Treating Hock Arthritis Costs & Options

[Firewater04]

Advice & opinions please...

I have a horse who has been diagnosed with arthritis in her hocks. I've put a claim in, with the insurance however they are currently saying they will not pay out saying it was a pre-existing condition prior to the policy being taken out. It is a bit of a grey area and I don't really want to get into the details.

The current vet bill for the lameness work up/ X-rays/ nerve blocks/ Joint medication is £1300. Does anyone think this is quite high? The bill is itemised and there is nothing on there which stands out as unnecessary.

She has been back at the vets for a follow up visit a month later and she is still disunited in canter, although comfortable in walk & trot. The vet would like to either re-inject the hocks and or treat the sacroiliac joint however I'm already resistant to undertake more costs.

Do you think the treatment is higher than normal because the vet thought the insurance would pay?
What are my options;
Pay for more treatment which may equate to more than the value of the horse?
Retire, although no room for another so would mean ending my riding.
Sound enough for a happy hacker however naps when alone.
Euthanise, which seems a drastic option but she also has ulcers and is not a particularly kind mare.
Sell as happy hacker, but could fall into the wrong hands with someone trying to make money from her.

I'm really at a loss with what to do and it's causing problems between myself and my husband. Please no nasty comments or opinions but I'd like to hear your views and advice...

 

[Firewater04]

Oh and she's only 10 so would be a long retirement.

 

[ihatework]

It’s very difficult to comment without knowing all the facts, so I can only talk in general terms.

I think if you present a non performing horse to a vet that is showing subtle lameness that isn’t easily identifiable where - then a longer winded and systematic work up, plus maybe top of the range joint injections could reasonably be expected to hit the 1.3k mark. And if the vet was unaware of a potential insurance issue and was working on the assumption you were covered might have taken that route.

But I also think that an experienced performance vet, coupled with a pragmatic owner who is clear they are self funding, could apply a more strategic lameness work up and treatment and be at a similar point for half what you have paid.

ETA:
What you do moving forwards is really up to you. You seem to be well aware of the options. Horses all over the country lead active lives with hock arthritis - you just have to manage it. Unfortunately horses are not a cheap hobby there is no way around that

 

[Firewater04]

BTW - I'm not trying to argue the cost of the treatment with the vet but simply evaluate whether further treatment of the hocks and sacroiliac is going to cost the same again. Also hock injections are not a permanent solution and if the cost is going to be around that figure potentially every year then it's not a viable option.

Obviously I can ask the vet but I figured it would put them in an awkward position as they're not going to say 'oh we thought the insurance was paying, we can actually do it cheaper'.

It's interesting that you say an experienced performance vet may have got to the same point for half the figure. I'm wonder if it is worth seeking an alternative vet for the further treatment?

 

[ihatework]

Once you have a diagnosis a basic joint injection should cost in the region of £150 a hock (plus any visit fees if you don’t transport to them).

A course of Cartrophen, from internet pharmacy, will prob be about £250.

A sacro injection is more complex as it will require good sedation and quite possibly guided imaging (depending on your vet experience) - but this isn’t something you would keep repeating, a one off might do it.

Then there is always good old bute as required.

In the grand scheme of ongoing management of horses - a bit of arthritis isn’t really a biggie.

 

[SEL]

I avoided nerve blocks and went straight to x-rays, but costs were probably not far off that given we had a course of catrophen as well.

I agree with IHW in that if the vets know you are self funding then they will often try and mitigate costs, but x-rays and joint injections are standard and I imagine make up the bulk of the bill along with examination fees. Another vet may have avoided the x-ray and just injected the joints, but their standard protocol is nerve blocks, x-rays etc.

Before you take any drastic action this is one time when I would pay for a really, really good physio. Often horses who have had arthritis for a while hold themselves poorly to compensate for the pain and a physio may be able to loosen up tight muscles. You'll need your vet's permission first but I've found mine to take a very pragmatic view with bodywork on a broken horse.

The ulcers you refer to will likely only improve when the horse is out of pain. Does the canter improve if she's on bute?

