know I made the right decision. If I couldn't send him to Rockley, I would have followed their guidelines. I recommend you read feet first by Nic barker of Rockley

 

[ester]

I would want to know if an MRI will make it more likely that the insurance would be to pay for rockley.

If not is it going to make a difference to how you treat? Wedges will not help long term and will likely result in even smaller heels remaining as they will put more pressure on the tubules growing down. the only way to really, functionally improve heels is out of shoes. My lads heels looked much better after a couple of cycles of shoeing in bar shoes but functionally they were no better at all.

It is possible to rehab at home though I think you do need to be a bit more secure in your head at what you are doing and I would always recommend to get someone good on your side, of the sort that will talk to you on a bank holiday when you are having a slight panic. I'd always said if I had a hoof issue I would take the shoes off but was talked into steroid injections a bar shoes. However I did put a definite time limit on how long we tried that for and neither my vet or farrier were that against taking shoes off (tho farrier wanted to try wedges, vet not keen) when it was obvious that plan A wasn't working and I pointed out if he were retiring shoes were coming off anyway .
Farrier admitted he knew nothing about rehab barefoot so I got a fabulous newly trained trimmer on board recommended to me by Nic, she even came with us when we moved and then slowly I took over.
Patience is the best thing you can have though.

 

[HollyJoyce]

My cob had the exact same issue only lame on the right however after nerve blocking him he ended up being lame on both fronts with navicular and everything possibly wrong with his front feet however he only ever seemed to be lame in trot and only visible on a circle. He went through the insurance and had months of treatment however once I got back on each time we introduced trot it went down hill. And kept up coming lame, Once all the insurance money was used and he was no better still lame he was also in alliminon heart bar shoes. We stopped all the treatment took his shoes of and had him bare foot and retired him for just over a year and since this Christmas he has been sound. This horse has so many problems with his front feet had all the treatment possible nothing worked so and turned him away and he is nearly good as new. Sound in walk trot and canter, Not lame on a circle happy being ridden again oveouslly taking it slow and steady and I won't over do it with him keeping him as a happy hack but it's just amazing what rest can do for them considering all his problems. He hasn't been on any supplement etc just let him chill worked a treat!

Good luck with the insurance I'm no help on that part of it but don't worry if you can't afford the treatment most likely the rest will do wonders! Fingers crossed for you