Potential Arthritis - what should I do?

[Ellietotz]

I'm in a bit of a dilemma so I apologise in advance for the long post while I ramble on with my thoughts and would love some advice from you lovely HHOers again please.

I will try to keep this as brief as possible.

The saddle I had been using has been confirmed as the wrong shape and doesn't fit my horse which means it potentially hasn't for the 3 years I've been using it. It was a second opinion saddle fitter that said this. Only until about 2 months a go she was starting to not want to be tacked up, she refused at a small jump which was unlike her but she fell forwards slightly from the weight of me on her neck and the sliding stop momentum before I came down so I got physio after the saddle fitter confirmed it didn't fit after the fall to ensure she was okay which found tightness in her shoulders which we put down to the bad saddle fit which was slipping forwards and not applying an even pressure behind the shoulders. This made her go from seeming stiff on both front legs to being more lame on the front right.

Last weekend she also went down to her knees without tripping while riding at walk but didn't panic, got back up and carried on as normal.

Fast forward to now, vet has checked and found very slight heat in both knees but more on the right and said it may be arthritis. We also have a saddle sorted now but the one I was riding in when she went down on her knees last weekend was different as I thought it would fit when the saddle fitter came but he said it was still wrong unfortunately but we have one that works now.

So, I think I have covered everything, now my questions are, do I get the xrays etc done to find out what or if something is going on in her knees? Could it actually just be strained from the saddle issue going on for such a long time?

I asked the insurers at the beginning of the week if arthritis was covered in her front legs and they said it is. However, if I get the xrays done, the insurance will only cover if the treatment is done doesn't it? But the treatment will only be injections I think? I'm still waiting for the vets to actually come back to me on what the options are though. I've heard the injections end up not working eventually anyway so the best management is constant movement and an anti-inflammatory supplement or NSAID so is it worth it or is it better to skip to management with an anti-inflammatory supplement to start with and not get the xrays? And also, now that the insurers know that I've asked about it, will they exclude it if I don't claim? I also don't have any savings to pay for investigations without claiming too so ideally I want to avoid putting any more money on my credit card.

I've started her on Boswellia, Glucosamine and MSM too. Should I get physio done again?

I just don't know what to do!

Sorry, I know this is long but I do really appreciate any advice and happy to answer questions if I've missed any details!

Hopefully I'll have a happy mare by the end of it all.

Thank you!

 

[PapaverFollis]

I don't know about insurance really. But don't want to read and run! Did the vet find heat in the knees after she fell onto them? How soon after? Could she have just bruised them going down? And the other stiffness be saddle fit issues?

Without insurance to think about I'd probably give her 2 weeks to a month off work, just hand walking to keep her moving. Perhaps with some bute for a week to take down any inflammation if the vet agreed. Massages and any physio recommended exercises to address any issues from the saddle fit. And see how she is after a bit of a rest and a chance for any issue from the saddle to iron out. Reintroduce saddle gradually. If she was still not right in the shoulders or sore on the knees I would either assume arthritis and follow vet management/treatment advice or x-ray to confirm.

With insurance it might be worth going straight in for an x-ray so if you want to try treatment you can claim.

If she does have knee arthritis I'm not sure what the prognosis is for ridden work but if it makes her randomly go down I'm not sure I'd want to ride her.

I'm sorry you're having this trouble.

 

[Frumpoon]

First of all, don't panic!!

There's lots of potential diagnoses that tie in to stumbling, however for the time being maybe don't ride, just gather your thoughts....going head first over your horsenis not going to do you any good at all

Have a long chat with your vet about the cost of diagnostics vs the best/worst likely outcome, have a jolly good think about what you can afford and what your ideal outcome would be

Make a list, I always make a list to help me think and prioritise...

 

[ycbm]

This is s no brianer to me. I can't imaging a bad saddle for causing heat in the knee, so i would immediately x ray her knees so you have some certainties whether or not they are an issue.

Insurance should pay out if the vet recommended it, whether or not it shows anything. Depending on your insurers! But i would want them anyway.
.

 

[Ellietotz]

I don't know about insurance really. But don't want to read and run! Did the vet find heat in the knees after she fell onto them? How soon after? Could she have just bruised them going down? And the other stiffness be saddle fit issues?

Without insurance to think about I'd probably give her 2 weeks to a month off work, just hand walking to keep her moving. Perhaps with some bute for a week to take down any inflammation if the vet agreed. Massages and any physio recommended exercises to address any issues from the saddle fit. And see how she is after a bit of a rest and a chance for any issue from the saddle to iron out. Reintroduce saddle gradually. If she was still not right in the shoulders or sore on the knees I would either assume arthritis and follow vet management/treatment advice or x-ray to confirm.