 

[Equi]

Bute won’t be an option really if she has ulcers I dont think.

From the tone of your post you are not too keen to be a happy hacker, so failing a random very good home who is willing to take her on with the issues I’d pts over retire. It’s only ever going to get worse.

That said it’s mangable and I know several who still compete with arthritis but the key is management - they need the supplements, physio, as much turnout as possible with no stable time if it can be avoided, weight management, correct hoofcare, some with injections yearly (but I hear they’re only allowed a certain number of them before they stop working) so technically you could still have a good few years out of her before thinking of pts but you might just need to learn to take it a little slower and work her differently/manage her differently. It won’t be £1300 every time she needs injections. But vet will want to X-ray now and then to check progress.

 

[SEL]

Bute won’t be an option really if she has ulcers I dont think.

I give danilon to a horse with recurring ulcers when she needs it. I tend to find that if the arthritis pain needs managing then there is a lot less risk of an ulcer flare up than just leaving the horse sore.

 

[Firewater04]

Insurance are paying for the Ulcer treatment and there has been some improvement so that's one thing. I can't use bute because of the Ulcers but it may be worth while as a one off to identify if the canter improves.

I'd be happy to do a bit of happy hacking however she naps. I had started working on this issue and was getting somewhere but then she's been out of work because of the lameness and we are back at square one. Plus the ulcers may have contributed to this so waiting for them to clear up completely before trying to tackle this issue.

We have our own land and yard, however the field is very muddy and wet, so although I can turn her out 24/7 Im struggling to exercise her given she won't hack out unless in company. My friend has a school but again it's getting there (other day she decided she didn't want to go on lorry so had to take her field mate, separation anxiety and loading added to the growing list of issues)

PTS - seems a drastic option and even the vet was surprised at my suggestion but there are a whole number of smaller issues, which on their own you could resolve/ manage but all together its whether it's worth it.

Retirement - no riding and like I say not a nice horse to have around, I won't let my daughter in the field with her to catch her pony as she pins her ears and swings her back end round.

If I could guarantee that the further treatment was going to be £600 for her to be sound, then I'd take a chance on that to see if she came sound and work on her issues. However it could be more... and she may never be truly sound.

I guess only I can decide, hmmmm hard one.

 

[jj_87]

I it helps I paid over £1,200 for a work up and Separately supplementary hock and SI injections cost £800 ~(Inc Sedatives etc) (Non insurance and discussed with vet) decided not to continue with the injections as they are not sustainable, I spent the ££ on water treadmill and physio for the horse..... this wasn't Arthritis btw.

 

[Firewater04]

I guess for me it's not the actual cost but whether i'd be throwing good money after bad... but then I suppose that's medical issues in general somethings work somethings don't and all you can do is try.

My daughters pony has arthritis but she's 19 so it's expected. We manage that with supplements, turnout and Danilon. She's a lovely little pony in all other aspects and that works for the level of work we require of her. I'm just not sure with mine though.

 

[be positive]

I wonder how much her napping is due to discomfort and if the hocks improve, the ulcers are resolved you may have a horse that is generally nicer and easier to hack, I would also go with having a physio out to see how much she has been compensating for everything she has going on.
As for exercise I would make an effort to get her going on long reins and see if that can help break the pattern of napping, if necessary I would wait until spring to have a real crack at her before making any further decisions.

 

[hopscotch bandit]

Advice & opinions please...

I have a horse who has been diagnosed with arthritis in her hocks. I've put a claim in, with the insurance however they are currently saying they will not pay out saying it was a pre-existing condition prior to the policy being taken out. It is a bit of a grey area and I don't really want to get into the details.

The current vet bill for the lameness work up/ X-rays/ nerve blocks/ Joint medication is £1300. Does anyone think this is quite high? The bill is itemised and there is nothing on there which stands out as unnecessary.

She has been back at the vets for a follow up visit a month later and she is still disunited in canter, although comfortable in walk & trot. The vet would like to either re-inject the hocks and or treat the sacroiliac joint however I'm already resistant to undertake more costs.

