Pain in all four feet

[jaquelin]

This is more of a “what would you have done” situation. Horse suddenly lost performance, not forward particularly on right, would not pick up canter on right, dis-United on both leads. 5 day Bute trial showed no improvement. Had a nerve block assessment (3.5 hrs! ) Showed pain in all four feet. Vet continued to assess pretty much everything, but I think another vet ( I do not know this vet very well) would have stopped at that point to discuss prognosis, treatments, etc.
Assessment showed pain in stifles and hocks, not suspensories. SI not tested.
Vet wanted me to ride horse after all the testing ( both horse & I pretty fed up by this point. ) Vet made various general treatment suggestions. ( As a bit of background, horse has long history of treatment for lameness, mainly SI and has blown through all insurance, so is basically uninsurable). After seeing the demonstrable levels of pain he was in, I made the decision to PTS. It was the pain in all feet that did it for me, tho there was demonstrable pain in other joints. Vet was not focussed on this, which seemed strange. I have had nerve blocks on him previously & on other horses, & have never quite seen a pain response like this.

 

[be positive]

I think you did absolutely the right thing by him, I find your description of the lameness assessment very strange, how or why could they keep going for so long with no idea of what was going on, to then ask you to ride a horse that is clearly lame on all 4 feet/ limbs is beyond belief, what on earth was he trying to prove by then, a more sensible, and possibly less expensive in the circumstances, option would have been a bone scan.

Sometimes they get so bogged down with trying to prove where the problem is they forget they are dealing with a living animal and also that the owner is footing the bill they are running up, I had similar with one of mine where they did numerous blocks on a very lame horse that had a displaced fracture of the splint bone that "should not have caused him to be so lame" nothing else was found to be wrong in the lower limb but they totally missed that he had pulled his SI, so a bill for around £2k had been run up doing the tests for no good reason although good for their income.

 

[jaquelin]

Be Positive, thanks for your comment and support. This is a hard decision to make.
Yes, I thought it was strange, once he found pain in all feet, why continue. He was working from a hypothesis of suspensories ligaments, but that proved wrong.
What I disn’t mention in my original post is that he called my yard owner the next day, & suggested the horse might show improvement as he had injected hocks with anti-inflammatories. He then phoned me as my yard owner felt, quite rightly, that she should not be involved. I found this very unprofessional, and I told him “this is not helpful, the horse is in pain”.It is as though he couldn’t see the horse and it’s needs, beyond a series of symptoms with possible treatments.
At least I ended up with a good understanding of my horses situation, very much justifying my sad decision.

 

[tallyho!]

So sorry for your loss - he certainly was a handsome boy.

If it was in the feet itself, why did the vet check only the legs? What about laminitis? Very common for it to present in all four feet.

 

[jaquelin]

Tally ho - who knows? He seemed to be focussed on suspensories, even tho the horse did little work that would put them under pressure. I agreed with “ ground up” approach, but why continue past the feet? Then why disregard foot issue in discussing various treatments.
He did not seem to have much horse empathy ( you suss this after 3.5 hrs together)
Also he didn’t take much notice of horses way of going on lunge, a lot of head twisting whilst on right lead only, suggesting discomfort, and quite marked falling in & rushing on both leads.

 

[ycbm]

I'd have put the horse down as you did. But surely pain in all four feet is laminitis? Requesting a horse showing the number one symptom of laminitis to be ridden is downright negligence by a vet. It honestly sounds like they were simply trying to work to work to a big bill.

 

[jaquelin]

After a week to reflect, I have now taken this up with the vet practice. Set out my concerns vis a vis failure to stick to the brief & over-assessment issues. We shall see....

 

[tallyho!]

Glad to hear you did Jacquelin. I think they missed something obvious personally. Let us know how you got on...

 

[Pinkvboots]

My immediate thought was laminitis strange how the vet didn't even really consider it I think you totally made the right decision so sorry for your loss

 

[ester]

I guess they carried on because blocking the feet did not resolve the lameness? There certainly has to be a happy medium as I have known the opposite where they stop as soon as lameness improves and then miss something.

I'm sorry to hear about your horse but suspect I would have made a similar decision, and certainly in appropriate to be discussing it with YO. Were you aware of the steroid injections (I've known owners not be told about that before too hence the question).

 

[jaquelin]

Yes' have spoken to practice manager whom I know well. Also sent follow up email.

Vet mentioned injecting inflammatories as he was doing them, no discussion beforehand.
As one does, I have been going over in my mind “what ifs” and “if only” but where would I have begun? I hate to see horses endlessly treated with no real prospect of coming good. I think he had been disguising his problems, by compensating in his performance, which explains to me some of his oddities & limitations in his way of going. I think it just all got too much for him, hence recent loss of performance.
Will update if/when I hear from vet.

 

[jaquelin]

An update. I am now in a dialogue with the vet’s practice manager. I got the bill. Actual cost of doing the nerve block (vet’s time) around £350, which I do not challenge. However, nearly £400 worth of anti-inflammatories, steroids injected. This I am challenging & won’t pay until they knock the price down. We shall see....

 

[jaquelin]

Final update- vet’s practice has agreed with me & removed cost of all unnecessary treatments, which brings bill down to a more reasonable level.
Always worth challenging, if you have a case.

 

[ester]

Well done for persuing this and it might at least make them think about that for future clients a bit more.

 

[tallyho!]

Good result. Was there any statement made about why only joints were examined and treated but not investigating laminitis as a possible cause?