With insurance it might be worth going straight in for an x-ray so if you want to try treatment you can claim.

If she does have knee arthritis I'm not sure what the prognosis is for ridden work but if it makes her randomly go down I'm not sure I'd want to ride her.

I'm sorry you're having this trouble.

Thank you, I really appreciate your response.
The vet checked the day after she went down on her knees. She may have rolled on a stone or something that I missed but I don't know.
There doesn't seem to be much heat in her knees now, she still looks stiff in her shoulders, I think or could be knees too, in trot though but that's prior to warming up aside from walking in hand around the school for 5 minutes and asking her to trot freely. She has had the last 2 months in very light work, first 2 weeks of it was just time off after physio and since then, it's been probably only once a week of either a 10 minute free school, just leading around over poles or a very short hack. I did ride her yesterday in the new saddle though and she was full of it as always. She's also been galloping around like a nutter in the field so not feeling too uncomfortable it seems.

Xrays from last year when I was getting her SI and back legs investigated showed extremely slight osteoarthritis in the hind pasterns which may also be a contributing factor along with being croup high and now 15 years old too so perhaps more wear and tear than normal. The SI injections showed no difference so it may be the arthritis or conformation causing the discomfort over that area too, maybe compensating on top of that with the front legs?

I just can't decide if it's worth it or if the supplement and regular physio will be the way forward anyway but I don't want the insurance to exclude it now that I've mentioned it but I also don't know if it's worth putting a claim in as that is still a risk.

Perhaps I'll get physio out again and a little more time off/in hand walking.

Thank you for your advice. ?

 

[milliepops]

This is s no brianer to me. I can't imaging a bad saddle for causing heat in the knee, so i would immediately x ray her knees so you have some certainties whether or not they are an issue.

Insurance should pay out if the vet recommended it, whether or not it shows anything. Depending on your insurers! But i would want them anyway.
.

this
this is what your insurance is for. Now, not at some random point in the future that may or may not come.
If vet examined her knees then it will be mentioned on her record and you could find you get an exclusion next year anyway because of that.

 

[ycbm]

the timing of the vet might change things, especially if there is no heat now.

 

[PapaverFollis]

I think it might be worth getting the x-rays if she's already been well rested and physio-d and is still sore. But I'm not sure if the heat in the knees could have just been from going down on them... I don't know how insurance works... if they x-ray the knees and find that they are fine do you still end up with knees excluded?

 

[ycbm]

this
this is what your insurance is for. Now, not at some random point in the future that may or may not come.
If vet examined her knees then it will be mentioned on her record and you could find you get an exclusion next year anyway because of that.

Good point.

 

[Ellietotz]

First of all, don't panic!!

There's lots of potential diagnoses that tie in to stumbling, however for the time being maybe don't ride, just gather your thoughts....going head first over your horsenis not going to do you any good at all

Have a long chat with your vet about the cost of diagnostics vs the best/worst likely outcome, have a jolly good think about what you can afford and what your ideal outcome would be

Make a list, I always make a list to help me think and prioritise...

Thank you, is my panic obvious? ?

She has never stumbled before and it really could have been anything but I'm just putting two and two together. When I "practiced my front flips over her head", it was probably a couple of weeks before the saddle fitter and physio too but that was unlike her as well so I wanted to get everything checked out.

I'm waiting for the vet to come back to me with their suggestions and answers to my questions and I would like to know if there is anything going on with her knees. I just wish they'd hurry up and give me the costs for xrays. At least then if I don't have the injections or anything done and manage her with other means after that, I would still know what is going on. I just want to be able to plan!

 

[Ellietotz]

This is s no brianer to me. I can't imaging a bad saddle for causing heat in the knee, so i would immediately x ray her knees so you have some certainties whether or not they are an issue.

Insurance should pay out if the vet recommended it, whether or not it shows anything. Depending on your insurers! But i would want them anyway.
.

Thank you for replying.
I was always under the impression that insurance only paid out if there was a diagnosis and treatment. I think I will get the xrays done then at the very minimum even if the end result of management is the same. It would give me peace of mind at least.

 

[Ellietotz]

the timing of the vet might change things, especially if there is no heat now.

Yes, I suppose it was only the day after it happened and has only been a week since. She is still stiff in trot when free schooling, no different to before her fall but this still could be muscular pain from the saddle and she has only had one lot of physio since discovering the 3 year saddle didn't fit. Only xrays will really tell me so I guess my stresses have been answered!