Do you think the treatment is higher than normal because the vet thought the insurance would pay?
What are my options;
Pay for more treatment which may equate to more than the value of the horse?
Retire, although no room for another so would mean ending my riding.
Sound enough for a happy hacker however naps when alone.
Euthanise, which seems a drastic option but she also has ulcers and is not a particularly kind mare.
Sell as happy hacker, but could fall into the wrong hands with someone trying to make money from her.

I'm really at a loss with what to do and it's causing problems between myself and my husband. Please no nasty comments or opinions but I'd like to hear your views and advice...

In my opinion euthanasia is the last resort, its spavin and in most instances is easily treatable. Firstly you can have the option of having the hocks injected, from memory its around £70 plus call out, plus examine equine fee, so call it £130. This may last 6 months, it may last 12 months. After a couple of cycles of this, if the gap between medicating the hocks is shorter you might wan, you can try Tildren as your next step. Usually 3 cycles at around £700 per cycle. After that if that doesn't work or after time stops working so well you have the option of hock fusion using chemicals (called chemical arthrodesis) or surgical fusion of the hocks. chemical arthrodesis was around the £700-£800 mark from what I recall with someone who had it done, but its effects last forever. Some horses can't have it but you find that out after xray with dye and xray imaging.That's the last resort and works well in a large proportion of horses. Or you can choose to just bute your horse, in which case you are looking anything from 68p to £1.15 per sachet depending on whether you get via prescription or just plain ripped off from your vets.

But none of the above will work unless you have careful management in place, a decent surface to ride on, a brilliant farrier who knows about foot balance and may have to provide your horse with additional support in the form of remedial farriery, a good joint supplement, as much turnout as possible, keeping weight off the horse to provide a more comfortable limb, and judging how and what you can do with your horse and reducing work if necessary. So there's loads you can do but most of it is careful management.

 

[dollymix]

My mare developed spavins aged 5 following an injury. We were able to claim for treatment, (which obviously helped financially) but I gave up on injecting the hock after the third attempt and after consulting with my vet. Instead, on his recommendation we gave her bute and worked her fairly hard to get the joint to fuse, which would mean less mobility, but no pain.

Once she was off bute and comfortable riding, for the next 5 years or so she was really just a happy hacker. Sometimes, she was fairly stiff and when discussing with vet and physio, we think the other hock fused too during this time.

She is now 13 years old and is currently in more work than she has ever been before - all at a fairly low RC level, but including jumping, dressage, fun rides, clinics etc. She is never going to be a world beater (due to me more than likely hahaha) but last week when having a chat with my physio, she said there is no reason she couldn't be competing at BE100!! (That is way above my comfort level - although I dream of completing a BE80 with her one day!)

I have to be careful with her management. She wears hock boots at night and I make sure I spend plenty of time warming up and cooling down. On cold days, she does come out a little stiff, but as long as she is walked for long enough, she is fine (I also try to put the hock boots on for half an hour before riding). I turn out as much as possible.

Her workload is very important. I ride almost every day because you can certainly see a difference in her if she has more than 3 days off in a row. I am also focusing currently on working her correctly with the help of a great dressage instructor. The idea being that correct work will build muscle to assist her joints i nthe long run.

She also has apple cider vinegar every day. She is fed Dengie Healthy Tummy and Baileys Performance Balancer.

Sorry for the ramble... but I hope it gives you hope. Spavins were a bit of a long drawn out process and still affect us daily, but it hasn't stopped me enjoying my mare!

 

[hopscotch bandit]

Also hock injections are not a permanent solution and if the cost is going to be around that figure potentially every year then it's not a viable option.
?

More permanent solutions for definite. Think these days vets are plumping for for surgical fusion as a final line of treatment if all else has failed.