 

[Ellietotz]

I think it might be worth getting the x-rays if she's already been well rested and physio-d and is still sore. But I'm not sure if the heat in the knees could have just been from going down on them... I don't know how insurance works... if they x-ray the knees and find that they are fine do you still end up with knees excluded?

She has only had physio once since discovering the old saddle didn't fit and if it was used for 3 years, I'm not sure if more sessions would be needed to really know or if the time off should have done its job too?
Hmm, not sure about the insurance. I would assume it would be covered if there was nothing wrong with them.

 

[Tiddlypom]

A good basic lameness workup should show the way forward, I’d have thought. If something shows up, then the insurance will kick in and pay up - that is why you pay the premiums. Unless there are exclusions?

The knees may or may not be an issue, they could have been bruised from the fall causing heat and swelling, but the insurance clock is already ticking on them as your vet has seen them, so they do need looking at and ruling in or out.

 

[Ellietotz]

A good basic lameness workup should show the way forward, I’d have thought. If something shows up, then the insurance will kick in and pay up - that is why you pay the premiums. Unless there are exclusions?

The knees may or may not be an issue, they could have been bruised from the fall causing heat and swelling, but the insurance clock is already ticking on them as your vet has seen them, so they do need looking at and ruling in or out.

The insurance has confirmed they will consider a claim for arthritis in the front legs and this isn't excluded.
The vet did a basic work up and said it was her front end that did seem stiff but he couldn't pin point a specific lameness as such except for finding the heat in her knees and saying they looked slightly abnormal. He said he was going to email me with his suggestions on the next steps, this was on Monday last week and I haven't heard apart from an email from the receptionist basically to say sorry for the delay but he will email soon. I know they are struggling staff wise so I'm just trying to be patient.
If nothing is found in her front legs, would it be a reasonable assumption to go down the physio route instead and almost finalise it as muscular? She has had her back xrayed last year, hind limb suspensories scanned and hind legs xrayed with the all clear apart from very low grade osteoarthritis in the pasterns (the low motion pastern joint as the record says). Vet and physio checked her neck and they don't think there is a problem there either.

 

[Tiddlypom]

What exclusions are there on her, is her whole front end covered?

 

[Ellietotz]

What exclusions are there on her, is her whole front end covered?

Exclusions are ulcers, forelimb conformation (not sure what this would be), front feet (not sure why), croup high conformation, straight hind limb conformation, back and spine, osteoarthritis of pastern joints (havent specified which, might question them on this and why the front feet and forelimb conformation is excluded), enthesiophytes in hock joints, sacroiliac and "all related conditions".

 

[Ellietotz]

Reflecting on this actually, the records show a small bone spur in her left hind hock and osteoarthritis in both hind pasterns but the previous vet who did this didn't elaborate on these things, said they weren't an issue and that I needed the SI joint medicated which did nothing. This vet did screw me over when it came to the insurance after and diagnosed her as behavioral...

 

[Tiddlypom]

I can see why you’re keen to get the knees checked out, that’s quite a list of exclusions, isn’t it .

The vet has to go through it methodically, though. There could be excluded areas contributing to her discomfort, which medicating her knees won’t help.

Not really sure what else to suggest. It’s hard when funds are tight.

 

[Ellietotz]

I can see why you’re keen to get the knees checked out, that’s quite a list of exclusions, isn’t it .

The vet has to go through it methodically, though. There could be excluded areas contributing to her discomfort, which medicating her knees won’t help.

Not really sure what else to suggest. It’s hard when funds are tight.

Yep! This is probably the only thing left that the insurance covers!

I just don't know what else it could be. Hopefully whatever it is, the insurance will cover it.

 

[milliepops]

With all those exclusions I'd be inclined to have as thorough a check of the forelimbs as funds allow and then cancel the policy ?

 

[Christmascinnamoncookie]

I‘d have x rays done then go from there. Mine had steroid injections into the joint which resolved the issue from several years, but ultimately the changes were too drastic and he retired, aged 17. It’s difficult to advise, there are multiple treatments, Tildren, steroids, basic painkillers, exercises. See what your vet says.

 

[ycbm]

Exclusions are ulcers, forelimb conformation (not sure what this would be), front feet (not sure why), croup high conformation, straight hind limb conformation, back and spine, osteoarthritis of pastern joints (havent specified which, might question them on this and why the front feet and forelimb conformation is excluded), enthesiophytes in hock joints, sacroiliac and "all related conditions".