 

[Goldenstar]

Horses can do so well with arthritic hocks .
Your initial bill sounds fine to me .
You will need to be able to fund the on going care it’s impossible to say how much because horses vary so much a thousand a year perhaps .
I would be worried that there’s more going on than the hocks and I do jump ship and PTS in such circumstances I know many people think that’s awful but unless the horse is doing a great job for us there’s a limit to how much money I will pour into a lame horse .
In your case the horse has had ulcers and secondary pain that tells me the horse was struggling on wrong for some time that’s not good IME those are the ones you struggle to get working .

Difficult decision it’s really up to you to decide and situations like this are hard .


ETA what ever you do dont try cider vinegar on a horse susceptible to ulcers if you have ever had a mouth ulcer you will know why .

 

[Firewater04]

In my opinion euthanasia is the last resort, its spavin and in most instances is easily treatable. Firstly you can have the option of having the hocks injected, from memory its around £70 plus call out, plus examine equine fee, so call it £130. This may last 6 months, it may last 12 months. After a couple of cycles of this, if the gap between medicating the hocks is shorter you might want to try Tildren as your next step. Usually 3 cycles at around £700 per cycle. After that if that doesn't work or after time stops working so well you have the option of hock fusion using chemicals (called chemical arthrodesis) or surgical fusion of the hocks. chemical arthrodesis was around the £700-£800 mark from what I recall with someone who had it done, but its effects last forever. That's the last resort and works well in a large proportion of horses. Or you can choose to just bute your horse, in which case you are looking anything from 68p to £1.15 per sachet depending on whether you get via prescription or just plain ripped off from your vets.

But none of the above will work unless you have careful management in place, a decent surface to ride on, a brilliant farrier who knows about foot balance and may have to provide your horse with additional support in the form of remedial farriery, a good joint supplement, as much turnout as possible, keeping weight off the horse to provide a more comfortable limb, and judging how and what you can do with your horse and reducing work if necessary. So there's loads you can do but most of it is careful management.

In my opinion euthanasia is the last resort, its spavin and in most instances is easily treatable. Firstly you can have the option of having the hocks injected, from memory its around £70 plus call out, plus examine equine fee, so call it £130. This may last 6 months, it may last 12 months. After a couple of cycles of this, if the gap between medicating the hocks is shorter you might wan, you can try Tildren as your next step. Usually 3 cycles at around £700 per cycle. After that if that doesn't work or after time stops working so well you have the option of hock fusion using chemicals (called chemical arthrodesis) or surgical fusion of the hocks. chemical arthrodesis was around the £700-£800 mark from what I recall with someone who had it done, but its effects last forever. Some horses can't have it but you find that out after xray with dye and xray imaging.That's the last resort and works well in a large proportion of horses. Or you can choose to just bute your horse, in which case you are looking anything from 68p to £1.15 per sachet depending on whether you get via prescription or just plain ripped off from your vets.

But none of the above will work unless you have careful management in place, a decent surface to ride on, a brilliant farrier who knows about foot balance and may have to provide your horse with additional support in the form of remedial farriery, a good joint supplement, as much turnout as possible, keeping weight off the horse to provide a more comfortable limb, and judging how and what you can do with your horse and reducing work if necessary. So there's loads you can do but most of it is careful management.

I have had the hocks injected at £1300 to date and the horse is still disunited in canter a month later. So the question is whether to pay more and have them re-injected and the Sacroiliac (which is what my money is on) or cut my losses. I do trying and stay positive and initially when I first suspected hock arthritis didn't let me get it down as, as you say can be easily treated, however there does seem to be so many other issues which point to this horse not being happy to be ridden.

 

[Firewater04]

My mare developed spavins aged 5 following an injury. We were able to claim for treatment, (which obviously helped financially) but I gave up on injecting the hock after the third attempt and after consulting with my vet. Instead, on his recommendation we gave her bute and worked her fairly hard to get the joint to fuse, which would mean less mobility, but no pain.

Once she was off bute and comfortable riding, for the next 5 years or so she was really just a happy hacker. Sometimes, she was fairly stiff and when discussing with vet and physio, we think the other hock fused too during this time.