Ooooh. I don't think you have much hope of the insurance paying out but it should cost c£400 and if you have it I would pay for peace of mind, particularly as the vet has said the knees look odd.
.

 

[Bonnie Allie]

Alternative thought for you that might stop you panicking............

two weeks ago my fabulous handyman husband left a shovel where it shouldn’t have been. I tripped over it with the washing basket in my hands so went down on hard concrete with my knees striking the ground first, followed by my arms after I threw the washing basket (full of whites straight onto the dirty concrete I might add).

Knees are still bruised and sore two weeks later, and it wasn’t a massive fall to the ground, just a trip. Just getting back into running this week and knees are complaining a bit. Right shoulder, and down my right arm whilst not sore - is stiff so heading to physio which is something I should have done at the beginning.

Maybe your horse has a similar injury to mine. The fall onto the knees most likely has caused some soreness both in the knees and body.

Give it a bit more time to heal before panicking.

 

[Ellietotz]

Alternative thought for you that might stop you panicking............

two weeks ago my fabulous handyman husband left a shovel where it shouldn’t have been. I tripped over it with the washing basket in my hands so went down on hard concrete with my knees striking the ground first, followed by my arms after I threw the washing basket (full of whites straight onto the dirty concrete I might add).

Knees are still bruised and sore two weeks later, and it wasn’t a massive fall to the ground, just a trip. Just getting back into running this week and knees are complaining a bit. Right shoulder, and down my right arm whilst not sore - is stiff so heading to physio which is something I should have done at the beginning.

Maybe your horse has a similar injury to mine. The fall onto the knees most likely has caused some soreness both in the knees and body.

Give it a bit more time to heal before panicking.

Thank you. That's a very good shout and the heat has seemed to have gone pretty much completely from her knees but she is still stiff on the front. This could still be her tight shoulder issue that the physio found from what we think was the saddle though but I'll still ask the vet for the xrays I think.

I hope you recover soon too and you managed to salvage your whites!

 

[sherry90]

The insurance may use the exclusion on front limb conformation to say any issue with the knees is excluded as well? If you can afford I’d X-ray regardless and then with that amount of exclusions be tempted to cancel and have a back up credit card.

 

[Dyllymoo]

Hmmm... that's a lot of exclusions on front and hind end. I would be tempted to xray the knees however I think speaking to the vet is a good call.

As above I would consider cancelling the insurance and having a 0% credit card if at all possible and putting the insurance monthly amount in a savings account. I would think the xrays would be circa £300-500 but I'm still waiting on my bill from the vet last week (xrays, lameness work up and scan of neck).

Hopefully your vet will have some suggestions of a way forward.

 

[Ellietotz]

The insurance may use the exclusion on front limb conformation to say any issue with the knees is excluded as well? If you can afford I’d X-ray regardless and then with that amount of exclusions be tempted to cancel and have a back up credit card.

Thank you for replying.

The insurance company has confirmed they will consider a claim for her knees so I'm waiting for the vets to come back with an estimate for xrays and treatment.

They suggested doing a whole lameness exam but my insurance definitely won't cover them doing everything else and my credit card is still being paid off from her last investigations!

 

[Ellietotz]

Hmmm... that's a lot of exclusions on front and hind end. I would be tempted to xray the knees however I think speaking to the vet is a good call.

As above I would consider cancelling the insurance and having a 0% credit card if at all possible and putting the insurance monthly amount in a savings account. I would think the xrays would be circa £300-500 but I'm still waiting on my bill from the vet last week (xrays, lameness work up and scan of neck).

Hopefully your vet will have some suggestions of a way forward.

Thank you. Yes, I'll probably cancel it after this as she is basically excluded entirely!

I have asked the vet for costs to just xray the knees and costs per injection that may be required. My other option is that they suggested is a month on painkillers which is only £63. I just think knowing what I'm actually dealing with is better though even if that is a cheaper option but it still wouldn't tell me what is wrong and if she needed to stay on them or not.

 

[Dyllymoo]

Thank you. Yes, I'll probably cancel it after this as she is basically excluded entirely!

I have asked the vet for costs to just xray the knees and costs per injection that may be required. My other option is that they suggested is a month on painkillers which is only £63. I just think knowing what I'm actually dealing with is better though even if that is a cheaper option but it still wouldn't tell me what is wrong and if she needed to stay on them or not.

I think I would like to know either way as well. It may not be the knees and then you can start looking at the issues caused by the saddle, but I think knowledge is power for sure.