She is now 13 years old and is currently in more work than she has ever been before - all at a fairly low RC level, but including jumping, dressage, fun rides, clinics etc. She is never going to be a world beater (due to me more than likely hahaha) but last week when having a chat with my physio, she said there is no reason she couldn't be competing at BE100!! (That is way above my comfort level - although I dream of completing a BE80 with her one day!)

I have to be careful with her management. She wears hock boots at night and I make sure I spend plenty of time warming up and cooling down. On cold days, she does come out a little stiff, but as long as she is walked for long enough, she is fine (I also try to put the hock boots on for half an hour before riding). I turn out as much as possible.

Her workload is very important. I ride almost every day because you can certainly see a difference in her if she has more than 3 days off in a row. I am also focusing currently on working her correctly with the help of a great dressage instructor. The idea being that correct work will build muscle to assist her joints i nthe long run.

She also has apple cider vinegar every day. She is fed Dengie Healthy Tummy and Baileys Performance Balancer.

Sorry for the ramble... but I hope it gives you hope. Spavins were a bit of a long drawn out process and still affect us daily, but it hasn't stopped me enjoying my mare!

Thank you, it's posts like yours that do give me hope and when initially diagnosed I heard lots of stories similar to yours which suggested there was no reason why she couldn't continue an active life. I also only want to compete at low level RC so if she was competent enough for this I would be happy. But I just worry that its going to take a lot of cost, time and effort to get there. I just wish she'd hack out happily and be a bit more pleasant to be around.

 

[Firewater04]

Horses can do so well with arthritic hocks .
Your initial bill sounds fine to me .
You will need to be able to fund the on going care it’s impossible to say how much because horses vary so much a thousand a year perhaps .
I would be worried that there’s more going on than the hocks and I do jump ship and PTS in such circumstances I know many people think that’s awful but unless the horse is doing a great job for us there’s a limit to how much money I will pour into a lame horse .
In your case the horse has had ulcers and secondary pain that tells me the horse was struggling on wrong for some time that’s not good IME those are the ones you struggle to get working .

Difficult decision it’s really up to you to decide and situations like this are hard .


ETA what ever you do dont try cider vinegar on a horse susceptible to ulcers if you have ever had a mouth ulcer you will know why .

Yes this is what I'm worried about pay more money, probably over and above the cost of purchase and still have problems. Including behavioural whether learnt or due to pain she's been in.

 

[SEL]

I just wish she'd hack out happily and be a bit more pleasant to be around.

If you can fix the pain then the behaviour tends to improve as well IMO.

My mare is napping and kicking out at the moment because she is sore. I have a 2nd opinion vet visit booked for the new year and until then she needs to be polite, but I also need to appreciate that she's telling me she hurts and can't do too much.

 

[hopscotch bandit]

I have had the hocks injected at £1300 to date and the horse is still disunited in canter a month later. So the question is whether to pay more and have them re-injected and the Sacroiliac (which is what my money is on) or cut my losses. I do trying and stay positive and initially when I first suspected hock arthritis didn't let me get it down as, as you say can be easily treated, however there does seem to be so many other issues which point to this horse not being happy to be ridden.

I understand where you are coming from to a point, if my girl had had to have her tooth out I would have began to question whether to pay £2K for the treatment given she is early teens and has neck, hock and coffin joint arthritis and she is, in my opinion getting very slightly worse neurologically when picking out her feet which can only be a slow sign of impending doom, although at present fine to hack out still. So I understand, but with a younger horse I would have to personally fling as much at it I could whilst it had a chance, but understand everyone is different.

 

[Theocat]

Having been through a very similar journey, in your shoes, if the injections haven't worked as they should and you suspect the SI, I would:

1) Medicate the SI first
2) Keep her out as much as possible
3) If there's no improvement, use danilon (if she can tolerate it), regular physio and hard work to get her through to a stage where she is comfortable. You're going to need to be able to hack a lot, though, which realistically means solving the napping.

The straightforward cases are generally the ones that only have one thing wrong and respond well to treatment. Yours does not fall into that category. I wouldn't jump straight to PTS, but I certainly - bitter experience- wouldn't throw huge amounts of money at it, either. And if any other problems start to emerge (which they often do) It's worthwhile considering in advance what your red lines are - financially, in terms of treatment, for the sake of the horse, and for your sake too.

It's easy to fall into the trap of "just a few hundred pounds more and she'll be fixed". Those - in my experience - never seem to end up fixed, and if she already has ulcers, you need to think carefully about what you put her through.

It's a rotten situation to be in.

 

[Tiddlypom]

Have you asked how much it would cost just to medicate the SI joint, as this would seem to be the next logical step?

Mine are all self insured, my vets know this and they are always happy to give me costs up front and to discuss any alternative, cheaper treatment options. I do have a Red Line though, which is different for each horse.

 

[Goldenstar]

It’s easy enough to get a quote for a procedure like the SI jab Because it’s one procedure and open ended like say having a work up can be .
Like Tiddlypom I have red lines for each horse and for me I have learnt that spending a fortune on lame young horses who have not already made them selves indepensable by being great at their jobs does not work out cost time or fun effective .
You have to be realistic and in these cases with ulcers probaly triggered by stress caused by pain SI and hock problems and a horse who is difficult I would be thinking I could easily spend half the cost of a new youngster in the next six months and in that six months still be working with a difficult horse and not having much fun and you always worrying is she in pain is this fair etc etc with an older horse doing its job it’s much easier to asses where you are because you know them and they have a level of training that makes it easy to know when performance is going a bit off .
I know it sounds harsh but in OP’s shoes on the basis of what she has told us I would call it a day .

 

[Firewater04]

Theocat - Good advice, you seem to understand where I am at with it.
Tiddlypom - No I haven't the vet is out on Monday though so will ask him in person and state Im self financing how much the SI joint would be to inject.
Goldenstar - Thank you realistically everything what you are saying is probably right.

Thank you for all your views it has helped rather than going over and over my options in my own head. I think my course of action will be to get a cost for the SI, wait until Ulcers are cleared before work on napping and check with Vet on monday if he is happy for Physio to come out and then take it from. I think the problem is the indecisiveness and not knowing what option to take.

 

[Goldenstar]

Good luck whatever you decide it’s an awful place to be you have all my sympathy .

 

[Tiddlypom]

Good luck whatever you decide it’s an awful place to be you have all my sympathy .

This from me, too.

 

[Wendi]

I have the same issue,, I have just bought my girly who's 19 had the vet and shes going to need hock injections,,, plus shes come lame in the front too probs a knock on a scar she has from travelling,,, shes such a beautiful soul and I'm desperately in love already,, I'm willing to pay for treatment but also know I haven't got a bottomless purse so i do and will have limits,, shes currently on bute for 2 weeks then my vet will come back to see her
Shoeing is been redone to help shes having wedged to help lift the heel
Shes an ex racer so crappy feet anyways,
I will do everything I can for my girly and in time like urs hopefully things will turn good.
Best of luck with everything

 

[hopscotch bandit]

YU

I have had the hocks injected at £1300 to date and the horse is still disunited in canter a month later. So the question is whether to pay more and have them re-injected and the Sacroiliac (which is what my money is on) or cut my losses.

I get what you are saying about the other issues. That is something you have to weigh up - horses are great at overcompensating for pain by using other areas of the body thus putting stress on these and causing issues and further pain. SI issues often run hand in hand with spavin as does KS.

You say the horse is still not right after a month but you are talking about steroid injections and whether to have them reinjected. There is no point having those re-injected if they didn't work the first time.

But if like my suggestion you plump for the chemical arthrodesis, it is a life long solution. But you obviously need to discuss this with your vet. I have known this to be successful on quite a few horses. I have also known for it to make diddly squat difference with one or two. But at around £300 for both hocks (that was around 2012) I would go for that as you have nothing to lose and a lot to gain if its successful. If it's not then you may have to pts. Its not a miracle cure by any means, and with it comes the careful management issues of shoeing, surfaces, rubber matting, joint supplements, weight loss, loads more turnout, etc, etc